You most likely witness how your patients who are expecting parents often go to great lengths to ensure everything is in place for their baby’s arrival such as attending checkups, following medical advice, and preparing their homes. There’s excitement, hope, and love, from the first ultrasound scan to the baby’s tiny kicks.
But sometimes, even with the best care, something deeply devastating can happen. A baby may pass away in the final stretch of pregnancy or during labor, when parents are just beginning to imagine holding them in their arms.
If you’ve ever had to tell a family that their baby no longer has a heartbeat, you know how devastating stillbirth can be. It refers to the loss of a baby after 28 weeks of pregnancy, either before or during birth. According to the World Health Organization, nearly 2 million stillbirths occur each year—that’s one every 16 seconds. More than 40% happen during labor.
Pregnancy loss not just a medical event but an emotional loss that reshapes the lives of the parents, the family, and yes, even you as the care provider.
Through this blog, we'll offer a refresher on what these losses mean for your patients and their families, and also how they affect you emotionally and professionally.
Pregnancy loss not just a medical event but an emotional loss that reshapes the lives of the parents, the family, and yes, even you as the care provider.
What causes late-term pregnancy loss?
Stillbirth, also known as intrauterine fetal demise, can be further classified based on the timing of fetal loss during pregnancy: early (20–27 weeks), late (28–36 weeks), or term (37 weeks or later). This differs from a miscarriage, which typically refers to fetal death occurring before 20 weeks of gestation.
Talking openly with your patients about the possible causes of late-term pregnancy loss helps you both stay on the same page and builds trust. This shared knowledge can also help patients feel a bit more in control as they think about their next steps or future pregnancies.
There are several leading causes of stillbirth and they include the following (Maslovich & Burke, 2022; National Institute of Child Health and Human Development, 2023; NHS, 2024):
Complications with the placenta
Placenta is your patient’s lifeline to their baby. It supplies oxygen, nutrients, and protection throughout pregnancy. When it does not function properly, such as in cases of placental abruption or restricted blood flow, it can sadly lead to stillbirth.
You might encounter this when a patient presents with sudden abdominal pain or bleeding, requiring urgent intervention.
Infections during pregnancy
You're highly aware that certain infections can silently complicate a pregnancy. When bacteria like group B streptococcus or viruses such as cytomegalovirus pass from mother to baby, especially before 24 weeks, the outcome can be tragic.
For example, a mild flu-like illness in your patient could turn out to be listeriosis, which poses a serious risk to the fetus if untreated.
Problems with the umbilical cord
You have probably seen how quickly issues with the umbilical cord can escalate. If the cord becomes knotted, compressed, or slips into the birth canal before the baby, oxygen can be cut off during labor.
In some cases, fetal distress appears suddenly, and despite your rapid response, the result may still be devastating.
Maternal health conditions
Chronic conditions such as hypertension, preeclampsia, and diabetes significantly raise the risk of stillbirth, especially later in pregnancy.
As a provider, you monitor these conditions closely, but complications can still progress quickly. You might recall cases where a mother with high blood pressure experienced placental deterioration, affecting the baby's wellbeing.
Fetal abnormalities and pregnancy complications
You may have supported families facing difficult news after a routine scan, such as the discovery of a fetal anomaly like anencephaly or a severe heart defect. These conditions often cannot support life and may lead to stillbirth.
Similarly, pregnancies involving twins, triplets, or early labor can become high-risk quickly, even when everything appeared normal just days before.
What are the risk factors of late-term pregnancy loss?
It’s just as important to recognize the risk factors for later-term pregnancy loss. While these factors don’t directly cause stillbirth, they can significantly increase the likelihood of it occurring.
Ethnicity
Certain ethnic groups, particularly Black and Indigenous populations, face higher risks of late-term pregnancy loss.
Non-hispanic black women had a fetal mortality rate more than twice that of non-hispanic white and Asian or Pacific Islander women (Macdorman & Gregory, 2015). This isn’t due to biology alone but also reflects systemic issues like unequal access to care, chronic stress, and healthcare bias.
Being mindful of these disparities helps you advocate for more equitable, personalized support.
Age
Most women over 35, risk of complications including stillbirth increases. Older maternal age can be linked to issues such as high blood pressure, gestational diabetes, or placental problems. While many have healthy pregnancies later in life, it often requires closer monitoring and more proactive care.
Stressful life events
High stress levels affect pregnancy outcomes. Events like job loss, grief, or trauma can influence hormonal balance and inflammation, potentially increasing the risk of late-term loss.
When your patient opens up about emotional strain, even outside of clinical symptoms, it’s a key opportunity to connect them with mental health support or additional check-ins. You can document these information because they can be helpful to mental healthcare providers in case of referrals.
Obesity
Can obesity complicate a pregnancy? Yes. Research says that obese and severely obese women were more likely to experience a wide range of pregnancy complications, and their risk of stillbirth was twice as high starting at 40 weeks of gestation (Akselsson et al., 2023). Weight-related risks can often be reduced with tailored guidance and consistent prenatal care.
Environmental exposures such as secondhand smoke and pollution
You may already be educating patients about the risks of tobacco exposure. Secondhand smoke and high levels of air pollution have both been linked to pregnancy complications and late-term loss.
Encouraging patients to avoid exposure where possible, and offering resources if they live in high-risk areas, can make a meaningful difference.
Low socioeconomic status
A patient with low socioeconomic status has limited access to nutritious food, or difficulty attending appointments, you know it can take a toll on both their physical and emotional health. These challenges often overlap, increasing the risk of poor pregnancy outcomes (Kim et al., 2018).
Your role in connecting them with support services and advocating for respectful care is more vital than ever.
Clinical management of late-term pregnancy loss
When late-term loss is suspected, diagnosis is typically confirmed through ultrasound, which shows the absence of a fetal heartbeat. A review symptoms such as reduced fetal movement is also typically conducted.
Remember that accurate diagnosis is crucial not only for clinical care but also to help parents understand what happened to their baby’s development. Here are some ways to manage such loss:
Managing pain and physical care
Even in the midst of grief, physical comfort still matters. You’ll want to walk parents through pain management options like epidurals, medications, or supportive care during labor.
Giving them choices helps ease their physical suffering while they’re coping with the emotional pain of baby loss.
Supporting decisions around labor or cesarean
Most of the time, labor is the safer and more recommended option, but some families may ask about cesarean delivery. The best approach is to present the facts clearly while respecting what the parents decide, especially when they’re already overwhelmed.
If needed, most hospitals will also issue a birth certificate, honoring the baby’s existence and the parents' experience.
Care after delivery and emotional healing
Postpartum care after a late-term loss includes watching for physical concerns like vaginal bleeding or infection, but emotional recovery is just as important. You may be the one who gently opens the conversation about what support is available, from counseling to follow-up care.
Many families have questions about whether they can have healthy babies in the future, and your reassurance and referrals can make all the difference.
Sample late-term pregnancy loss management plan
If you need a sample management plan for your patient, we've crafted a sample for you!
Please do note that this is a fictional patient case created solely for educational purposes and to illustrate an example of a late-term pregnancy loss management plan.
Client name: Sarah Bloom DOB: 3/14/1992
Age: 32 Date: 5/27/2025
Diagnosis: Late-term pregnancy loss at 38 weeks gestation
Problem: Medical management following confirmed late-term pregnancy loss
Sarah experienced an intrauterine fetal demise at 38 weeks. Immediate clinical care is needed to support safe delivery, monitor for complications such as vaginal bleeding or infection, and plan for follow-up to support future pregnancies.
Goal: Safely manage the delivery and immediate postpartum period, minimizing complications and preparing for future reproductive planning.
Objective 1: Sarah will undergo delivery within 48 hours of diagnosis with appropriate monitoring.
Intervention 1: Initiate labor induction using misoprostol and/or oxytocin based on cervical readiness, with continuous monitoring of vital signs and vaginal bleeding throughout the process.
Objective 2: Sarah will receive a full medical evaluation to assess potential causes and risks for future pregnancies within 2 weeks postpartum.
Intervention 2: Conduct placental pathology, genetic testing, and maternal bloodwork (e.g., for clotting disorders or infection) and schedule a follow-up consultation to discuss results and next steps in managing healthy pregnancies going forward.
How can you provide emotional and psychological support?
Supporting your patient through late-term pregnancy loss is deeply challenging. You can offer them the following emotional and psychological support:
Listen and acknowledge their feelings
One of the most important things you can do is simply listen without rushing to fix or explain. Let parents share their pain, anger, or confusion in their own time and words. Acknowledging their feelings shows you see their loss as real and deeply impactful.
Offer compassionate and non-judgmental support
It’s normal for grieving parents to feel a wide range of emotions, from guilt to relief, and they need space to express all of it without judgment. Remind them that their feelings are valid and that there’s no “right” way to grieve after baby loss.
Being compassionate means being patient and gentle, even when their emotions feel intense or confusing.
Provide resources and encourage professional help
Many parents find comfort in talking to counselors, support groups, or mental health professionals who specialize in pregnancy loss.
You can help by sharing information about local resources or online communities where they can connect with others who understand their experience. Encouraging this step doesn’t mean you’re saying their pain isn’t enough but you're giving them extra support during a tough time.
Support their journey toward healing and hope
Grief after a late-term loss is a process that takes time, and your ongoing support matters beyond the initial crisis. You can check in on how they’re doing in the weeks and months ahead, offering reassurance that it’s okay to seek help whenever they need it.
Helping them focus on healing while gently acknowledging their hopes for healthy babies in the future can offer some light during a challenging time.
Conclusion
Late-term pregnancy loss is a deeply complex and emotionally challenging experience for patients and healthcare providers alike. Understanding its causes, risk factors, clinical management, and support strategies allows you to provide safe, compassionate, and informed care.
While medical interventions are crucial, emotional and psychological support is just as important in helping families heal.
Staying informed and emotionally aware can help you continue offering the kind of care that truly makes a difference during such a difficult time.
While medical interventions are crucial, emotional and psychological support is just as important in helping families heal.
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