A mum without a baby

The delivery suite was dimly lit. The air was still and the room appallingly quiet. She was sitting on the edge of the bed weeping. Her eyes were red and puffy. Her husband, standing next to her, was holding and hugging her tightly. They were gazing attentively at their baby boy who was lying motionless in a little white crib He was a stillborn.

E, a first-time mum was at her 32 weeks of gestation. She was admitted to the hospital because her water bag had burst and the umbilical cord had slipped out into the birth canal. Oxygen to the baby was cut off abruptly. Her baby’s heart had stopped beating on arrival to the hospital. Following my advice, labour was induced with her consent and a stillborn delivered the next day.

Every year across the world, there are more than three million babies who are delivered as stillborn. In Singapore, the number is around 80 to 120.

Stillbirth refers to foetal death occurring during pregnancy or delivery. Majority happen before labour and in 30 to 40 percent of cases, no cause can be found.

Common causes of stillbirths include:

1. An abnormal baby due to:

• Chromosomal, genetic or metabolic abnormalities

• Structural abnormalities

2. Placental malfunction:

• Placental abruption or premature separation of the placenta can result in foetal death by cutting off the oxygen supply to the foetus. Preeclampsia or pregnancy induced hypertension increases the risk of abruption by twofold.

• IUGR (intrauterine growth restriction), preeclampsia, gestational diabetes, or postdates pregnancy are more liable to placental malfunction

3. Umbilical cord accident:

• Cord prolapse as in E’s case

• Cord round the baby's neck (nuchal cord) which becomes too tight and cuts off the oxygen supply to the baby

4 Maternal conditions and lifestyle:

• Bacterial or viral infection of the mother may cause foetal death

• Alcohol and cigarette consumption by the mother

There are some risk factors which predispose the mother to deliver a stillborn. They include

• Age: teenage and older mums (35 years and above) are more prone to have stillbirths

• Obesity: Women who are overweight are more prone to having stillbirth

• Multiple pregnancies

• History of previous pregnancy loss

To help E cope emotionally with the loss of her baby, I advised her to consult a professional counsellor as grieving is a vital step in the recovery process. Her friend also invited her to join a support group of child bereavement in her church.

Three months had passed. I received a letter from E.

” Dear Doc, let me share with you my feelings soon after I lost my baby. I was confused, sad, frustrated and bewildered. My nights were long. I could not sleep well, often waking up in the middle of the night staring at the cot I had prepared for him and searching desperately for him. These were the darkest hours of my life. I was in a bottomless abyss. Thanks for your help in getting me the professional counsellor. I am slowly but gradually coming out of my grief. I am feeling much better now."