Articles

Key takeaways

• Stillbirth is when a baby dies before or during birth after 24 weeks of pregnancy.
• You will be supported to make decisions about your baby’s birth and care.
• Physical recovery and grief can take time, and everyone experiences them differently.
• Many support organisations and resources are available for you and your family.

What is stillbirth?

A stillbirth is when a baby is born dead after 24 completed weeks of pregnancy. This means the baby dies before or during birth.

Care and birth options after diagnosis

Being told your baby has died before birth is devastating. Your maternity team will support you through the decisions ahead and help you access practical and emotional support.

You are not alone in this experience. Many families are affected by stillbirth. Support is available for you during this difficult time.

It can be hard to process information at this time. It can be helpful to have someone with you when you speak with doctors and midwives. This could be a partner, parent, or friend. They will discuss your options for giving birth.

Legally, the decision on how to give birth to your baby is yours. Your healthcare team will provide information to help you decide. Your wishes will be respected.

Waiting for labour to start naturally

If there is no medical reason for your baby to be born immediately, you may choose to wait for labour to start naturally. Most women will go into labour within 3 weeks of your baby dying. Your healthcare team will give you a 24-hour contact number if you have any concerns while waiting.

If you wait for more than 48 hours, you will usually be offered regular hospital reviews. This is because a small number of women can become unwell while waiting.

Induction of labour

You may choose to have your labour started (an induction of labour). This can happen as soon as possible after your baby's death is confirmed. You may also prefer to go home for a short while before you give birth. Your healthcare team will discuss the benefits and risks of each method with you.

Labour can be induced by medicines that help soften the cervix and start contractions. Your healthcare team will explain which options are available and the benefits and risks of each.

During labour

Your midwife will be there to support you and explain what is happening. They will talk to you about pain relief options to help you be as comfortable as possible. These can include:

• Massage
• Movement
• Different positions
• Breathing techniques
• Gas and air (Entonox)
• Opioid pain relief
• An epidural

You may want to bring some items from home to make you more physically comfortable. These could include:

• Cool clothes
• Snacks
• Drinks
• A dressing gown
• Slippers
• Pyjamas

You might also want to bring a special babygrow, blanket, or cuddly toy for your baby.

Having a partner, friend, or relative as a birth partner can be a huge support. In most cases, birth partners can stay with you throughout.

Delivering the placenta

After labour, you will also need to give birth to the placenta. An injection of oxytocin may be offered to help your womb contract and deliver the placenta. Your healthcare team will explain the benefits and possible side effects.

If the placenta does not come away or there are complications, you may need to go to theatre to have it removed under a spinal anaesthetic.

Caesarean section

Doctors usually recommend a vaginal birth. This is because a caesarean section (C-section) is major surgery with more risks. It can also affect future pregnancies and usually requires a longer recovery period.

However, there may be reasons why you want a C-section. You can discuss this with your doctor to understand the risks and make your decision.

If you have a C-section, you will usually be advised to have a spinal or epidural anaesthetic. This numbs the lower part of your body so you stay awake.

Seeing your baby

It is your choice whether you see and spend time with your baby. There is no right or wrong decision. Some parents find this helps them acknowledge their baby’s life and create memories. Others decide it is not the best thing for them.

Your maternity team will support you in thinking about what might be best for you. If you are unsure, you can ask your midwife to describe your baby’s appearance first. They can also take a photograph for you to look at before deciding. You may also choose to see just your baby's hand or foot.

It is okay to change your mind about seeing your baby. Any decisions you make do not need to be final. If you do not want to see your baby right after birth, having a photograph or a memory box can be helpful later.

Creating memories

You can spend as much time as you need with your baby. Hospitals may have a special cool cot that slows down changes to your baby's appearance. You may also be able to take your baby home in a cool cot if you wish.

You can bathe or dress your baby, or wrap them in a shawl or blanket. You might want to sleep with your baby in a cot next to you. Some parents read a story, sing, or say prayers with their baby. You may also decide to name your baby.

Making and sharing memories of your baby can help you grieve. Staff can take photos of your baby for you, even if you are unsure if you want them at first. You can also take photos yourself.

Your physical and emotional recovery

Your body will need to recover after the birth. This can be very challenging as the emotional trauma of shock and grief can feel worse than the physical effects for many people. Others find the physical issues just as challenging.

Breast milk after stillbirth

When your breasts fill with milk (breast engorgement), they can feel large and tight. They may also be painful and tender. You will be offered medicines that can stop your breasts from making milk. Your care team can discuss this option and any side effects. Some people prefer to let their milk dry up naturally.

You can help the discomfort with paracetamol or ibuprofen and by wearing a well-fitting bra. Breast pads can be helpful if you are leaking milk.

Some parents choose to donate their milk. Your healthcare team can explain whether this is available in your area.

Vaginal birth recovery

It is normal to have some bleeding from your vagina after birth (lochia). It is your body getting rid of the lining of your womb and blood from where your placenta was attached. The bleeding will be heavy at first and will continue for a few weeks. It is best not to use tampons until after your 6-week postnatal check.

You may have after-pains, which feel like contractions or strong period pains. This is your womb returning to its normal size. Pain relief can help with this.

Piles (haemorrhoids) are common after any birth and usually go after a few days or weeks. Drinking water and eating fruit, vegetables, and wholegrains can help.

Exercising your pelvic floor strengthens the muscles around your bowel, bladder, womb, and vagina.

C-section recovery

You will likely be in hospital for 1 or 2 days after a C-section. You may need to take things easy for a few weeks.

Gentle exercise like walking will help you recover and reduce the risk of blood clots. Avoid lifting heavy things or vacuuming for about six weeks.

A hospital midwife will tell you how to care for your wound. Contact your midwife or GP if you have symptoms of infection or a blood clot. These include:

• Bad pain
• Pus
• Heavy bleeding
• Swelling in your lower leg

Emotional recovery

Your hormone levels rapidly change after birth, and postnatal mood swings and tears are normal. These changes can make your grief even harder in the early weeks and months.

You may feel disappointed or angry at your body. Please speak to your healthcare team if you feel this way.

You may have physical reactions to grief, such as:

• Heart palpitations
• Shaking
• Chest discomfort
• Extreme tiredness
• Difficulty sleeping
• Vivid dreams or nightmares.

Contact your GP, midwife, or bereavement team if your grief feels overwhelming or you are struggling with day-to-day life.

Grieving as a couple

People grieve in different ways. One person may want to talk about their baby, while the other may prefer time alone. Try to be open about your feelings, even if you manage differently.

It is common for intimacy and sexual relationships to change for a time. Be kind and patient with yourself and each other.

Support from family and friends

Family and friends may want to help. Some parents welcome this, while others find it exhausting. It is okay to say no to social events if you do not want to go.

Practical help can be very useful, such as home-cooked meals, laundry, or looking after other children.

Baby loss is understandably frightening for many people. Some friends and family may not know how to talk to you. It is okay to surround yourself with people who listen and support you.

Support and next steps

Follow-up medical care

You will be offered different investigations to try and find out why this happened. These may include a test of your baby's chromosomes, a detailed examination of your placenta, and blood tests. An examination of your baby after death (a post-mortem) can provide important information. You will need to give consent for these investigations.

You will have a follow-up appointment with your obstetrician to discuss the results. This may take several months if a post-mortem was done. This appointment is also an opportunity to talk about any future pregnancies. If returning to the maternity unit is distressing, tell your healthcare professionals so an alternative can be arranged.

Emotional support

Many people find it helpful to talk with other parents who have had a stillborn baby. Your bereavement midwife can tell you about local and national baby loss support groups.

• Sands(Stillbirth and Neonatal Death Charity) – offers emotional support and practical help. Helpline: 0808 164 3332.
• Tommy's – Provides online resources and bereavement-trained midwives. Tommy's also has a closed Baby Loss Support Group on Facebook. Helpline: 0800 0147 800.
• Petals – Offers specialist counselling in certain hospitals.
• Teddy's Wish – Offers free counselling sessions for parents after stillbirth.
• The Lily Mae Foundation – Offers sessions with a trained support worker.

Practical matters

Funeral arrangements

You may decide to have your baby blessed in the hospital. You can ask to speak to the hospital chaplaincy team. Your own religious figure may also be able to come into the hospital.

All stillborn babies must be buried or cremated by law. You can plan a small, private family funeral or a larger ceremony. Some hospitals can arrange a funeral for you.

Registering your baby’s stillbirth

You will need to register your baby's stillbirth. A single certificate will be issued rather than birth and death certificates. Your maternity team will explain how to do this.

Returning to work

You are entitled to any maternity leave and pay that you would normally qualify for. Some people prefer to return to work sooner, while others prefer to take their full entitlement. There may be grief triggers at work, such as pregnancy announcements.

When to seek urgent medical attention

Contact your midwife, GP, or local maternity unit straight away if you have any of the following symptoms after birth:

• Severe pain, or pain that is getting worse.
• Pain that is not controlled by your pain relief.
• Difficulty or pain when passing urine.
• Heavy vaginal bleeding (soaking a pad in an hour or passing large clots), or bleeding that gets heavier after the first week.
• Vaginal blood or discharge that has an unpleasant smell.
• High temperature (fever) or chills.
• Feeling generally unwell, for example, with nausea, vomiting or diarrhoea.
• Cough, chest pain, or shortness of breath.
• Swelling, redness, or pain in one of your lower legs.
• A persistent or severe headache.
• Breast redness, pain, or swelling that is getting worse or not improving after 24 hours, or you develop flu-like symptoms.
• Sudden shortness of breath, severe chest pain, or coughing up blood.