What is stillbirth?

A stillbirth occurs when a fetus has died in the uterus. The Australian definition specifies that fetal death is termed a stillbirth after 20 weeks gestation or the fetus weighs more than 400 grams (14 oz). Once the fetus has died the mother still has contractions and remains undelivered. The term is often used in distinction to live birth or miscarriage. Most stillbirths occur in full term pregnancies.

Causes
The causes of a large percentage of human stillbirths remain unknown, even in cases where extensive testing and autopsy have been performed. A rarely used term to describe these is sudden antenatal death syndrome or SADS, a phrase coined by Cacciatore & Collins in 2000.[1]

In cases where the cause is known, some possibilities of the cause of death are:

-bacterial infection
-birth defects, especially pulmonary hypoplasia
-chromosomal aberrations
-growth retardation
-intrahepatic cholestasis of pregnancy
-maternal diabetes
-high blood pressure, including preeclampsia
-maternal consumption of recreational drugs (such as alcohol, nicotine, etc.) or pharmaceutical drugs contraindicated in pregnancy
-postdate pregnancy
-placental abruptions
-physical trauma
-radiation poisoning
-Rh disease
-umbilical cord accidents
+"Prolapsed umbilical cord" - Prolapse of the umbilical cord happens when the fetus is not in a correct position in the pelvis. Membranes rupture and the cord is pushed out through the cervix. When the fetus pushes on the cervix, the cord is compressed and blocks blood and oxygen flow to the fetus. The mother has approximately 10 minutes to get to a doctor before there is any harm done to the fetus.
+"Monoamniotic twins" - These twins share the same placenta and the same amniotic sac and therefore can interfere with each other's umbilical cords. When entanglement of the cords is detected, it is highly recommended to deliver the fetuses as early as 31 weeks.

+Entanglement of cord in twin pregnancy at the time of Caesarean Section
Umbilical cord length - A short umbilical cord (<30 cm) can affect the fetus in that fetal movements can cause cord compression, constriction and ruptures. A long umbilical cord (>72 cm) can affect the fetus depending on the way the fetus interacts with the cord. Some fetuses grasp the umbilical cord but it is yet unknown as to whether a fetus is strong enough to compress and stop blood flow through the cord. Also, an active fetus, one that frequently repositions itself in the uterus can cause entanglement with the cord.a hyperactive fetus should be evaluated with ultrasound to rule out cord entanglement.
+Cord entanglement - The umbilical cord can wrap around an extremity, the body or the neck of the fetus. When the cord is wrapped around the neck of the fetus it is called a nuchal cord. Again, these entanglements can cause constriction of blood flow.These entanglements can be visualized with ultrasound.
+Torsion - This term refers to the twisting of the umbilical around itself. Torsion of the umbilical cord is very common ( especially in equine stillbirths) but it is not a natural state of the umbilical cord.The umbilical cord can be untwisted at delivery. The average cord has 3 twists.
Sometimes a pregnancy is terminated deliberately during a late phase, for example for congenital anomaly. UK law requires these procedures to be registered as "stillbirths".

Prenatal diagnosis
It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress.A decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably little space in the uterus for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery.

Constricted Umbilical Cord
When the umbilical cord is constricted (q.v. "accidents" above), the fetus experiences periods of hypoxia, and may respond by unusually high periods of kicking or struggling, to free the umbilical cord. These are sporadic if constriction is due to a change in the fetus' or mother's position, and may become worse or more frequent as the fetus grows. Extra attention should be given if mothers experience large increases in kicking from previous childbirths, especially when increases correspond to position changes.

Prevention
As many of the causes are unknown or untreatable, prevention is difficult. Symptoms of bacterial infection, such as from a dental abscess, in pregnant women may also include unusual periods of incoherence and symptoms of shock, and should be treated by a physician immediately. High blood pressure, diabetes and drug use should be regulated with physician's advice. Umbilical cord constriction may be identified and observed by ultrasound.

Prenatal maternal treatment
An in utero stillbirth does not usually present an immediate health risk to the woman and labour will usually begin spontaneously after two weeks, so the woman may choose to wait and birth the fetal remains vaginally. After two weeks, the woman is at risk of developing blood clotting problems, and labor induction is recommended at this point. In many cases, the woman will find the idea of carrying the dead fetus emotionally traumatizing and will elect to be induced. Caesarean birth is not recommended unless complications develop during vaginal birth.

Prevalence
Stillbirth is a relatively common, but often random, occurrence. The mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or on an average one every 20 minutes. In Australia,England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births, in Scotland 1 in 167. (From The National Statistical Office and other sources.) Many stillbirths occur at fullterm to apparently healthy mothers, and a postmortem evaluation reveals a cause of death in only about 40% of autopsied cases.

In developing countries, where medical care can be of low quality or unavailable, the stillbirth rate is much higher.

Deep in thoughts

Are there any support groups specially for grieving mothers affected by stillbirth or miscarriages or death of a child here in SA?If anyone has an answer please let me know.Are the organisation dedicated to research on the cause of stillbirth and come up with preventative measures?Hmmm I haven't come across any,so please if someone knows of it please to let me know.I am even wondering if there are companies doing gifts for grieving parents like pendants etc...I spent the whole day googling and all I could find is overseas shops.

I know that the number of stillborns here in South Africa have increased but what is our doctors doing about it.I remember in the hospital I was,they gave me a private room for delivering but after they took me to an empty room just next door the nursery and all I can hear the whole night is crying babies,how insensitive that is.When the shifts changed,the night nurses did not inform the day nurses that in that room there is a mother who just lost her child and all I heard all morning was "where is your baby?" Do you want me to bring her for feeds."I just laid there in tears and with a shaking voice said "my baby died."In my heart I just couldn't wait for my husband to come and answer these questions for me and he eventually came at 6:30 and rescued me and we had to wait there and be tortured till the gynae arrived to discharge me.

Do not get me wrong,I did not want preferential treatment but some sort of sensitivity.So yaah when my psychologist advised me to start a blog,even though I was hesitant at first but I thought about it thoroughly and asked myself what will people think etc...but I said to hell cause most women here in South Africa go through stillbirth almost everyday and some more than once and keep it to themselves.I will write a blog and even though it is personal maybe it might help someone some day.

It is not wrong to grieve for your child that was bornsleeping,we go into depression because we do not talk,since we are not allowed to.Some they did not get to give their children decent burials and will never eract a tombstone cause culture says stillborns should be buried at the back of the family home.But I would like to say,that should not permit you to think of your child or do something to honour their memory.I remember I was so pissed that in her death certificate they only wrote "baby Kulani."whilst we had names for her,to me that is just so inconsiderate and unfair to the parents.But I have decided that I won't let a death certificate deprive me of honouring my daughter.When you talk to people about your late child,they look at you like you are mad or obsessed.It doesn't not mean that if my baby died,she was not my child.She came out the same way other living children come out the only difference is she came out sleeping with no heartbeat.

I urge everyone to respect angel moms and allow them to talk freely about their children and birthing experience if they want.All kids are special to their parents and every parent is proud of their children.So don't look at me like I am crazy when I talk about my girls,yes you heard me rights "girls",I am a proud mother of two beautiful girls,one here on heart filling my heart with joy and one in heaven filling my heart with strength and hope.

To be honest if I had a gift of crafting I would open a shop that only sell keepsakes and jewelry for the stillborns,so unfortunately.I want to paste reference of what other countries are doing in support of stillbirths,it is not taboo to talk about this,it might help someone some day and wouldn't you be happy that you did something to help prevent another mother from experiencing such a painful thing.

Anyone who like to share their story with the world in this blog you can,let's raise awareness.drop at kulimas@webmail.co.za and I will post it for you.

www.uk-sands.org
www.MyForeverChild.com