Understanding Stillbirth: What Happens to the Fetus When a Woman Has a Miscarriage at 20 Weeks Pregnant and Beyond

Introduction

When a pregnancy ends in miscarriage after 20 weeks, those can be incredibly difficult moments for expectant parents. The consequences and procedures that follow such an event are complex and often varied, encompassing legal rights, medical decisions, and emotional support for the bereaved family. This article aims to demystify the process and provide a comprehensive overview of what happens to the fetus and how expectant parents may proceed if a stillbirth occurs.

What Happens if a Woman Experiences a Miscarriage at 20 Weeks Pregnant?

Once a pregnancy has reached the 20-week mark, it is no longer considered a miscarriage but rather a stillbirth. A stillbirth refers to the birth of a fetus that has died in the womb after 20 weeks of gestation. While a miscarriage signals the natural end of a pregnancy before about midway through the gestation period, a stillbirth occurs later and involves different processes and considerations.

Post-Stillbirth Procedural Steps

Following a stillbirth, the mother typically undergoes a series of medical examinations and tests to determine the cause of the fetal demise and ensure that both the mother and the fetus have not been subjected to complications. Some of the steps that might be taken include:

Blood Tests and Swabs: The medical team may conduct blood tests and swabs of the fetal tissue to check for any abnormalities, infections, or other health issues that may have contributed to the stillbirth. Post-Birth Care: The baby will undergo similar care as if the pregnancy had gone to term, including washing, taking photographs, and collecting footprints. However, the overall aftercare will vary based on the baby's condition immediately after birth.

Parental Choices and Support

Parents facing the loss of a stillborn child often have to contemplate their next steps. They may choose to:

Burying the Baby: Parents can choose to have the baby buried according to their cultural or personal preferences. This option provides a physical and symbolic closure for the parents. Cremation: Another option is to have the baby cremated. This process converts the body into ashes, which parents can keep or scatter in a meaningful place. Medical Establishment Assistance: Some parents opt to leave the medical establishment to handle the aftercare and burial, allowing them to focus on their grief and emotional support.

Legal and Ethical Considerations

When a stillbirth occurs, parents may encounter various legal and ethical considerations. These can include:

Medical Record and Documentation: Doctors will document the stillbirth and may request parental consent for certain procedures, such as an autopsy, to determine the cause of death. Support Services: Parents may have access to grief counseling, support groups, and other resources to help them through this challenging time. Legal Rights: Depending on the jurisdiction, parents may have specific legal rights regarding the disposition of the baby's remains.

Common Causes of Stillbirth

Stillbirths are rare but can occur due to a variety of factors. Some of the most common causes include:

Intrauterine Fetal Demise: A term used when the baby dies before delivery in the third trimester. Blood Clots and Blockages: Such as knots in the umbilical cord or a clot in the placenta. Uterine Rupture or Abruption: Where the placenta separates from the uterine wall or the uterus tears. Severe High Blood Pressure: Such as pre-eclampsia, which can lead to complications and stillbirth.

Preterm Labor vs. Stillbirth

It's also important to differentiate between stillbirth and preterm labor. Preterm labor occurs when a woman goes into labor before 37 weeks of gestation and the risks and outcomes depend on the gestational age of the baby. A late-term stillbirth, or delivery in the third trimester, generally has a better prognosis for the baby compared to a stillbirth in the first few weeks of the third trimester.

Conclusion

Understanding the process surrounding stillbirth can help expectant parents prepare and face this challenging experience more effectively. Whether it is choosing how to honor their baby or seeking support to cope with the loss, parents have options that can provide both practical and emotional comfort during this deeply difficult time.