Intrauterine Fetal Demise (Stillbirth)

Intrauterine fetal demise, more commonly known as stillbirth, is one of the most devastating experiences a family can face. When a baby dies during pregnancy at 20 weeks of gestation or later, parents are left with profound grief and many unanswered questions. Understanding what stillbirth is, what may cause it, and what comes next can help families navigate this unimaginable loss while receiving the compassionate medical care and emotional support they need and deserve.

This page offers clear, medically accurate information about stillbirth to help families understand their diagnosis, make informed decisions, and find support during an incredibly difficult time.

What Is Stillbirth?

Stillbirth, also called intrauterine fetal demise (IUFD), refers to the death of a baby in the womb at 20 weeks of pregnancy or later. This distinguishes it from earlier pregnancy losses, which are typically classified as miscarriages.

Stillbirth can occur at any point during the second half of pregnancy or during labor and delivery. When a baby dies before labor begins, it is sometimes called antepartum stillbirth. When death occurs during labor or delivery, it is called intrapartum stillbirth.

The loss is confirmed through ultrasound, which shows the absence of a fetal heartbeat and no signs of movement or life.

How Common Is Stillbirth?

Stillbirth is more common than many people realize. According to the Centers for Disease Control and Prevention (CDC), there were approximately 21,000 stillbirths in the United States in 2020. The national stillbirth rate is about 5.7 per 1,000 births, which means that roughly 1 in every 175 pregnancies ends in stillbirth.

Unfortunately, significant disparities exist. Stillbirth rates are higher among certain racial and ethnic groups, particularly Black and Indigenous families, as well as among families with limited access to prenatal care or who live in underserved areas. These disparities reflect broader inequities in healthcare access, quality of care, and social determinants of health.

Causes of Stillbirth

One of the most painful aspects of stillbirth is that in many cases, a clear cause is never identified. Even with thorough medical investigation, up to one in four stillbirths remain unexplained. This uncertainty can be agonizing for parents who want answers.

However, when a cause can be determined, it often falls into one of several categories.

Placental Problems

The placenta is the organ that nourishes the baby throughout pregnancy. Problems with the placenta are the most common known cause of stillbirth. These problems can include:

• Placental abruption, where the placenta separates from the uterine wall too early
• Placental insufficiency, where the placenta does not provide enough oxygen and nutrients
• Blood clots or vascular problems within the placenta

When the placenta does not function properly, the baby may not receive what it needs to survive.

Umbilical Cord Complications

The umbilical cord connects the baby to the placenta. Complications involving the cord can reduce or cut off the baby’s oxygen supply. These include:

• A cord that becomes tightly wrapped around the baby’s neck or body
• True knots in the cord
• Cord prolapse, where the cord slips into the birth canal ahead of the baby and becomes compressed

Fetal Growth Restriction and Birth Defects

Babies who are not growing as expected (small for gestational age) are at higher risk of stillbirth. This can result from placental problems, infections, genetic conditions, or other factors.

Structural or chromosomal abnormalities in the baby can also lead to stillbirth, especially when they affect vital organs like the heart or brain.

Maternal Health Conditions

Certain health problems in the mother can increase the risk of stillbirth, including:

• High blood pressure or preeclampsia
• Diabetes (which can increase stillbirth risk up to five times, especially if poorly controlled)
• Obesity
• Infections such as syphilis, listeriosis, parvovirus B19, or toxoplasmosis
• Autoimmune disorders, including lupus and antiphospholipid syndrome
• Blood clotting disorders

Managing these conditions with quality prenatal care can reduce risk, but does not eliminate it entirely.

Multiple Pregnancies

Pregnancies involving twins, triplets, or more carry a higher risk of stillbirth due to complications such as twin-to-twin transfusion syndrome, growth discordance, or preterm labor.

Other Risk Factors

Additional factors that may increase the likelihood of stillbirth include:

• Advanced maternal age (especially over 35 or 40 years)
• Previous stillbirth or pregnancy loss
• Use of assisted reproductive technology
• Smoking, alcohol use, or drug use during pregnancy
• Inadequate or late prenatal care
• Physical trauma to the abdomen

It is important to remember that even when risk factors are present, the vast majority of pregnancies result in healthy babies. Conversely, stillbirth can occur even when there are no identifiable risk factors.

Warning Signs and Symptoms

The most common warning sign of stillbirth is a noticeable decrease or absence of fetal movement. Babies typically establish a pattern of movement that becomes familiar to expectant mothers. If this pattern changes significantly or stops, it is important to contact a healthcare provider right away.

Other signs may include:

• No fetal heartbeat detected during a prenatal visit
• Lack of fetal growth during routine measurements
• Vaginal bleeding or cramping

However, stillbirth can also occur suddenly without any warning signs. Some mothers report feeling completely normal until an ultrasound or examination reveals the loss.

If you notice reduced fetal movement or have any concerns about your baby’s well-being, do not wait. Trust your instincts and seek medical attention immediately.

How Stillbirth Is Diagnosed

When a healthcare provider cannot detect a fetal heartbeat using a handheld Doppler device during a prenatal visit, an ultrasound is performed to confirm the diagnosis. The ultrasound will show whether the baby’s heart is beating and whether there are any signs of movement or life.

This is often a moment of profound shock and disbelief for parents. Medical staff trained in compassionate care should provide information gently, allow time for questions, and offer emotional support.

What Happens After a Stillbirth Diagnosis

Learning that your baby has died is devastating. What comes next is both a medical process and an emotional journey. Healthcare providers should guide families with sensitivity and respect for their choices.

Delivery

In most cases, labor will be induced within a day or two of the diagnosis. Carrying a baby who has died poses health risks to the mother, including infection and blood clotting problems, especially if time passes without delivery.

Labor is typically induced using medications that help the cervix soften and contractions begin. For most families, vaginal delivery is the safest option and allows for a shorter recovery period. In some cases, depending on the mother’s health and circumstances, a cesarean section may be recommended.

The thought of going through labor and delivery after losing a baby can feel unbearable. Medical teams can provide pain relief options, emotional support, and time for families to process what is happening.

Seeing and Holding the Baby

Families are given the option to see, hold, and spend time with their baby after birth. This is a deeply personal decision, and there is no right or wrong choice.

Many parents find comfort in having this time together. Hospitals can help create memories by taking photographs, collecting handprints or footprints, providing a lock of hair, or offering keepsakes such as blankets or clothing. Some parents choose to have these keepsakes held by the hospital and made available later if they are not ready at the time.

Bereavement programs and perinatal loss specialists can help guide families through these moments with care and dignity.

Finding Out Why It Happened

After delivery, medical teams will often recommend tests and evaluations to try to determine the cause of the stillbirth. These may include:

• Examination of the placenta and umbilical cord by a pathologist
• Genetic testing through blood tests or tissue samples
• Autopsy of the baby, if parents consent
• Testing the mother for infections, clotting disorders, or other medical conditions
• Review of the pregnancy history and any prenatal test results

While these tests can sometimes provide answers, it is important to know that a definitive cause may not always be found. Even without a clear explanation, the information gathered can sometimes help guide care in future pregnancies.

Parents have the right to decline any or all of these tests. Healthcare providers should explain the potential benefits and respect each family’s decision.

Medical and Emotional Support

Stillbirth is not just a medical event. It is a profound loss that affects every aspect of a family’s life.

Immediate Support

Hospitals should provide access to:

• Bereavement counselors or social workers
• Chaplains or spiritual care providers, if desired
• Written materials about grief, recovery, and resources
• Information about funeral arrangements, burial, or cremation

Ongoing Care

After leaving the hospital, mothers will need follow-up medical care to monitor physical recovery. This includes managing postpartum bleeding, breast milk production (which may begin even after stillbirth), and any complications from delivery.

Emotional recovery takes much longer. Grief after stillbirth is complex and deeply personal. Parents may experience sadness, anger, guilt, numbness, or a mix of emotions that change over time. There is no timeline for healing.

Support options include:

• Individual therapy or counseling specializing in perinatal loss
• Support groups where families can connect with others who have experienced stillbirth
• Online communities and forums
• Books, podcasts, and other resources focused on pregnancy and infant loss

Many hospitals and medical centers in New York, including NYU Langone, Mount Sinai, Columbia University Irving Medical Center, and Albany Medical Center, offer comprehensive bereavement programs and multidisciplinary support for families navigating stillbirth.

Support for Partners and Siblings

While much of the focus is often on the mother, partners and other family members also experience profound grief. Partners may feel helpless or unsure how to support their loved one while managing their own pain. Siblings may struggle to understand what happened.

Family counseling, age-appropriate books and resources for children, and open communication can help everyone begin to process the loss together.

Planning for Future Pregnancies

Many families wonder whether they can have a healthy pregnancy after stillbirth. The answer is often yes, but it depends on individual circumstances.

Before trying to conceive again, it is important to:

• Allow time for physical and emotional healing
• Meet with a healthcare provider to review test results and discuss any identified risk factors
• Develop a care plan for the next pregnancy that may include more frequent monitoring, early ultrasounds, and management of any chronic conditions

If a cause for the stillbirth was identified, your provider may recommend specific interventions or treatments to reduce the risk in future pregnancies. If no cause was found, your provider will still work closely with you to ensure the best possible care.

Pregnancy after loss can be filled with anxiety and fear. Many medical centers offer specialized care for families who have experienced stillbirth, including closer monitoring and emotional support throughout the pregnancy.

Prevention and Risk Reduction

While not all stillbirths can be prevented, high-quality prenatal care plays a critical role in reducing risk. This includes:

• Regular prenatal visits beginning early in pregnancy
• Routine ultrasounds to monitor fetal growth and development
• Management of chronic health conditions such as diabetes and high blood pressure
• Screening and treatment for infections
• Monitoring fetal movement, especially in the third trimester
• Avoiding smoking, alcohol, and recreational drugs
• Maintaining a healthy weight and lifestyle

For pregnancies considered high risk, additional monitoring such as non-stress tests, biophysical profiles, or more frequent ultrasounds may be recommended.

If you have risk factors or a history of pregnancy complications, working with a maternal-fetal medicine specialist can provide an extra layer of expertise and support.

Research and Efforts to Reduce Stillbirth

Stillbirth rates in the United States have remained relatively stable in recent years, which has prompted renewed focus on understanding and addressing preventable causes.

Current research is exploring:

• The role of the placenta and how placental problems develop
• Genetic and chromosomal factors that contribute to stillbirth
• The impact of infections and inflammation
• Social determinants of health and racial disparities in outcomes
• Advances in screening and monitoring technologies

Organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) continue to update clinical guidelines to improve care, support families, and reduce preventable stillbirths through better access to quality prenatal care and culturally competent bereavement services.

Finding Reliable Information and Support

Navigating the medical, emotional, and practical aspects of stillbirth can feel overwhelming. NYBirthInjury.com exists to provide trusted, accurate information and connect families with qualified medical professionals and support resources throughout New York and across the country.

If your family has experienced stillbirth or you have questions about pregnancy loss, know that you are not alone. Compassionate, expert care and meaningful support are available.

Additional Resources

• CDC Stillbirth Resources: Information and statistics from the Centers for Disease Control and Prevention
• March of Dimes: Support and advocacy for families affected by pregnancy and infant loss
• Star Legacy Foundation: A national organization focused on stillbirth education, research, and support
• National Share: Pregnancy and infant loss support with local chapters nationwide
• Return to Zero: Center for Healing**: Offers counseling and resources for bereaved families

Stillbirth is a tragedy no family should face alone. With understanding, compassionate care, and the right support, families can begin to heal while honoring the memory of their babies.