The unthinkable has happened. You've learned your baby has died only weeks or even days before you should have delivered a healthy newborn. You may be in shock or already beginning your grieving process.
There are a lot of things on your mind. Why did this happen? Is there anything you could have done differently? How will you tell your family and friends? What are you going to do with the gifts you got at your shower? It's probably hard to concentrate on anything right now.
One thing that may not have occurred to you is what's going to happen to you physically. Unlike a miscarriage, your choices are a lot more limited in a late pregnancy loss (a.k.a. stillbirth, or fetal demise). You'll need to deliver the baby vaginally or, in some cases, by C-section.
Why Do I Have to Deliver the Baby?
Once your baby has grown to near or full-term size, surgical options that would have been available to you if you'd miscarried earlier in pregnancy are no longer possible. The only option is for you to deliver the baby as you were already planning on doing.
How Do I Decide Which Way to Deliver?
Your doctor will recommend a vaginal delivery in most cases. It's the safest way for most women. There are, of course, exceptions in which a C-section is the best option.
Those reasons include:
- Breech presentation: If your baby is positioned with his feet or bottom presenting at the cervix, your doctor may recommend a C-section. Even though there is no risk to the baby in the case of stillbirth, there is still a higher risk of the mother requiring difficult interventions, possibly even surgery, if the baby's head did not deliver after the body.
- If you've had previous C-sections: Your doctor will probably offer you a repeat C-section if you've already delivered other children that way. This may also be the case if you've had surgeries on your uterus.
- Multiple pregnancies: Whether one or more of your babies have died, a multiple pregnancy can often require a C-section to prevent the umbilical cords from becoming entangled.
- Placental problems: If you've experienced a placental abruption or if your placenta is over your cervix, there is an increased risk of bleeding. A c-section may be the safest option.
- Inability to deliver vaginally: If you've undergone induction of labor or gone into labor on your own but your baby will not deliver for some reason (such as a disparity between the size of your baby's head and the size of your pelvis) you may require a C-section.
Will Delivery Hurt Even Though My Baby Is Stillborn?
The physical experience of labor will not be much different for you. You will still have contractions at the same rate you would have in a normal labor. The same pain control options will be available:
- "Natural" or unmedicated labor: This technique uses breathing and other relaxation techniques to control your pain, usually with the help of your partner or labor coach. Other options include massage, whirlpool therapy, walking, guided imagery and self-hypnosis.
- IV pain medication: There are many pain medications given in small doses that can last anywhere from a few minutes to a few hours. In the case of a stillbirth, you actually have a wider variety of options in this method because there is no risk to the baby.
- PCA, or patient-controlled analgesia: With this method, your IV will be attached to a special computerized pump that will allow you to give yourself doses of pain medicines as you feel you need them.
- Epidural: An anesthesiologist will place a small catheter in the pocket of fluid around your spine to give you a continuous, low-level dose of numbing medications that should decrease your pain sensation from the top of your belly down.
What Will Happen at the Hospital?
You'll be admitted by a nurse and your doctor will write orders for the treatments you will need. This can include everything from the kind of pain medications available to whether or not you can eat before delivery.
You will most likely have an IV and your vital signs checked. If you're being induced, your doctor or nurse will give you medication to start contractions. You will probably meet a lot of new faces soon after you arrive. Even in a small community hospital, you may need to meet more than one nurse, an anesthesiologist and possibly a social worker or grief counselor.
In induction of labor, you'll begin having contractions as the medications take effect. As labor progresses, you can decide how you want to control your pain.
When your cervix is fully dilated, your nurse will coach you through the pushing. Your nurse and labor coach (husband, boyfriend, mom, sister, friend, etc.) will help you get into comfortable positions to push. The doctor will arrive when you are close to delivering and help you finish the process.
The last step is expelling the placenta. This usually happens naturally within 15 minutes of the baby's arrival. Your doctor will repair any tears or episiotomies that need stitches. Your nurse will help clean up your bottom and bedding, and put ice packs and pads on to help control pain and reduce swelling. If you've had an epidural, it will be turned off at this point and you'll begin to get feeling back in your legs and belly.
How Will My Experience Be Different from a Typical Labor?
The most significant difference is that you won't have a monitor put on your belly to track the baby's heartbeat. Some women find that upsetting, particularly if they've had children before or had frequent fetal monitoring during their pregnancy. Unfortunately, once your baby has died, there is no heartbeat to monitor. You may still have a monitor put on your belly to keep track of contractions.
As we discussed above under pain control, there will be a wider variety of pain medications available to you than in a typical labor.
If your bag of water ruptures, there is a possibility it will be dark in color or bloody. This is expected after a baby has died.
One of the hardest parts of any stillbirth comes in the moment immediately after delivery. We are conditioned to listen for that first cry as soon as a baby is born. In stillbirth, the silence is heartbreaking.
In some hospital settings, you may not be transferred to the postpartum or mom/baby unit.
If you have no other medical problems and an uncomplicated delivery, you could be declared "stable" as soon as six hours after delivery. If you wish, you may go home the same day, though most physicians and hospitals will allow you to stay longer if you don't feel ready to leave.
After delivery, you will have to discuss final arrangements for your baby. The hospital social worker will be available to help you. Depending on your state law, you will most likely need a funeral home to assist with transportation and burial or cremation of your baby. You might want to begin the process of choosing a funeral home before you deliver.
What Happens Next?
You will probably be offered the chance to see and hold your baby, and even given the opportunity to get photographs, footprints and other mementos with your baby. This is a good time to have family members visit if you wish.
Your physical recovery will begin immediately. You'll experience vaginal bleeding, some uterine cramping, and probably perineal pain. Your nurse will help you manage your pain while you're still in the hospital. On the plus side, you'll be able to eat and drink again, if you've been restricted.
If you don't already know the reason for your baby's death, your doctor will discuss your options regarding and autopsy and other testing of the baby. You may need to have some blood drawn or other testing yourself.
Your doctor will schedule a follow-up visit with you to make sure your body is recovering from your pregnancy and to discuss any results from tests to determine the baby's cause of death. He or she will also want to talk about your emotional recovery and assess you for signs and symptoms of depression.
Emotional recovery is a long, personal process that varies greatly from person to person. Grief is a natural part of losing a baby. Be patient with yourself, accept help when you need it and work through your grief at your own pace and in your own style.
For even more information about stillbirth and recovery from stillbirth, please see the following articles:
- Physical Recovery from Stillbirth
- Emotional Recovery from Stillbirth
- Causes of Stillbirth
- Pregnancy After Stillbirth
- Funeral Planning After Pregnancy Loss
- An Overview of Stillbirth
American Pregnancy Association, "Stillbirth: Trying to understand." Apr 2006. Accessed 11 Oct 2011.
Wisconsin Stillbirth Service Program, "When Your Baby is Stillborn." University of Wisconsin - Madison. Accessed 11 Oct 2011.
Varney, H., Kriebs, J., et al. Varney's Midwifery, Fourth Edition. 2003.