How do health care providers manage stillbirth?

If the stillbirth occurs in the womb, the next step is to deliver it and the placenta. This delivery does not always have to happen right away. Some parents might take time to cope or to make arrangements. Others might prefer to complete the process as soon as possible.¹

Health care providers usually use one of the following methods to deliver the fetus and placenta¹:

• Induction. Providers give the pregnant woman medicine to start labor. Then they rupture the pregnancy membranes and proceed with regular labor and delivery. This method is used more often later in pregnancy.
• Dilation and evacuation. In this procedure, providers first give the pregnant woman medicine to help the cervix open or dilate. Once the cervix is open, providers give medicine to numb the birth canal and uterus. Then they surgically remove the fetus, the placenta, and other pregnancy material by inserting instruments through the vagina and cervix into the womb. Dilation and evacuation is only an option in the second trimester.

Removing the placenta once the fetus is removed or delivered is an important part of all pregnancies. The placenta provides for the transfer of oxygen and nutrients through blood. If it is not removed, or is only partially removed after the pregnancy has ended, the risk for life-threatening problems, such as hemorrhage or sepsis, is very high.

Providers will try to figure out a cause for the stillbirth, if possible. According to the American College of Obstetricians and Gynecologists, knowing a cause can provide some closure to families, and it can help identify risks that might affect future pregnancies.

Health care providers might examine a stillbirth by¹:

• Inspecting the exterior of the fetus, placenta, and other tissues. This examination can reveal problems, such as a knot in the umbilical cord or a problem with the development of the placenta, that could have caused or contributed to the death. The exam may include weighing and measuring the fetus and placenta and getting recordings or photographs to put in the medical record or to show to a specialist.
• Examining individual cells and genetic material. With parents’ permission, providers may take tissue and fluid samples and send them to a lab for analyses. These tests may identify problems with cells, chromosomal or genetic abnormalities, or infection as a possible cause of the stillbirth.
• Performing an autopsy. With parents’ permission, providers may do an autopsy. An autopsy involves examining the fetus to look for problems with the brain, heart, or other organs.
  • If an autopsy is not performed, X-rays or other types of imaging may be done to show the inside of the body and help find the cause of death.¹

Experiencing a stillbirth can be devastating for a pregnant woman and her family. Getting support from providers, counselors, friends, and family is important for the healing process. People handle loss differently, and there are many ways to support someone through a stillbirth.¹ Read more about coping with grief after stillbirth.

Managing factors to reduce the risk of future stillbirth is challenging. In some cases, no known risk factors are present when a stillbirth occurs, or the risk factors are not changeable. In other cases, no cause may be identified, or the cause may have been spontaneous.

Families that have experienced a stillbirth should work with health care providers to identify and address any changeable risk factors before trying for another pregnancy. The families may also want to consult genetic counselors and others who may be able to provide additional insights.¹

Learn more about risk factors for stillbirth.