Talking with Families about Stillbirth

Why it's important

For many stillbirths, the causes are unknown. A careful evaluation can often provide valuable answers that may help in the healing process. Every family deserves the opportunity to understand as much as possible about what happened to their baby.

Healthcare providers can help families by:

• Discussing their loss
• Helping them access grief and coping resources
• Helping them make decisions about testing to try to identify causes

Background

Nearly one third of stillbirths do not have a known cause.^[1] Among those that do, the identified causes often fall into three categories:

• The fetus has a birth defect or genetic problem
• The placenta or umbilical cord had a problem
• The mother had certain health conditions (e.g., uncontrolled diabetes)

Conducting a complete and careful evaluation is one of the most important ways to identify a cause for the stillbirth. Even when the cause may seem obvious, additional tests may provide useful information.

Different stillbirth evaluation protocols exist. Most include a detailed medical history, an autopsy, evaluation of the placenta, and genetic testing.

Talking about testing

Be sensitive: The parents and other family members are understandably devastated after such a tragic and often unexpected loss. Healthcare providers should be sensitive to these feelings while still explaining the importance of an evaluation. This will enable the family to make an informed decision.

Explain possible next steps: Explaining the evaluation process as part of grief counseling services has proven useful in many institutions. However, each family's choice regarding evaluation should be respected.

Link families to additional resources: There are alternative options, such as a limited autopsy, that families may prefer. Help families find organizations and resources that may be able to offer them support and guidance.

After the conversation

It is important to fully document patient and clinical information in the medical record. Reporting should include the diagnosis of fetal death, the fetus's weight and other measurements, and an external exam of the fetus. Properly noting and documenting maternal health conditions and relevant lab tests is also critical. Having this information readily available can also help in properly counseling patients regarding future pregnancies.