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Stillbirth is not miscarriage

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Monday, April 25, 2011

Stillbirth is not miscarriage

Those who have not gone through a prenatal loss often lump all prenatal losses into the same category: "miscarriage." We've heard things like, "How's Jamie doing since the miscarriage?" or, "My friend had a miscarriage recently too."

Miscarriages are tremendously painful. My sister-in-law had 2 miscarriages last year and at Kaylee's service, I noted that she had 2 cousins to greet her in heaven. My brother and his wife were probably more emotionally impacted by Kaylee's death than any of my other siblings because they could relate to that loss in a way that was more understanding. Pointing out the difference in stillbirth and miscarriage does nothing to diminish the significance of a miscarriage.

But a stillbirth is not a miscarriage.

For the purpose of this post, I'm including "preterm deliveries" in the same category as "stillbirths" since some babies who are lost prenatally are actually born alive for a short time and are therefore not technically stillborn. These infant losses are usually cases in which a known birth defect will not allow the child to live for more than a few minutes or hours outside of the womb.

The National Center for Biotechnology Information (NCBI) defines miscarriage like this:
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. (Pregnancy losses after the 20th week are called preterm deliveries.)
I suspect the clarification regarding the difference between a pre- and post-20-week loss is due to confusion that people have. I also suspect this confusion is because miscarriage is so common, so it's the term people know.

And this is part of what makes stillbirth so different from miscarriage: miscarriage is a relatively common event. Many couples wait to announce a pregnancy until after the first 10 to 14 weeks gestation, knowing that their risk for a prenatal loss has significantly dropped after the first trimester.

The NCBI underscores the commonality of miscarriage with this data:
It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15-20%.
By contrast, the rate of stillbirth is less than 1%. Here's a summary from Wikipedia:
The mean stillbirth rate in the United States is approximately 1 in 115 births.... In Australia, England, Wales, and Northern Ireland, the rate is approximately 1 in every 200 births, in Scotland 1 in 167.
I should point out that a more common definition of stillbirth in other countries is any baby who weighs more than 1 pound (weight determinations vary from 350 to 500 grams). More broadly, online forums usually simply divide the two categories of prenatal loss into "miscarriages" and "2nd and 3rd trimester losses."

So it's well-established that miscarriage is far more common than stillbirth and that one occurrence is generally considered to be before 20 weeks gestation and the other is after. But still, a loss is a loss, right? Are the two losses really that different? Why get particular about the technical definitions?

We have friends who have had the awful experience of going through both a preterm delivery and a few miscarriages. They talk about the miscarriages as a footnote of life. By contrast, they often speak of their son who died at 28 weeks gestation. They have pictures with him on a wall in their home. They reached out to us as soon as they learned of Kaylee's diagnosis to relay their own experience with a preterm delivery.

Life is no less real in the first trimester of pregnancy than it is in the second or third. However, our experience with the child certainly changes in that time and we become more attached to the baby we're waiting to meet. Here are just a few things that make the connection to the baby so much more significant later in pregnancy:
  • A baby bump develops (~12-16 weeks)
  • Gender is often known (~16-20 weeks)
  • Baby kicks (~16-22 weeks)
  • Baby becomes viable outside the womb (~23 weeks)
  • Baby is often named
These are just a few of many developments that bring us closer to the baby we're about to welcome into the world.

Each one of us loves our children dearly from the moment we see that positive pregnancy test. Each one of us grieves our prenatal losses, the children we never got to meet here on earth.

But I've never seen a memorial service or a funeral for a child who was lost in the first trimester. A baby lost within the first month or two rarely has an empty nursery waiting for them. Parents of miscarried children have just begun to dream of the life they're going to give their new babies; parents of stillborn children have often purchased the going-home outfits, built the cradles, and bought the car seats.

Of course, there are exceptions to every rule. For every 5 people who reached out to me with their stillbirth story, 1 has reached out with their story of miscarriage. Miscarriage impacts each person who goes through it differently. For some, miscarriage is a footnote of life and for others it's one of the most significant events they've gone through. But while each family's experience with stillbirth is also different, I have yet to meet a parent who has gone through a second or third trimester loss and has not been permanently and tremendously affected by it.

Stillbirth is not miscarriage. Miscarriage is not stillbirth. No parent going through either experiences wishes to be in either camp, but no grieving parent wishes their camp to be confused with the other. To understand the place in which each prenatal loss falls is to understand just a little more what each family is going through. For the sake of grieving moms and dads, the distinction is worth understanding.

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Blogger Pat Stream declared,

Great post Joey, pointing out a necessary distinction. At a minimum, having an awareness of the differences between the two tragedies is important to sufficiently loving someone going through either.

4/25/2011 2:58 PM  
Blogger Carla declared,

Thank you for this, Joey.

You have thoughtfully and gently educated.

4/26/2011 10:20 AM  
Blogger Carla declared,

I have been to several small, quiet servies for babies lost in the first trimester. FYI

4/26/2011 10:22 AM  

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