Shining some light on this taboo topic
There's a new movie that hit me with a sucker-punch right to the gut: Return to Zero is based on the true story of a couple (played by Minnie Driver and Paul Adelstein) expecting their first child. Just weeks before their due date, they discover that their baby son has died and will be stillborn.
It's a complicated film about grief and the myriad of ways people deal (or don't deal) with it. It's sad and sweet, and you'll need a whole box of Kleenex. While I hesitate to recommend this movie to any pregnant woman because stillbirth is every mother's worst nightmare, stillbirth has been in the closet for far too long, and it's high time we start talking about it.
What is stillbirth?
According to the March of Dimes, stillbirth is defined as a fetal death that occurs after 20 weeks gestation. Before 20 weeks, it's called miscarriage. While miscarriage happens fairly often, stillbirth happens in only 1 in 160 births.
"Stillbirth doesn't happen very often (thank God)," says Desiree Bley, MD, OB-GYN from Portland, OR. "But it happens often enough though that every birth professional can expect to encounter it at least once in her career."
Why do stillbirths happen?
A lot of the time, we simply don't know. The baby is born looking perfect, and there's nothing specific to blame. We do know, however, what causes some stillbirths. Here's what the March of Dimes has to say:
- About 15-20 percent of stillbirths are caused by birth defects including chromosomal disorders and other genetic or environmentally caused problems.
- About 25 percent are caused by placental problems like placental abruption, where the placenta peels away from the uterine lining prematurely.
- About 40 percent of stillborn babies have poor fetal growth, and while size itself isn't necessarily the problem, the reason why they're small (like mom having high blood pressure or being a smoker) might create conditions that impact life.
- About 10-25 percent are caused by infections, especially in babies younger than 28 weeks gestation (but mom may not have any infection symptoms at all).
- About 10 percent of stillbirths are related to a mother's chronic health conditions like high blood pressure, diabetes, kidney disease and blood clotting disorders. These create the conditions for poor fetal growth and placental problems.
- Only about 2-4 percent are caused by umbilical cord accidents like a cord around the neck or a knot in the cord, which cuts off baby's oxygen supply.
Why we need to talk about it
I've experienced stillbirths in my 20 years as a labor and delivery nurse, and they're devastating. We shepherd mothers through their birth experience with as much tenderness and compassion as possible, but then they go back into the world that expects them to bring a live baby with them. And since we don't talk enough about this frightening experience, women often feel like they're wading through a special world of grief that no one else has ever been through. This is worsened by the fact that research on stillbirth remains lacking.
"When a baby dies, the dreams of raising that baby die, too," says Jessica Zucker, PhD a Los Angeles-based psychologist who specializes in maternal mental health. "Grief can show itself in many ways—depression, guilt, anxiety, and anger, and it can create a sense of impenetrable isolation."
How do mothers cope?
"Feeling supported is of utmost importance," says Zucker. "Grief counseling can provide helpful tools, and reaching out to friends, family, and/or medical professionals might ease feelings of isolation and despair." There are also some excellent resources for grief, future pregnancies, and more available on the Return to Zero website.
Many of those mothers eventually decide to have another baby. When they do they're understandably overwhelmed with a bewildering mixture of grief, fear, hope and excitement as they become pregnant and relive their earlier baby's life and death at the same time that they're anticipating the birth of a new baby.
"We follow mothers who've had a previous stillbirth very closely," says Dr. Bley. "If we know what happened with the first birth, we can try to prevent the situation from happening again." If doctors don't know what caused the previous stillbirth, they'll provide as much support and reassurance as possible. "We'll do everything we can to make sure that the family goes home with a healthy baby," she adds.
When's the right time to try and conceive again?
Physically, that's up to the mother and her doctor. But remember: "Grief knows no timeline," Zucker says. "For some, attempting to get pregnant again and create a family is an important next step, but everyone processes grief differently, and there is no 'right' way to grieve, heal, or 'move forward.'"
I won't give away the ending to Return to Zero—except to say that the promo-pictures show Minnie Driver holding a live baby, and that image reflects the reality of what happens for most couples who've had a stillbirth. The odds of it happening again are extremely low, and perhaps that can inspire a little bit of courage and provide some comfort for parents brave enough to try for another baby: a live, gorgeous, healthy baby is in reach.