Stillbirth Prevention

Ways to reduce the risk of a stillbirth in pregnancy

No expectant mom likes to think about a stillbirth, but it is something we should all be aware of. While it isn’t common, if it does happen to you, it’s a devastating loss for parents to experience. You will need time and space to work through your emotions and grieve the loss of your baby. The grief process takes time and there is no right or wrong way to grieve. Consulting with a counsellor can help you cope with the loss as you move through the grief process towards acceptance and healing.

Are You at Risk for a Stillbirth?

In medical terms, a stillbirth is when a baby dies in the womb after 20 weeks. Most stillbirths occur prior to labour, but a small number may occur during this phase. Stillbirths can happen in any family and in about one third of cases, there is no known cause. The other two thirds may be caused by birth and genetic defects, problems with the placenta and/or umbilical cord, high blood pressure, maternity infections or conditions like heart and renal disease, and poor lifestyle choices.

 The following factors can increase your risk for a stillbirth:

• You had a previous miscarriage or stillbirth
• You’re a more mature mom – over 35 years of age
• You are pregnant with multiples
• You had complications in a previous pregnancy (preeclampsia, premature birth etc.)
• You have a pre-existing health issue like diabetes mellitus and hypertension (high blood pressure)
• You start your pregnancy over-weight (Body Mass Index of over 30)
• You drink alcohol, smoke or use drugs (unmonitored by your healthcare provider) while pregnant
• You are a victim of gender-based violence
• Malnutrition and inadequate healthcare also increases the risk of a stillbirth

Reducing the Risk of a Stillbirth

 While not all stillbirths can be prevented, there are ways to reduce the risk. What can you do to protect your baby?

• Quit smoking and don’t drink alcohol or use drugs

Overuse or abuse of these substances (all types of drugs –  street drugs and medication – over-the-counter (OTC) and prescription medication) can have a serious effect on the health of your baby. Research has shown that smoking tobacco products or marijuana (dagga), using illegal drugs or taking prescription painkillers can double or triple the risk of stillbirth. The baby may also be born prematurely, with an increased risk for birth defects and developmental or intellectual delays.

Good advice: If you have used alcohol or drugs during your pregnancy, be honest with your healthcare provider. Your disclosure will be treated as confidential and instead of being judged, you will be treated with compassion and the information will allow your healthcare provider to provide additional care and support for you and your baby as required.

• Eat healthy and monitor your weight gain

Following a healthy diet and getting regular exercise is part of a healthy pregnancy for all expectant moms. If you start your pregnancy overweight, speak to your healthcare provider about an eating plan tailored for your needs.

Good advice: While dieting is never advocated in pregnancy, if you start your pregnancy over-weight, you can make healthier diet choices that will help to reduce the amount of weight you gain. This can help to reduce the risks associated with obesity during pregnancy. Always consult your healthcare provider or a dietician. Your diet should be carefully instructed and monitored by your healthcare provider.

• Keep prenatal visits

Prenatal visits monitor your health and your baby’s development. If your healthcare provider notices anything that requires intervention or additional care or treatment, it can be started immediately. Your blood pressure and urine should be checked at every prenatal visit. These tests are important to pick up preeclampsia, a serious pregnancy condition characterised by hypertension (high blood pressure), protein in the urine and oedema (swelling caused by fluid retention) in the ankles, feet and hands. Untreated, preeclampsia can lead to serious complications for mother and baby and may be fatal.

Good advice: In many cases, preeclampsia has no symptoms, but if they do occur, they include a severe headache, vomiting, visual disturbances (blurring or flashing) or pain below the ribs. If you experience any of these symptoms, contact your healthcare provider immediately.

• Sleep on your side

After 28 weeks, go to sleep on your side (either side is fine), but not on your back. Sleeping on your back can put pressure on the main blood vessels that supply blood to the uterus. This can restrict the flow of blood and oxygen to the baby.

Good advice: Place a pillow behind your back to prevent yourself from rolling over. Don’t be too concerned if you wake up on your back. The weight of your bump is unlikely to allow you to lie in this position for an extended length of time before you instinctively will move. Research into sleep positions has shown that the position you fall asleep in, is likely to be the one you stay in the longest during the night. If you wake up to use the bathroom, go back to sleep on your side.

• Get the flu vaccine

Pregnant women are at added risk from complications with flu, including pneumonia and bronchitis. Stillbirth may be a risk for those women who develop severe illness. The flu vaccine helps to prevent serious illness and reduces your risk for hospitalisation. It is available in South Africa from April onwards and is safe to take in any trimester, with the added benefit that if you breastfeed, you’ll pass antibodies to your baby.

Good advice: There is also increased risk for severe illness that may require hospitalisation with COVID-19, the disease caused by the new coronavirus. If you are not yet vaccination against COVID-19, you can take the vaccine during any stage of pregnancy.

• Monitor movements

From about 24 to 28 weeks, keep track on your baby’s movements. Every baby is different, so get to know your baby’s movement patterns. This will make it easier to spot changes. If the movement pattern reduces or changes, let your healthcare provider know.

During your last month of pregnancy, you will be asked to see your healthcare provider every two weeks initially, and then every week until your baby’s birth. Your health and your baby’s health are carefully monitored, so do keep these appointments. If you have any questions about your baby’s movements, or any aspect of your pregnancy, or labour and delivery, contact your midwife on the Maternity Programme.

 Contact your healthcare provider or midwife for further support.

Resources:  https://www.nhs.uk/; https://my.clevelandclinic.org/; https://www.tommys.org/ https://www.marchofdimes.org/; https://medlineplus.gov/; https://www.drugabuse.gov/; https://raisingchildren.net.au/; https://www.nih.gov/; https://www.mayoclinic.org/; https://www.nicd.ac.za/