Pregnancy & Infant Loss

Infant and pregnancy loss is a term used to describe the death of an infant before one year of age or the death of a fetus before birth. It encompasses miscarriage, abortion, stillbirth,  neonatal death and any death that occurs between the first and 12th month of life. 

Pregnancy Loss

Pregnancy loss is the death of a fetus at any time before birth. According to Stanford Health, it is extremely common, occurring in as many as one in four pregnancies, usually during the first three months. Pregnancy loss can occur in a number of ways, including:

• Embryonic pregnancy: A pregnancy in which a fertilized egg never develops into an embryo. This is also known as a “blighted ovum” because the yolk sac and placenta begin to develop but the embryo does not. 
• Miscarriage: In the United States, a miscarriage is defined as any pregnancy loss that occurs before 20 weeks of gestation. It is also called a spontaneous abortion. Miscarriages are further classified as early or late. An early miscarriage happens before 12 weeks gestation; a late miscarriage occurs between 13 and 20 weeks. Beyond 20 weeks, in-utero death is called stillbirth. 
• Ectopic pregnancy: An ectopic pregnancy occurs when the embryo implants outside the uterus, usually in a fallopian tube. Ectopic pregnancies can also occur in the cervix, pelvis or abdominal cavity. Ectopic pregnancies are never viable and require medical treatment to prevent complications that can endanger the health of the mother. 
• Molar pregnancy: A molar pregnancy is a rare form of pregnancy loss in which abnormal cells known as trophoblasts replace placental tissue. It is a chromosomal abnormality characterized by two sets of male chromosomes, either alone or in conjunction with one set of female chromosomes. Like an ectopic pregnancy, a molar pregnancy requires medical treatment and never produces a viable fetus. 
• Abortion: Although the term abortion may be used to describe any pregnancy loss that occurs before 20 weeks gestation, in today’s vernacular it typically refers to a pregnancy that is terminated intentionally, for either psychosocial, economic or medical reasons (for example, when genetic testing shows a non-survivable chromosomal defect or when the health of the mother is in jeopardy.) Abortion may be performed surgically or through the ingestion of abortifacient medication such as mifepristone. 
• Selective fetal reduction: Selective fetal reduction is the abortion of one or more fetuses in a multiple pregnancy in order to reduce the risk of complications for both mother and surviving fetuses. It is typically done when a mother is carrying more than three fetuses at once. The procedure may be performed using surgical methods or abortifacient medication. 

Regardless of the cause, any pregnancy loss can be extraordinarily difficult for the expectant parents and extended family. Feelings of grief, depression, anger and anxiety are common, especially in people who have experienced more than one pregnancy loss. The psychological effects of pregnancy loss often persist for some time, even if the person later goes on to have a healthy pregnancy and live-birth delivery.

Stillbirth

Stillbirth is pregnancy loss that occurs after 20 weeks gestation. It is characterized as early, late or term. 

• Early stillbirth is when fetal death occurs between 20 and 27 weeks of pregnancy
• Late stillbirth is when fetal death occurs between 28 and 36 weeks of pregnancy
• Term stillbirth occurs when fetal death occurs any time after 37 weeks

Early stillbirth often goes unnoticed until the next scheduled prenatal visit, when an ultrasound reveals no fetal heartbeat. If this occurs between 20 and 24 weeks of gestation, surgical evacuation of the pregnancy may be possible, depending on state law. But if fetal demise occurs at or after 24 weeks gestation, the baby must be delivered, either vaginally or via Cesarean section. This can be extraordinarily difficult for the mother, who must go through the experience of labor and delivery knowing that her baby has died. 

A few options are available to deliver babies who have died in utero after 24 weeks. Usually, the safest option is to induce labor because carrying a deceased fetus for more than a few weeks can endanger the mother’s life. If the mother and her healthcare team choose this course, the doctor will prescribe medication that will typically start labor within two days. 

Alternatively, the pregnant woman may choose to wait for labor to begin naturally, which will usually happen within two weeks of fetal demise. It may be more difficult to obtain a fetal autopsy if the family chooses this course, and there is an increased risk of complications the longer the pregnancy goes on. 

In rare cases of stillbirth, doctors will perform an emergency Cesarean-section. This procedure is typically performed only when the mother’s health is in jeopardy, since it carries a high risk of complications and long-term implications for future pregnancies.  

Regardless of the timeframe of pregnancy loss, it is a devastating experience for the vast majority of people, who experience it as acutely as the death of an already living child. It is essential to remember that the grieving parents and extended family are deserving of sympathy and support, regardless of how far along the pregnancy was. 

Infant Loss

Infant loss is loosely defined as the death of any child during the first year of life. It includes term stillbirths, neonatal death and Sudden Unexpected Infant Death, which includes the diagnosis of Sudden Infant Death Syndrome or SIDS. Infant loss may also occur due to congenital birth defects, complications related to preterm birth and low birth weight, and infections.

Neonatal Death

Neonatal death, also called newborn death, is the term used for the death of a baby within the first 28 days of life.  It is relatively rare in the United States, occurring in about 4 in every 1,000 newborns. It is more common in babies born of mothers who are non-Hispanic Blacks than in any other demographic group. 

Most neonatal deaths occur in the first few days of life and are attributable to causes associated with prematurity, low birth weight or birth defects. Complications during delivery, most notably birth asphyxia or failure to breathe, are a leading cause of neonatal death globally, although less common in the United States.  

Prematurity and low birth weight

Premature infants are at risk of a number of life-threatening health conditions simply because their organs have not had time to fully mature. They are also very small, typically weighing less than 2,500 grams (5 pounds, 8 ounces) and sometimes as little as 500 grams (1 pound, 1 ounce.) Both prematurity and low birth weight can lead to a number of health conditions. Of these, the most common are:

• Respiratory Distress Syndrome or RDS: RDS is a breathing problem that occurs most often in babies born before 34 weeks of pregnancy. It results from a lack of surfactant in the lungs, a protein that helps keep the small air sacs in the lungs inflated. Babies with RDS typically need supplemental oxygen and may need to be on a ventilator for some time. About 825 babies die from RDS annually. 
• Intraventricular hemorrhage or IVH: An intraventricular hemorrhage is bleeding in the brain, and it is a common complication in babies born before 32 weeks gestation. The bleeding can be minor, and usually resolves on its own. In more severe cases, the baby can die shortly after birth or develop complications that affect its development later on. 
• Necrotizing enterocolitis or NEC: Necrotizing enterocolitis is an extremely serious illness in which the lining of the intestine becomes inflamed and infected, leading to necrosis (cell death) of the colon. The cause of NEC is unknown, but it is most common in premature infants, and usually occurs within a week or two of birth. About 50% of infants who develop NEC will die.
• Infections: Because premature infants have an underdeveloped immune system, they are at a higher risk of contracting life-threatening infections, including pneumonia, sepsis and meningitis. Although advances in neonatal care have allowed more of these infants to survive, infections remain a major cause of death and disability in premature infants.

Birth Defects

Congenital birth defects are relatively common in the United States, affecting one in every 33 babies born, or about 120,000 infants annually. Not all birth defects are life-threatening, but many are. Those that most often result in neonatal death include:

• Heart defects: Heart defects are the number one birth defect in infants born in the United States, affecting about 40,000 infants each year. They are also the leading cause of death due to birth defects annually. Thanks to advances in surgical treatments and supportive care, fewer babies with congenital heart defects die today than in decades past. However, heart defects still account for about 4% of neonatal deaths. 
• Genetic abnormalities: A number of genetic disorders can result in neonatal death. These deaths generally are caused not by the genetic abnormality itself but by the severe birth defects that arise from it. For example, babies with trisomy 13 or Patau’s syndrome typically have heart defects, poor muscle tone, low-birth weight, cleft lip and/or cleft palate and multiple other congenital anomalies. These multiple conditions usually result in the death of the infant within the first few weeks of life. 
• Neural tube defects: Neural tube defects or NTDs are abnormalities of the brain and spinal cord. The most serious NTD is anencephaly, a condition in which the infant’s brain and skull fail to develop properly. Many babies with anencephaly die in utero. Those who are born usually die within the first few hours of life. 

Other neural tube defects include encephalocele and spina bifida, conditions in which the neural tube (the embryonic structure that develops into the brain, spinal cord and surrounding membranes) fails to close all the way, leaving parts of the brain or spinal cord exposed. Depending on the severity of the defect, both conditions can often be treated successfully with surgery. However, if the defect is severe, the infant has other congenital abnormalities or is premature, either can be fatal. 

Sudden Unexpected Infant Death (SUID)

In the United States and other high-income countries, most full-term infants survive their first year of life. Of those who do not, 40% die within the first 28 days, usually from one of the causes mentioned above. After the first month of life, infant deaths are categorized as Sudden Unexpected Infant Death, which includes accidental suffocation or strangulation and Sudden Infant Death Syndrome or SIDS. 

Accidental Suffocation and Strangulation

Accidental Suffocation or Strangulation During Infant Sleep, also called Accidental Suffocation and Strangulation in Bed (ASSB), is a leading cause of accidental death in infants in the United States. It occurs when something impedes a baby’s breathing while they are asleep. The infant may become stuck between a mattress and crib-rails, or suffocate when its head becomes trapped in soft bedding such as a comforter or blanket. In some instances, babies have been accidentally suffocated by a sleeping adult with whom they shared a bed. It is most common in children under six months old, especially during the first three months of life. 

Sudden Infant Death Syndrome or SIDS

Sudden Infant Death Syndrome is the sudden death of a baby between one month and 12 months of age which is unexplained despite a thorough clinical history, death investigation and autopsy. It is the most common cause of infant death after the first month of life, accounting for about 38 deaths per 100,000 live births annually in the United States. SIDS was once called crib death because the vast majority of SIDS cases occur while the infant is or appears to be asleep. 

Despite a vast amount of research over several decades, the cause of SIDS remains unknown. However, experts have proposed a number of theories, most of which revolve around a defect in the baby’s brain that makes regulating respiration more difficult. It may be that these infants have a defect in their ability to detect high carbon dioxide levels in the blood, and therefore lack the physiologic stimulus to breathe. (Carbon dioxide levels are primarily responsible for respiratory drive.) This may be coupled with a defect in the infant’s sleep/wake mechanism, since death typically occurs when the baby is asleep. Most babies who die of SIDS have no history of observed apnea, or long pauses in breathing, before death occurs.  

Despite not knowing what causes SIDS, experts are aware of many risk factors that may influence the likelihood that a baby will die of SIDS. These include: 

• Prematurity and low-birth weight
• Recent upper respiratory infection
• Male sex
• Age between 2 and 4 months 
• Ethnicity: Black, Native American and Alaskan natives have a higher incidence of SIDS
• Exposure to second-hand smoke
• Maternal age less than 20 years
• Maternal drug, alcohol or tobacco use
• Poor prenatal care

Additionally, an infant’s sleep environment has been shown to play a major role in the incidence of SIDS. Babies who sleep on their stomach or sides or on a soft sleep surface have a greater risk of SIDS, as do those who sleep in the same bed as parents or caregivers. Since the National Institute of Child Health and Human Development (NICHD) implemented its widespread and very successful Back to Sleep campaign in 1994, urging that all babies be placed on their backs on a firm sleep surface for sleep, the incidence of SIDS has dropped from about 130 deaths per 100,000 live births in 1990 to 38.4 deaths per 100,000 live births in 2020. Now dubbed the Safe to Sleep campaign, the most up-to-date guidelines for infant sleep include additional recommendations issued by the American Academy of Pediatrics in 2022. These include:

• Place infants on their backs on a firm, flat surface free of blankets, comforters, pillows and soft toys for every sleep
• Feed human milk as much as possible
• Offer the infant a pacifier for sleep and naps
• Avoid overheating. Remove head coverings for sleep 
• Whenever possible, put the infant to sleep in the same room as but on a separate surface from a responsible adult for its first 6 months of life
• Avoid exposing the baby to tobacco smoke
• Immunize the infant in accordance with established public health guidelines

Additionally, the AAP urges expectant mothers to refrain from using alcohol, opioids, marijuana, tobacco or any illicit substances, and get regular prenatal care. This is especially important for women whose age or ethnicity puts their babies at greatest risk. 

The Emotional Impact of Pregnancy Loss

The loss of an infant, whether during pregnancy or after birth, is a tragedy experienced by far too many families worldwide. And while the death of an infant is typically understood to be incredibly impactful for the mother, father and family as whole, the emotional effects of pregnancy loss are not as widely recognized. Many women and their partners feel disenfranchised in their grief and find it difficult to reach out for emotional support. 

According to research published in Frontiers in Global Women’s Health, miscarriage or spontaneous abortion is the most common obstetric complication worldwide, occurring in about 20% of all pregnancies. Further, research suggests that up to 50% of women who experience miscarriage or stillbirth develop significant psychological symptoms afterwards, including depression, grief and anxiety. The incidence of these symptoms is higher in women who are already marginalized or otherwise vulnerable, including women living in poverty, immigrants and childless women. Lack of social support or the support of an intimate partner were also associated with more significant levels of emotional distress after pregnancy loss.

Recurrent miscarriage is an even greater predictor of psychological complications in both women and their partners. Families who lose more than one pregnancy tend to feel discouraged and distressed; they also experience high levels of depression, grief and anxiety and feelings of anger and guilt. And while women tend to experience these effects more acutely, they also  impact their partners, who often feel the need to stifle their pain in order to support their partner in her grief. 

Stillbirth

While stillbirth is a form of pregnancy loss, it is in most instances even more emotionally devastating than miscarriage because it occurs late in the pregnancy. By the time a woman has reached 20 weeks gestation, she has formed a relationship with the unborn child, and she and her partner have begun to envision a life that includes them. Thus, a stillbirth is no less psychologically impactful than the loss of an infant shortly after birth. The parents and extended family will feel shock and disbelief along with the intense pain of losing a child that they had already come to love.  

In almost 50% of stillbirths, the cause of fetal demise is never discovered, so the bereaved parents, especially the mother, can also experience a great deal of guilt and shame. And while medical providers have the opportunity to reassure them that nothing they did caused the fetus to die, in many cases they fail to provide the support, information and compassion the family needs. This lack of support can worsen and prolong their grief and exacerbate their anxiety about the prospect of future pregnancies. 

Depression and anxiety is also extremely common for both members of a couple following a stillbirth, occurring in about 50% of couples for up to 3 years after the death of the child. Most couples begin to experience some ability to return to “normal” life within about 18 months of the loss, but this varies a great deal. Complicated grief or prolonged grief disorder, in which the grief reaction lasts far longer and is significantly more intense than what is considered “normal”, is not uncommon and may be present to some degree in up to 60% of couples who experience stillbirth. A strong social support system and a good relationship between partners may help to mitigate the risk of complicated grief. Feeling seen and heard by friends, family and loved ones can also be a buffer against prolonged grief. Parents who feel that their loss is acknowledged and their grief validated are often more able to successfully navigate through this incredibly difficult time.  

Grieving Infant Loss 

The loss of an infant is an unimaginable tragedy and the grief that follows such a loss is profound and enduring. Deep pain and sorrow can permeate every aspect of the parents’ life and lead to profound feelings of loneliness, emptiness, and sadness. Many parents feel stigmatized and alienated from close friends and family, especially if they were in any way responsible for the infant’s death (for example, not providing a safe sleep environment). Even when parents are totally blameless, feelings of guilt and shame can drive them to isolate themselves from those who could offer comfort and support. 

The emotions experienced by parents who lose an infant can be complex and varied. Some may find themselves grappling with intense feelings of guilt or anger, questioning why this happened to them. Others may feel a sense of helplessness or despair, struggling to envision a future where happiness seems possible again. It is not uncommon for parents to experience symptoms of depression and anxiety following infant loss. Marital problems are also extremely common as bereaved partners struggle to support each other while also navigating their personal journey through grief. 

The grieving process after losing an infant is profoundly personal and unique to each individual. It’s important to remember that there’s no “right” or “wrong” way to grieve – each person’s grief will be as unique as the bond they had with their child. What is crucial, however, is acknowledging these feelings and seeking out support—be it through therapy, support groups, or conversations with loved ones.

It is also essential to remember that it is not just the parents who grieve the loss when an infant dies. Grandparents, siblings, and close friends may also experience a deep sense of loss and may need support and understanding as they navigate their own grief.

Ultimately, understanding and talking about the emotional impact of losing an infant is a crucial step towards healing. While the pain may never completely disappear, with time, compassion, and support, it is possible to find a path towards healing and hope.

Sources

“Overview of Pregnancy Loss”. Stanford Medicine. https://www.stanfordchildrens.org/en/topic/default?id=overview-of-pregnancy-loss-90-P02466 

“Molar pregnancy”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175 

“How Do Abortifacients Work?”. RxList. https://www.rxlist.com/how_do_abortifacients_work/drug-class.htm 

“Mifepristone (Mifeprex) – Uses, Side Effects, and More”. WebMD. https://www.webmd.com/drugs/2/drug-20222-325/mifepristone-oral/mifepristone-oral/details 

“Pregnancy loss: Consequences for mental health”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9937061/ 

“About Stillbirth”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/stillbirth/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/stillbirth/facts.html 

“Newborn infections”. World Health Organization. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/newborn-infections 

“Neonatal Death”. March of Dimes. https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/neonatal-death 

“Perinatal asphyxia”. World Health Organization.  ​​https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/perinatal-asphyxia

“Necrotizing Enterocolitis”. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513357/ 

“Congenital Heart Defects”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/heart-defects/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/heartdefects/features/heartdefects-keyfindings.html 

“Trisomy 13”. MedlinePlus. https://medlineplus.gov/genetics/condition/trisomy-13/ 

“Anencephaly”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15032-anencephaly 

“What is Encephalocele?”. Nationwide Children’s. https://www.nationwidechildrens.org/conditions/encephalocele 

“Spina bifida”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860 

“Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5139812/ 

“Infographic: Accidental Suffocation and Strangulation during Infant Sleep”. Safe to Sleep. https://safetosleep.nichd.nih.gov/resources/social-digital/accidental-suffocation-and-strangulation-during-infant-sleep-text-alternative 

“Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS)”. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/sudden-unexpected-infant-death-suid-and-sudden-infant-death-syndrome-sids 

“Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment”. American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022?autologincheck=redirected 

“Protective and risk factors for women’s mental health after a spontaneous abortion”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7478879/

Although it is immensely difficult to navigate a loss due to sudden unexpected infant death (SUID), several options can be helpful as individuals work through the complex emotions and challenges associated with SUID. These options can include pursuing counseling or therapy, connecting with other people who are affected by similar losses, and finding healthy outlets or coping mechanisms for channeling grief. It is important to note that coping is an ongoing process, and everyone’s grief journey will be different based on their unique experiences. 

Coping requires patience and understanding with the knowledge that grieving and healing are gradual processes. It is important to remember that there isn’t a right or wrong way to grieve following the loss of a baby, and likewise, the grief experience typically doesn’t follow a timeline. Additionally, each family member will likely process and progress through their grief at different times and intervals. Although many coping strategies can be practiced as a family, it is crucial to give family members the privacy to grieve individually in the manner that feels most natural and appropriate to them. 

Seeking professional help through the guidance of a counselor or therapist is highly encouraged for families affected by SUID. Grief counseling and therapy sessions provide a safe space for bereaved individuals to share their thoughts, express their emotions, and process the loss they have experienced. Many mental health professionals specialize in helping their clients navigate the grieving process and can provide guidance on coping strategies or interventions for further support. 

Some people find it helpful to connect with others who have been impacted by SUID or experienced a similar type of loss. The ability to share experiences, emotions, and stories with other people who have navigated similar circumstances can reduce feelings of isolation by reminding bereaved individuals that they are not alone. It also helps by enabling them to develop a support network that they can reach out to as needed. Local meetups, online communities, and support groups are all potential pathways to connect with others. 

Due to the personal nature of the loss, some families may not initially be comfortable with sharing their stories or meeting with other people who have experienced similar losses. Some family members may be more comfortable reflecting and processing the loss with other members of the family or loved ones before moving forward with a support group or similar community. This is normal and tends to be more common directly after the loss has occurred. In general, everyone in the family is likely to have boundaries and limitations that will need to be respected as they grieve.

Finally, establishing healthy outlets and coping mechanisms early in the grief process can be highly beneficial. By engaging in activities such as art therapy, journaling, exercising, meditation or similar practices, people who are grieving can learn to channel the intense emotions associated with their loss and practice self-care. Many people find solace in turning to an activity or mindfulness when they begin to feel overwhelmed by their grief. 

Sources

“When a Family Grieves”. University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=1&contentid=1746 

“Bereavement Support”. Maternal and Child Health Library at Georgetown University. https://www.mchlibrary.org/collections/suid-sids/Bereavement/index.php 

“Family Grief: Five Keys to Grieving Well Together”. Psychology Today. https://www.psychologytoday.com/us/blog/between-the-generations/201908/family-grief-five-keys-grieving-well-together 

Safe sleep practices can help prevent sudden unexpected infant death (SUID) by creating a sleep environment that ensures babies are not at risk of smothering or suffocating. In fact, establishing a safe sleep environment can reduce the risk of all sleep-related deaths. Several practices that can help prevent SUID include: 

• Placing babies on their backs to sleep 
• Only allowing babies to sleep on a firm sleep surface without an incline 
• Discontinuing swaddling when babies develop the ability to roll
• Removing pillows, toys, bumpers, and blankets from the crib 
• Moving babies to a safe sleep environment if they fall asleep in a stroller, car seat, or carrier 
• Room-sharing with babies instead of bed-sharing 
• Giving babies a pacifier at nap time and bedtime 
• Don’t allow babies to sleep on couches, armchairs, or cushions 

Although parents or caregivers may think sleeping directly with a baby is harmless, it can present several risks. Falling asleep while the baby is in the bed can create the risk of smothering, suffocation, entrapment, or overheating. Using room-sharing instead of bed-sharing ensures that a parent or caregiver can actively monitor the baby and provide care if needed without potentially endangering the baby by allowing them to sleep on an unsuitable surface. A general recommendation is to practice room-sharing for at least the first six months of life. 

Frequently, individuals are unaware that their behaviors or environment can potentially put babies at risk for sleep-related deaths, which means promoting infant safety and well-being through safe sleep education is crucial. The American Academy of Pediatrics has established initiatives for further education regarding safe sleep practices, including the Sudden Unexpected Infant Death (SUID) Prevention Program. The program serves as a resource that provides evidence-based education to caregivers and families regarding how to implement safe sleep practices effectively. It also provides policy and guidance toward efforts to reduce rates of SUID in addition to racial and ethnic disparities in SUID. 

Sources

“Safe Sleep Fact Sheet”. American Academy of Pediatrics. https://downloads.aap.org/AAP/Campaigns/Safe%20Sleep/safe%20sleep%20fact%20sheet.pdf 

“How to Keep Your Sleeping Baby Safe: AAP Policy Explained”. American Academy of Pediatrics – Healthy Children. https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/a-parents-guide-to-safe-sleep.aspx 

“Sudden Unexpected Infant Death (SUID) Prevention Program”. American Academy of Pediatrics. https://www.aap.org/en/patient-care/safe-sleep/sudden-unexpected-infant-death-suid-prevention-program/ 

Sudden unexpected infant death (SUID) refers to the death of an infant under one year of age that occurs suddenly and without explanation. The cause of death can vary and, in some instances, may never be identified even with investigation. However, SUID typically meets one of the following criteria: 

• Accidental suffocation
• Accidental strangulation 
• Sudden infant death syndrome (SIDS)
• Unknown causes 

When babies die by accidental suffocation or strangulation, these are typically sleep-related deaths due to unsafe sleep environments, such as a bed with blankets, pillows, toys, or other items that may result in an obstructed airway. These deaths can be prevented by learning to incorporate safe sleep practices into naptime or bedtime routines and creating a safe sleep environment before babies fall asleep. Education and counseling regarding safe sleep can provide parents and caregivers with the knowledge and resources to reduce this cause of SUID. 

Additionally, encouraging breastfeeding for all children until at least 6 months of age may reduce the incidence of SIDS by up to 50%. 

Sometimes there are physical factors that can put babies at risk for SIDS. These can include factors such as low birth weight, respiratory infections, or brain defects. One theory suggests that SIDS deaths occur in babies who have an underlying vulnerability, such as a genetic abnormality, which results in a predisposition for sudden death when exposed to an unidentified trigger in their environment. Potential risk factors and predispositions that can result in SIDS include: 

• Teen pregnancy 
• Unsafe sleeping environment or position 
• Late or no prenatal care 
• Smoke exposure during or after pregnancy 
• Overheating 
• Preterm birth or low birth weight
• Exposure to alcohol 
• Prior medical history of apnea 
• Being a twin 
• Being a sibling of other babies that have died from SIDS
• Being assigned male at birth 

Sources 

“Data and Statistics for SUID and SIDS”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/sudden-infant-death/data-research/data/?CDC_AAref_Val=https://www.cdc.gov/sids/data.htm 

“SIDS Risk Factors and Protective Factors”. Nebraska Department of Health and Human Services. https://dhhs.ne.gov/Pages/SIDS-Risk-Factors.aspx 

“Sudden Infant Death Syndrome (SIDS)”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800 

“SIDS (Sudden Infant Death Syndrome)”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13646-sudden-infant-death-syndrome-sids 

Sudden unexplained infant death (SUID) is a broad term that is used to describe sudden and unexplained deaths in infants under the age of one year old. It is a term that is applied to different causes of death, some of which may not be identifiable by a coroner or medical examiner during a death investigation. Deaths that are typically categorized as SUID include: 

• Accidental suffocation
• Accidental strangulation 
• Sudden infant death syndrome (SIDS)
• Unknown causes 

It is estimated that there are around 3,400 cases of SUID in the United States each year. Statistics from the Centers for Disease Control (CDC) indicate that SIDS was the leading cause of death in cases of SUID in 2020. The following breakdown includes the total number and percentages of deaths categorized as SUID:

• Sudden infant death syndrome: 1389 deaths (41%) 
• Unknown cause: 1062 (32%) 
• Accidental suffocation and strangulation in bed: 905 (27%)

SUID is a devastating loss for parents and families since the deaths attributed to it often occur during sleep and may happen without any clear reasons or warning signs. It may not always be possible to determine the cause of SUID, which can make it challenging for parents or caregivers to identify preventative actions that could have been taken. Other times, SUID may be the result of health conditions such as metabolic disorders, heart issues, severe infections, or unidentified birth defects. Whether the cause is known or unknown, there is an immense emotional toll on surviving loved ones. 

Given its ongoing implications for infant mortality, SUID is a significant public health concern. Although statistics can vary from year to year, SUID continues to be a prevalent cause of infant mortality in the United States and abroad. Understanding the factors that contribute to SUID, raising awareness, and providing consistent education are essential to developing effective prevention strategies to protect future generations from SUID.

For sleep-related deaths that are categorized as SUID, implementing safe sleep practices can help reduce overall risk. Safe sleep practices include using a firm sleep surface, only allowing babies to sleep on their backs, removing any items that can be suffocation hazards from the environment, and sleeping with the baby in the same room instead of the same bed. By following guidelines and pursuing additional education, parents and caregivers can create a safe sleeping environment to reduce these deaths. 

Sources 

“About SUID and SIDS”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/sudden-infant-death/about/?CDC_AAref_Val=https://www.cdc.gov/sids/about/index.htm 

“Data and Statistics for SUID and SIDS.” U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/sudden-infant-death/data-research/data/?CDC_AAref_Val=https://www.cdc.gov/sids/data.htm

When it comes to pregnancy loss and the risk of future losses, statistics are a bit different for miscarriage and stillbirth. Experiencing a miscarriage does not in and of itself increase the risk of having another, and most people are able to have healthy pregnancies afterward. According to the Mayo Clinic, about one percent of women who have a miscarriage will experience another, with the risk rate during a future pregnancy hovering around 20 percent (on par with those who have not miscarried). After two or more miscarriages, the risk does increase to 28 percent and 43 percent, respectively.

For stillbirth, according to the National Institute of Child Health and Human Development, on average, the likelihood of experiencing another stillbirth does increase after having one. Some studies have shown the risk increases by as much as 50 percent, with a higher risk for those who lost their pregnancy between 22 and 28 weeks of gestation. Nevertheless, most people are able to have healthy deliveries after a stillbirth. 

With both miscarriage and stillbirth, there are some underlying risk factors that may increase the chances of experiencing multiple losses. Recurrent miscarriages may happen due to thyroid issues, biology (abnormally shaped womb, cervical weakness) or genetics. Stillbirth risk factors can include diabetes, pre-eclampsia or pregnancy growth restriction. People who fall into these categories should work closely with their healthcare provider to address any potential concerns to increase the likelihood of a successful pregnancy in the future.

Sources 

“Pregnancy after miscarriage: What you need to know”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134 

“Other Stillbirth FAQs”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/stillbirth/more_information/other-faqs 

“Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study”. BMC Pregnancy and Childbirth. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04355-7 

“Recurrent miscarriage”. Tommy’s. https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/recurrent-miscarriage 

“Pregnant after a stillbirth or late term loss”. Tommy’s. https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/pregnant-after-stillbirth-or-late-term-loss 

Progesterone has been shown to have protective qualities both prior to pregnancy and throughout the duration of the pregnancy. Prior to pregnancy, progesterone promotes the development of the uterine lining to support embryo implantation. During the second and third trimesters of pregnancy, progesterone reduces immune responses that can cause preterm labor. Medical experts have suggested that some women may not produce enough progesterone during the early stages of pregnancy, which may result in miscarriage. 

Recent studies have found that progesterone supplementation may reduce the risk of miscarriage in women with early pregnancy bleeding if they have a history of prior miscarriages. Improvement was more significant among women who had a higher number of miscarriages, highlighted by a 15% improvement among those who had three or more miscarriages. While these findings are promising, further research is needed, since previous studies had suggested that progesterone therapy was ineffective when administered during the first trimester of pregnancy.

While there may be a link between progesterone and protection against pregnancy loss, it is important to note that pregnancy loss can be the result of many different factors, some of which may not be responsive to progesterone levels. Those who are considering progesterone supplementation should consult with their healthcare provider prior to taking any action. If a progesterone imbalance is a potential cause of recurrent miscarriage, a healthcare provider can order the appropriate labs and conduct further evaluation to determine if supplementation is a suitable treatment. 

Sources

“The role of progesterone in miscarriage”. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/progesterone-in-miscarriage 

“Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/32609084/ 

“A Randomized Trial of Progesterone in Women with Recurrent Miscarriages”. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1504927 

It’s a common concern for pregnant people whether certain medications or medical procedures can increase the risk of miscarriage — the answer is, unfortunately, not a simple yes or no. Most medications sold in the United States feature labels stating any pregnancy risk, though if you’re pregnant or planning to be, you should absolutely check with your physician prior to starting or continuing any prescription, over-the-counter medication, vitamin or supplement.

There are certain medications that should be avoided, especially in early pregnancy, as they’ve been linked to an increased risk of pregnancy loss or birth defects. These include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, decongestants containing pseudoephedrine or phenylephrine (Sudafed), ACE inhibitors for heart issues or hypertension, isotretinoin (Accutane) for cystic acne, and methotrexate for psoriasis or rheumatoid arthritis.

There are also certain medical procedures that are considered dangerous for pregnancy. These include X-rays, which should only be performed if absolutely necessary and with proper shielding to protect the fetus. Procedures that involve anesthesia, including most surgeries (which also carry risks due to blood clotting), should be avoided unless deemed necessary by a medical professional.

Chemotherapy and cancer treatments pose a complex issue during pregnancy. The safety of these treatments largely depends on the type of cancer and its location, the stage of pregnancy, and the specific drugs or procedures being used. Generally, chemotherapy is not recommended during the first trimester, though some chemotherapy drugs may be used during the second and third trimesters. Radiation therapy is not safe in areas near the developing baby, but may be approved in more distant areas with proper shielding. As with all medical situations during pregnancy, it’s crucial to consult with healthcare professionals to provide advice tailored to individual circumstances to ensure both parent and fetus receive proper care.

Sources 

“Medications During Pregnancy: What’s Safe and What’s Not?” What to Expect. https://www.whattoexpect.com/pregnancy/pregnancy-health/medications-during-pregnancy/ 

“More evidence of NSAID risk in early pregnancy”. Reuters. https://www.reuters.com/article/us-health-miscarriage-nsaids-idINKBN1JG2VU/

“ACE Inhibitors and Heart Disease”. WebMD. https://www.webmd.com/heart-disease/medicine-ace-inhibitors 

“Methotrexate (Rheumatrex, Trexall, and others) – Uses, Side Effects, and More”. WebMD. https://www.webmd.com/drugs/2/drug-3441/methotrexate-anti-rheumatic-oral/details 

“Things to avoid during pregnancy”. Pregnancy, Birth, and Baby. https://www.pregnancybirthbaby.org.au/things-to-avoid-during-pregnancy#x-rays “Cancer During Pregnancy”. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/cancer-during-pregnancy.html

Access to contraception can help decrease the risk of miscarriage and stillbirth as it allows people to better plan their pregnancies. When pregnancies are planned, future parents are more likely to be in optimal health — both physically and mentally — which can decrease the risk of complications. Contraception also allows for strategic spacing between pregnancies, which is important as short intervals can increase risks associated with complications. The American College of Gynecology recommends waiting at least 18 months between pregnancies.

Further, access to contraception helps reduce the number of unintended pregnancies, which are often linked to more negative outcomes. Also, seeking contraception typically requires people to engage in preconception/general medical care, which can contribute to a better foundation of health ahead of any future pregnancies. Contraception access often comes with education about reproductive health as well, which empowers individuals to make informed choices. Together, these factors contribute to improved pregnancy outcomes and a lower likelihood of miscarriage and stillbirth.

Sources

“Family Planning”. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/objectives-and-data/browse-objectives/family-planning

“Interpregnancy Care”. The American College of Obstetrics and Gynecology. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/01/interpregnancy-care

“The risk of perinatal mortality following short inter-pregnancy intervals—insights from 692 402 pregnancies in 113 Demographic and Health Surveys from 46 countries: a population-based analysis”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10522774/ 

Skin-to-skin contact, also called kangaroo care, is frequently associated with stabilizing many of the core vital functions, such as heart and respiration rates. It is a practice that is beneficial for all babies but particularly beneficial for those who are at-risk, such as babies born prematurely or with a low birth weight. Some of the benefits associated with skin-to-skin contact include: 

• Regulating the baby’s heart rate 
• Encouraging more consistent and quiet sleep 
• Reduce pain associated with procedures and tests
• Regulating breathing patterns 
• Encouraging further development 

A key benefit of skin-to-skin contact for at-risk infants is its ability to improve physiological stability. This typically includes heart and respiration rates but can also include oxygen saturation, body temperature, and blood sugar levels. Regulation of body temperature is particularly beneficial for preterm and low-weight babies who are unable to consistently maintain their temperature independently.  In general, studies have also shown that skin-to-skin contact can regulate anxiety, stress, and psychological distress of the mother and the baby.

Since the brain is not fully developed following birth, interactions help to influence brain activity and shape brain development. Even minimal exposure to skin-to-skin contact can encourage healthy brain activity patterns, promote hormones related to attachment or stress, and increase the likelihood of higher scores on cognitive tests. Infants who experience skin-to-skin contact typically have more brain activity related to higher-order thinking, emotional regulation, and curiosity about the world around them.

Skin-to-skin contact can reduce the pain associated with the variety of procedures and tests that infants experience after birth. Although there is not always a reduction of pain during the procedure, the reaction to pain following the completion of a procedure is often reduced. In addition to the numerous physical benefits, skin-to-skin contact promotes emotional bonding which can create a greater sense of security and well-being. The closeness of skin-to-skin contact results in the release of oxytocin which helps to comfort the baby and reduce crying. 

Sources

“Kangaroo Care”. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/12578-kangaroo-care 

“Influence Of Giving Kangaroo Mother Care On Body Temperature and Oxygen Saturation On Low Birth Weight”. Open Access Health Scientific Journal. https://oahsj.org/index.php/oahsj/article/view/36 

“Parent–Infant Skin-to-Skin Contact and Stress Regulation: A Systematic Review of the Literature”. National Library of Medicine.  ​https://pmc.ncbi.nlm.nih.gov/articles/PMC8124223/ 

“Early Skin-to-Skin Contact Helps Baby’s Brain”. WebMD. https://www.webmd.com/parenting/baby/features/skin-to-skin-baby-brain 

“Skin‐to‐skin care for procedural pain in neonates”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6464258/ 

Although there are no actions guaranteed to prevent the leading causes of infant mortality, there are actions that can reduce the risk by promoting the health and well-being of mothers and their infants. Standard preventative measures for infant mortality include:

• Reducing the likelihood of congenital disabilities 
• Promoting appropriate pre-pregnancy and prenatal care 
• Addressing preterm births and low birth weights
• Encouraging newborn screening programs to detect serious health conditions
• Ensuring a safe sleep environment for infants 

Appropriate pre-pregnancy and prenatal care can include educating expectant parents about the importance of adequate nutrition, screening for health risks and chronic conditions, and counseling against alcohol, tobacco, and other substances. Many of these actions also help to reduce the risk of congenital disabilities. Encouraging mothers to maintain consistent physical activity or exercise is another way to emphasize healthy behaviors that promote a healthy pregnancy and delivery. Additionally, expectant mothers need consistent check-ups to ensure that any potential risks are identified early.

Addressing preterm births and low birth weights includes a variety of best practices that support both the mother and the infant. Premature and low-birth-weight infants typically need increased skin-to-skin contact with their mothers to stay warm. They may also require additional attention in a hospital or other medical facility for some time. Increased attention to hygiene and close monitoring are also necessary since preterm and low-birth-weight babies tend to be more susceptible to infections and potentially dangerous health conditions. Since these infants may gain weight slowly, additional support for breastfeeding and close monitoring of growth are essential factors in achieving positive outcomes. 

Public health initiatives such as newborn screening programs effectively detect disorders and health conditions that can result in disability or death. These programs screen babies within the first 24 to 48 hours following birth by using blood samples to test for up to 50 conditions. Screenings for heart issues and hearing disorders are also included in addition to the traditional blood tests. If a newborn is at increased risk for severe health conditions, healthcare professionals will arrange further testing.

Finally, ensuring that mothers have access to adequate healthcare services and education for new parents is crucial. These services not only provide suitable care throughout the pregnancy but also provide critical educational resources about how to initiate breastfeeding, create a safe sleep environment, provide proper nutrition through the introduction of first foods, maintain updated vaccinations, recognize the signs of postpartum depression, and many other aspects of motherhood. Implementing these measures can reduce infant mortality rates while promoting a healthier future for mothers and their babies.

Sources

“Are there ways to reduce the risk of infant mortality?”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/infant-mortality/topicinfo/reduce-risk 

“Newborn mortality”. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/newborn-mortality 

“Newborn Screening”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/newborn 

An ectopic pregnancy happens when a fertilized egg implants itself outside of the uterus, and usually happens in the fallopian tube (in which eggs travel from the ovaries to the uterus). This is also known as a tubal pregnancy. Ectopic pregnancies can also occur in other areas such as the cervix, ovary, or abdominal cavity. This type of pregnancy is potentially life-threatening and requires immediate medical attention.

An ectopic pregnancy is a serious condition because, as the fertilized egg grows, it can lead to rupture of the fallopian tube or other structures where it has implanted. This can result in severe bleeding and critical complications for the mother if left untreated. Additionally, the embryo cannot survive outside of the uterus, which means it cannot develop into a viable pregnancy. To protect the health and safety of the mother, an ectopic pregnancy must be diagnosed and treated as soon as possible.

Symptoms of ectopic pregnancy

Initial symptoms may include such as abdominal pain, vaginal bleeding or spotting. In some cases, blood may leak from the fallopian tube where the embryo is implanted and cause shoulder pain or the urge to defecate.

Dangerous symptoms of ectopic pregnancy include fainting, acute lightheadedness and shock. This may occur if the fertilized egg causes a rupture of the fallopian tube, which can cause bleeding into the abdomen. If any of these symptoms are experienced, it is crucial to seek medical attention, and for severe symptoms, it’s necessary to do so immediately. 

Confirming an ectopic pregnancy

An ectopic pregnancy can be diagnosed through blood tests and ultrasounds. Once diagnosed, treatment options will depend on the size and location of the ectopic pregnancy, as well as individual health factors. Treatment may involve medication to stop the growth of the embryo or surgery to remove it.

Sources

“Ectopic pregnancy”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093 

A molar pregnancy is a rare pregnancy complication that results from the abnormal fertilization of an egg. It is sometimes referred to as a hydatidiform mole or gestational trophoblastic disease (GTD) and is estimated to occur in less than 1% of pregnancies or 1 out of every 1,000 pregnancies. Molar pregnancies may be complete or partial, but placenta abnormalities occur in both types.

When a complete molar pregnancy occurs, abnormal placental tissue grows and contains tumors or cysts. An embryo is not present in a complete molar pregnancy. However, abnormal placental tissue produces a hormone called hCG, which normal placental tissue also produces during pregnancy. This hormone ultimately causes the symptoms associated with pregnancy and can result in a positive pregnancy test even though the person is not pregnant. 

If abnormal placental tissue grows with an embryo and the egg has been fertilized by two sperm, it is considered a partial molar pregnancy. An embryo in a partial molar pregnancy has a chromosomal abnormality since it contains both the mother’s chromosomes and two sets of chromosomes from the father, resulting in 69 chromosomes rather than 46. Although the embryo may continue to develop, it typically does not survive.

While molar pregnancies are rare, it is important to understand that anyone can experience one. Some individuals are at higher risk of having a molar pregnancy, such as those who have had two or more miscarriages or those with a previous history of molar pregnancies. Molar pregnancies are characterized by several symptoms, including: 

• Nausea and vomiting 
• Vaginal bleeding during the first three months of pregnancy 
• High HCG levels 
• Anemia 
• Abdominal swelling 
• High blood pressure (preeclampsia) 
• Small grape-like cysts discharged from the vagina 

Most individuals who have molar pregnancies experience full recovery and can have viable pregnancies in the future with appropriate treatment. Although molar pregnancies cannot result in a live birth, they can pose a serious health risk due to complications if they are untreated. Early diagnosis and treatment are necessary, and even after treatment, hCG levels must be monitored to prevent further issues. Taking this into consideration, those who suspect they may be experiencing a molar pregnancy are encouraged to contact a healthcare provider and seek immediate medical attention.

Sources

“Molar pregnancy.” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy 

“Molar pregnancy.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175 

“Molar pregnancy: Symptoms, risks, and treatment.” American Pregnancy Association. https://americanpregnancy.org/healthy-pregnancy/birth-defects/molar-pregnancy/ 

Physical complications can occur following a stillbirth or miscarriage, but the severity can vary depending on the circumstances. When someone has a miscarriage and tissue remains in the uterus, it can result in a uterine infection known as a septic miscarriage within a matter of a few days. Common symptoms can include: 

• Chills
• Fever
• Vaginal bleeding
• Foul-smelling vaginal discharge
• Pain in the lower abdomen 

This type of infection can become life-threatening and requires immediate medical attention. Another common complication that may occur after a miscarriage is heavy bleeding, which is called a hemorrhage. Sometimes a hemorrhage may be accompanied by other symptoms including: 

• Dizziness due to low blood pressure 
• Fatigue or weakness due to anemia 
• Fast heartbeat

Complications after a stillbirth are generally similar to those that are experienced after a miscarriage. However, in some instances when a fetus dies near term or during late pregnancy yet remains in the uterus, it may result in the development of a clotting disorder known as disseminated intravascular coagulation (DIC). DIC is a potentially life-threatening condition that can lead to uncontrolled bleeding, organ failure and death. 

Individuals should also be aware that symptoms associated with complications can vary since everyone’s body is unique and may respond to trauma differently. If a miscarriage or stillbirth is suspected, it is crucial to seek medical attention as soon as possible and follow the recommended post-loss care instructions provided by a healthcare practitioner. Even if there is any doubt regarding whether someone is experiencing symptoms of a complication, the best course of action is to seek medical guidance to prevent, diagnose, and treat the symptoms to reduce the risk of any potential health threats. 

Sources

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

“Disseminated Intravascular Coagulation (DIC)”. MedScape. https://emedicine.medscape.com/article/199627-overview?form=fpf#a8 

In the event of a suspected pregnancy loss, medical tests such as an ultrasound and/or bloodwork are typically used to determine miscarriage or stillbirth. It’s possible these tests may not provide instant confirmation, and depending on the test, may need to be repeated the next day or week. 

To confirm or diagnose miscarriage or stillbirth, tests may include:

• Ultrasound — Most often performed with a probe inserted vaginally, this allows doctors to determine if there is still a fetal heartbeat and if the pregnancy is developing normally. If there is no heartbeat or the fetus appears to have stopped growing, this may be an indication of pregnancy loss. If the results of an initial ultrasound aren’t clear, you will likely be asked to have another in about a week.
• Blood test — This measures the level of the pregnancy hormone hCG, or human chorionic gonadotropin. The levels of hCG in the blood can indicate whether a pregnancy is progressing normally. If the levels are abnormally low or decreasing, it may be a sign of an impending miscarriage.
• Pelvic exam — Doctors may also perform a pelvic exam to check if your cervix has started opening, which can indicate a miscarriage.
• Tissue testing — If you’ve passed clots or tissue, it may be sent to the pathology lab to confirm pregnancy loss and/or determine if there was a different cause.

Sources

“Miscarriage: Diagnosis”. NHS. https://www.nhs.uk/conditions/miscarriage/diagnosis/ 

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-treatment/drc-20354304 

If you suspect a pregnancy loss has occurred, it is important to seek medical attention as soon as possible. While it is advisable to contact your healthcare provider to inform them of your concerns, seeking emergency care is crucial to ensure there aren’t any imminent threats to your health. A healthcare provider will be able to provide guidance regarding the next steps to confirm whether a pregnancy loss is in process or has occurred. In any instance, emergency services should be contacted immediately.

When pregnancy loss results from a miscarriage, it may happen very suddenly or gradually, sometimes over several weeks. It is often characterized by symptoms such as stomach pain, vaginal bleeding, and cramps. Some types of miscarriage can cause tissue to remain in the uterus and may even result in a life-threatening infection known as sepsis, so it is important to get evaluated by a medical professional immediately. Your healthcare provider will ensure that you are stabilized and can also conduct tests that may provide more insight into the cause of the pregnancy loss. 

After receiving medical care, it is important to connect with your support network. This may be a family member, a close friend, or a mental health professional such as a counselor or therapist. These individuals will be able to help you navigate through the grief process and can provide you with additional support during moments that are especially difficult. Some individuals also find it helpful to attend a support group to connect with other individuals who have experienced a recent pregnancy loss. 

Ultimately, if you suspect that you are experiencing a pregnancy loss or one has previously occurred, it is important to prioritize your physical health and seek medical attention immediately, followed by taking necessary steps to attend to your mental and emotional well-being. Remember that your experience with pregnancy loss is unique, and allow yourself to grieve and experience your emotions in the manner that feels the most authentic to you. Self-care and being sensitive to your needs will be essential in the overall process of your recovery.

Sources

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-treatment/drc-20354304 

“How do I know if I’m having a miscarriage?” Planned Parenthood. https://www.plannedparenthood.org/learn/pregnancy/miscarriage/how-do-i-know-if-im-having-miscarriage 

A pregnancy loss that occurs before 20 weeks gestation is known as a miscarriage or, medically, a spontaneous abortion. This most often happens in the first trimester (up to week 13). After 20 weeks, pregnancy loss is known as stillbirth. There are various signs and symptoms that may indicate pregnancy loss, both early- and late-term.

Signs of Potential Miscarriage (Before 20 weeks)

According to Cleveland Clinic, signs of a miscarriage may include:

• Vaginal bleeding — This can range from light spotting to heavy bleeding, and may or may not be accompanied by cramping and pain.
• Passing tissue from the vagina — This may look like large blood clots or grayish tissue (if possible, save tissue that you pass for examination by a healthcare provider).
• Abdominal pain — This may feel like menstrual cramps, though is often more severe.
• Lower back pain — Mild to severe.
• Fast heartbeat
• Absence of pregnancy symptoms — If you’d been experiencing symptoms like nausea, breast tenderness, food cravings/aversions that suddenly disappear, it could be a sign of miscarriage.

Signs of Potential Stillbirth (After 20 weeks)

• Decreased fetal movement — If you notice that your baby is moving less than usual or not moving at all, it can be a sign of stillbirth. This is often the only noticeable sign. If your baby is vigorously moving much more than usual, this could be an indication something is amiss, though fluctuations in fetal activity are normal.
• Abdominal cramps and vaginal bleeding — This is experienced by some but not all.

Please note that experiencing any or all of these signs and symptoms does not necessarily mean a miscarriage or stillbirth has occurred and could be related to other pregnancy issues. It’s always best to consult with a healthcare provider if you experience any of these signs or have concerns about your pregnancy.

Sources

“Stillbirth”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9685-stillbirth 

“What Causes a Loss of Pregnancy Symptoms?”. Parents. https://www.parents.com/is-loss-of-pregnancy-symptoms-a-sign-of-miscarriage-2371242 

“Miscarriage”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9688-miscarriage 

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

While there are some tests available that can help identify potential causes of pregnancy loss, it is important to acknowledge that not all pregnancy losses can be fully explained. Medical tests can be helpful in identifying underlying factors that may contribute to or increase the risk of pregnancy loss and can provide valuable insights. Specific tests that are recommended by a healthcare provider will vary based on each individual’s circumstances and medical history.

Prior to any testing, your healthcare provider should spend time gathering a detailed history that focuses on medical, family, surgical, and genetic background. An ultrasound is usually the most common test that is conducted first, since it allows the physician to evaluate the uterus and uterine cavity. Other tests that might be conducted for additional insight include a saline ultrasound, hysterosalpingogram, X-ray, MRI, and hysteroscopy. Saline ultrasounds are used to identify abnormalities within the uterus, such as the presence of fibroids or polyps and differ from a conventional ultrasound due to the injection of saline during the test. If fibroids or other abnormalities are suspected, an MRI may be used to locate them for further evaluation. A hysterosalpingogram X-ray provides imaging of the uterus and inside of the fallopian tubes to determine whether they are open or closed. Your healthcare provider may also choose to conduct a hysteroscopy to look more directly into the uterus. However, hysteroscopy is typically considered to be a minor surgical procedure since it can also be used for fibroid and polyp removal or resection of scar tissue. 

Blood tests are another common approach to gaining insight into the cause of pregnancy loss. Labs may be drawn for antiphospholipid antibodies, thyroid function, thyroid antibodies, follicle-stimulating hormone, and prolactin measurement. Healthcare providers are frequently interested in potential hormone imbalances since inappropriate levels of progesterone may sometimes result in pregnancy loss and can usually be treated. Some healthcare providers may also order an ovarian reserve test to determine if one or both ovaries are functioning properly. Depending on the outcome, a referral to a fertility specialist may be necessary.

Finally, chromosomal analysis or karyotype test may be performed to determine if the chromosomes of the fetus indicate the presence of a genetic disorder or abnormalities. Sometimes this testing is only performed when all other abnormalities have been ruled out. While these types of abnormalities are rare, they can significantly reduce the likelihood of embryo survival if certain chromosomes have an extra or missing copy. 

Sources

“Recurrent pregnancy loss”. UCLA Health. https://www.uclahealth.org/medical-services/obgyn/conditions-treated/recurrent-pregnancy-loss 

“Diagnosing Recurrent Miscarriage”. NYU Langone Health. https://nyulangone.org/conditions/recurrent-miscarriage/diagnosis#:~:text=Hysterogram,that%20can%20lead%20to%20miscarriage

“Can genetic testing explain the cause of recurrent miscarriages?”. UT Southwestern Medical Center. https://utswmed.org/medblog/miscarriage-genetics/

Whether you can take bereavement leave for a miscarriage depends on your employer’s policy.  Some companies proactively include miscarriage and pregnancy loss in the eligibility criteria for their bereavement leave policies, whereas others may have separate policies defined specifically for miscarriage. When a miscarriage is included in an existing bereavement leave policy, you can generally expect to have a few days of paid time off from work. However, if miscarriage is not included in the policy, it may mean that you have to take unpaid time off or use vacation time to cover your absence.

As an alternative to bereavement leave, women who have experienced a miscarriage are entitled to take time off under the Family Medical Leave Act (FMLA). Miscarriage is considered a serious health condition related to pregnancy, and most women are entitled to up to 12 weeks of unpaid, job-protected leave through FMLA. This extended leave may be helpful if you need additional time to process your loss. However, if your employer has a bereavement policy that allows you to take a certain number of days off with pay, this may be more helpful if you need your income to support yourself and your family. 

In an effort to address gaps and lack of consistency regarding leave coverage for miscarriage, many states have started amending legislation to require that companies acknowledge pregnancy loss in their bereavement leave policies so that employees can take time to grieve and process their loss. Further advocacy will likely be needed to maintain momentum in the efforts to have pregnancy loss widely recognized and included in bereavement leave policies throughout the nation. Until then, advocating for yourself and being transparent about the need for time off after experiencing a miscarriage is a crucial component in caring for your well-being and prioritizing your health.

Sources

“You Can Take Time Off After a Miscarriage. Here’s How to Do It.” InHerSight. https://www.inhersight.com/blog/pregnancy/miscarriage-leave-from-work 

“Emerging trend: Bereavement leave covers reproductive losses”. HR Morning. https://www.hrmorning.com/news/bereavement-leave-pregnancy/ 

When your healthcare provider conducts tests to diagnose a miscarriage, they may use specific terms to describe the type of miscarriage that has occurred. What has happened to the tissue during the miscarriage and the potential complications that may result after a miscarriage often determine how it will be categorized. Some common types of miscarriage include incomplete, septic, and missed miscarriages.

Sometimes you may not realize that you have had a miscarriage. This often happens with a missed miscarriage that occurs when the fetus or embryo ceases to develop very early but the body hasn’t stopped producing pregnancy hormones. A missed miscarriage may be diagnosed during an ultrasound, which often reveals an empty amniotic sac, no sac, or a significantly smaller fetus or embryo within the sac. In instances where the sac is empty or is not present, your body may have reabsorbed the embryo. 

When tissue from the pregnancy remains in the uterus, it is typically considered an incomplete miscarriage. Like other miscarriages, you will likely experience bleeding and dilation of the cervix. However, your body might have difficulty fully passing the tissue. It is not uncommon to pass the remaining tissue after diagnosis, which usually means you will not need further treatment or monitoring from your healthcare provider. However, if you are unable to pass the tissue, it can lead to complications such as heavy, prolonged bleeding or infection.

Infections that occur following a miscarriage should be treated promptly since they can rapidly progress from the uterus into the bloodstream and cause septic shock. When sepsis develops due to an infection from the tissue that remains in the uterus after a miscarriage, it is called a septic miscarriage. Sepsis is a life-threatening condition that requires immediate medical attention. If you experience any of these symptoms after having a miscarriage, you should seek emergency care immediately for further evaluation:

• A fever of 100.4 or higher 
• Chills
• Unusual drowsiness 
• Pelvic pain 
• Tenderness in the uterus 
• Bleeding and cramping for over two weeks  
• Foul-smelling vaginal discharge 

It is important to understand that regardless of the terms used to describe the miscarriage, these circumstances are often deeply emotional and can be traumatic. While prioritizing medical care following a miscarriage, it is equally important to emphasize the value of emotional support. Those who have experienced a miscarriage are encouraged to connect with their healthcare provider to explore additional resources to support their emotional and mental well-being. 

Sources 

“Missed Miscarriage: Causes, Symptoms, Diagnosis, and Treatment”. Very Well Health. https://www.verywellhealth.com/missed-miscarriage-symptoms-treatment-and-coping-5189858 

“What to Know About Incomplete Miscarriage”. Parents. https://www.parents.com/incomplete-miscarriage-symptoms-causes-treatment-8645920 

Since every state has guidelines for reporting fetal death and stillbirths, the provision of a certificate and the type issued can vary. These state guidelines determine whether an individual is required to file for a death certificate or an alternative certificate after a stillbirth or miscarriage has occurred. Types of certificates that may be issued based on state requirements can include the following:

• Fetal death certificate 
• Certificate of spontaneous termination of pregnancy (miscarriage)
• Certificate of stillbirth

If the fetus has reached a gestational age of 20 weeks or beyond, some states will issue a fetal death certificate. This certificate may also be issued if the fetus weighs 350 grams (12 ounces). Although the gestation requirement of 20 weeks is relatively consistent across states, the weight requirement can vary. In states where a certificate of spontaneous termination of pregnancy (miscarriage) is available, such as New York, the certificate is typically issued for fetuses that are 20 weeks of gestation or less. 

Fetal death certificates must be filed within a specific period after delivery according to each state’s reporting requirements. For example, Alaska requires the filing of fetal death certificates within three days after delivery. States can also choose to adhere to a five-day reporting period per the recommendations in the Model State Vital Statistics Act and Regulations of 1992.

When fetal death certificates are not issued, alternative forms of documentation, such as the certificate of stillbirth or the certificate of spontaneous termination of pregnancy (miscarriage), are used instead. These certificates may serve some administrative or legal purpose. However, their primary purpose is to acknowledge the loss that the individual has experienced. 

In states that have specific weight or gestation requirements, a fetal death certificate may not be required if the fetus doesn’t meet those requirements. If a state bases its fetal death certificate requirement solely on gestational age, but the gestational age cannot be determined, the parents are generally allowed to decide whether they want to file the fetal death certificate or not. 

Sources

“Stillbirth or Miscarriage Certificate”. NYC 311. https://portal.311.nyc.gov/article/?kanumber=KA-03562 

“State Definitions and Reporting Requirements”. NCHS. https://www.cdc.gov/nchs/data/misc/itop97.pdf 

“Model State Vital Statistics Act and Regulations”. NCHS. https://www.cdc.gov/nchs/data/misc/mvsact92b.pdf 

The term “rainbow baby” or “double-rainbow baby” refers to a child born following the loss of a previous pregnancy or infant. This loss may be due to miscarriage, stillbirth, or other types of infant loss. A “rainbow baby” follows one loss, while a “double-rainbow baby” follows two. The rainbow terminology is intended by many as a symbol of hope and joy after a difficult period, much like a rainbow appears after a storm. It is important to note that while this term is beautiful and meaningful to a large community, not all parents are comfortable with this metaphor, as experiences of loss are deeply personal.

Parents in a subsequent pregnancy or with a new baby after a loss navigate unique emotional challenges, celebrating the arrival of a child while mourning the loss of another. While these parents may feel joyful and excited about their new baby, they also tend to feel anxious and sometimes fearful for the future since they have already experienced loss. Sometimes feelings of guilt emerge as some parents may feel that they don’t have the right to be happy about the arrival of a new baby since they are still grieving the loss of their previous child or children. This complex range of emotions often means that parents navigating pregnancy after a loss are also facing the unique challenge of experiencing how grief and joy coexist throughout their journey into parenthood.

Navigating Pregnancy After Loss: Finding Support

The anxiety and complex emotions of a pregnancy after loss are normal, and seeking support is a sign of strength. Practical strategies include:

• Seek Specialized Professional Support: Consider a therapist or counselor specializing in perinatal mental health or grief. They can provide tools to manage anxiety and process conflicting emotions in a safe space.
• Connect with a Supportive Community: Seek out in-person or online support groups specifically for pregnancy after loss. Sharing experiences with those who truly understand can reduce feelings of isolation. Your healthcare provider or local hospital may offer referrals.
• Communicate with Your Care Team: Be open with your obstetrician or midwife about your history and anxieties. They can offer more frequent check-ups, additional monitoring, or simply a listening ear to help you feel more secure.
• Develop a Coping Plan: Work with a partner, friend, or professional to identify what triggers anxiety and establish calming rituals, such as mindfulness, gentle movement, or journaling, to use when feelings become overwhelming.
• Honor Your Unique Journey: Allow yourself to feel all emotions without judgment. It’s okay to be cautious about bonding during pregnancy, to celebrate milestones on your own terms, and to find personal ways to remember your lost baby while embracing the new pregnancy.

Many parents also find connection and recognition on National Rainbow Baby Day, observed on August 22nd, although not all parents affected by pregnancy after loss choose to participate solely on this date. The intent in observing this day is to reflect, remember, and honor these losses that have been experienced. It also serves as a day of gratitude and celebration for babies who were eventually born after these losses occurred. 

Sources

“What is a Double-Rainbow Baby? A Pediatrician Explains”. Romper. https://www.romper.com/life/what-is-a-double-rainbow-baby 

“What to Know About Having a Rainbow Baby”. Parents. https://www.parents.com/baby/what-it-means-to-be-a-rainbow-baby-and-why-rainbow-babies-are-beautiful/ 

The cost of an infant or stillbirth funeral can vary, but it can cost a minimum of $3000 when embalming, a casket, and additional services are included. Similar to adult funeral expenses, fees for services such as body preparation and transportation can quickly increase the overall cost of the funeral. While many people are prepared for an adult funeral due to pre-planning, most individuals do not anticipate the death of an infant and frequently struggle to afford the costs of making final arrangements. 

There are often significant medical expenses associated with a stillbirth or the death of an infant. Although insurance can cover many of these expenses, it can be difficult to afford the additional expenses of a funeral after paying the out-of-pocket costs following a stillbirth or infant death. The costs of funerals, burials, and cremations often need to be handled more imminently and many individuals struggle to pay. Hospital social workers can help by connecting affected individuals with financial assistance programs and non-profit organizations that may be willing to help cover these costs. Additionally, some hospitals set aside funds for financial assistance if individuals can demonstrate need and an overall inability to pay for a funeral. 

There are many funeral homes that are willing to work collaboratively to plan a funeral that fits within the budget of families who have experienced a stillbirth or infant death. Options such as financing may be available, and some funeral homes will also significantly discount the cost of services to make a suitable funeral more affordable. Ultimately, maximizing the use of local resources and working closely with a funeral home can help bereaved families design a funeral that honors their infant or stillborn baby in a sensitive and dignified manner. 

Sources

“Tips for Getting Through Infant Funeral Planning”. Direct Cremate. https://www.directcremate.com/tips-for-getting-through-infant-funeral-planning/ 

“From diagnostics to autopsy to burial, stillbirths are alarmingly expensive in America”. Vox. https://www.vox.com/the-highlight/2019/7/23/20698480/stillborn-stillbirth-baby-costs-expensive 

The final arrangement options that are available for a stillborn infant can sometimes vary based on the gestational age and weight of the baby in accordance with state regulations for fetal deaths. For example, Texas state law requires that stillborn babies weighing over 350 grams (12 ounces) or older than 20 weeks gestation must be buried or cremated by a funeral home. But Pennsylvania state law has a similar requirement for stillborn babies who are 16 weeks gestation or older. Assuming that the registration for fetal death requirement is met, many states treat stillbirths the same as adult death and require a cremation or burial as a result.

A key distinction that varies among states is the alternative option of allowing the hospital to make final arrangements. There are some states that mandate the disposition of fetal remains and provide the option of allowing the hospital to handle the arrangements, while there are other states that only require that the death be registered and a certificate of stillbirth issued if necessary. When hospitals become responsible for the disposition of the remains, communal cremations or burials in a shared plot are the only options available. 

Ultimately, while the responsibility of making arrangements generally falls on the guardian or parent, state laws and mandates often greatly inform which arrangements can be made. Due to the complexities of state laws and ongoing legislation surrounding fetal death, individuals are advised to consult with local professionals to understand the requirements and respective options that are relevant to their state. Factors such as whether the stillbirth occurred at home or in the hospital can often affect how state laws are interpreted, and likewise, if there are specific criteria that must be met for a cremation or burial to occur. 

Sources

“Arrangements after a miscarriage or stillbirth”. Texas Children’s Hospital. https://www.texaschildrens.org/patients-families/patient-and-family-resources/death-child/arrangements-after-miscarriage-or 

“Navigating Immediate Decisions & Situations After Stillbirth”. Bodily. https://itsbodily.com/blogs/pregnancy-loss/stillbirth-support-what-you-need-to-know

An autopsy, also known as a post-mortem exam, is not mandatory when an infant dies of known causes, but may be recommended for further insight into the extent of those causes. However, the National Association of Medical Examiners (NAME) forensic autopsy performance standards indicate that a forensic autopsy should be performed if death is unexplained or unexpected in an infant or child. Some states have laws that require autopsies if the cause of death is Sudden Unexpected Infant Death (SUID). The state of Florida, for example, requires an autopsy within 24 hours or as soon as possible following the death of an infant under one year of age. 

If the physician is already aware of the cause of death of the infant, an autopsy may be requested so that the physician can understand the full extent of the condition or abnormality that caused the death, as well as any potential underlying conditions that were not previously known. These autopsies are typically voluntary, which means that they can only be performed with the consent of the parent, guardian, or other legally authorized representative. If the death is unexplained or unexpected and an investigation is mandated, then a coroner’s autopsy or forensic autopsy is conducted instead. These autopsies are required to resolve any investigative concerns surrounding a death of unnatural, suspicious, or unknown causes. 

Whether an autopsy is necessary following the death of an infant depends largely on the circumstances surrounding the death, as well as the professional discretion of legal authorities and medical providers in the area. Understandably, the idea of an autopsy can be a sensitive matter for those who are grieving the recent loss of a baby. However, autopsies can provide valuable insight into the cause of death, which can be a source of clarity and solace after a loss. In any regard, complying with a request for an autopsy is generally recommended, especially if there are any concerns surrounding the death.

Sources

“Autopsy Information for Parents and Relatives”. Manning Family Children’s Hospital. https://www.manningchildrens.org/services/hospital-services/autopsy-information-for-parents-and-relatives/ 

“The 2024 Florida Statutes (including 2025 Special Session C)”. The Florida Legislature. http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0300-0399/0383/Sections/0383.3362.html 

“Under What Circumstances Will an Autopsy be Performed?” Washoe, NV Regional Medical Examiner’s Office. https://www.washoecounty.gov/coroner/faq/when_is_autopsy_performed.php#:~:text=The%20National%20Association%20of%20Medical,in%20an%20infant%20or%20child. 

Some common memorial options for honoring your baby after a loss can include creating physical memorials, incorporating personalized jewelry or keepsakes, or establishing a legacy. Since losing a baby is often an intensely emotional experience, finding ways to honor and remember your baby can be an important part of facilitating the healing process. There is no ‘one-size-fits-all’ approach to memorialization, but finding a memorial option that feels right for honoring your child can aid in providing solace and comfort as you navigate through your grief.

Many people prefer physical memorials since they provide a more tangible sense of connection and create a space for reflection. Some popular choices for physical memorials include: 

• Planting a tree or shrub
• Creating a memorial garden 
• Making a dedicated space in your home for pictures and keepsakes
• Preserving your baby’s nursery 
• Creating artwork such as paintings or illustrations 
• Make a memory box, hope chest, or a collage 
• Have a memorial gathering 
• Start a website or a blog 
• Write poetry 

Another common memorial option that provides a similar level of tangibility is creating personalized jewelry or keepsakes. Many companies create personalized items such as keychains, necklaces, bracelets, rings, resin sculptures and more. These items can include your baby’s name and birthdate, but can also include a fingerprint or ashes if that is your preference. These are very popular options since jewelry and keepsakes can be kept close as you proceed with your daily routine. Additionally, you can also take a do-it-yourself approach to create something truly unique to carry with you. 

The decision to establish a legacy is a personal choice and can be a great way to honor your baby while having a positive impact on the lives of other people. There are a variety of ways to accomplish this. Some people opt to make a donation to a charity or foundation in memory of their baby, while others might prefer to start their own foundation or community initiative. Other possible activities include volunteering for charitable causes, helping out with community events, or even running a marathon. If the loss of the baby was due to a specific illness or disorder, some parents find it helpful to get involved with advocacy and other supportive efforts to increase awareness and fund research aimed at treating the disease.  

Sources

“11 Ways to Honor Your Baby Who Died on Their Loss Anniversary”. Pregnancy After Loss Support. https://pregnancyafterlosssupport.org/honor-baby-died-loss-anniversary/ 

“​​Ways to honor a baby who dies in pregnancy or infancy”. BabyCenter. https://www.babycenter.com/pregnancy/your-life/honoring-a-baby-who-dies-in-pregnancy-or-infancy_10339724 

Coping with the termination of a pregnancy for medical reasons is an emotionally complex experience, and it is important to allow yourself to experience your emotions without judgment. Grieving is a deeply personal process, and everyone’s grief is different. Your feelings of grief, loss, sadness, anxiety or anger are normal. Many people who have terminated a pregnancy for medical reasons feel as if they don’t have a right to grieve, but your grief is a valid response to the challenging circumstances that you have experienced. 

It is crucial to have a consistent source of support as you grieve this loss. This might include your family members, close friends, your partner, and a trusted therapist. It is not uncommon to feel isolated due to the nature of this loss, so you may find it especially helpful to connect with others navigating the same loss through an online or local support group. Sharing your feelings with others who understand and can relate to your circumstances can aid in your recovery process as you continue processing the loss. They may also share coping strategies or suggestions regarding what has been helpful for them during their grief journey. 

Self-care can also be beneficial in the overall efforts to cope with your loss. Everyone has their own approach to self-care, and a wide variety of activities can be helpful depending on your personal preferences. If you haven’t taken any time off from work yet, you may want to consider submitting a request to your employer so you have extra time to reflect on your experience. Some people find meditation, prayer, breathwork, or physical exercise appropriate additions to their self-care routine. Even simple practices such as getting plenty of sleep and eating well can support your body as you process your grief. 

Remember to be patient and gentle with yourself. Much like grief, healing takes time. Healing does not mean that you won’t think about this loss again or that it won’t hurt anymore. Instead, healing can look like feeling more comfortable about sharing your story with other people and proactively allowing yourself to experience all of the emotions that can emerge with loss over time. For many people, healing can also mean releasing any blame or guilt that they carry regarding the loss and acknowledging that the termination of the pregnancy was not their fault.

Ultimately, coping with the termination of a pregnancy for medical reasons is a personal journey. Allow yourself the space to grieve, be patient with yourself, and reach out to others for support if you are struggling. Over time, these actions will help you to cope with the loss of your pregnancy and enable you to transition into a space where you can feel more comfortable focusing on honoring the memory of your child. 

Sources 

“The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review.” Science Direct. https://www.sciencedirect.com/science/article/pii/S0266613821001753 

“What happens after a medical termination of a pregnancy and how to cope.” What to Expect. https://www.whattoexpect.com/pregnancy/pregnancy-loss/coping-after-a-medical-termination-of-pregnancy 

An abortion doula is an individual with expertise in providing emotional, mental, and physical support throughout the abortion process, including before and after the abortion occurs. They are knowledgeable about trauma-informed care and understand how to provide emotional support under sensitive circumstances. Many abortion doulas also serve as advocates for their clients. Some examples of ways that abortion doulas provide support can include: 

• Addressing misinformation and common myths regarding abortion 
• Answering any questions or concerns about abortion 
• Easing discomfort with guided meditation, calming touch, visual relaxation, and other techniques 
• Assisting clients with getting access to behavioral health services, child care, meal planning, or other resources so they can access abortion providers

Similarly, a miscarriage doula is an individual who specializes in providing emotional, mental, and physical support surrounding the birthing process, as well as before and after delivery. Many miscarriage doulas serve as pregnancy loss doulas and birth doulas due to the nature of the circumstances. Examples of ways that miscarriage doulas provide support can include:

• Asking if the parents plan on having an ultrasound photo prior to birth 
• Assisting in articulating medical preferences 
• Bringing a tangible gift or keepsake for the mother 
• Photographing the labor, birth, funeral, or memorial service if requested 
• Writing about the birth 
• Encouraging the client’s social circle to support with meals or other gestures
• Sharing grieving resources 
• Attending medical follow-up visits with the client

Although abortion doulas and miscarriage doulas address different needs, they both have crucial roles in supporting their clients during sensitive moments in the human experience. They are skilled in helping their clients make informed decisions, guiding their overall well-being, and being a consistent source of compassion when it is needed the most. Whether clients are grieving or simply need someone who is willing to listen, abortion and miscarriage doulas are a supportive presence during a major life event. 

Sources

“How To Be A Miscarriage Doula”. Still Birth Day. https://stillbirthday.com/2011/07/how-to-be-a-miscarriage-doula/ 

“7 Different Types of Doulas and What They Do”. Planned Parenthood. https://www.plannedparenthood.org/blog/7-different-types-of-doulas-and-what-they-do

The approach to explaining a stillbirth to a younger sibling will vary based on the sibling’s age and level of understanding. It is essential to use simple and age-appropriate language that is suitable based on the child’s development. Children need straightforward and honest explanations to conceptualize what you are communicating, so it is essential to avoid using euphemisms. For example, instead of saying that the baby “went to a better place,” explain that the baby died. This might mean explaining that the baby’s body was not strong enough to continue living after birth or giving examples of things that the baby was not able to do on their own after birth. 

Depending on the age and level of cognitive development, a younger sibling may not fully comprehend what death means. Some ways to address this include explaining that the baby will not be coming home from the hospital or that it wasn’t breathing anymore when it was born. Some individuals find it helpful to share an illustrated book or watch an animated video explaining death or stillbirth. Many children ask repetitive questions about death, so it is crucial to be prepared to share the same explanation or to have multiple answers that can help them conceptualize what death means. 

Once the younger sibling understands that the baby has died, they may have concerns about whether this means that the baby’s mother is going to die, too. It can be helpful to explain that this person is still healthy and reassure them that they will not die due to what happened. Another common question that younger siblings may ask is whether they will die like the baby died. You might answer this question by reminding the siblings that they are healthy; they can eat and play, and most people die when they are much older. Additionally, it can be reassuring to remind them that nothing they said, did, or thought about that caused the death. 

Sources 

“Talking About the Loss of a Baby With Young Siblings”. Zero to Three. https://www.zerotothree.org/resource/talking-about-the-loss-of-a-baby-with-young-siblings/

“Siblings’ Grief After a Pregnancy Loss”. Prisma Health. https://prismahealth.org/services/womens-health/maternity/your-pregnancy/experiencing-a-pregnancy-loss/siblings-grief-after-a-pregnancy-loss 

Yes, there are many support groups available for families who have experienced the loss of an infant. Support groups provide a safe and supportive environment for grieving families to share their emotions, experiences, and challenges with other individuals who have lost an infant in similar circumstances. They can also help bereaved families find additional resources and guidance to help them navigate their loss. 

Joining a support group has many benefits for families who have experienced infant loss. By connecting with other people who have had similar losses, families can feel less alone in their grief journey. Additionally, the ability to share meaningful memories and stories, and discuss emotions with others who understand from experience can be deeply comforting and further support healing following the loss. Many support group members can form long-lasting friendships and find peace through their shared experience of grief and acceptance. 

Support groups can be facilitated in a variety of settings, such as in person or through an online platform. Most are categorized based on the type of loss experienced or how the loss of the infant occurred, such as a support group for sudden infant death. For individuals who aren’t yet comfortable with attending a support group session in their community, attending a support group online can provide a sense of connection and additional guidance while still maintaining a larger sense of privacy regarding a personal loss. Some groups also provide access to mental health professionals such as counselors, therapists or bereavement specialists. 

Sources

“Find Support”. March of Dimes. https://www.marchofdimes.org/find-support/topics/miscarriage-loss-and-grief 

“Find an Online Support Group”. PostPartum Support International. https://postpartum.net/get-help/psi-online-support-meetings/ 

“Online Support Groups”. First Candle. https://firstcandle.org/online-support-groups/ 

One of the most important ways to offer support to a loved one who is grieving after an abortion is to create a safe, non-judgmental space for them to express themselves. It is essential to approach the situation with respect, compassion, and empathy while encouraging your loved one to communicate their emotions openly and honestly. They may not initially feel comfortable with sharing how they feel or talking about their loss, so it’s important to let them know that you will be there to listen to them and support them when they’re ready.

As with grief in other scenarios, there are a variety of ways to be supportive. This might look like checking in with your loved one regularly or offering more practical support by taking care of household chores and other responsibilities. It is normal to feel emotionally and physically exhausted while grieving, so handling tasks or preparing meals can be very helpful. In addition to proactively offering to take care of these concerns, the approach that you take to navigating difficult conversations with your loved one can be incredibly important. 

After an abortion, your loved one may be struggling with blaming themselves for their decision and may be experiencing guilt, shame, or regret. Some may even feel that they do not have the right to grieve or experience the wide range of emotions associated with their loss. Your ability to hold space for your loved one and emphasize that you are not there to judge them can be an integral factor in helping them to work toward acceptance and healing during their grief process. In a supportive environment, a loved one who is struggling with their grief after an abortion may eventually feel more comfortable with allowing themselves to grieve more openly when they realize they aren’t being judged by friends or family members. 

It is also important to understand that providing support to your loved one does not mean that you are expected to provide a solution or advice. Unsolicited advice can sometimes seem dismissive and can potentially disenfranchise an individual who is grieving after an abortion. Instead, you should aim to show up authentically for your loved one and demonstrate active listening when they want to talk with you about their thoughts and feelings. Some individuals may develop depression after an abortion, so be mindful of any potential indicators that your loved one may need to pursue more professional support through counseling or therapy. 

Sources

“50 Practical Gestures to Help a Grieving Friend”. Authoracare Collective. https://www.authoracare.org/50-practical-gestures-to-help-a-grieving-friend 

“Emotional health after an abortion”. Northland Family Planning. https://northlandfamilyplanning.com/patient-information/emotional-health-after-an-abortion/ 

“Depression after abortion: Risk factors and how to cope”. Medical News Today. https://www.medicalnewstoday.com/articles/313098 

Navigating the grief and healing process after losing a child or experiencing pregnancy loss can be overwhelming, although there are some steps that you can take to foster healthy coping. Infant and pregnancy loss can be devastating, so it is important to give yourself the space to grieve and acknowledge your feelings for as long as necessary. It is normal to experience feelings of anger, sadness, guilt, and many other emotions that may emerge as you navigate your grief. You may even experience physical symptoms or reactions in relation to your grief. 

While you may initially experience feelings of shock or numbness, there may also be moments when you feel completely fine. The emotions associated with grief can be unpredictable, and it’s common to experience mood swings or have a mix of what feels like ‘good days’ and ‘bad days’. What matters is that you allow yourself to experience and express these emotions at your own pace. Someone else’s grief and healing process may look and feel completely different when compared to your own, so allow yourself to navigate through this process in a way that feels right for you. 

Another important aspect to consider is that you may grieve differently from your partner. Some individuals try to work through grief independently instead of seeking help or support from other people. Due to societal norms, some individuals may be uncomfortable openly grieving or displaying emotion since they are typically viewed as the source of strength in relationships. Other people may be more expressive about their grief and might seek support groups, mental health professionals, or talk with friends and family. There is no wrong or right way to grieve, but it’s important to understand that we all grieve differently in our efforts to achieve healing.

Taking the time to memorialize your baby can be helpful to the healing process. You can create a memorial, plant a tree, participate in a remembrance event, or wear memorial jewelry to honor your baby. Some people find it beneficial to establish a ritual or routine to maintain their connection with the children that they have lost. 

Even with these activities, it’s important to remember that healing takes time and often occurs very gradually. During this time, it is crucial to prioritize your physical and mental well-being as much as possible. This can involve practicing meditation, journaling on a regular basis, participating in hobbies, or attending counseling and therapy sessions. Over time, some of these activities may help you to gain a sense of acceptance of your loss. 

Sources

“Grieving for your baby after a stillbirth”. Tommy’s. https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/coping-grief-after-loss-baby-parents 

“Coping with Miscarriage”. Stanford Medicine. https://www.stanfordchildrens.org/en/topic/default?id=coping-with-miscarriage-1-4036 

“Dealing with grief after the death of your baby”. March of Dimes. https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/dealing-grief-after-death-your-baby 

There are several ways you can provide comfort and support to a friend or family member who has experienced infant or pregnancy loss. First and foremost, it is important to acknowledge their pain and offer to listen to them. Encourage them to share their thoughts and emotions if they are comfortable, and let them know that you will be there for them. Sometimes people who are grieving an infant or pregnancy loss may isolate themselves due to the intense emotional response associated with their grief, so being proactive about reaching out to them can be helpful even if you aren’t quite sure of what to say.

Although your primary goal should be to listen to what your loved one is willing to share, it is important to be mindful of what you say when you do speak. Avoid making any dismissive comments or oversimplifying what has happened to them, since this can be both disenfranchising and upsetting to your loved one. Instead, focus on validating their emotions and sharing brief condolences. While it is important to be mindful of what you say, most individuals affected by infant or pregnancy loss do not mind if their child is mentioned by name during conversations. Similarly, don’t try to avoid the topic of the loss entirely since this may seem as if you are invalidating the infant’s death. 

A friend or family member who is grieving may need additional help throughout the day. Navigating grief can make it difficult to keep up with daily tasks, routines, and responsibilities. A great way to provide support is to offer to help by assisting with meal preparation, childcare, household chores, or taking care of pets. Ask your loved one about which tasks they’re having difficulty with and if they’d be open to letting you help them for a while. There may also be some tasks associated with the loss that are simply too emotional for them to handle on their own due to their grief, such as removing baby items from a nursery or coordinating the final arrangements. 

Finally, it is crucial to understand the grieving process. Everyone experiences grief and copes differently, so remember to be patient and compassionate with your loved one as they navigate their loss. Checking in on them during important dates such as anniversaries or due dates can be meaningful and provide additional opportunities for support. If you notice they are struggling significantly, encourage them to seek professional help, such as a support group or therapy. Above all, the best way that you can support your friend or family member after an infant or pregnancy loss is to be a consistent source of love, support, and understanding as they progress through their journey of grief and healing. 

Sources 

“Supporting someone through pregnancy loss”. Miscarriage Association. https://www.miscarriageassociation.org.uk/your-feelings/supporting-someone-through-pregnancy-loss/ 

“What To Say to Someone After Miscarriage or Stillbirth”. Parents. https://www.parents.com/pregnancy/complications/miscarriage/what-to-say-to-a-friend-who-has-lost-a-baby/ 

“Tips to Support Someone After the Loss of a Baby”. New York Presbyterian  – Health Matters. https://healthmatters.nyp.org/tips-to-support-someone-after-the-loss-of-a-baby/ 

Since recovering from a pregnancy loss is a deeply personal matter, the duration of the recovery process can vary. It is important to understand that there isn’t a specific timeline for emotional healing. While emotional distress typically begins to resolve after several months, everyone grieves differently and the duration of emotional distress can be influenced by a variety of external factors. Additionally, since there is a wide range of complex emotions that emerge following a pregnancy loss, it is crucial to allow enough time and space to process these emotions and pursue additional support from loved ones or mental health professionals.

Recovering emotionally from a pregnancy loss can take significantly longer when compared to physical healing. Although the body can physically heal effectively enough to attempt to conceive after one normal menstrual cycle has occurred, it can take at least several months for emotional distress to improve and progress toward healing. Individuals who are grieving a pregnancy loss are often surprised by the intensity of emotions that they experience, as well as how unexpectedly they can emerge during their daily routine. This means that although some days may be easier to navigate than others, sometimes the intensity of emotions such as sorrow, guilt, or anger can become overwhelming. 

Support and self-care are vital components in the process of emotional recovery following a pregnancy loss. It is important to remember that there isn’t a wrong or right way to grieve. Additionally, many people find it helpful to pursue professional support, especially if the intensity of their grief is making it difficult to return to their routine after an extended period of time. 

Sources

“Coping with Miscarriage”. Stanford Medicine. https://www.stanfordchildrens.org/en/topic/default?id=coping-with-miscarriage-1-4036 

“Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4468887/ 

Although it is often overlooked, pregnancy loss can have a significant impact on the emotional and mental well-being of the father or partner. When it happens repeatedly, such as with recurrent miscarriages, the psychological impact worsens with each experience of pregnancy loss. Since many fathers and partners perceive that they are responsible for taking a supportive role in the relationship, it often prevents them from appropriately recognizing and honoring their own loss. As a result, some partners may turn to compulsive behaviors such as substance use as a coping mechanism. 

Research indicates that the grief responses of partners after pregnancy loss can differ from those of the pregnant person. Following a pregnancy loss, partners are particularly susceptible to depressive symptoms. However, the intensity and duration are often perceived to be less pronounced in comparison to the person who physically experienced the pregnancy.

There is a significant need for increased recognition and care for grieving fathers and partners since they often feel marginalized after pregnancy loss. Lack of support and insight into their experiences further contributes to the silence and stigma associated with pregnancy loss, even though the stigma of this particular loss has decreased among women. As a result, fathers and partners often internalize their grief and struggle with managing the complex physical, mental, and emotional reactions that result from the loss itself. Being mindful of this, it is important to establish better care, resources, and support for all individuals affected by pregnancy loss, with the acknowledgment that grief often extends further into the structure of the family (or chosen family).

Sources

“The experiences of men following recurrent miscarriage in an Irish tertiary hospital: A qualitative analysis”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9122424/ 

“The impact of pregnancy loss on men’s health and wellbeing: a systematic review”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5688642/ 

“’It is OK to feel it’: One dad’s mission to help men cope with pregnancy loss”. Today. https://www.today.com/parents/fathers-grieve-pregnancy-loss-much-get-no-help-t140765

The death of an infant can have a significant impact on siblings, who may experience a variety of intense emotions. These emotions can vary from sadness to frustration or anger, and some may also seem indifferent. Developmental phases can often influence how children grieve and process the loss, so sibling reactions to the death of an infant may shift as the siblings continue to age. This type of loss can have long-lasting effects on siblings, so it is important to be as supportive as possible as they navigate what may be their first experience with death, grief, and loss. 

Younger siblings may not fully comprehend the meaning of death and may require additional explanations regarding what has happened. They may notice the absence of the infant even if they do not initially connect this absence with the concept of death. Older siblings are often more noticeably affected by death. They may understand the concept of death and may have concerns that something they thought about or did may have caused the loss. They may also fear that the death of an infant means that their parents may die as well. Sometimes they may seem indifferent in an effort to seem strong and supportive to others, whereas other times they may be visibly emotional and distressed. 

It is often challenging for parents to understand how their children are affected by death since the perceptions and comprehension level of a child can vary significantly by age and developmental stage. Sometimes children don’t want to talk about the death of an infant sibling at all, often due to the uncertainty or fear surrounding the topic of death itself. Younger children might also discuss death very intermittently through brief conversations between playing or other activities. Support groups can be helpful in understanding how children grieve and experience emotions in relation to the death of an infant, especially since it can provide siblings with the opportunity to meet and interact with other children who have experienced the same loss. 

Parents should involve their children in the grieving process in age-appropriate ways. Including children in funeral or memorial arrangements in some way can sometimes help them navigate their grief as long as they receive support from parents, family members, and other loved ones. It is also important to be mindful that children can develop traumatic grief, complicated grief, or long-term emotional effects due to the loss of a sibling. Parents and caretakers are encouraged to monitor the mental health and emotional well-being of children affected by the loss of an infant sibling, since professional support and resources may be necessary. 

Sources

“​Sibling Loss: Experiencing Grief Through a Child’s Eyes”. American Academy of Pediatrics. https://www.aap.org/en/news-room/aap-voices/sibling-loss 

“Support for siblings after a neonatal death”. Tommy’s. https://www.tommys.org/baby-loss-support/neonatal-death-information-and-support/support-siblings-after-neonatal-death 

“Traumatic Grief”. The National Child Traumatic Stress Network. https://www.nctsn.org/what-is-child-trauma/trauma-types/traumatic-grief 

Early pregnancy loss, such as miscarriage and ectopic pregnancy, can have a significantly detrimental impact on a woman’s mental health. Research has shown that following pregnancy loss, women experience symptoms of depression, perinatal grief, and anxiety. Due to the traumatic nature of pregnancy loss, some women may also experience symptoms of post-traumatic stress disorder, such as nightmares, flashbacks, or intrusive thoughts. Additionally, many women continue to struggle with their mental health for years after they have successfully given birth to a healthy child. 

Women who experience early pregnancy loss don’t consistently receive appropriate mental health care. Although the medical concerns surrounding pregnancy loss are addressed, many women don’t receive patient education or follow-up appointments that address the psychological and emotional toll associated with this type of loss. Without suitable mental health care, psychological symptoms can worsen and women may struggle to cope with their grief. 

It is essential to acknowledge the psychological impact of early pregnancy loss and improve access to targeted services and resources for those who are affected. Making improvements to assessment, treatment, and communication surrounding early pregnancy loss can be crucial in achieving better patient outcomes. By increasing awareness and public health initiatives pertaining to early pregnancy loss, adequate mental health care and support can be achieved at scale. 

Sources

“Pregnancy loss: Consequences for mental health”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9937061/ 

“Women Who Miscarry Have Long-lasting Mental Health Problems”. University of Rochester Medical Center. https://www.urmc.rochester.edu/news/story/women-who-miscarry-have-long-lasting-mental-health-problems 

“After miscarriage, I was rocked by depression. Like many other women, I didn’t get follow-up care for this loss.” Washington Post. https://www.washingtonpost.com/health/after-miscarriage-i-was-rocked-by-depression-like-many-other-women-i-didnt-get-follow-up-care-for-this-loss/2019/11/29/bd3dcff0-0729-11ea-8292-c46ee8cb3dce_story.html 

After an abortion, it is common to experience uncomfortable physical and emotional symptoms, and both should lighten as days go by. For a day or two after a medication abortion (when you take abortion pills) or an in-clinic abortion (also known as surgical abortion), you will likely feel tired, experience cramping and bleeding or discharge, may have tender breasts that could leak, and could feel nausea, fever or chills. Most people are able to return to their usual level of activity the next day. If you have a Dilation and Evacuation (D&E) procedure, you may require a little more downtime. It’s important to follow your doctor’s instructions for recovery and take any medication as prescribed to help manage side effects.

After any abortion, if nausea, diarrhea or vomiting persists for over 24 hours, you should seek medical attention as it may mean you have an infection. After an in-clinic abortion, if you have cramping or pain that doesn’t improve with pain medication, are soaking two maxi pads per hour for two or more hours, or have a fever over 100.4 degrees, you should contact your doctor.

In addition to physical symptoms, it’s normal to experience a range of emotional effects after an abortion. These can include feelings of sadness, guilt, relief, grief and even numbness. Everyone’s experience with abortion is unique and there is no right or wrong way to feel afterwards. It’s important to give yourself the time and space to recover emotionally — engaging with your feelings, even if uncomfortable, can help you process the experience. You can do this on your own by journaling, or seeking support from friends, family, professionals, calling or texting a free, nonjudgmental support line, or checking online resources.

If you have concerns or are experiencing persistent or debilitating physical or emotional effects, it’s important to speak with your healthcare provider. Remember, be kind to yourself and give yourself time to heal both physically and emotionally after an abortion.

Sources

“What can I expect after I take the abortion pill?”. Planned Parenthood. https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/what-can-i-expect-after-i-take-the-abortion-pill 

“What can I expect after having an in-clinic abortion?” Planned Parenthood. https://www.plannedparenthood.org/learn/abortion/in-clinic-abortion-procedures/what-can-i-expect-after-having-an-in-clinic-abortion 

“How to Recover Emotionally After Abortion”. Waterleaf Women’s Center. https://waterleafwc.org/how-to-recover-emotionally-after-abortion/ 

“All-Options Talkline”. All-Options. https://www.all-options.org/find-support/talkline/ 

“After-Abortion Textline”. Exhale Pro-Voice. https://exhaleprovoice.org/after-abortion-textline/ 

“Support After a Miscarriage or Abortion”. Planned Parenthood. https://www.plannedparenthood.org/planned-parenthood-orange-san-bernardino/patients/miscarriage-support 

In most instances, those who have experienced a miscarriage or stillbirth can have successful pregnancies and healthy babies in the future. Early pregnancy losses usually do not result in uterine issues that can contribute to infertility. However, it is important to be aware of potential risk factors and complications that may arise in future pregnancies, especially since the odds can vary depending on whether the loss was a miscarriage or stillbirth. 

Most women who have a miscarriage will have healthy pregnancies and healthy babies in the future. It is estimated that only 1 percent of women experience recurrent miscarriages. However, the risk of a future miscarriage is estimated to be around 20 percent after the initial miscarriage has occurred. In women who have recurrent miscarriages, the risk of miscarriage continues to increase. Projected risks for miscarriages are included below:

• One miscarriage: 20 percent risk of a future miscarriage
• Two miscarriages: 28 percent risk of a future miscarriage 
• Three or more miscarriages: 43 percent risk of a future miscarriage 

These estimates are similar to those that are projected for stillbirths. Most women who have previously had a stillbirth can have healthy babies if they become pregnant again in the future. It is estimated that 1 to 2 percent of women who have experienced a stillbirth will have another during a future pregnancy. The likelihood and risk of having another stillbirth are often influenced by other factors such as whether the mother uses tobacco or has a high BMI, but can vary significantly. 

Taking care of physical and emotional health after a pregnancy loss is essential and can help increase the chances of having a healthy pregnancy in the future. Although the cause of miscarriage or stillbirth often is unknown, there is value in proactively practicing healthy lifestyle behaviors to reduce potential complications. This can include getting regular exercise, eating a balanced diet, and managing chronic conditions as much as possible. Individuals who are concerned about their risk for future stillbirth or miscarriage are encouraged to contact their healthcare provider to discuss options to increase the likelihood of having a successful pregnancy. 

Sources

“Pregnancy after miscarriage: What you need to know”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134 

“Pregnancy risk factors: Previous miscarriage or stillbirth”. All About Women Advanced Gynecology. https://www.allaboutwomenmd.com/knowledge-center/previous-miscarriage-or-stillbirth.html

Although the United States is one of the wealthiest countries in the world, it has a high infant mortality rate in comparison to other high-income and developed countries. Understanding the major contributors or causes of infant mortality is crucial in efforts to effectively reduce the death rate. The leading causes of infant mortality in the United States in 2020 were:

• Birth defects
• Preterm birth and low birth weight 
• Sudden infant death syndrome 
• Injuries 
• Maternal pregnancy complications 

Birth defects are structural changes that are present in a baby’s body at the time of birth and are often accompanied by serious health conditions. Many birth defects are found during the first year of life. Some are visibly noticeable, such as a cleft lip.  But other conditions, such as hearing loss and congenital heart defects, can only be discovered through specialized tests. Additionally, although some birth defects have a known cause, such as fetal alcohol syndrome, there are numerous birth defects that have no identifiable cause. In these instances, birth defects may be influenced by factors such as genes, parental lifestyle and health behaviors, or exposure to potentially harmful elements in the environment. 

Preterm birth occurs when a baby is born before the 37th week of pregnancy. Since babies continue to grow and develop throughout the last weeks of pregnancy, preterm birth can limit the development of vital organs such as the lungs, liver, and brain. Low birth weight is often associated with preterm births and can increase the risk for additional complications since the baby may struggle to eat, gain and maintain weight, and recover from infections. Preterm birth and low birth weight were attributed to 16% of infant deaths in the United States in 2020.  

Sudden infant death syndrome (SIDS) is a term used to describe the death of a baby under the age of one year, whose death does not have a known cause. It is distinguished from sudden unexpected infant death (SUID), which is a broader term used to reference all sudden infant deaths or those that cannot be distinguished directly from SIDS. If the medical examiner or coroner cannot determine the cause of death, it may be categorized as SIDS on the death certificate. Similarly, when babies die due to injuries such as suffocation, strangulation, or other injuries, these may be categorized as SUID. 

Maternal health complications during pregnancy can also contribute to infant mortality. Some complications that commonly occur include infections, heart conditions, blood clots, high blood pressure, and stroke. These complications can also contribute to stillbirth, miscarriage, or the death of the mother during pregnancy or shortly after giving birth. It is important to note that if potential complications are identified early in the pregnancy, they may be managed more effectively or even prevented entirely with appropriate treatment and monitoring. 

Sources

“Infant Mortality”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/maternal-infant-health/infant-mortality/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm 

“About Birth Defects”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/birth-defects/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/birthdefects/facts.html 

“Fetal Alcohol Syndrome”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fetal-alcohol-syndrome/symptoms-causes/syc-20352901 

“Preterm Birth”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/maternal-infant-health/preterm-birth/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm 

“Definitions and Terms”. Safe to Sleep. https://safetosleep.nichd.nih.gov/about/terms 

“What is SIDS/SUID?” American SIDS Institute. https://sids.org/what-is-sidssuid/ 

Several socioeconomic factors influence the rates of pregnancy loss in the United States. These socioeconomic factors include: 

• Low socioeconomic status or position
• Educational attainment
• Insurance coverage 
• Race
• Ethnicity 

Socioeconomic status is often a key determinant in pregnancy loss rates. Low socioeconomic status can result in disparities in access to education, quality healthcare and resources. This often correlates with higher pregnancy loss rates among low-income and poverty-level populations. Pregnant women with low socioeconomic status also have significantly more depressive symptoms and higher stress levels, particularly during the third trimester. Low socioeconomic status is often associated with limited access to prenatal care, food insecurity or inadequate nutrition, and increased environmental exposure to hazards in disadvantaged communities. 

Insurance coverage can also significantly affect access, quality, and level of care received during pregnancy. Interrupted care and delayed access to services through Medicaid can result in adverse health and birth outcomes. Unfortunately, many women with Medicaid are less likely to start prenatal care during their first trimester of pregnancy and less likely to receive suitable prenatal care when compared to women with private insurance. While this does not result in noticeable differences in birth outcomes or pregnancy loss, it demonstrates how access to care can vary significantly for low-income people. 

Numerous studies have documented increased maternal death in women with lower education levels, public or no insurance coverage, or minority race and ethnicity. Racial and ethnic disparities often have a prominent influence on pregnancy loss and maternal and infant health. For example, the pregnancy-related mortality rate for Black women who have completed a college education or beyond is 5.2 times higher than that for white women with the same level of educational attainment. Similarly, Black women who receive adequate prenatal care have higher rates of infant mortality even when compared to white women who receive little or no prenatal care, suggesting that issues such as structural racism influence pregnancy loss even in the absence of socioeconomic factors.

Sources 

“Fact Sheet: Women & Socioeconomic Status”. American Psychological Association. https://www.apa.org/pi/ses/resources/publications/women 

“Access in Brief: Pregnant Women and Medicaid”. Medicaid and CHIP Payment and Access Commission. https://www.macpac.gov/wp-content/uploads/2018/11/Pregnant-Women-and-Medicaid.pdf 

“Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7104722/ 

“Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them”. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/ 

“Why Are Black Mothers at Higher Risk for Miscarriage?” WebMD. https://www.webmd.com/baby/features/why-black-mothers-higher-risk-miscarriage 

Maternal health has a direct role in the incidence of pregnancy loss and stillbirth, most notably through the influence of several factors. While this does not mean that the mother caused the pregnancy loss, it is important to acknowledge that the mother’s health can affect the outcome of the pregnancy. Common factors that influence pregnancy loss and stillbirth include: 

• Pre-existing medical conditions 
• Prenatal care 
• Maternal age 
• Lifestyle choices 
• Healthcare access 
• Socioeconomic factors 

Pre-existing medical conditions such as hypertension, autoimmune disorders, and diabetes can increase the risk of pregnancy complications, especially if they are not effectively managed. Once a pregnancy has been identified, maintaining regular check-ups and screenings enables healthcare providers to discover potential health concerns early enough to provide the necessary interventions to support the well-being of mother and child. 

Advanced maternal age has been found to be correlated with stillbirth and pregnancy loss. Advanced maternal age, generally defined as pregnancy at 35 years or older, has been found to be correlated with stillbirth and pregnancy loss. This increased risk is primarily associated with biological factors, such as the development of chromosomal abnormalities. Furthermore, advancing age is also associated with a higher prevalence of underlying maternal health conditions.

Separately, modifiable lifestyle choices and environmental factors can have a significant impact on maternal and fetal health, resulting in an increased risk of complications. Smoking, alcohol, and substance use often have a direct association with adverse pregnancy outcomes. Additionally, factors such as poor nutrition, high stress levels, and exposure to environmental toxins are also recognized contributors. 

Healthcare access is another pivotal factor in relation to pregnancy loss and stillbirth. For some pregnant women, access is compromised because there are very few medical facilities within the community, prenatal care is not an option at available facilities, or only basic care is offered to patients. Similarly, there may be limitations based on whether patients have private, public, or no insurance coverage. Minimal healthcare access is often adjacent to the socioeconomic factors that influence the incidence of pregnancy loss, such as inadequate nutrition, poverty, status or position, educational attainment, and more. 

In consideration of these factors, efforts to reduce the incidence of pregnancy loss and stillbirth should include a greater focus on addressing and improving maternal health. Providing education regarding healthy lifestyle choices, increasing access to healthcare services, and ensuring the availability of comprehensive prenatal care are all actions that can proactively address maternal health outcomes. Additionally, focusing on providing more widespread support that is inclusive of individuals from marginalized groups can further reduce the prevalence of pregnancy loss.

Sources

“Pregnancy Loss (Before 20 Weeks of Pregnancy)”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/factsheets/pregnancyloss 

“Advanced Maternal Age”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22438-advanced-maternal-age 

“March of Dimes Research Shows Access to Care Worsening for Millions”. March of Dimes. https://www.marchofdimes.org/about/news/march-dimes-research-shows-access-to-care-worsening-millions 

Although the exact causes of stillbirth can be difficult to determine, researchers have identified several potential causes or contributing factors to stillbirth. It is important to note that in most instances, the cause of a stillbirth will remain unknown even after significant testing. However, analyses of data from the Stillbirth Collaborative Research Network (SCRN) have suggested that stillbirths often result from the following potential causes or contributing factors:

• Pregnancy and labor complications
  • Preterm labor 
  • Pregnancy with twins or triplets 
  • Separation of the placenta 
• Issues with the placenta, namely insufficient blood flow 
• Birth defects and fetal genetic abnormalities 
• Infection
  • Escherichia coli 
  • Group B Streptococcus 
  • Enterococcus 
• Issues with the umbilical cord, such as knotting or squeezing 
• High blood pressure
  • Preeclampsia 
  • Chronic high blood pressure before pregnancy 
• Medical problems before pregnancy, such as a chronic condition like diabetes 

Other potential factors contributing to an increased likelihood of stillbirth include exposure to trauma or unhealthy lifestyle behaviors such as tobacco, alcohol, and substance use. However, doctors consider stillbirth to be a multifactorial occurrence, meaning that multiple factors or potential causes may be involved. This can make it difficult for healthcare providers to determine the exact cause of the loss, even with comprehensive testing. The enormous emotional impact of stillbirth on those affected further highlights the need for further research, education, and specialized support.

For this reason, ongoing efforts aim to increase awareness and research on stillbirth prevention. By addressing the significant causes of stillbirth and reducing the likelihood by targeting specific risk factors, researchers and healthcare professionals may eventually be able to reduce the incidence of stillbirth. Likewise, individuals and families impacted by the intense emotional toll of stillbirth will be more likely to receive adequate and appropriate support.  

Sources

“What are possible causes of stillbirth?” U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/causes 

The United States has the highest infant mortality rate in comparison to other high-income countries. When mortality data were analyzed in 2021, the United States was found to have an infant mortality rate of 5.4 deaths per 1,000 live births. The leading causes of infant mortality in 2021 included: 

• Birth defects
• Preterm birth and low birth weight 
• Sudden infant death syndrome (SIDS)
• Injuries 
• Maternal pregnancy complications 

Within the United States, the highest infant mortality was observed in the South, the Midwest, and Alaska. Additionally, only 19 states were able to meet the targeted objective of reducing infant deaths to 5.0 per 1,000 live births. Ethnic and racial disparities have also emerged from the high infant mortality rate with a leading rate of 10.6 infant deaths per 1,000 live births among non-Hispanic Blacks. The breakdown of infant mortality rates by race and ethnicity for 2021 indicated the following findings:

• Non-Hispanic Blacks: 10.6 
• Non-Hispanic Native Hawaiian or other Pacific Islander: 7.8 
• Non-Hispanic American Indian/Alaska Native: 7.5 
• Hispanic: 4.8 
• Non-Hispanic White: 4.4 
• Non-Hispanic Asian: 3.7 

Given the significance of the high infant mortality rate in the United States, efforts are being made to improve birth outcomes and gradually reduce infant mortality. Rate reduction can be achieved by addressing social and health risk factors, acknowledging the need to improve quality and access to maternal pregnancy care, and developing strategies to reduce ethnic and racial disparities. Working collaboratively with healthcare providers and communities to increase initiatives and education regarding the leading causes of infant death can improve the likelihood of attaining better outcomes for all infants in the future. 

Sources

“U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes”. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 

“Infant Mortality”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/maternal-infant-health/infant-mortality/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

Stillbirth typically affects around 1 in 160 pregnancies each year in the United States, and there were around 21,000 reported cases of stillbirth in 2020. Improvements in maternity care have helped to reduce the occurrence of stillbirth. However, the decline has slowed in recent years, and it remains a significant concern around the world. Among pregnancy loss, stillbirth is differentiated from miscarriage based on the number of weeks of pregnancy before fetal death. Stillbirths are characterized by fetal death after 20 weeks, whereas miscarriages are characterized by fetal death before 20 weeks. There are also three classifications of stillbirths in relation to the weeks of pregnancy: 

• Early stillbirth: Fetal death between 20 and 27 weeks of pregnancy 
• Late stillbirth: Fetal death between 28 and 36 weeks of pregnancy 
• Term stillbirth: Fetal death during the 37th week of pregnancy or beyond 

Stillbirths can affect any pregnancy, and healthcare experts are still learning what contributes to this form of pregnancy loss. There are risk factors that can increase the likelihood of a stillbirth occurring during pregnancy. These factors include:

•  Chronic health conditions
•  Previous pregnancy complications
•  High-stress levels
•  Substance use
•  Limited access to resources and prenatal care
•  Being within certain age groups, such as adolescents and women aged 35 or older. 

Healthcare providers need to identify potential risk factors and address them with patients early in the pregnancy to reduce the incidence of stillbirth. Although there is much that remains unknown about the cause of stillbirth, reducing health disparities among patient populations and proactively working with patients to introduce more healthy lifestyle behaviors can improve chances for positive outcomes. Additionally, numerous public health initiatives and studies are being conducted to help healthcare professionals better understand the cause of stillbirth and how to prevent it. 

Sources

“Stillbirth”. March of Dimes. https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/stillbirth 

“Data and Statistics on Stillbirth”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/stillbirth/data-research/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/stillbirth/data.html 

“Stillbirth”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9685-stillbirth 

It has been estimated that around 10% to 20% of known pregnancies result in miscarriage. Frequently, miscarriages occur very early into the pregnancy, often before the pregnancy has been identified. This means that the actual number of miscarriages that occur may be significantly higher than this estimate. Another estimate suggests that 23 million miscarriages happen annually on a global scale. 

The loss of a pregnancy is classified as a miscarriage when it occurs prior to reaching 20 weeks of pregnancy. Most miscarriages are caused by chromosomal abnormalities, which result in around 50% of all miscarriages during the first 13 weeks of pregnancy, or the first trimester. These chromosomal abnormalities occur when an egg or sperm has more or less chromosomes than normal, resulting in an abnormal number of chromosomes for the fetus. Chromosomal abnormalities that do not result in a miscarriage will often develop into chronic conditions such as Down syndrome, Patau Syndrome, and trisomy 16. Infants born with these abnormalities typically suffer from a range of birth defects. 

After the first trimester has passed, risk of miscarriage can drop significantly but is not entirely eliminated. Although chromosomal abnormalities account for a high percentage of miscarriages, there are many other factors that are believed to increase the risk of miscarriage. These factors can include:

• Exposure to TORCH diseases
  • Toxoplasmosis 
  • Other infections such as HIV, parvovirus B19, syphilis, and varicella 
  • Rubella 
  • Cytomegalovirus 
  • Herpes simplex virus 
• Infections 
• Uterine abnormalities 
• Being over the age of 35 
• Hormonal imbalances 
• Tobacco, alcohol, or drug use 
• Unmanaged diabetes 
• Radiation 
• Thyroid disease 
• Congenital heart disease 
• Severe kidney disease 
• Malnutrition 
• Autoimmune disorders 
• Certain medications 
• Cervical insufficiency 

Most miscarriages are not the result or consequence of something that someone did or did not do, although many people blame themselves when a miscarriage occurs. The factors that contribute to an increased risk of miscarriage are typically not factors that most people are able to control or even influence, especially those that are related to chromosomal abnormalities, age, or pre-existing conditions. Additionally, miscarriages are not always an indicator of a fertility issue. Around 87% of women who have experienced a miscarriage are capable of having successful pregnancies and births in the future. 

Sources

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

“Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/33915094/ 

“Down Syndrome”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/birth-defects/about/down-syndrome.html 

“Trisomy 13 (also known as Patau syndrome)”. Minnesota Department of Health. https://www.health.state.mn.us/diseases/cy/trisomy13.html 

“A rare description of pure partial trisomy of 16q12.2q24.3 and review of the literature”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9082733/ 

“Birth Defects”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12230-birth-defects 

“Miscarriage”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9688-miscarriage 

SevenPonds recommends the following resources to our clients who wish to learn more about pregnancy and infant loss.

Share Pregnancy and Infant Loss Support

This organization (Share) operates as a vital national touchpoint for families navigating the immediate and long-term aftermath of miscarriage, stillbirth, or early infant death. By providing a blend of virtual support groups, packet resources, and targeted peer connections, it fosters a community where grief is openly validated rather than silenced. Their secondary focus includes educating employers, friends, and spiritual leaders on how to properly sustain the family unit during profound bereavement.

Return to Zero: H.O.P.E. (RTZ Hope)

RTZ Hope bridges the gap between grassroots peer support and clinical mental health practices, specializing in holistic healing pathways for families experiencing reproductive trauma. The non-profit designs trauma-informed processing workshops and specialized retreats tailored to different stages of the grief journey, including spaces for mothers ready to physically and emotionally reconnect with themselves. Additionally, they provide crucial, structured guidance for families navigating the complex anxiety of a subsequent pregnancy after a loss.

Postpartum Support International (PSI) – Perinatal Loss Care

While globally recognized for maternal mental health advocacy, PSI maintains a highly specialized, dedicated wing focused entirely on reproductive and infant loss. They offer free, weekly online support groups facilitated by trained mental health professionals who understand the intersecting biological and psychological challenges of postpartum grief. By ensuring accessible, remote care, PSI protects vulnerable parents from having to suffer in isolation during their darkest moments.

Pregnancy Loss and Infant Death Alliance (PLIDA)

PLIDA serves as a central international framework that connects healthcare practitioners, researchers, and parent advocates to standardize the quality of perinatal bereavement care. The alliance develops evidence-based practice guidelines and position statements used to train hospital staff in relationship-based, trauma-informed bedside communication. Their work ensures that hospitals view compassionate bereavement care as a mandatory clinical imperative rather than an optional service.