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Causes

Why?

The moment after the shock has registered that you are losing, or have lost, your baby, the million dollar question pops into your head. Why? Why did this happen to me, to us?

While we seek a reason, a cause, or someone or something to blame, the fact is that there often is no reason. While medical science has made giant leaps since the Middle Ages, doctors will be the first to admit that fertility, pregnancy and the death of a baby are still largely in the realms of mystery, wonder and awe.

Doctors can tell you what to do to increase your chance of falling pregnant, but they cannot explain why a man with deformed sperm or a low sperm count and a woman with a uterus that is supposedly incapable of growing a baby can suddenly fall pregnant and go on to produce a beautiful, healthy baby.

Likewise, while they can tell you how to reduce your risk of losing a baby, oftentimes they can’t actually tell you why you lost your baby. More often than not, a diagnosis of the reason for your loss is a process of elimination. This means that the doctor will be able to tell you what has NOT caused your loss, but will be unable to say what HAS caused your loss (none of which makes it any easier to go through what you are experiencing).

Looking at the lists below, there seem to be so many possible reasons. In the light of this, the fact that about half of deaths are still unexplained is incredible. What is even more incredible is that the number of unexplained deaths has remained fairly constant since the early 1980s, despite advances in medical science. From 2003 to 2009 stillbirth rates in SA have only declined by 0.9%, while in the rest of the world they have only declined by 1.1%. Before then, the number decreased steadily through a combination of improved ante-natal care and advances in scanning technologies.

In order to make sense of the lists of reasons below, there are a few definitions you need to know.

Definitions

Every country has its own way of defining when the death of an infant is a miscarriage and when it is a stillbirth. Some define stillbirths by the weight of the infant (over 500g or over 1000g), while others define it based on the infant’s gestation (over 20 weeks, over 24 weeks, over 28 weeks).

In South Africa, a stillbirth is termed as the perinatal death of an infant over 1000g. (For statistical reporting, a stillbirth is termed as taking place only after 24 weeks gestation.) Both miscarriage and stillbirth are termed as perinatal deaths.

Neonatal deaths are more standardised across nations, and are defined as deaths between birth and 28 days of life.

Premature birth is any birth earlier than 37 weeks gestation. The earlier a baby is born, the more premature it is, and the less likely it is to survive. Babies born before 24 weeks have less than a 50% chance of survival, even with proper medical treatment.

High risk pregnancies

Women who are classified as ‘high risk’ pregnancies are at a much greater risk of losing their pregnancy. These are women who:

  • are over 35 years of age
  • smoke, drink or use any drug
  • are obese
  • suffer from an existing medical condition (e.g. diabetes, hypertension)
  • are pregnant with twins, or more
  • have had recurrent miscarriages/ stillbirths
  • have a past history of other obstetric problems

Causes of miscarriage & stillbirth

Even if you do not have a high risk pregnancy, there are other factors that may cause a miscarriage or stillbirth. These include:

  • genetic disorders (ie chromosomal disorders) in the baby
  • hormonal imbalances of insulin or prolactin, or the malfunctioning of the thyroid gland
  • Antiphospholipid Syndrome (blood clotting disorder) in the mother
  • hereditary thrombophilias (blood clotting disorders) in either the mother or the baby, e.g. Factor V Leiden
  • fibroids (benign tumours inside the uterus)
  • cervical insufficiency/ incompetence (a cervix that is weak, so starts to dilate too early on in the pregnancy – any time after about 4 months)
  • congenital uterine problems (when the uterus grows incorrectly so has the wrong structure or shape, or has two chambers instead of just the one)
  • scarring inside the uterus from a D&C, caesarian section scars or from treatment for fibroids
  • an excess of amniotic fluid (though this usually only causes premature births)
  • undetected ectopic pregnancy (embryo implants itself into the Fallopian tubes or inside the abdomen onto the outside of one of the mother’s organs, rather than in the uterus)
  • taking contra-indicated drugs (always ask a doctor before taking any drugs during a pregnancy)
  • untreated syphilis in the mother
  • Rubella (German Measles) infection in the mother
  • pre-eclampsia (pregnancy-induced hypertension)
  • any chronic illness or infection that causes the mother to have an extremely high fever
  • infection introduced into the uterus via an amniocentesis (unlikely, but possible)
  • umbilical cord twisted or wrapped around the baby’s neck, preventing oxygen and nutrients from reaching the baby and waste products from being removed to the mother
  • tremendous stress events
  • physical trauma (e.g. car accident)

Recent research also shows that sleeping on your back or right side during the last month of pregnancy doubles your risk of having a stillbirth. The reasons for this are not yet understood, but it is thought to have something to do with decreased blood flow to the uterus for prolonged periods of time. The same piece of research also shows that women who do not go to the loo during the night before they give birth are at double the risk of having a stillbirth. (source: http://bit.ly/igYcwa)

About half of all recurrent miscarriages and stillbirths are unexplained. However, 70% of couples who have recurrent miscarriages or stillbirths go on to produce a healthy baby, which is very good news.

Causes of neonatal deaths

Any baby who manages to survive birth still has a major battle on its hands to live. Most neonatal deaths occur within the first week of life. The longer a baby lives, the greater its chances of surviving are. Common causes for a neonatal death are:

  • Sudden Infant Death Syndrome (SIDS) (can occur up to about 2 years old)
  • genetic disorders
  • low birth weights (e.g. if the infant was from a multiple pregnancy)
  • birth defects (which are very strongly associated with premature or preterm birth), also termed congenital abnormalities
  • premature birth
  • complications during labour
  • post-birth infection (e.g. pneumonia – common in preterm babies because their lungs are not properly developed and their immune systems are also immature)
  • pre-birth infection may have been introduced into the uterus during an amniocentesis

Whatever the reason for our loss, losing our babies makes us think that we did something wrong, that somehow we have failed in our duty as parents. While this is a natural reaction to grief, it is not our fault, and believing that only complicates and prolongs our grieving.

Statistics

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8 Comments leave one →
  1. shannon permalink
    August 26, 2010 7:06 pm

    Hi my name is shannon and i
    Have just lost my beautiful
    Baby boy at 22 weeks the
    Cause that has been given
    To me was premature labour
    One thing I don’t understand
    Is if you going to a gyne
    Before you fall preg
    and they know your history
    Why don’t they help! I really need
    To talk to some one who
    Has lost a baby like myself
    As I am lost! Please advise
    Thanks shannon

    • August 27, 2010 9:43 pm

      Hey Shannon. We’re so sorry that you’ve suffered this tragic loss, but glad that you’ve found us. We’ll email you directly, but know that you are not alone in this! Hang in there.

  2. February 28, 2014 9:33 pm

    Hi, please help me before I do something really bad to myself. I lost my son at 7 months pregnant (last year September) it has been 5 months. I still can’t find closure, I can’t get over this, I cry every night, I feel so empty with a very strong urge to hurt myself. I don’t know what to do. I have been to a psychologist but I still feel the same. I feel lost and empty and alone. Baby daddy is not around, mommy and daddy are far and some times I think they don’t care or too scared to care? I’m really loosing myself slowly, I try to be strong but it’s tiring! Why did God take my son from me? I had him for 7 full months and He takes Him away, why????? Please please help

  3. March 1, 2014 5:52 am

    Hello Nonto – thanks for reaching out. Do not deapair – 5 months is really a very short time in your grief journey and to expect yourself to have “got over this” by now is being very harsh. Most people find it takes up to two years to learn to live with the grief of losing a child. Coping with out support as you seem to be is very difficult – there are specialist grief counselors who could help. Where in the country are you living, perhaps we can put you in touch with someone? Email us on bornsleeping@gmail.com and let’s see how we can help you.

    Be gentle with yourself.

    Much love
    Born Sleeping

  4. June 4, 2014 5:29 pm

    This is my first time visit at here and i am in fact pleassant to read everthing at one place.

  5. Danielle permalink
    November 14, 2014 11:11 am

    We just recently found out that we were expecting. We were overjoyed. We have one daughter age 9, Had another pregnancy 2 years ago where the gyne could only pick up the sac but no baby. Had to go for a D&C. Yesterday we had to go for our first scan at 10 weeks. The baby measured 9 weeks and 5 days. There was no movement and no heart beat. My heart is breaking and I don’t know how to cope I also don’t know how to comfort my husband that is trying to be strong for me

    • November 14, 2014 3:34 pm

      That is really, tough, Danielle! Our deepest sympathies to both you and your husband. There is right or wrong way to support each other through this. What is important is to talk and tell the other what you need, and to be understanding of the fact that each of you will grieve in different ways at different times, and that’s okay. It is helpful for men to have a male friend they can talk to, but if your hubbie doesn’t have anyone, then we would be very willing to be available. Strength to you both over the next few months! Keep in touch as we would be honored to support you on your journey.

Trackbacks

  1. The Lancet report: 15 April 2011 « Bornsleeping

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