Stillbirth is a tragic experience, often shrouded in silence and misunderstanding. In Singapore, it’s a topic that’s only recently started to receive the attention it deserves.
This article delves into the heartbreaking reality of stillbirth in this developed nation, from understanding what it is to explore the statistics and risk factors. We also shed light on personal stories of loss, recent legislative reforms for recognition, and strategies for managing this devastating event.
Join us as we navigate this poignant issue, in the hope of fostering greater awareness and support for those affected.
What is Stillbirth?
Stillbirth refers to an unforeseen event where a baby is not alive when it is born after 24 weeks of pregnancy. It’s an unfortunate occurrence that affects about one in every 200 to 300 pregnancies according to SingHealth.
Why Do Stillbirth Cases in Singapore Occur?
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Even with a number of stillbirth cases not only in Singapore but everywhere else, the cause of about 40% of stillborn cases remains unknown. For known causes, they can be grouped into three main categories:
Birth defects in the baby
- Fetal chromosome, genetic or metabolic abnormalities
- Fetal structural abnormalities
Problems with the placenta or umbilical cord
- Foetus gets entangled with the umbilical cord
- Placenta separates, causing interference with, or a cutoff of the flow of blood, oxygen and nutrients to the baby
Maternal illnesses or conditions
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The mother’s use of nicotine, alcohol, and/or illicit substances
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The presence of diabetes in the mother
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Existing health issues in the mother such as diabetes and high blood pressure, particularly if she isn’t receiving consistent prenatal care
The Statistics and Risk Factors
In Singapore, a developed country with a low stillbirth rate (SBR) for decades, the lower boundary of gestational age for stillbirth remains at 28 weeks as mentioned in the Singapore Medical Journal. About 20% of pregnancies in Singapore end in a miscarriage, while stillbirth happens in 0.5%-1% of pregnancies according to Annabelle Psychology.
There are known risk factors for stillbirths, such as obese mothers or those who smoke. However, most stillbirths happen to healthy mothers as shared by The New Paper.
New Regulations and Reforms
The Singapore government has taken a significant step to support grieving parents. Under the Stillbirths and Births (Miscellaneous Amendments) Bill, stillbirth refers to the death of a baby after the 24th week of pregnancy. This new amendment allows parents of stillborn children to register their names, offering a form of closure and recognition.
Management Strategies for Stillbirths
A comprehensive management strategy to reduce stillbirths includes community and patient education, early or shared antenatal care, and careful prenatal monitoring as indicated in a study on PubMed.
Delivering a Stillborn Baby in Singapore
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Immediate Steps After Stillbirth in Singapore
Usually an in utero death of a foetus does not pose any immediate health dangers to the mother. The mother will usually go into labour in two weeks time naturally. Most mothers, however, choose to induce labour immediately.
This is done with the help of vaginal pessaries (removable device placed into the vagina) that will soften the cervix to induce the process. Sometimes, an intravenous (IV) drip may be given to start the uterine contractions while painkillers (usually given as intramuscular injections) could be administered to ease the labour pains.
Post-Delivery Procedures
After delivery of a stillborn baby, part of the placenta may be retained within the uterus. The mother may therefore need a D&C (dilation and curettage procedure) under general anaesthesia in the operating theatre to remove the placenta completely.
Once the delivery is completed, parents are given a choice by the medical staff if they would like a post-mortem examination done on the stillborn baby. A post-mortem examination can provide useful information about the internal organs and whether there were any abnormalities that could have led to the stillbirth. The post-mortem is not mandatory. Hospital staff will usually also discuss with parents about their preferred last rites.
Recovery and Follow-Up
After about two to four days in hospital, the mother should be ready for discharge.
Parents may be required to return within 6 weeks for a follow-up check up and to review post-mortem results if any. If the mother was in advanced stage of pregnancy, some additional medication to suppress breast milk production might be needed.
Mothers are eligible for full maternity leave if they have a stillbirth in Singapore. The stillbirth will not be counted in determining eligibility for maternity leave benefits for the next delivery here in Singapore.
Supporting Someone Who Has Had a Stillbirth in Singapore
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When trying to help a woman who had lost a baby, the rule of thumb is just good manners: don’t offer your personal opinion of her life, her loss or her prospects for children.
Before talking about the baby with the parents, it is imperative you ask if they’re ready to talk about their loss. If they’re not ready, respect that and let them know you’re always there to listen. Anything that validates what the family is experiencing is acceptable. Allowing those involved to grieve for those moments is also providing them with a form of respect.
Avoid phrases like “it was meant to be”, “you’re young, you can have another” or, “your baby is in a better place”. No woman is looking to poll her acquaintances for their opinions on why it happened or how she should cope. Just being honestly sensitive is key.
Your Personal Guide to Coping with Stillbirth in Singapore
Going through a stillbirth is an extremely traumatic experience for any family. Feeling intense emotions ranging from sadness and disbelief, denial and confusion to anger and bitterness is natural and part of the grieving (and healing) process. To ease your pain, it may be helpful to try the following:
Say goodbye to baby
Grieving is a vital step in the recovery process, it is best not to avoid the mourning process. Depending on how far along the pregnancy was, it may be hard to grieve for a baby that you have never seen, held or named. You may feel better if you arrange a funeral or burial for your child. This might help to make the death more real.
Save a memento of the baby
Experts say that it is best to have a memento of the deceased so you have a tangible reminder. Mementos could be a lock of hair, hand and footprints, a picture of you holding Baby or the Baby’s hospital shawl. There is a volunteer organization called Now I lay Me Down To Sleep, where volunteer photographers assist in providing you with a complimentary keepsake photo of your child(ren).
Another volunteer organisation, Angel Hearts, provides comfort to bereaved women and send angel babies off with dignity through upcyling of preloved wedding gowns into apparel for the little angels. They also conduct sewing workshops for bereaved mothers to “work through their loss”.
Each gown that the baby wears is sewn by an Angel Hearts volunteer and comes with a set of charms—one each for mum and baby.
Image source: iStock
Seek support for stillbirth in Singapore
Lean on your spouse, family and friends for support. Stay away from people who make you feel worse about the loss. At this moment in time, it’s extremely vital that you get over your grief and surround yourself with positive and supportive people. Perhaps, joining a support group of parents who have experienced a similar ordeal could be something that you need, or even some counselling advice. Luckily, there are various places you can find support after experiencing such tragedies such as stillbirth in Singapore.
Exploring Stillbirth Support Options in Singapore
Here are some options you might like to consider for stillbirth support in Singapore:
- Child Bereavement in Singapore. This is an informal network of parents who have experienced loss. They offer support, resources, and monthly meetings to help you navigate through your grief. Visit their website here.
- Pregnancy and Infant Loss Support Group Singapore. Recognising the pain of loss, this group provides a platform for emotional peer support and friendship. To join, send a private message with a brief note to ‘Fiona J C O’Carroll (Clarke)‘ in order to become a member, including a brief note.
- KK Women’s and Children’s Hospital. Many hospitals in Singapore, like KKH, provide counselling services for parents dealing with stillbirth. Their Bereavement Support Committee not only offers counselling, but also advice on the next steps, and helps in creating memories of your loved ones.
From Heartache to Healing
Comprehending the complexities of stillbirth in Singapore is indeed crucial for expecting parents and healthcare professionals alike. Despite the journey often being challenging, please know that you are not alone. Indeed, there are numerous resources and support systems available to assist you in navigating this difficult time.
Moreover, if you or someone you know is grappling with a stillbirth, don’t hesitate to reach out for professional help. Importantly, remember it’s perfectly okay to talk about your experience and actively seek support.
Ultimately, the journey of healing and moving on after losing a child is invariably difficult. However, as we mourn and acknowledge our loss, it’s comforting to know that they remain forever close to our hearts.
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