That positive on a pregnancy test stick usually leads to a warm, fragrant, bundle in your arms nine months later. But what if it doesn’t?

One of the most harrowing experiences an expectant mum can go though is having a stillborn baby. It’s not the same as the losing a grown child (read: how to cope when your child is gone), but stillbirth is a topic that most would prefer not to talk about. Just the thought of baby and death in the same sentence? Cue that lump in the throat, that burn behind the eyeballs.

But while stillbirths are not as common these days, they do happen. The global stillbirth rate is 19 per 1,000 births. In Singapore, it is two per 1,000 births – the lowest in the world – same as in Finland.

A stillbirth refers to an infant born after a minimum of 28 weeks of gestation which, after expulsion or extraction from its mother, does not breathe or show any signs of life, says Dr Seng Shay Way, a specialist in Obstetrics and Gynaecology and a Consultant at Raffles Fertility Centre and Raffles Women’s Centre.

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Causes of Stillbirth

Around 60 per cent of stillbirths have unknown causes. The other 40 per cent can be caused by or associated with conditions such as the following:

• Bleeding (hemorrhage) before or during labour

• Placental abruption – where the placenta separates from the womb before the baby is born (this may be associated with bleeding or abdominal pain)

• Pre-eclampsia – a condition that causes high blood pressure in the mother

• Umbilical cord problems – the cord can slip down through the entrance of the womb before the baby is born (cord prolapse), or it could wrap around the baby and become knotted

• Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis – a liver disorder during pregnancy characterised by severe itching

• Genetic physical defects in the baby

• Pre-existing diabetes

• Infection in the mother that also affects the baby

While most cases remain unexplained, there are certain risk factors that can be associated with stillbirth, such as obesity, alcohol consumption in pregnancy, smoking, previous Caesarean section, and advanced maternal age.

“Stillbirths are usually diagnosed during ultrasound scans which can detect if the baby is moving or if the foetal heart is still beating,” says Dr Seng. “Symptoms of stillbirth include the absence of foetal movements, failure of the womb to grow in size and bleeding from the vagina.”

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The Birth Process after a Stillbirth

Once a stillbirth has been diagnosed, the most difficult part of the process follows. Dr Lubna Ahmad Harharah, a Specialist Obstetrician and Gynaecologist at Parkway East Hospital and Mount Elizabeth Novena Hospital takes us through it.

“After the death of a baby has been confirmed by ultrasound scan, doctors and midwives will explain the choices for birth and tests may be offered which may provide answers and help with a future pregnancy.

“Choices of birth include induction of labour or waiting for labour to start naturally. A vaginal birth is usually recommended as it is less risky, recovery is quicker and future pregnancies are less likely to be complicated. Some mothers may request a Caesarean birth or require it by virtue of their condition. If the mother’s wellbeing is stable, delaying delivery by a day or two is usually harmless. Blood tests may be done to monitor the mother’s wellbeing for mothers who wish to delay delivery for a prolonged period.”

Whether a woman chooses to induce labour or not is usually up to her and her husband. “It’s safe to wait for labour to occur naturally – typically within two weeks of foetal death – but many opt to have labour induced as it is often emotionally taxing to carry a stillborn baby till the natural labour,” says Dr Seng.

When stillbirth occurs, doctors will usually carry out investigations to determine the cause. “You and your husband can give your consent to have an autopsy performed on the dead infant, as the additional information obtained could prove useful in handling your future pregnancies,” Dr Seng suggests.

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Moving on after a Stillbirth

Unfortunately, as unpleasant as it can be, there are formalities that have to be dealt with after the birth. “After the baby is born, parents can inform staff about the funeral choices according to their religious and cultural beliefs,” Dr Lubna says. “Registering the birth is necessary if the baby was born at or after 28 weeks of pregnancy. Couples are also offered some form of bereavement support.”

Even if you have only been with your baby for a fleeting moment, the sense of loss can be overwhelming. Give yourself time to grieve. There is a Child Bereavement Support Group in Singapore set up by parents who have lost their children. Get help to move on after the loss of your child.

When you are ready to try again, you probably do not need to worry about a repeat stillbirth unless the reason for it happening in the first instance was genetic.

“The majority will experience healthy pregnancies after a stillbirth, although parents with genetic defects or maternal diseases may be at an increased risk of subsequent stillbirths,” says Dr Seng.

Dr Lubna elaborates: “The chances of stillbirths in future pregnancies may be increased depending on the cause. Unfortunately, despite tests, the deaths cannot be explained. A genetic counsellor can assist couples where a genetic cause of stillbirth was found.

“Couples can conceive again when their medical condition is optimised and when they are mentally ready. It is also important to see an obstetrician early in the next pregnancy.”

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