An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study

BACKGROUND Stillbirth occurring after 28 weeks gestation affects between 1.5-4.5 per 1,000 births in high-income countries. The majority of stillbirths in this setting occur in women without risk factors. In addition, many established risk factors such as nulliparity and maternal age are not amenable to modification during pregnancy. Identification of other risk factors which could be amenable to change in pregnancy should be a priority in stillbirth prevention research. Therefore, this study aimed to utilise an online survey asking women who had a stillbirth about their pregnancy in order to identify any common symptoms and experiences. METHODS A web-based survey. RESULTS A total of 1,714 women who had experienced a stillbirth >3 weeks prior to enrolment completed the survey. Common experiences identified were: perception of changes in fetal movement (63% of respondents), reports of a "gut instinct" that something was wrong (68%), and perceived time of death occurring overnight (56%). A quarter of participants believed that their baby's death was due to a cord issue and another 18% indicated that they did not know the reason why their baby died. In many cases (55%) the mother believed the cause of death was different to that told by clinicians. CONCLUSIONS This study confirms the association between altered fetal movements and stillbirth and highlights novel associations that merit closer scrutiny including a maternal gut instinct that something was wrong. The potential importance of maternal sleep is highlighted by the finding of more than half the mothers believing their baby died during the night. This study supports the importance of listening to mothers' concerns and symptoms during pregnancy and highlights the need for thorough investigation of stillbirth and appropriate explanation being given to parents.