Stillbirth symptoms and risks

Many women who suffer a stillbirth don't notice any changes in their pregnancy and there is nothing that can be done to save their baby. However, there are some things that you should look for during your pregnancy.

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Movements

You will probably start to feel the movements of your baby in the womb somewhere between 16 and 22 weeks. As the weeks go on you may become aware of a particular pattern of movement that is familiar to you. Your baby may move more in the evenings when you are resting or before you go to sleep at night. You may also find certain activities such as a bath, putting your feet up and resting on the sofa or eating and drinking seem to cause your baby to move more. Recognising these patterns of movement can be very useful during your pregnancy.

If at any time during the pregnancy, once the movements have become regular, you notice that there is a change, in particular a reduction in movements, or a period of time without movements, always seek help straight away.

What to do

Unless you have been given alternative numbers to ring during your pregnancy, the best place to ring is usually the labour ward. It is not only available for women in labour but also for emergencies during the pregnancy. The ward should be open 24 hours a day and there should always be a midwife there who will be able to discuss with you what you are experiencing and advise you.

They may suggest doing any of the things above that normally work to make your baby move, or to come straight to the hospital to be monitored. If you are advised to wait at home, but are unhappy that the movements are not normal, then consider going to the hospital to be monitored.

Once at the hospital they will probably check your health and listen to the baby’s heartbeat. They may attach you to a heart rate monitor which records a trace of the baby’s heartbeat so this can be looked at for any signs of problems. You may also be given a button to push every time you feel the baby move and this can also be seen on the print out of the baby’s heartbeat.

It's quite common that once you lie down, hear the baby’s heartbeat and relax you start to feel the baby kicking a lot. Don’t feel embarrassed about this - midwives see this everyday. It is far better to go and be checked so that any potential problems can be picked up.

Leaking fluid

If you experience any leaking of fluid from your vagina during your pregnancy before 37 weeks you should contact the hospital immediately and go to be monitored.

Waters can break at anytime during pregnancy, not just in the last couple of weeks, and this can lead to premature birth. If you feel a gush or trickle of fluid, or feel damp, it could be a sign that your waters have broken. In these cases put on a clean sanitary towel (not a tampon) and call the labour ward. They may ask you to sniff the pad – as it is common to leak urine in pregnancy - or they may ask you to check the pad again in around 20 minutes to see if it is damp.

Amniotic fluid – the fluid from around the baby – smells different to urine and is usually clear, pinkish or can be green or brown. If you believe it is amniotic fluid it is important to go straight to the hospital to be examined.

When you go to the hospital they will monitor you and your baby. They may well carry out an internal examination (inside the vagina) to check if fluid is leaking, and to look for signs that your cervix is opening or softening for labour.

Infections

You should report any discharge from your vagina which is smelly, and any colour other than white, as it may be a sign of an infection. Infections can weaken the bag of membranes around the baby, cause an infection inside the womb or make your waters break.
If you experience an unusual discharge contact your midwife, GP or hospital and ask for a swab to be taken to look for infection.

Diabetes

For women with diabetes in pregnancy, miscarriage, pre-eclampsia, preterm labour, stillbirth and problems with the baby (whilst in the womb, at delivery and after the birth) are sadly more common. This means that good control of your blood sugar levels and regular monitoring are vital.

Whether you had diabetes already, or develop diabetes during pregnancy (known as gestational diabetes), you will need to be closely monitored, and you will need to be aware of how best to care for yourself and your baby during your pregnancy.

What to do

If you have diabetes you should get good pre-pregnancy counselling and support before stopping contraception and trying for a baby. It's also important that girls with diabetes understand the importance of avoiding unplanned pregnancies.

If you are pregnant with diabetes ensure that you have a good team caring for you. You will probably be regularly seen by a consultant and a specialist diabetes midwife. If you are not happy with the care you are receiving talk to the women's health department manager to ask that your condition be correctly monitored. Make sure that you attend all your scheduled appointments and seek help immediately from your GP, midwife or hospital doctors if you are concerned about your glycaemic control or any other factors affecting either your pregnancy or your diabetes.

Monitoring the growth and movements of your baby is more important than in other pregnancies, so make sure you are clear as to who you should contact if you are concerned. Remember, out of usual working hours you can contact the labour ward to speak to a midwife.

Pre-eclampsia

Pre-eclampsia is a condition which affects around 10% of all pregnancies in the UK, and untreated, can sadly cause stillbirths. You are most likely to get it in your first pregnancy or a subsequent pregnancy with a new partner. The main symptom is high blood pressure. It is very important that you attend all your antenatal appointments, as pre-eclampsia is one of the pregnancy conditions that your midwife will be looking out for.

If during your pregnancy you are told that your blood pressure has increased since the beginning of the pregnancy ask your midwife how significant the rise is. Your midwife will also be looking for any protein in your urine so always provide a urine sample at every appointment. If you refuse to give a sample the midwife cannot pressure you to give one, but it could mean a vital clue is missed.

What to do

Between appointments look out for any of the warning signs of pre-eclampsia, including severe headaches, altered vision such as seeing flashing lights in front of your eyes, and sudden swelling, particularly of your feet, ankles, hands and face.

Some women also experience pain in their upper abdomen, just below the ribs. If you notice any of these signs you should contact your GP, midwife or labour ward for advice. Do not wait until your next scheduled appointment and ensure that you are seen by someone the same day.

Working with your medical team

It is important that any concerns you have, or things that you notice, are taken seriously. Report all complications, no matter how insignificant they may seem.

Try to get to know the team of midwives that are caring for you during your pregnancy. Even if you meet a new midwife at every appointment aim to use every appointment to your best advantage.

Ask about the size of your baby – if it is particularly large or small do you need further scans? If your blood pressure is raised do they think it could be the start of pre-eclampsia – do you need more appointments to monitor this? Report any unusual symptoms such as headaches, blurred vision (seeing stars), any pains, any aches, nosebleeds, feeling dizzy or faint.

Itching is particularly important as it can be a sign of obstetric choleostasis. A common symptom of this condition is itching of the hands and soles of the feet, but you should report all itching. A simple blood test can be used to diagnose this.

If you have a scan or blood test and there seems to be a problem that needs closer monitoring make sure you know as much as you can about the condition they are looking at. If you haven’t been referred to a consultant yet, ask to see whichever consultant specialises in the problems that have been identified. Make sure you know any symptoms to look out for and what to do in the event of experiencing any of them.

Early in your pregnancy ask your midwife who you should contact if you have any other symptoms or concerns between appointments. Never leave a worrying symptom till your next appointment. Contact your GP, midwife or hospital and ask to be seen.

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