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What is a stillbirth?
A stillbirth occurs when a fetus 24 weeks to full term gestational age has died in the womb or during labor or delivery and leaves the maternal body. There is some disagreement in the international medical community on what is considered the earliest week that the exiting of a fetus would be considered a stillbirth. Evie's Network considers it from that time which a fetus could conceivably live outside of the womb. As of this date, only a few babies have left the womb before 24 weeks of gestation and been able to survive.


 

How often do stillbirths occur?
About one in every 200 births is stillborn in the US - or approximately 25,000 a year. The stillbirth rate in developing countries is higher, though the rate has declined almost everywhere in the last 30 years - in the US by as much as 50% - because of improved pregnancy education and medical services.

 

It is difficult to determine exactly how many stillbirths occur since no medical standard has been agreed on in this country, or internationally, that states exactly how many weeks along is considered a stillbirth. Without this standard, many stillbirths are grouped in infant mortality rates along with neo-natal deaths such as SIDS. In the United States, statistics are gathered by state with different states having different standards and methods of record keeping, as well as differing laws on the issuing of birth and death certificates for stillborn infants.

 

Why do stillbirths happen?
Stillbirths are considered a common natural occurrence, happening since the beginning of humankind. Unfortunately, there is no way to predict one, and they can affect anyone. One half of all stillbirths happen in overall good, healthy pregnancies. A large percentage (some sources report as many as 50%) of stillbirths are from unexplained or unknown causes, even in cases where extensive testing and an autopsy have been performed. There has just not been extensive research on the causes of stillbirth - it has been a forgotten area of medical research until recently - see section on autopsies below.

 

There are three main categories of causes:

 

Birth Defects

 

Placenta and Cord Problems

 

Maternal Conditions


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Why do women labor and deliver the infant instead of having a C-section?
Up until the introduction of labor-inducing drugs in the 1930's, women had to wait for natural labor and delivery of a stillborn infant. Today doctors prefer the healthiest way for the mother - delivering vaginally, as soon as possible. There are three ways a stillborn can be delivered, all of which should be a decision between you and your doctor:

 

Waiting for natural labor and delivery, usually in about 2-4 weeks, with many put on bed rest. Obviously, it can be emotionally traumatic to carry a dead infant in your womb for that long before delivering, but the cervix may not be ready. There may also be some expected complications from the labor-inducing drugs that would require this method. But some women want to be with the baby as long as possible. This should be a decision between you and the advice of your doctor.

 

Inducing labor and having a vaginal delivery is the preferred way by most physicians. It is most healthy on the body to go through as much of a regular labor and delivery as possible. Potential complications, such as blood clots, can be avoided. It is usually a shorter labor with less pushing, the baby's features are more intact for viewing, and an autopsy is easier to perform. But again this is up to you and the advice of your doctor.

 

C-sections and the use of instruments are used if there are complications during regular labor and delivery - or to save the life of the mother. This is based on the advice of your doctor.

 

Should I allow or ask for an autopsy at the hospital?
An autopsy is a careful examination of the internal tissues and organs to determine any problems that may have caused a death. Some hospitals automatically conduct an autopsy on infants as policy, but they should always ask for your permission first before performing one.

 

Don't be afraid to ask what the normal procedure is in your hospital for infant autopsies. It is ultimately up to you to decide - and there may also be religious rituals for you to consider, depending on your faith. An autopsy does not have to delay your burial plans. Though it is a very difficult time to be making such a serious decision that may sound invasive to your child, it is usually recommended to perform an autopsy to find out what happened. It may be valuable information for you if and when you decide to get pregnant again. Some results are returned in 1-2 days, some as long as 6-8 weeks.

 

Also, the lack of autopsy information in the health research fields has impaired the general research on stillbirth. The medical profession encourages women to allow for an autopsy, as it will help provide needed information for overall stillbirth research that could help other babies in the future.

 

What happens to the baby's body at the hospital?
Nowadays stillborn infants are usually first left with the mother for her (and the father) to connect with privately for as long as needed. The nurses will take your baby when you are ready - this should be an open discussion between you and the nurses and doctor.

 

The baby is then usually put in the hospital's morgue to await pickup by the family or funeral home. Some people take the infant home for preparation for burial or transport the infant to the funeral home themselves Some hospitals charge a transportation fee for removing the baby or other special costs. Their procedures and costs should be made known to you and your husband/partner and/or other family member at the time. Don't be afraid to ask about them about how they handle this.


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Will the hospital issue a birth or death certificate for my infant?
This is a growing issue in the United States as states vary on what type of certificate, if any, is issued with the delivery of a stillborn. Some states issue a death certificate, some a special stillbirth certificate, some nothing at all. This has not only been a issue with parents who feel that their infant is not being recognized legally, but also an impediment in collecting standardized data for stillbirth research in the US. Legislation for certificates continues to be introduced in some states. Recently, both sides of the abortion debate have become involved as states grapple with the issue of how many weeks is considered a stillborn.

 

http://www.missingkate.org/main.htm

 

What do I do if I think the doctor or hospital faulted in any way?
The US medical industry has not done a good job teaching doctors and nurses to deal with death in general. And there has not been a lot of research on stillbirths - so much is still unknown. Stillbirth is a tragic experience. You are in shock. The death of your child will not make sense and you will be looking for answers - and for blame.

 

But it doesn't necessarily mean the doctor or nurse or midwife is at fault. They most likely will be feeling great sorrow for your lost. Medical care advances in the last 20-30 years have actually decreased the number of stillbirths. If you do feel that your health care facility or professionals have been at fault or in error in any way, then write down your story - try to remember the series of events in detail. And contact legal counsel.

 

How has American culture historically dealt with stillbirth?
The United States has been a primarily a Caucasian protestant and Catholic population who have heavily influenced much of the American culture. This has lead to a stoic and suppressed view of death that has permeated our general American culture. Our culture also values achievement over failure and winning over losing. Death, and most particularly pregnancy loss, forces us to face those aspects of our lives that we have no control over, and thus don't easily fit into the American Dream of getting ahead.

 

Before the growth of the funeral business in the earlier part of the 20th century, many people died, were prepared for burial, and then buried at home. This included infants. At the turn of the 20th century, 1 out of 10 babies died in the first year of life. Though Victorian culture did embrace death in its own way, infant death was still minimize as it had been for centuries. A concern and methodology for dealing with death did not emerge until the psychological healing movement in the 1970's. since then books have been written, courses taught, support groups founded to help with all sorts of physical and mental health concerns. But there is still much to improve.

 

How do other cultures deal with stillbirth?
There is little anthropological research on pregnancy loss in human history, as the life of the ordinary woman has been mostly overlooked. Most cultures of the world have grappled with the issue of when a fetus becomes a baby and thus has human status, and what does having or not having human status mean in their religion. But with such traditionally high infant mortality rates in the first year of life, many people were not even willing to give a small child human status, or name them until they felt they could survive.

 

In general, if the primary role of women is seen as bearing children then a stillbirth is usually seen as a failure. Cultures that have found women at fault have attributed it to ancestral spirits, uncleanliness, or problems with social relationships such as with your husband or your in-laws. Unfortunately they have also been the cultures that have not dealt well with the aftermath - many not letting the mother participate in the burial. Many times it has not been customary to mourn for someone the community did not know.

 

Some cultures have embraced the woman, as they understand that pregnancy is difficult. There have been rituals for massaging and bathing the woman lovingly, and for respectful burials and ceremonies. Many times the other members of the community have participated - such as the elder women. And much has changed in the Western world in the last 30 years with the rise of the psychological healing movement. Most important to know is that in spite of what the culture does or does not do, it is understood that all women mourn the loss of their child form stillbirth - that is a universal human response.


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