When a woman gets pregnant the last thing she wants to think about are any of the possible risks that may arise during the pregnancy. But try as we may, avoiding the topic of such things like stillbirth doesn't do much to help curb our fears or address the issue. Stillbirth is one of those issues that touches many, yet is not always fully understood or explained even by doctors, as well as those who experience it or know someone who has.

The more we know about things like stillbirth the more we can try to avoid them, although there is no proof-positive way to completely be shielded from all the possible complications that can arise during pregnancy. The more knowledge we can arm ourselves with, the better.

Stillbirth, according to the National Institutes of Health (NIH), is the loss of a pregnancy due to natural causes, after the 20th week of gestation. If such a loss takes place before the 20th week it is considered to be a miscarriage.

"The subject of stillborn is very complex and deserves a very thorough dissertation," says Dr. Alan Gibstein, an OB/GYN and assistant professor of Obstetrics and Gynecology at the New York University College of Medicine. "The definition of stillborn is any fetus greater than 20 weeks gestation or 350 grams (less than 1 pound), born with no breathing, pulse, voluntary movement or cord pulsations."

Stillbirth happens at a higher rate than most may realize. The overall rate in the United States is about six out of every 1,000 births. "But that doesn't really tell the story, since the rate varies with race, maternal age, previous stillborn or genetic abnormality and any co-morbidities," says Dr. Gibstein.

The actual incident rates, according to the American College of Obstetricians and Gynecologists (ACOG), are approximately one out of every 160 deliveries in this country ending in stillbirth. When you evaluate the rates, black women have the highest, 11.25 per 1,000 births. In all, there are around 25,000 stillbirths reported each year in the United States. The risk of recurrence is around 7.8 to 10.5 per 1,000 births before 37 weeks, and 1.8 per 1,000 births after.

"There are many causes of stillborn infants, and regrettably in some we fail to find a cause," says Dr. Carl Smith, professor and chairman of the Department of Obstetrics and Gynecology at the University of Nebraska Medical Center.

In fact, the NIH reports that in at least half of all stillbirth cases researchers are unable to find a cause. One of the signs of a stillbirth is that the mother does not feel the fetus kicking or moving around. It is helpful for women to have an ultrasound and fetal heart monitoring.

"Patients are frequently asked to monitor fetal movement each day," says Dr. Smith. "There are many recommended techniques, but the simplest is the count-to-10 method. In this method, women record the amount of time needed for the baby to move 10 times. If it takes longer than two hours, she should call her doctor."

Risk factors associated with stillbirth, according to ACOG, include being a minority, no previous births, advanced maternal age, obesity, hypertension, bacterial infections, placental abruption, genetic defects, diabetes and multiple gestations (being pregnant with two or more fetuses at once). Delaying childbirth until after the age of 40 also puts women at greater risk for stillbirth.

Some ways that women can try to help avoid having a stillborn is to be as healthy as possible prior to getting pregnant. This includes losing weight if needed, quitting smoking, avoiding drugs and alcohol, getting diabetes glucose levels under control and having them monitored throughout the pregnancy, and getting proper prenatal care. Additionally, it is believed that there are some benefits to taking folic acid before and during pregnancy in order to help prevent genetic defects.

Stillbirth is a painful experience. The parents usually do not understand what has happened, but they are also left wondering how they should pick up the pieces and try to move on. This is normal and it is important that those who are going through the situation be allowed to grieve, visit with their baby and perform their normal family customs and activities. Most hospitals have staff members and procedures to offer support.

"The body cannot tell whether or not a live baby was born; all it knows is that the pregnancy ended," says Dr. Shoshana Bennett, a clinical psychologist and the author of several books, including Postpartum Depression for Dummies (Wiley Publishing, 2007). "To add insult to injury, a biochemical depression can set in on top of the emotional grief. Whatever medical mental health professional is helping [the mother] needs to know this in order for her to receive proper treatment. Her breasts will probably fill with milk as if there's a baby to feed, so hormonally as well as psychologically she may be in great pain."

In addition, Dr. Bennett says it's important that the couple receive counseling and work through the process of understanding and accepting the feelings and frustrations that may arise. "Instead of being able to rely on one another for support, therefore, the partners may feel emotionally separate and isolated from each other, exacerbating the anguish," she says.

"People just don't want to talk about death; it makes them uncomfortable," says Stephanie Cole of Lancaster, Pa., whose daughter, Madeline, was stillborn in January 2007, one week after her due date. "And the death of a baby is not something people want to think about; it is just too painful. So they ignore and avoid the topic whenever possible."

Cole, like so many parents who have experienced stillbirth, has tried to use that experience as a way to help others who are grieving. She has also become an activist for the cause, holding an art exhibit for bereaved parents, speaking to nurses and doctors at hospitals and creating the Sweet Pea Project (www.sweetpeaproject.org) in memory of her daughter. The project collects blanket donations, which are given to hospitals and birthing centers to wrap the stillbirth babies in and then later given to the parents to keep.

Like Cole, Virginia Williams of Shaker Heights, Ohio, didn't experience any complications throughout her pregnancy and leading up to the stillbirth of her son, Benjamin, six years ago. She found a great deal of support online within the blogging community. Just a couple of years ago she began her own blog about stillbirth (www.landofbrokenhearts.blogspot.com), which has helped her a great deal.

"I've learned, through blogging, that I'm normal, that my feelings in marking the yearly anniversary of Ben's death are quite typical," Williams says. "It's been so reassuring to me to have that community to turn to, to know that they understand and don't think I'm lingering on my loss, that they don't judge me, or won't tell me to forget about it. They understand how Ben is with me every day."

Content on this site is not a substitute for professional medical or healthcare advice, diagnosis or treatment, and may not be used for such purposes. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical question or condition. Reliance on information presented on this site is at your own risk. This site contains the opinions and views of other users. Given the interactive nature of this site, we cannot endorse, guarantee, or be responsible for the accuracy, efficacy, or veracity of any content generated by our users.