Stillbirth: causes, investigations and bereavement care in the UK

Stillbirth is usually first suspected because a baby's movements have reduced or stopped, or a heartbeat cannot be found at a routine check. Confirmation comes from an ultrasound scan that shows the heart is no longer beating, and a second person normally checks the scan. Many parents ask for time, and staff can offer a private room, a bereavement midwife and the chance to have a partner or family member with you.

The NHS notes that some stillbirths are linked to problems with the placenta, birth defects or the mother's health, but often no cause is found. It is important to say that stillbirth is rarely caused by anything a parent did.

The RCOG leaflet says that after full investigation a cause is identified in up to two-thirds of cases. Groups of causes include a placenta that has not supported growth, placental bleeding, infection, problems with the umbilical cord, conditions such as pre-eclampsia, diabetes or blood-clotting disorders, and genetic or structural conditions in the baby.

• Placental problems, including abruption and poor growth.

• Infection affecting the mother, placenta or baby.

• Pre-eclampsia, diabetes or clotting disorders in the mother.

• Chromosomal or structural conditions in the baby.

• Complications during labour.

Most parents are advised that vaginal birth carries fewer risks, a quicker recovery and fewer complications in future pregnancies. The decision still belongs to you, and a caesarean is available if you prefer it or if your own health makes it safer.

Induction can usually begin soon after the diagnosis. Some people prefer to wait for labour to start naturally; the RCOG leaflet notes that most women who wait go into labour within three weeks, with hospital check-ups twice a week once 48 hours have passed. A tablet may be given up to 48 hours before induction to prepare the body.

Investigation is offered, never required. The tests below can be accepted individually, and you can say yes to some and no to others.

• Blood tests on the mother, looking for pre-eclampsia, diabetes, infection and clotting disorders.

• Swabs from the vagina, cervix, placenta or baby if infection is suspected.

• Genetic testing of the baby's chromosomes from placenta, cord or skin.

• A detailed examination of the placenta.

• A post-mortem examination of the baby, which can be as limited or as detailed as you choose.

Sands describes a post-mortem as a medical examination to help understand why a baby died. A professional should explain the options, and consent is yours alone to give. Results can take time, and Sands acknowledges that it can sometimes be months before parents receive the report, so ask who will contact you and when.

A bereavement team can also explain how to register a stillbirth and make funeral arrangements, with respect for religious and cultural wishes. Hospitals often offer to make footprints, handprints, photographs or a lock of hair, and can keep them in your records if you are not ready to take them home.

After the birth, your body will go through the changes of any birth, including milk coming in. Options include medicine to stop milk, letting it settle on its own, or donating milk to a neonatal unit, and ice packs and supportive bras help with discomfort. Your midwife and GP can check on your recovery and emotional health, and charities such as Sands and Tommy's run helplines and groups for parents, grandparents and siblings.

If you become pregnant again, specialist care typically includes additional antenatal appointments, extra scans and a plan based on your test results. Delivery by about 39 weeks, by induction or planned caesarean, may be discussed. The NHS also advises routine measures such as going to every antenatal appointment, sleeping on your side from 28 weeks, and avoiding smoking, alcohol and drugs.