Understanding Stillbirths - a look at Stillbirths in Singapore
In Singapore, there are an estimated 80 to 120 stillbirths annually or an average of 2 to 3 out of every 1000 pregnancies.
Stillbirth is a common term used to describe the death or demise of a foetus in the uterus or during labour/delivery. There are an estimated 80 to 120 stillbirths in Singapore annually or an average of 2 to 3 out of every 1000 pregnancies. 2014 saw 86 stillbirths in Singapore out of a total of 42,318 births.
While there is some dispute over the legal definition and the time frame which the terminology refers to, here in Singapore, a baby is considered stillborn after the 28th week of gestation. Prior to that, a woman is regarded to have had a miscarriage.
The cause of about 40% of stillborn cases remains unknown. The known causes 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
- Maternal consumption of nicotine, alcohol and/or recreational drugs
- Maternal diabetes
- Pre-existing maternal medical conditions like diabetes and hypertension, especially if she is not getting regular antenatal care.
Usually an in utero death of a foetus does not pose any immediate health dangers to the mother. If left alone the mother will usually go into labour in two weeks time. However most mothers 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.
After the stillborn baby is delivered, 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, the 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. The hospital staff will usually also discuss with parents about their preferred last rites.
After about two to four days in hospital, the mother should be ready for discharge. Most hospitals in Singapore offer parents counselling after such a tragedy.
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.
In Singapore mothers are eligible for full maternity leave if they have a stillbirth. The stillbirth will not be counted in determining eligibility for maternity leave benefits for the next delivery.
When trying to help a woman who has 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, then be there when they are, and just let them know you’re always there to listen. Anything that validates what the family is experiencing is acceptable. 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.
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 from someone who died 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).
Take your time to clear out baby's nursery - there is no rush.
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. Join a support group of parents who have experienced the same thing and sign up for counselling. You may consider joining the Child Bereavement in Singapore support group and the Singapore infant loss support group on Facebook. Do also read Mummy Blogger Jolene L's stillbirth experience.