Stillbirth is a devastating experience, and it is completely understandable for parents to look back over the pregnancy and ask whether earlier concerns should have been taken more seriously. Some stillbirths cannot be prevented, but warning signs such as changes in a baby’s movements, concerns about a baby’s growth, maternal high blood pressure, vaginal bleeding, abdominal pain or severe itching should always be listened to and properly assessed.

When parents raise concerns during pregnancy, midwives, doctors and maternity units should respond with care. Where the right checks are not carried out, or where clear warning signs are dismissed, there may be grounds to investigate whether medical negligence played a role.

In this guide, the medical negligence experts at JMW will explain what can cause stillbirth in pregnancy, potential warning signs and the options available to families who feel that medical mistakes may have contributed to this tragic outcome.

What Causes a Stillbirth?

Stillbirth is when a baby dies before birth after 24 completed weeks of pregnancy. According to data from the NHS, this sadly occurs around once in every 250 births in England.

In many cases, parents may not receive one clear answer about why their baby was stillborn. Most stillbirths occur in otherwise healthy babies, with statistics from the charity Tommy's suggesting that around 60% of stillbirths are unexplained. However, in other cases, there are known causes, associated conditions and other pregnancy complications that may play a role.

These include:

• Problems with the placenta: many stillbirths are linked to complications with the placenta, which supplies oxygen and essential nutrients to the baby in the womb enabling the baby to grow.
• Placental abruption: this happens when the placenta separates from the womb before the baby is born. It may cause bleeding or abdominal pain.
• Pre-eclampsia: this is a condition that causes high blood pressure in the mother and can create serious risks during pregnancy.
• Umbilical cord problems: the umbilical cord connects the baby to the placenta. Problems that can cause stillbirth include cord prolapse, where the cord slips down before the baby is born, or the cord becoming wrapped around the baby or knotted.
• Intrahepatic cholestasis of pregnancy: also known as obstetric cholestasis, this is a liver disorder associated with severe itching during pregnancy.
• Birth defects or genetic conditions: in some cases, a stillborn baby may have a genetic physical defect or another condition that affects their development.
• Diabetes: pre-existing diabetes can be associated with stillbirth and often requires careful and frequent monitoring during pregnancy.
• Infection: some infections in the mother can also affect the baby. These may include bacterial infections that travel from the vagina into the womb, such as chorioamnionitis or Group B Streptococcus (GBS), as well as other infections such as rubella, parvovirus B19, cytomegalovirus and listeriosis.

There are also a number of potential risk factors that may increase the chances of stillbirth:

• Having twins or a multiple pregnancy
• Having a baby who is not growing as expected in the womb
• Being under 20 or over 35 years old
• Smoking, drinking alcohol or misusing drugs while pregnant
• Having a body mass index of 30 or above
• Having a pre-existing physical health condition, such as diabetes, high blood pressure, anaemia or kidney disease

A baby’s growth is an important part of antenatal care. Midwives should check the baby’s growth and wellbeing at antenatal appointments, and that if a baby is smaller than expected or their growth pattern tails off as the pregnancy continues, this may suggest the placenta is not working properly. This can increase the risk of stillbirth.

To learn more about potential stillbirth causes, visit the NHS website.

Why Early Concerns During Pregnancy Matter

Mothers often know what feels normal for their pregnancy. If a baby’s movements change, symptoms suddenly appear, or something feels wrong, those concerns should always be taken seriously.

The NHS advises that you should contact your midwife or maternity unit immediately if you notice your baby’s movements slowing down, stopping or changing. You should not wait until the next day or your next routine appointment to seek advice.

Concerns that should be raised straight away include:

• Reduced movements in the baby: a change in your baby’s movements can be an important warning sign. This may include fewer movements, weaker movements or a pattern that feels unusual for your baby.
• Baby’s movements slowing or stopping: if your baby is moving less than usual, or you cannot feel them moving, you should contact your midwife or maternity unit immediately.
• Concerns about the baby’s growth: if your baby’s growth has slowed, their growth pattern tails off, or you are told your baby may be smaller than expected, this may need closer monitoring.
• Vaginal bleeding: bleeding during pregnancy should always be checked, especially if it is accompanied by abdominal pain or changes in your baby’s movements.
• Abdominal pain: sudden or severe abdominal pain can be linked to serious problems, including placental abruption, where the placenta separates from the womb before birth.
• High blood pressure readings: high blood pressure can be linked to pre-eclampsia and should be monitored carefully during pregnancy.
• Severe itching: severe itching, particularly if it affects the hands or feet and is worse at night, can be linked to obstetric cholestasis, a liver disorder that can develop in pregnancy.
• A strong sense that something is wrong: parents should never feel embarrassed about asking for help. If something feels different, it is better to contact a midwife, maternity triage unit or doctor and ask for advice.

Although these may not result in anything serious with your baby, it is important to raise  concerns early, as they may be the first sign that a baby’s health needs to be checked. The midwife or doctor can act accordingly and also put your mind at ease should everything be fine once checked. Checks might involve listening to the baby’s heartbeat, arranging monitoring, reviewing the baby’s growth, checking blood pressure or carrying out further tests. Assessing the baby’s wellbeing promptly can make a meaningful difference.

Learn more from the NHS about preventing stillbirths.

When Can Stillbirth Be Linked to Medical Negligence?

Not every stillbirth happens because of medical negligence. In some cases, even with appropriate care, it may not have been possible to prevent the baby sadly dying before birth. However, a medical negligence claim may be possible if a midwife, doctor or hospital team failed to provide the standard of care expected, and earlier action may have changed the outcome.

Examples of potential medical negligence may include:

• Changes to the baby’s movements that were not investigated: if a mother reported that her baby’s movements had slowed, stopped or changed, this should usually have led to an assessment. Depending on the stage of pregnancy, this may have included checking the baby’s heartbeat, arranging cardiotocography (CTG) monitoring and/or asking an obstetrician to review the situation.
• Concerns about the baby’s growth were missed: if the baby’s growth appeared to slow down, or the growth pattern tails off as the pregnancy continues, doctors and midwives should consider whether the baby needs closer monitoring. Missed foetal growth restriction may increase the risk of stillbirth.
• High blood pressure was not acted on: high blood pressure during pregnancy can be linked to pre-eclampsia and problems with the placenta. If abnormal readings, symptoms or test results were not followed up, this may have placed the mother and baby at avoidable risk.
• Gestational diabetes was not managed properly: where gestational diabetes is diagnosed, the pregnancy may need closer monitoring. If concerns about the baby’s growth, wellbeing or timing of birth were not reviewed properly, this may raise questions about the care provided.
• Symptoms of placental abruption were not escalated: placental abruption can happen when the placenta separates from the womb before birth. Symptoms such as vaginal bleeding, abdominal pain or changes in the baby’s movements should be treated seriously.
• Umbilical cord problems were not responded to urgently: umbilical cord problems, including cord prolapse, can affect the baby’s oxygen supply. In urgent situations, delays in recognising and responding to these problems may have serious consequences.
• Abnormal monitoring or scan results were not followed up: if CTG monitoring, ultrasound scans, blood flow checks or other tests suggested concerns about the baby’s health, the results should have been reviewed and acted on.
• Problems with the baby’s heart rate during labour were not escalated: during labour, the baby’s heart rate can slow down during contractions and then recover, which is normal. However, sometimes the baby’s heart rate can slow down and not recover, which requires intervention to deliver the baby. If CTG monitoring is in place, this dip in the baby’s heart rate should be noted and acted upon should it fail to recover promptly. If not, the consequences can be catastrophic. 
• Parents were not given clear safety advice: before someone is sent home from triage, hospital or an antenatal appointment, they should be told what symptoms to look out for and when to return or call for urgent advice.

The key question is whether the care provided at the time was reasonable. If warning signs were dismissed, investigations were delayed, or a known risk was not monitored, it may be possible to investigate whether earlier action should have been taken.

What Should Doctors and Midwives Do When Concerns Are Raised?

When a pregnant woman raises a concern, the response should depend on what she has reported, how many weeks of pregnancy she is at, her medical history and whether there are any known risk factors. The concern should be listened to, recorded and assessed in line with the symptoms described.

Depending on the situation, doctors and midwives may need to:

• Listen carefully to the concern: maternity staff should take the time to understand what has changed, when it started and whether there are any other symptoms, such as vaginal bleeding, abdominal pain, severe itching or reduced baby’s movements.
• Check the baby’s heartbeat: if there are concerns about the baby’s movements or wellbeing, checking the heartbeat may be an important first step.
• Arrange CTG monitoring: a CTG trace may be needed to monitor the baby’s heartbeat and look for signs that the baby needs further assessment.
• Review the baby’s growth: if there are concerns about the baby’s growth, doctors and midwives may need to review growth charts, fundal height measurements or scan results.
• Arrange an ultrasound scan: scans may be used to check the baby’s growth, amniotic fluid, placental blood flow, depending on the concern raised.
• Check the mother’s health: this may include blood pressure checks, urine tests, blood tests or reviewing symptoms that may suggest pre-eclampsia, gestational diabetes, infection or a liver disorder.
• Escalate concerns to an obstetrician: if symptoms suggest that the baby or mother may need urgent review, a midwife should involve a doctor or obstetrician promptly.
• Give clear advice before discharge: if a mother is sent home from triage, hospital or an antenatal appointment, she should be told what to look out for, when to return and who to contact if symptoms continue or change.

These steps will not be required in every situation. However, when a mother reports a change in the baby’s movements, a concern about the baby’s growth or symptoms that may point to serious problems, the response should be careful, timely and clearly recorded.

What If My Concern Was Dismissed and My Baby Was Stillborn?

If you raised a concern during pregnancy and your baby was stillborn, it is natural to question whether more should have been done. Many bereaved parents replay appointments, phone calls and hospital visits in their minds, especially if they felt dismissed or reassured when something did not feel right.

It is important to remember that you were entitled to rely on the advice you were given. You should not blame yourself for trusting a midwife, doctor or maternity unit. When a parent reports a reduction in a baby’s movements, a change in the baby’s growth, abdominal pain, vaginal bleeding, severe itching or another concern, maternity staff have a responsibility to assess the situation properly and decide whether further checks are needed, in order to help prevent perinatal deaths.

If you are worried that warning signs were missed, useful evidence may include:

• Maternity notes: these may show what you reported, what checks were carried out and what advice you were given.
• Triage records: these can help to confirm when you contacted the maternity unit, what symptoms you described and whether you were asked to attend hospital.
• CTG traces: these record the baby’s heartbeat and whether the results needed further review, e.g. if the heart rate dipped and was slow to or failed to recover
• Scan reports and growth charts: these document the baby’s growth and may indicate foetal growth restriction or problems with the placenta.
• Blood pressure, urine and blood test results: these may be important if there were concerns about high blood pressure, pre-eclampsia, gestational diabetes, infection or a liver disorder.
• Phone records, messages or written notes: these may help to build a timeline of when you raised concerns and what response you received.
• Evidence from a partner, relative or friend: someone who attended appointments or heard advice being given may be able to help explain what happened.

A medical negligence solicitor can review the timeline, obtain the medical records and consider whether the care you received met a reasonable standard. Where needed, independent experts can advise on whether earlier assessment, monitoring, escalation or delivery may have changed the outcome.