Stillbirth: Seeking some answers for a friend

[USAmma]

I am asking about some details for a friend. This birth was a stillbirth and the person is searching for answers. I thought maybe you could shed some light on this. Do you think the baby had kidney problems? Would that affect the placenta, or the other way around? Could there have been some autoimmune response to the baby? Is there a way to test for this now that the placenta has probably been destroyed?

The placenta was found to have acute decidual inflammation with no viral inclusions. It was quite vibrous and calcified and looked like the placenta of a heavy smoker or drug user. This woman is a very healthy eater and does not smoke or do drugs. Infarct of less than 5% and some meconium staining on the placenta but not the baby. There was no amniotic fluid found when they did an u/s to confirm the death but the water had not broken (the woman is quite certain of this and it may have been confirmed through test strips). Baby died at 39 weeks gestation and was a normal weight at the birth. The woman had two previously healthy pregnancies and live births.

Thanks so much for any thoughts or info that I can give her, including web links that speak in plain English.

ETA: Just to clarify I am not a birth professional and did not attend the birth. I am just trying to help her because she's actively trying to still find out what may have happened. Thanks again.

[lorijds]

How very sad. I'm so sorry for your friend's loss, and for you as well.

As someone who has been around these boards for a while, you know that it is all a guessing game when something like this happens, and they will probably never know why this happened. Even if they determine the actual, specific cause of death, they might never know why that particular event occurred.

You also know that it is normal and healthy to be asking all these questions and to want answers, even when your head knows that there aren't any definitive ones. All of us who work or are involved in the birthing community know this, and we all still do it when something like this happens.

I am far from an expert in this situation; my experience is with healthy moms and healthy babies, and even then I am no expert. I'm sure someone who knows more than I do will be able to add something.

Firstly, did they request/perform an autopsy on the infant? Were there any obvious, visible anomolies? During the ultrasound that determined death, what other information was obtained that might shed light on the situation--any congenital anomolies? Absence or underdevelopment of organs? Did they have any other ultrasounds that revealed anything that at the time might have seemed inconsequential, but in retrospect may provide some clues?

Secondly, my first thought is similar to yours, judging by your question. If there were no amniotic fluid, I wonder if the baby's kidneys were not fully developed, or if the infant had been dead for some time and the mother's body had reabsorbed it?

In regards to the placenta, was the mother ill during her pregnancy? Does she have any connective tissue diseases? Does she take any vitamin or mineral supplements, or any medication? It could also be that the baby again was ill or had died more than just a day or two ahead of the birth, and that the changes seen in the placenta were due to the death of the infant and the subsequent normal physiological breakdown.

I pose these questions and comments not really to provide you or her with any answers, but to give your friend an idea of some specific questions to ask, to stimulate an informative, though horribly bittersweet and probably unsatisfying, conversation with her physician/midwife. She really needs to pose these questions to him/her. They will have more insight than anyone here will.

Again, I am so sorry for her loss, and even knowing the answers would not bring her baby and that baby's future back. I am really, truly sorry she is going through this.

I would make one suggestion, that perhaps you edit the title to show that the thread discusses a stillbirth. Though this is the birth practitioners' forum, a lot of others read the posts, and for some this might not be a good topic.

[USAmma]

Thanks so much for your thoughtful reply. They chose not to have an autopsy but the baby appeared to be perfectly normal at the birth. The baby also had a 20 week u/s and all looked well.

For her sake I wish it could be discovered that perhaps there was something wrong with the baby, and not her placenta or her ability to carry a baby. As you can imagine she feels her body failed her. They are planning to investigate this further when she has some time to recover.

[mwherbs]

so I don't have enough info to even make much of a guess- and in most stillbirths cause is not found--
but this bit "acute decidual inflammation with no viral inclusions" signs of inflammation that were not viral- and this is a finding in stillbirths that are infection caused-- most common infection pathogen found ecoli , but there are many others including listeria ... lack of water may or may not be of import-

[MsBlack]

I recently was present at a home stillbirth that sounds much like what you describe as far as details, baby had passed within 24hrs of labor's natural start....no water w/baby, and a strong belief that water never broke prior to labor (not verified, but certainly no usual signs of water breaking/leaking in days before, and I saw her 48 hrs prior w/active baby then, and no untoward signs of any kind). In this case, mec--that looked 'old'-- in baby's mouth and lungs but no staining of baby (not sure about placenta, it was whisked away by paramedics called at birth so I never got a good look at it). Normal size, apparently well formed infant; very clean and healthy living mom who never used drugs or anything like that, no signs of infection. In this case, autopsy was performed but no results yet (2.5 mos since death).

This death led to my research of late term intrauterine death. As mwherbs said, most stillbirths are never figured out as to cause. I did learn tho, that a baby who looks right might have malformed organs anyway; also that on autopsy organs might also look right enough, but cellular studies of the organs tell a different tale. Infection can be a cause, or an effect of something else--so it is not necessarily a given that if infection was found, it was truly the underlying cause of death--tho it might be presumed as such, depending on those making the pronouncements. Meconium staining or in lungs can also be an effect rather than a cause...staining is then an 'incidental' finding, rather than any kind of defining factor.

It is so hard to lose a baby...and it seems harder still if no reason for it can be determined. Without autopsy, from what you have shared, there is little likelihood that a cause of death will be found for this infant. Even with autopsy, often there is still no way to really determine a cause. Some babies die, is all we know. While medical science has discovered many different things that can cause fetal malformation and/or death--medications and other chemical toxins, viruses or bacterial infections at various stages of pregnancy, blood incompatibilities, genetic matters, 'accidents' or incompleted actions of fetal development (such as some heart defects, not all that unusual tho mostly non-life threatening)....the fact is that for the greatest number of those infants who do die, we never find out why.

Perhaps your friend will figure it out, with research and time. For the parents I know who lost their little girl, they are not sure they want to go there (tho they will be notified of autopsy results, ordered by local police). For better or worse, they are feeling that it will do them no good to know why...and prefer to grieve and get on with life. I would dearly love to know why, myself, but my research did not bring me any answers or comfort, only more questions. And I know that they are very right in one thing: knowing why will not ease their grief.

I wish them, and you, peace with your journeys of grieving and healing.

[USAmma]

Thanks for your answers. I will forward these replies on to her. I think she accepts that she will probably never know what happened-- but I don't think she's given up yet on finding the clues to what most likely might have happened. She has two little girls that are keeping her in the now, which is good.

[MsBlack]

In her shoes, surely I would hope to discover whether or not there was something that *I* could change, to avoid another loss. Or whether there was perhaps a genetic factor borne between myself and mate, to be prepared for in future. But it is so seldom that clear.

Thanks be for love and those who help us/force us to stay in the now...and for once or more having given birth to healthy children who are with us yet. The mom in my case had 2 prior m/c...then her stillbirth. Still, she is young yet and with a wonderful man, and they speak of trying again, when healing is further down the road....