Stillbirth: Encyclopedia - Stillbirth

Stillbirth

Stillbirth is when pregnancy ends without a live birth due to natural causes, including pregnancy loss, miscarriage, or spontaneous abortion. Some pregnancies do not result in a live birth.

Miscarriage is commonly used to describe the loss of a fetus, usually before the age of gestation of 20 weeks. Stillbirth is the delivery of an infant which is dead at birth, regardless of the stage of development. In the United Kingdom, this term is used for an infant delivered showing no signs of life after 24 weeks gestation.

If a pregnancy is terminated deliberately, this is termed induced abortion, which may be medical or surgical in nature.

Stillbirth - Causes

Stillbirth, or more generically pregnancy loss, may be caused by:

• genetic defects, such as cardiac malformation or chromosomal abnormalities. Chromosomal abnormalities appear to be particularly common in early pregnancy loss.
• infection
• maternal illness, such as diabetes or measles
• placental dysfunction
• unknown causes

The cause for any specific stillbirth is not always known, but parents should always be offered investigations, such as an autopsy, in order to try and determine a cause, and also plan care in future pregnancies (Wright and Lee 2004).

Stillbirth - Effects

Pregnancy loss is often emotionally devastating to the parents, particularly the mother. The stillbirth of an infant near or at term may be even more difficult to bear than early miscarriage. Parents who have lost a child to stillbirth may experience rage, depression, isolation, marital difficulties, and trouble resuming normal life.

Stillbirth - Perinatal Bereavement: Loss at the time of Pregnancy

• Molar pregnancy
• Reproduction
• Maternal death

Perinatal death in the U.S. alone can affect as many as 40,000 families. While the causes may be many, the experience of loss is nearly universal. "Perinatal bereavement" is the grief experienced in and around the time of birth, and the initial synthesis of the grieving process may last two years or more. Perinatal death includes miscarriages, stillbirths and neonatal deaths. SIDS is usually considered in a separate category. Loss at abortion may also be considered in this general area.

At the death of an infant, parental expectations turn upside down. At a time when plans are made to announce a birth, announcements of the death take place, usually from a hospital. Reactions to the death early on may include shock and numbness and the reality of the event is difficult to assimilate, followed by waves of grief and despondency. Over the first few weeks, these opposite waves of feelings of loss and numbness ebb and flow, often followed by depression and occasionally rage over people or events associated with the timing of the infant's death. Characteristics of all normal grief including perinatal bereavement include appetite and sleep disorders, stress related symptoms and illnesses, a lowering of the immune system's function, depression, nightmares and even having random experiences of the pregnancy in what is termed 'phantom' movement or even cries.

Stillbirth - Morbid or Difficult Reactions

Morbid or complicated reactions include the inability to do such activities as taking down a nursery even after a year or more, extreme phantom experiences which cause distress, 'replacement child syndrome' in which the next child is saddled with the expectations of the 'ideal' first child, or 'vulnerable child syndrome' in which all subsequent children are seen as very fragile and prone to harm or illness.

Stillbirth - Essential Choices & Facilitation of Grief

While grief cannot be treated or 'cured' as an illness, there are things which aid families experiencing perinatal loss. These include: 1) Choices in making funeral plans, 2) Choices in early hospital arrangements 3) Seeing, holding and saying goodbye to the infant, which is thought to alleviate experiences of phantom crying and bring closure to the death, 4) Crisis intervention and effective listening by health care providers and loved ones, 5) Keeping memorabilia to anchor grief such as clothing, hospital bracelets or footprints/ultrasound photos, and 6) Freedom to allow for individual differences in relinquishment of the infant in the grieving process. There is often a blurr between what is normal and not in perinatal bereavement.

Stillbirth - Negative Consequences

When the intense grief of perinatal loss is not dealt with, severe familial reactions may occur including loss of intimacy, sexual dysfunction, divorce, alcoholism, juvenile delinquency and other difficulties. Openness and acceptance of the normal process of grief along with careful listening skills may often bring about the greatest effect.

Stillbirth - Intervention

Over the past 25 years, radical changes have been made in in-hospital effectiveness in treatment or intervention with perinatal bereavement. International Self-Help Resources include SHARE - for the support of parents experiencing Stillbirth, HAND - for those experiencing a neonatal death, and The MISS Foundation - a volunteer-based organization committed to providing crisis support and long term aid to families after the death of a child from any cause.

Stillbirth - Reference

Wright C, and Lee REJ (2004) Investigating perinatal death: a review of the options when autopsy consent is refused. Archives of Disease in Childhood Fetal and Neonatal Edition 2004;89:F285 [1]

Adapted from the Wikipedia article "Stillbirth", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki