Care during and after stillbirth
If your baby has died in the womb, you’ll need to give birth to him or her. It can be a shock for parents to realise that this needs to happen – your obstetrician will explain the process and options to you. You’ll be cared for sensitively by your care team, which can include an obstetrician, midwife, nurse, and anaesthetist.
You’ll need to make some important decisions, including about:
- when, where and how to give birth to your baby
- what investigations you wish to take place to look into the cause of your baby’s death
- having a memorial service and funeral for the baby, and registering the death
The choices that people make vary very much from person to person. Your preferences may depend on many factors, such as your personal beliefs, health and religion. You may find some decisions harder to make than others. Talking to your partner, family, friends, nurse, obstetrician and other professionals may help.
Care during the birth
Legally, the mother has the final say in choices regarding the labour and birth, but you don’t need to make decisions alone. If you would like help and support, your care team can make recommendations for the type of birth, the medical facilities needed and the timing. Your obstetrician will advise you to give birth in a place that has emergency care available. You may want to ask for a private area away from other mothers and babies. Some hospitals have facilities for your partner or a companion to stay with you too.
Unless there is an immediate risk to your health, the birth does not need to happen rightaway. If you want to, you can delay the process (eg for a few days) until you feel more prepared. If you decide to go home, make sure you have a 24-hour contact number for information and support.
Some women choose to wait for the birth to begin naturally. With this approach, five out of six women go into labour within three weeks of their baby’s death being diagnosed. If you do this, you’ll need to have a blood test twice a week to check your health. It’s best not to delay too long though, as this can lead to complications and may worsen any anxiety you have. Waiting can also lead to a decline in the baby’s appearance, and can make it harder to work out the cause of death.
Alternatively, you may choose or need to have your labour induced (started artificially) using medicines. Most women who have labour induced give birth within 24 hours.
Most women are advised to give birth naturally (vaginally) rather than to have a caesarean, because there are fewer health risks and you’ll recover sooner. Your care team will make the necessary arrangements and will do their best to make you comfortable and minimise your distress and pain.
Labour is painful, and you’re likely to want some pain relief. A midwife or anaesthetist specialising in births will explain your options. These include medications or regional anaesthesia. The medicines could be tablets, Entonox (usually called ‘gas and air’) or injections (diamorphine). Once labour is underway, you may want a stronger pain relief, in which case you may have an epidural (an injection of anaesthetic near the spine). This is safer than a general anaesthetic and women tend to recover quicker. If you have a caesarean an epidural is usually required. Another option is patient-controlled pain relief, where you press a button to get a small dose of painkiller through a drip.
Once your baby is born, be prepared that the room may feel unbearably quiet. You can see, hold and spend time with your baby after the birth. Your care team can make any preparations you need, and can explain how your baby looks. You may feel frightened or unsure about seeing the baby. Don’t feel pressured to see the baby if you don’t want to. Equally, it’s an extremely precious moment for some parents. Do what is right for you.
Your care team can help with mementos of your baby, such as photos, a hand or footprint or lock of hair. It’s your choice whether or not you have these. They can be kept securely at the hospital for you if you’re unsure. You may wish to take other keepsakes to the hospital, such as matching blankets or toys, to be kept with you and the baby.
Care immediately after the birth
After the birth, you’ll receive any additional medical treatment and support you need. You will usually be offered visits from the community midwife for the first 10 days, who will offer emotional support and check your physical recovery. You may be offered antibiotics if your obstetrician thinks you have an infection or are at particular risk.
If you need to stay in hospital, there might be an option to stay in a different area than the maternity ward, if you prefer. As soon as you’re well enough, you can go home.
Women who have had a stillbirth still produce breast milk. This can be painful and a difficult reminder of the loss of your baby. You can have medication to stop your breast milk. Most women find that a medication called a dopamine agonist (eg cabergoline) works well with few side-effects. Other options include using a support bra, ice pack or painkillers, but you’re likely to have some breast pain with these approaches.
You’ll also have vaginal bleeding after the birth for a few weeks.
It’s best not to get pregnant again until you feel physically and mentally ready, so your care team may give you advice on contraception. They’ll also let other healthcare professionals involved in your pregnancy and antenatal care know what has happened.
Making arrangements after the birth
If you’d like to name your baby, it is important you choose a name before the death is registered. The name cannot be changed or entered afterwards.
You and your partner will need to decide on plans for a burial, cremation and remembrance for your baby and arrange this with others’ help. Your care team can provide information to help you decide. If you want to hold the funeral within 24 or 48 hours of your baby’s death for religious reasons, let your care team know right away. If your baby is having a post-mortem, arrangements will need to be made swiftly. It may be that a full post-mortem cannot be performed in the timeframe.
Investigations into the cause
Most people want to know the reason for the loss of their baby. However, in almost half of all stillbirths a cause can’t be found. This can be difficult to cope with. Most often, the baby’s death is caused by a problem with the placenta, such as it coming away from the womb. There are many other reasons a stillbirth can happen though, including congenital problems with the baby (problems with the baby’s development in the womb), an infection or a medical condition the mother has.
Your obstetrician will recommend that tests are done to check your health and to try to work out why your baby died. This is important to check whether you need any additional medical treatment. These tests can also help to work out if you’re at risk of having another stillbirth, and how you may be able to reduce this risk.
Assessments that you’ll be offered include a physical examination, blood tests, urine tests, and vaginal and cervical swabs. If your blood type is rhesus D negative, you might be offered a test to check whether there has been a transfer of your baby’s blood into your circulation. This can make you produce antibodies that attack the baby’s blood, causing the baby to develop anaemia (low numbers of red blood cells). If this happened during your pregnancy, it could explain why your baby died. Unfortunately if this transfer of blood has happened, you are at risk of the same problem occurring during another pregnancy. If you get pregnant again, your care team will keep a close eye on this. If your blood type is rhesus D negative but this transfer of blood hasn’t happened, there are treatments that can stop this happening in the future.
Assessment of the baby usually includes a physical exam and taking blood samples and swabs. Sometimes imaging, such as an X-ray, is performed too. The placenta, umbilical cord and membranes will be checked too.
You can choose whether or not to give your permission for genetic testing and a post-mortem (autopsy) of your baby. These tests often help to confirm why your baby died. A post-mortem can also help to plan any special care you may need for future pregnancies. Not everyone wants their baby to have a post-mortem or genetic testing. You do not have to give your consent for these tests if you don’t want to.
If you choose for your baby to have a post-mortem, your baby’s body will be treated with dignity and any arrangements to transport the body will be explained. You can specify whether you agree to a full or partial post-mortem. For example, you can choose whether or not your baby is examined internally. You can also specify that only the placenta is examined in the post-mortem if you prefer. For more information on what happens in a post-mortem, see our FAQ below.
Rarely, a coroner (or procurator fiscal in Scotland) may order a post-mortem by law – it can then happen without your permission and you won’t have choices over the type of post-mortem.
Be aware that you’ll need to wait some weeks for the results of a post-mortem, depending on the hospital and the tests performed. You should be offered an appointment to discuss the results within six to 12 weeks.
You’ll be offered a follow-up appointment about six weeks after the birth. This is to check how you’re doing physically and mentally, to talk through any results the hospital has so far, and to answer your questions. This will usually be at the hospital, but depending on your local services, you may be able to have it elsewhere if you prefer. You may find it helpful to write down any questions before your appointment. This is also an opportunity to give feedback to the hospital about your previous care.
If your baby had a post-mortem, you’ll be invited to an appointment with an obstetrician after six to 12 weeks to discuss the results.
You may wish to ask about the location of any follow-up appointments. If there will be other mothers and babies in the waiting area, you might find this upsetting.