Dr Alexander Heazell and his then-wife were happily getting ready for the birth of their first child in 2001. They planned to name him Jack.
But the foetus was small for its gestational age, his wife's blood pressure had shot up during the pregnancy, and at 26 weeks, she noticed the baby was no longer kicking.
Losing the baby was devastating for Heazell and his wife. The stress and grief contributed to their divorce, Heazell said. And the experience led him to alter the course of his career from general medicine to obstetrics and gynaecology in the hopes of learning more about stillbirth and preventing it from happening to other couples.
"It inevitably has a profound impact on your life," Heazell said.
Stillbirths a big problem
Stillbirth, defined as a foetus that dies after the 20th week of gestation, occurs in about one in 160 pregnancies in the US, according to the American College of Obstetricians and Gynaecologists.
Worldwide, the problem is even bigger, said Heazell, who wrote about his experience and the need for greater research and awareness about stillbirth in a recent issue of the BMJ. There are some 3 million stillbirths a year, many of them in developing countries.
Though the rate of neonatal deaths is falling, the rate of stillbirth hasn't budged. In the United Kingdom, for example, the rate has remained at 5.3 stillbirths for every 1,000 births for the last decade.
Even worse for parents is that in up to half of all stillbirths, the cause is never discovered, leaving couples to wonder what went wrong and whether it could happen again, Heazell said.
How stillbirths occur
What is known is that stillbirths that occur before 32 weeks tend to result from different causes than those that occur later in pregnancy, said Dr Alan Fleischman, medical director for the March of Dimes Foundation.
Factors that contribute to stillbirths earlier than 32 weeks are often similar to those that raise the risk of premature birth: smoking, alcohol use, obesity, clotting or metabolic problems and kidney or liver disease in the mother, Fleischman said.
During the final weeks of pregnancy, stillbirth is often due to a catastrophic problem with the placenta or the umbilical cord, including placental abruption, when the placenta sheers off the uterine wall, leaving the baby without oxygen and nutrients.
Little can be done to prevent these types of stillbirths, Fleischman said. But some obstetricians recommend mothers "count kicks" at the same time every day to monitor how often the foetus moves. If movement drops off noticeably, mothers should seek medical attention in the hopes of delivering a baby in distress before it's too late.
Much of Heazell's research focuses on what goes wrong with the placenta. Often, an examination of the placenta after a stillbirth shows signs of reduced blood flow or abnormal ageing. "A placenta is a bit of a record of pregnancy," he said. "If we can understand what goes wrong, we might be able to stop more stillbirths."
If the placenta has deteriorated, the foetus will stop moving to conserve energy, Heazell said. "We think there's a small window of opportunity, maybe between 24 and 48 hours, for some," Heazell said.
For several years, on the anniversary of the pregnancy loss, Heazell would take time off from work to grieve and be alone. Unlike grief associated with other deaths, grieving for a stillborn baby can be isolating. Families don't share in the loss because they hadn't yet grown attached to the baby.
The magnitude of the problem and the emotional impact it can have on couples justify more research into preventing it, Heazell said.
"If you ask parents to rank the risks to their baby, the things they are most worried about is cot death [sudden infant death syndrome], Down syndrome and then stillbirth," Heazell said. "But cot death affects about one in 3,000, while Down syndrome affects between one in 800 and one in 1,000. Stillbirth affects more than one in 200."
"We have to raise the profile of stillbirth, and we need to get people talking about it," he said.
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Most stillbirths unexplained