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. 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.
According to Health Xchange, about 25 per cent of pregnancies end in miscarriage.
There are an estimated 80 to 120 stillbirths in Singapore annually or an average of 2 to 3 out of every 1000 pregnancies. 2018 saw 89 stillbirths in Singapore out of a total of 39,039 live births recorded in the Report on Registration of Births and Deaths.
Why do stillbirths occur?
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
- 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.
Delivering a stillborn baby
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.
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.
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.
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.
Supporting someone who has had a still birth
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.
If you are personally coping with Stillbirth
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.
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.
Here are some options you might like to consider:
- Child Bereavement in Singapore support group — It is an informal network of bereaved parents who supports each other through their grief. Join in their monthly support meetings and gain access to resources and information through their website, https://www.cbss.sg/.
- Pregnancy and Infant Loss Support Group Singapore — They recognise the grief and pain, and that has led to the creation of this support group. It is a platform that allow those who is grieving the loss of their baby to seek emotional peer group and friendship. To join the group, do 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.
Their Bereavement Support Committee lend a helping hand to patients who have lost their loved ones. Apart from providing counselling, they also advise bereaved parents on next steps and help them create memories of their loved ones, amongst other services.
- Lastly, read all about Mummy Blogger Jolene L who shares about her stillbirth experience
The journey of healing and moving on after losing a child is always difficult. But as we mourn and know that we have lost them, know that they are but forever close to our hearts.