A post-stillbirth medical consult
Written by Diana Adams MD, FACOG
The loss of a child is one of the most devastating things that we can endure as parents. Can I just pause to say: I am so sorry for your loss.
As a mom and physician of those having experienced this, I acknowledge the gaping hole in your heart that pangs deeper than we could have ever imagined. And we don’t mean to fill that place with information and next steps - in fact, we want you to know your child will never be forgotten. That space in your heart is theirs forever. Their names, their footprints, their warmth, their breathless being, will never be forgotten. Your pain will subside, in time. We don’t mean to speed that up. We know you are in pain, and we pray every family that reads this article feels known and understood.
As a physician, I also want to share medical insight into what a stillbirth consult might consist of after delivery. We hope this helps you understand what to expect or ask for in a post-stillbirth consult, and to know how you can be proactive. We are also here for you should you want to break this down over a video consultation with a maternal fetal medicine specialist.
This article is broken down into two parts:
The basics of a post-stillbirth consult
Preventing stillbirth, whether or not you’ve had one in the past
The basics of a post-stillbirth consult
It is so important to consult with your physicians (OB and/or MFM) after stillbirth to discover and record the important facts. While this can be painful, many patients do find hope and the information empowering for your present recovery and any future pregnancies. Here are the 5 key things your physician can do after loss to help determine cause, and help you prepare for future pregnancy outcomes. It is important to note not all of these are possible after every loss:
Receive a perinatal autopsy or placental pathology. While devastating to take this on as a family, we cannot emphasize enough the importance of perinatal autopsy after stillbirth whenever possible:
“Perinatal autopsy may provide information about the cause of fetal death that is different from that derived from other clinical examinations. This information often changes the estimated risk of stillbirth recurrence and frequently influences recommendations for management of future pregnancies. For these reasons, we recommend offering perinatal autopsy to parents of stillborn infants.” - UpToDate
Have your delivering clinician estimate time of death: this is often related to the reason for your loss, if possible to attain an estimate
Determine cause: While a large percentage of stillbirths are unexplained, you can ensure your care team is seeking to find identifiable reasons for loss
Consider a detailed antenatal scan: this assists maternal health care. Although fetal death poses limitations on findings, it may contribute important details
Perform any recommended maternal labs
Preventing stillbirth, whether or not you’ve experienced this in the past:
How can you take ownership? Here are a few ways you can actively love your baby in the womb, whether or not you have had a prior occurrence of loss or stillbirth! Studies show that suboptimal medical/obstetric care plays a role in perinatal death. While this seems much easier to identify in hindsight and shouldn’t cause unnecessary fear, if you feel unsupported or desire additional monitoring for you and your baby, JUST ASK!
Ensure your team knows your maternal history: if you are an individual with medical and obstetric disorders that carry an increased risk for stillbirth, ensure you have the recommended extra measure of attention from your OBGYN and necessary specialists
Physical activity: manage weight, especially if obesity is a risk factor in your pregnancy.
Avoid smoking, drinking and recreational drugs
Limit the number of embryos transferred if doing IVF, as there is a higher risk of stillbirth with multiples
Take recommended vitamins. Folic acid is advised for all patients (at a higher dose for some). Low-dose aspirin is advised for many
Perform all recommended labs throughout your pregnancy, including screening for diabetes
Go to all recommended scans, for example: an early pregnancy dating scan (7-10 weeks), NT scan (12-13 weeks), Anatomy scan (18-20 weeks), and growth scans in the third trimester. (32 - 36 weeks)
Count the kicks! Reduced fetal movement is a critical thing to be cognizant of. Go in for extra monitoring if you are concerned or unsure. There is no reason to wait or be embarrassed by asking in your final weeks of pregnancy, if counting has been difficult. Get to know your baby’s pattern of movement, and monitor it. Your medical team’s purpose is to support you and your baby, so don’t hold back!
Ask for more frequent antenatal surveillance (ultrasound or nonstress tests) as needed. This can occur 1-2X weekly beginning at 32+ weeks. Timing should be individualized for patients with an earlier prior stillbirth. Nonstress tests and biophysical profiles (BPP) typically monitor pregnancy in weeks 36-40. Note: studies show no correlation to reduction in stillbirth, but this is primarily for your own comfort and stress levels, especially after a prior loss.
Timed delivery: While this warrants a conversation of its own, we do recommend you take the time to discuss delivery timing with your care team, especially in the presence of known risk factors (e.g. history of abruption or stillbirth). Delivery may be recommended much earlier than the standard pregnancy at 39+ weeks. For those carrying a “healthy” pregnancy (aka no known risks), you can discuss with your care team the proven benefits of delivering in the 39th week and how that relates to a reduced incidence of fetal demise
Share information from your past perinatal autopsy, placental pathology and genetic testing reports if you have a past history of stillbirth
Know your dates: In cases of prior stillbirth due to fetal growth restriction and demise from many other conditions, careful dating helps your care team optimize delivery timing
