Stillbirth and neonatal death

The tragedy of stillbirth and death of a newborn baby is an upsetting subject but having the facts can help.

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A stillbirth is defined as a baby who’s born dead after the 24th week of pregnancy. Neonatal death is when a live-born baby dies before the age of four weeks.

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In the UK, 17 babies a day are stillborn or die in the first four weeks of life – just under 1% of all births.

In some cases, the fact that the baby has died is discovered before the birth. Or perhaps the mother notices that the baby has stopped moving and goes for a check. Sometimes it is discovered during routine antenatal care. In other cases, the death of the baby isn’t discovered until the time of delivery.

In almost half of stillbirths, the cause isn’t known, but there are many possible causes, which are usually beyond your control. These include infections in pregnancy such as listeria or rubella (German measles), pre-eclampsia or eclampsia (toxaemia of pregnancy), illness or injury in the mother, ante-partum haemorrhage (bleeding from the uterus) or extreme prematurity.

In some instances, the baby is stillborn because of severe abnormality. In a small number of cases, there is a complication during labour that leads to the baby dying during delivery, but these cases are increasingly rare due to advances in foetal monitoring during labour.

Even if the cause of death is identified, it may not be possible to fully explain the chain of events leading to the death of the baby. For parents in this position, as well as those whose stillbirth has no known cause, the uncertainty adds to the pain of the loss, and can prolong the grieving process.

What can cause neonatal death?

The commonest cause of death within the first four weeks of life is a congenital abnormality (birth defect) such as congenital heart disease or severe spina bifida or rubella syndrome (the effects of German measles infection in early pregnancy).

The second most common group to die within the first few weeks are very premature babies and babies with very low birth weight. Others die from infections such as pneumonia and severe neonatal listeria infection.

A few babies still die soon after birth as a result of complications during labour and delivery.

How do families cope?

Losing a baby to stillbirth or shortly after birth is the loss of a child, which shouldn’t be underestimated. The parents must be allowed to grieve fully and need to be supported in their grief. It is important that they name their child and have a funeral in the normal way as this helps with the normal bereavement process.

It is painful for parents when friends and family try to avoid mentioning the baby. This is usually done from the best of motives, but can make the parents feel as though their baby and their loss hasn’t been acknowledged.

It is also quite common for friends to direct all sympathy to the mother and forget that the father too has had his world turned upside down. It’s very important not to leave out the grieving dad.

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Who else can help?

Most maternity units offer counselling services to parents in this situation. Help is also available through GPs’ surgeries. The Stillbirth and Neonatal Death Society – SANDS – is very good for advice; or call the helpline – 020 7436 5881 (Monday to Friday, 10am to 3pm).

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