When Samantha Banerjee was pregnant with her first daughter, Alana, she had what felt like the perfect pregnancy and felt thrilled she was finally going to be a mother.
“I really thought that I knew everything there was to know about being pregnant and how to have a healthy pregnancy and a wonderful birth,” Banerjee, 36, who lives outside New York City and is the executive director of PUSH for Empowered Pregnancy, told TODAY. “I was so looking forward to it.”
Four days before her due date, she was lying in bed when she felt Alana kicking, as she often did at night. But it was different.
“They felt like waves rolling through my belly. It was weird. And I didn’t really know what it was but I knew I’d been having Braxton Hicks contractions and I hadn’t felt them. They were showing up on the monitor when I went in for my regular checkups,” she explained. “I was like, ‘Oh, this must be Braxton Hicks contractions, I reckon. It’s finally stronger for me to feel it.’”
Then the movement stopped and she discover a little bit of blood. Previously, her doctor had ruptured her membranes to induce labor and told her to expect it. The next day, she felt her first “real contraction.” For a day, she labored at home. When she called her doctor, she heard a question that made her pause.
“The midwife who was on the call said, ‘Oh, how’s your baby moving?’ and I said, ‘Oh you know, I’m having a really hard time telling the difference between the contractions and the movements,’” she said. “She’s like, ‘Hmmm maybe you should come in just to be safe.’”
Banerjee’s contractions hadn’t progressed enough so she drank some strawberry lemonade and laid on her side to count the kicks. She was told she needed to feel 10 kicks in an hour (a guideline she later learned is outdated). She only felt contractions. Panicked, she rushed to the hospital.
“I thought my worst fear was coming true, which is I was about to rush into an emergency C-section,” she said. “The thought had never occurred to me that, in this ... low risk, perfect pregnancy, that my baby died.”
The midwife struggled to find Alana’s vitals.
“They said, ‘I’m so sorry. There’s no heartbeat,’” Banerjee said. “The entire world just came crashing down around us. It was this surreal nightmare.”
Since 2013, she’s been researching why her healthy pregnancy ended in stillbirth and joined PUSH to raise awareness of preventable stillbirths to help others.
“You know your baby and your body better than anyone else. If you’re noticing that something is different and you don’t feel reassured by the testing they’re doing or whatever you’re being told, keep speaking up,” Banerjee said. “You are your baby’s best advocate and you can literally be saving your own or your baby’s life.”
Stillbirths in the United States
The Center for Health Statistics considers fetal death at 20 weeks or later a stillbirth.
“The incidence is going to vary based on the definitions that you use. It’s also variable depending on a lot of other factors, such as the location and race and maternal age, medical history,” Dr. Burton Rochelson, chief maternal-fetal medicine, Northwell Health System, told TODAY. “Overall in the States, it’s about six per 1,000 live births.”
People are at higher risk of having a stillbirth, include those with:
- Uncontrolled diabetes
- High blood pressure
- Obesity or overweight
- Previous stillbirths or miscarriages
- Smokers
- African American
“If you’re above the age of 35, risk goes up with every year of maternal age,” Dr. Uma Reddy, professor in the department of obstetrics, gynecology and reproductive sciences at Yale School of Medicine who worked on the American College of Obstetrician and Gynecologist’s stillbirth guidance, told TODAY. “Being over the age of 40, the risk is equivalent to having one of those medical conditions, like diabetes and chronic hypertension.”
For those at higher risk, such as people with uncontrolled diabetes or hypertension, managing the underlying condition prior to pregnancy can reduce risk of stillbirth. People with diabetes and chronic hypertension are also at greater risk of preeclampsia and the U.S. Preventive Services Task Force recommends that they take low dose aspirin daily starting at 12 weeks.
“In studies where they were using it to try to prevent preeclampsia there was a decreased risk of stillbirth and preterm births as well,” Reddy said.
People with “placental insufficiency” are also at greater risk of stillbirth.
“The other category of babies that we worry about are those for whom we know that the placenta is not as strong as we could like it to be,” Dr. Nicole Alexandria Smith, an assistant professor of obstetrics/gynecology at Harvard Medical School, told TODAY. “That’s something that women can’t control if they have a placenta that’s not robust.”
Smith said it’s essential to emphasize that some stillbirths couldn’t have been prevented.
“There’s so much blame that we put on ourselves when we have pregnancy complications and certainly for moms who lose their babies,” she said. “A really big part of our job is to try to take some of that guilt away.”
In later pregnancy, some recommend “kick counts” to track how active babies are. But what people learn about what to expect expected varies.
“I usually suggest people check in with the baby a couple of times a day at the end of the pregnancy to make sure the baby is following his or her normal periods of activity,” Smith said. “If moms still aren’t feeling the babies move then we recommend they come in right away.”
For the past two years, Dr. Heather Florescue has been using a protocol developed in the United Kingdom and Australia to try to reduce stillbirths in her practice. At 20 weeks, she educates patients about fetal movements in late term. Some say that 10 kicks per hour is normal “but if that baby is a 100 kicks an hour baby, 10 kicks is severely decreased.” That’s why discussing it remains important.
“It really standardizes fetal movement education,” the OB-GYN at Women’s Gynecology and Childbirth Associates in Rochester, New York, told TODAY. “Somewhere around two thirds to three quarters of women who present with stillbirth will complain of decreased fetal movements beforehand.”
The protocol also gives staff a decision tree to advise people who call in worried when baby’s movements change. Florescue also recommends patients who notice decreased movement do not use a home doppler. Many times they do that, hear a heartbeat and think everything is fine. Instead, Florescue urges them to call their doctor.
“Fetal movements are very important,” she said. “If their baby is not moving and they’re worried about it, they need to call their provider and get evaluated.”
Hope for the future
Banerjee and Ana Vick, co-director of awareness at PUSH, hope that the conversations like Florescue has with her patients become the norm. They know talking about stillbirth feels scary but having a conversation about kick counts could help a lot of people. And, they encourage self advocacy and encourage people to use “their mom voice” if their concerns feel unheard.
“Your voice in this matters because you’re actually the one with your baby all day and these doctors want to do what’s best for your baby, too,” Vick, 38, of North Carolina, told TODAY.
They also hope that understanding of fetal movements and monitoring them becomes “standardized” among practitioners and there’s more research dedicated to understanding stillbirths in low-risk people.
Like Banerjee, Vick noticed that her second child, a boy, wasn’t moving like he used to and called her doctor. After drinking and eating and noticing Owen still wasn’t moving, she went to the emergency room. After several scans, she headed to an emergency C-section. When they put her under, she felt terrified.
“I said, God, please don’t take me. I need to be here for my daughter, my husband, my little boy. Please protect them,’” Vick said. “When I woke up … they said, ‘We are sorry he didn’t make it.’ I cried like a wounded animal.”
Vick grappled with the thought that “sometimes healthy babies just die” and tried finding answers.
“I’d researched it all. I stayed up every night. I was losing my mind,” she said. “There has to be some reason.”
The two feel so passionate about PUSH because they want to help people avoid the devastation they faced.
“It feels like we’re swept under the rug and so many of us are just told to go away after it happens, ‘Sorry, go have another baby,’” Vick said. “And we’re not given any information as to what happened. So how are we supposed to avoid it again as stillbirth actually reoccurs more often.”
On October 1 they had a NYC Onesie Walk where they lined up 900 onesies, one for each of the babies in New York who were stillborn in a year.
“Those onesies should have been worn by babies and they’re never worn,” Vick said. “We know stillbirth can’t always be prevented. But so many times it can and that’s what we’re here for. It doesn’t bring my son back. But at least it gives me a little peace in my heart that I’m not just sitting here quietly.”
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Editor's Note: This story was updated on October 22, 2021 to clarify that Samantha Banerjee later came to learn that the "10 kicks in an hour" guideline was outdated.