As her due date approached, Mary Beth Lowell wondered if everyone else could see the bulge constantly rolling across her belly as baby Reese kicked fiercely inside her. Reese, who had a reputation for being an active baby, was due Aug. 31. But a week before, her kicking waned.
At first Lowell, a 34-year-old public relations director in Seattle, told herself it was normal -- that there was just less room for Reese to move around.
"My older daughter didn't kick much towards the end," said Lowell, remembering her first pregnancy with daughter Riley. "I was never the type to really count kicks. I just didn't think much about it."
But as Lowell became more aware of the absent kicks, panic set in. With her husband Roger, she went to the hospital just to make sure everything was OK. A nurse hooked Lowell up to a non-stress test machine to measure baby Reese's heart rate. When that didn't work, they did an ultrasound.
"By this point, I was starting to go into shock," Lowell said. "Everything was kind of hazy and I couldn't really see."
And then, in a soft voice, Lowell's doctor delivered the devastating news. Reese was stillborn.
"Suddenly Reese was gone," Lowell said with a shaky voice. "All I could think was, 'What happened? I don't understand?'"
Roughly one in 160 pregnancies ends in stillbirth in the United States, according to a 2009 report from the American College of Obstetricians and Gynecologists. In some cases, genetic abnormalities, umbilical cord accidents or placental problems are to blame. But often the cause is a mystery. Lowell was told she might just be that "unlucky one."
"I don't think there are many more painful losses," said Dr. Roger Harms, associate professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minn. "Although there is no evidence that mother could have changed the outcome, I don't know of an episode where they don't feel like they should have."
A study published Monday in the British Medical Journal suggests that how women sleep in the late stages of pregnancy may influence the risk of stillbirth. Women who slept on their back or on their right side were more likely to experience the loss than women who slept on their left side, researchers from Auckland, New Zealand, reported. And women who regularly slept during the day were also more likely to experience a stillbirth.
But some doctors are urging caution when interpreting the study's results.
"The only warranted implication of this study is that it may be worth looking more closely at sleep position and fetal compromise," said Harms. "The unwarranted implication is a wave of monstrous guilt for women who have lost a baby near term."
That guilt, for Lowell, was overwhelming.
"You think about every little thing -- what you ate, what you drank, the air you breathed," Lowell said. "You always wonder, 'Was there something I could have done differently?'"
Lowell said it's hard to hear about studies that suggest moms could have lowered the risk.
"It's hard to not go back and think you are overall responsible for whether or not your child survives and comes out healthy," she said. But Lowell did sleep on her left because she heard it was better for the baby. And even if she did find out what caused Reese's death, "it's not going to bring her back," she said.
Stillbirth: Saying Hello is Saying Goodbye
After a stillbirth, mothers still have to endure what could be hours of painful labor, "which adds some physical pain to the loss, and many hours to consider what this would have been like if the baby hadn't died," said Harms. "Saying hello to her newborn is also saying goodbye. The sadness is indeed profound."
Lowell delivered Reese by C-section the following day. The nurses asked if she wanted to hold her baby girl and have a photographer to take pictures. But Lowell was terrified.
"You get these horrible images in your head of what to expect," Lowell said. "You wonder, 'What does a dead baby look like?'"
Lowell decided not to hold Reese or have a photographer -- a decision she now regrets. But at the time, the grief was too much for her to bear.
"To be pregnant for nine months, to give birth, to see your child -- and then she's gone," Lowell said. "You grieve not only your baby, but you grieve what was supposed to be. You think about how she'll never be one, never be two, never graduate from high school."
Lowell found solace in blogging about her stillbirth, which connected her with other moms who shared her loss. One mom started Molly Bears, a non-profit organization that makes weighted teddy bears in memory of stillborn babies. Lowell's Reese Bear weighs 7 pounds, 14 ounces.
"When we got her in the mail, I picked her up and I thought, 'She's so heavy,'" Lowell said. The bear is one of many ways that Lowell, with husband Roger and their 3-year-old daughter Riley honor and remember Reese, who was "born into heaven" after 38 weeks.
"Even when you lose a child, I believe you're called to mother them in a certain way," Lowell said. "You do this by loving them and honoring them, telling your story, and giving back to the rest of the world."