Stillbirth: understanding the diagnosis and finding support

What it is and what is found

Stillbirth is the death of a baby before or during birth, generally from 28 weeks in Indian definitions and from 20 or 24 weeks elsewhere. India carries a substantial share of the world's stillbirths, and a large proportion are considered preventable with better antenatal care.

Causes that are found: placental problems, infections including malaria and syphilis, high blood pressure and pre-eclampsia, poorly controlled diabetes, growth restriction, cord accidents, congenital abnormalities, and obstructed or prolonged labour. In many cases no cause is identified.

Reduced fetal movement is the single most important warning sign that can be acted on, which is why the daily count from 28 weeks matters so much. A slump in movements is a same-day hospital visit, every time — never a wait-until-morning.

What happens after the diagnosis

The diagnosis is confirmed with an ultrasound, usually by more than one clinician. Many parents describe wanting to be told again, plainly; it is reasonable to ask.

Delivery is usually vaginal, most often induced, and this surprises and frightens many parents who assume a caesarean. Labour is generally safer for the mother and allows better recovery, and pain relief including an epidural is available. It may not happen immediately — you may be given time to take in the news and, in some cases, to go home first.

You have choices, and you are entitled to be asked about them: seeing and holding your baby, naming them, photographs, handprints and footprints, and who is present. There is no right answer, and parents who take mementoes rarely regret it while some who declined do — many hospitals will keep photographs on file in case you want them later.

Tests may be offered — examination of the placenta, blood tests, sometimes a post-mortem. A post-mortem is a hard decision made at the worst moment; it is also the best chance of an explanation and of information for a future pregnancy. You can decline, and you can ask for a limited examination instead.

Practical matters that nobody warns about: your milk will come in a few days later, which is distressing, and there are ways to manage it — ask before you leave hospital. Registration of the birth and death, and any hospital paperwork, can usually be handled by someone else.

Afterwards

Physical recovery follows the same course as any birth: bleeding for weeks, afterpains, and a six-week check that should not be skipped — it covers healing, blood pressure, contraception and mood.

Ask for a follow-up appointment with your obstetrician six to twelve weeks later to go through any findings and what it means for a future pregnancy. Write your questions down in advance, because you will not remember them.

Grief after stillbirth is intense and long, and it does not follow a schedule. Many parents describe the second and third months as harder than the first, when the practical activity stops and everyone else has moved on.

In India, the silence around this is heavy: the pregnancy is often unspoken afterwards, and mothers are frequently told to move on and try again. You are entitled to speak about your baby, to use their name, and to grieve for as long as it takes.

When to see a doctor

In any pregnancy: reduced or absent fetal movements after 28 weeks is a same-day hospital assessment, always. So are bleeding, severe abdominal pain, severe headache with visual changes, sudden swelling of face and hands, high fever, or leaking fluid. Call 108 if transport is difficult.

After a stillbirth, seek care for: heavy bleeding, fever, foul-smelling discharge, calf pain or swelling, chest pain or breathlessness, or a wound that is not healing.

Grief after a pregnancy loss is real grief, at any number of weeks. If you are struggling — persistent low mood, hopelessness, panic, an inability to function, or any thought of harming yourself — that deserves help rather than endurance. Tele-MANAS on 14416 is free, confidential and answers round the clock in Indian languages.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: Was it something I did? — Almost never. Stillbirth is not caused by ordinary activity, working, lifting, travel, or something eaten. If a cause is found, it is usually medical and outside your control.

Q: Should we see and hold the baby? — There is no right answer, and there is no rush — many hospitals will allow time. Parents who choose to rarely regret it; parents who feel unable to should not be pressed.

Q: Will it happen again? — For most families, no. A future pregnancy will be treated as higher-risk with closer monitoring, and that monitoring works. Ask for a pre-pregnancy consultation before trying again.

Q: How do we tell our other children? — Simply and honestly, in age-appropriate words, without euphemisms like 'gone to sleep', which frighten young children. They will need to be told more than once, and their grief will surface in behaviour rather than words.