At 4½ months pregnant, Heather Rotondi's baby bump barely shows through her black wrap dress. It's hard to imagine the outgoing 37-year-old New Jersey mom being anything but happy and calm, let alone depressed. But after her first pregnancy, she was depressed for months.
Dominic Francis Rotondi was delivered Feb. 28, 2006, a couple of weeks shy of his due date, a day Heather and Robert Rotondi now call his "angelversary." While other mothers left the hospital with balloons and babies, Rotondi, who'd had a perfectly normal pregnancy, had only a death certificate.
"I had a son, I am a mother, and I had nothing to show for it," says Rotondi.
Dominic's story is just one of 2.6 million, according to a special series published in the Lancet on Wednesday.
According to the series, which offers the first comprehensive look at the heavy global burden of stillbirths around the world, more than 7,300 stillbirths occur every day. The World Health Organization defines "stillbirth" as fetal death after 28 weeks of pregnancy. Ninety eight percent of stillbirths happen in low- and middle-income countries, and nearly half of them occur during childbirth, particularly among women who do not have access to basic medical services. But even in wealthy countries, one in 200 pregnancies results in a stillbirth.
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Stillbirth rates vary dramatically, both among and within nations. Collectively, Pakistan, India, Nigeria, China and Bangladesh account for half of stillbirths worldwide. In India, rates vary by state, from 20 to 66 per 1,000 births. Within the United States, which has a national rate of three stillbirths per 1,000 births and ranks 17th out of 193 countries, non-Hispanic blacks experience double the stillbirth rate of white women.
Ways to prevent these deaths are relatively simple and well-known, and the series' authors conclude that global use of 10 interventions could prevent 45 percent of stillbirths. The availability of comprehensive emergency obstetric services alone, which can prevent complications at the moment of childbirth, could prevent nearly 700,000 stillbirths, according to the series.
A Silent Death
The series also highlights the sense of fatalism and stigma surrounding stillbirth. The belief that stillborn babies were never meant to live is widespread, according to the authors, emphasizing the need for greater awareness that the majority of these deaths can be prevented.
A survey of health care providers in 135 countries found that mothers who deliver stillborn children are subjected to blame. In sub-Saharan Africa, survey respondents reported that the deaths are frequently seen as the mother's fault, or are attributed to witchcraft. Most women are also expected to forget the loss and have another child.
In a statement, Dr. Joy Lawn, a lead author of the series, says "almost no burden affecting families is so big and yet so invisible both in society and on the global public health agenda."
Saving the Future
Lawn cites Mexico and China, where stillbirths have been reduced by more than half in the past decade, as proof that progress can be made through fairly simple measures. "Mexico didn't have full coverage of care at birth, and now they do," says Lawn.
Through First Candle, a bereavement group that helps parents who have experienced stillbirth and infant mortality, Heather Rotondi and her husband started a fund in Dominic's name. The Rotondis have purchased a fetal heart monitor for at-risk women, and say they've so far saved two babies. They believe this helps Dominic's spirit live on.
"These babies are our future. ... I don't want any other parent to go through what I have. And they don't have to," says Heather Rotondi.