Salt Lake City, UT -- (ReleaseWire) -- 10/04/2021 --Losing a baby late in pregnancy can be devastating. Understanding why fetal demise sometimes occurs is a complex topic that continues to be studied. Dr. Jessica Page, a maternal fetal medicine specialist with Intermountain Medical Group who cares for patients with high risk pregnancies and has studied stillbirths, works with parents to help understand what is and isn't known about stillbirths.
"Stillbirth is defined as fetal death at or after 20 weeks of gestation," explained Dr. Page. "Miscarriages refer to pregnancy at 12 weeks or earlier. Early fetal losses (those between 13 and 19 weeks) are sometimes managed similarly to stillbirths."
Stillbirths are less common than miscarriage. In the U.S., stillbirths happen in about 6 per 1000 pregnancies. "It doesn't sound like a lot, but each loss is devastating, and it happens more often than it should," said Dr. Page. "In the U.S. we continue to study the issue, learn more and work to improve."
It's often hard to know the precise cause, as there can sometimes be more than one potential condition and it can be difficult to assign causality. One of the most common potential causes of stillbirth is placental insufficiency. This refers to situations in which the placenta doesn't work well to provide the fetus with blood and oxygen. This can be due to maternal medical conditions, disruptions such as placental abruption or umbilical cord occlusion. Sometimes preterm labor prior to fetal viability (about 24 weeks) occurs and leads to stillbirth.
Identifying a potential cause of death after a stillbirth can help families achieve emotional closure, and can help providers better manage that woman's future pregnancies. Additionally, better identification of potential causes of death improves our ability to prevent and better understand stillbirth.
"As OB providers it is important for us to deliver compassionate and clear information about what tests are most likely to identify a potential cause of death," said Dr. Page. "Families often need time to consider their options and it is helpful to given them multiple chances to ask questions and process the information."
Dr. Page said the most useful tests for identifying a potential cause of death are fetal autopsy and placental pathology. Fetal autopsy is an exam of the baby. This can be a difficult topic for patients emotionally and it is important for providers to explain the options and high yield of this exam. "The patient can spend as much time as desired with the baby prior to the exam and following the exam, and the incisions are easily hidden with normal baby clothes," said Dr. Page. This gives families the option to have funeral services or other memorials as desired. There are also options for less invasive exams which may include an external exam only or imaging with MRI. Autopsy can identify fetal anatomic abnormalities, evidence of infection or other pathologic processes leading to the death.
Placental pathology is a detailed microscopic examination of the placenta and umbilical cord. This is very useful for understanding if placental abnormalities or damage led to the stillbirth.
"We also recommend genetic evaluation and testing for antiphospholipid syndrome in cases of stillbirth," said Dr. Page. "If abnormal results are found, this may affect management of future pregnancies."
Understanding causes of stillbirths enables us to better identify targets for prevention of stillbirth and to characterize those pregnancies at the highest risk.
"Pregnancy loss at any point is difficult, but particularly as pregnancy progresses it can be emotionally devastating. It's important to take time and space for families to grieve. Creating mementoes are helpful for many families as they navigate this grieving process," said Dr. Page.
Dr. Page adds that labor and delivery nurses, OBs, and midwives help provide comfort to mothers who experience a stillbirth. "Labor and delivery staff are experienced in all aspects of childbirth, from the joys in celebrating a new birth to comforting those who experience loss. A lot of it is meeting the patient where she and her partner are at that moment and providing the emotional support they need during their grief process. During a difficult time such as this, it's common not to internalize all the information and details. Giving patients time and opportunity to ask questions and to acknowledge the loss of their child is especially important."
"While rare, stillbirths affect more families than you think. It's important to recognize the role of that child in that family's life. Just acknowledging the baby and supporting the family and listening without making judgments or commentary are what are often most helpful," said Dr. Page.
"You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance," said Dr. Page. "If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help."
Women experiencing stillbirth in Utah can reach out to Intermountain's Angel Watch program that offers support for women experiencing fetal demise. The program is staffed by master's level social workers, nurses, bereavement specialists and chaplains who are available on-call to provide counseling specific to this type of loss, through in-home or virtual visits. The service is free and available to anyone, not just Intermountain patients. For more information call, 801-698-4486 or visit: https://intermountainhealthcare.org/services/women-newborn/resources/angel-watch.
Intermountain Healthcare also provides an Emotional Health Relief Hotline at 1-833-442-2211. This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.
Intermountain Moms is another social media resources for new mothers and can offer tips and advice.
"If depression or anxiety persists and you don't have a mental health provider there are some walk in services available," said Dr. Page. "In Utah, Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available."
Dr. Page adds there are other resources available throughout the country, and suggests women talk to their doctor, OB or midwife on how to access those resources.
About Intermountain Healthcare
Intermountain Healthcare is a nonprofit system of 25 hospitals, 225 clinics, a Medical Group with 2,600 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Utah, Idaho, and Nevada. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and in efficient healthcare delivery. For more information about Intermountain, visit intermountainhealthcare.org. For helpful advice for expectant moms and new parents, see Intermountain Moms online or follow us on www.facebook.com/intermountainmoms, www.instagram.com/intermountainmoms, or https://twitter.com/IntermtnMoms.