Stillbirth Is a Preventable Tragedy
And this ambiguity is contributing to a persistent and preventable public health crisis: stillbirth.
Samantha Durante Banerjee, BS-Economics, BAS
Without standardized guidance, expectant parents are left uncertain about what fetal movement patterns mean, how to monitor them, and when to seek help. Worse still, many healthcare providers lack consistent protocols for evaluating or responding to reported changes.
I learned this the hard way in 2013, when my own daughter was stillborn just 2 days before her due date — despite an otherwise healthy pregnancy. Since then, more than 200,000 American families have experienced the same devastating loss. That's the equivalent of a full school bus of babies, every single day.
Stillbirth affects approximately 21,000 families in the US each year: a rate that has barely improved in two decades, branding us as one of the worst in the world. By contrast, countries like the UK and Australia have reduced stillbirth by 25% and 21%, respectively, through standardized national protocols and public health campaigns. Some nations now report fewer than two stillbirths per 1000 births, which is half the US rate.
At least one in four US stillbirths is preventable, including nearly half of all stillbirths at term. Yet despite this, our prenatal care guidelines lack a national standard for educating patients about or helping clinicians to assess one of the simplest, most commonsense indicators of pregnancy health: fetal movement.
Why Fetal Movement Matters to Clinicians
Fetal movement changes can be a late-stage warning sign of underlying complications, particularly those involving the placenta or umbilical cord — two of the most common contributors to stillbirth. Despite this, standard prenatal care and even high-risk care settings do not routinely screen for cord or placental abnormalities in a way that allows for proactive identification, monitoring, and if needed, intervention to prevent a tragic outcome.
As a result, fetal movement monitoring is one of the key tools at our disposal to help indicate a baby's and mother's well-being. The CDC includes 'baby's movement stopping or slowing' among its 15 urgent maternal warning signs.
Scientific literature consistently supports altered fetal movement — whether a decrease in frequency or strength, sudden rapid increase in intensity, or overall altered pattern — as a red flag for fetal compromise. Clinicians must be equipped not only to communicate this importance to patients, but also to respond with appropriate diagnostic and clinical action when changes are reported.
Monitoring fetal movement is simple, but currently, no universal protocol exists in the US for educating pregnant patients about fetal movement tracking or for responding to reports of decreased or altered movement. This is a critical gap in care and one that is disproportionately harming Black and Indigenous families, who experience more than twice the rate of both stillbirth and maternal mortality compared to their White peers.
A Path Forward for Clinical Leadership
Recognizing the urgent need for alignment with global best practices, PUSH for Empowered Pregnancy (PUSH) has partnered with Kicks Count UK and other worldwide organizations to help facilitate a fetal movement consensus statement offering clear recommendations for clinicians and patients alike. This international statement reinforces the critical role of fetal movement awareness, education, and timely clinical response as essential components of stillbirth prevention.
While parent-led advocacy organizations like PUSH continue public awareness efforts, it is ultimately clinical institutions that hold the power to drive the systemic change our country needs. The American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and other professional bodies are uniquely positioned to:
Develop and implement national guidelines for fetal movement monitoring and response, following proven models from countries with lower stillbirth rates
Ensure the integration of patient education on fetal movement into standard prenatal care practices
Improve training and protocols to ensure immediate, evidence-based clinical response to reported changes in movement
Enhance early detection of stillbirth risk factors through targeted screening (eg, fetal growth restriction, placental insufficiencies, cord abnormalities) and better risk assessment tools
Resources for Clinicians
Despite lagging US efforts to prioritize stillbirth prevention, resources are available today for clinicians seeking to integrate global best practices. Evidence-based tools, accredited interdisciplinary training, and clinical communication resources are available through PUSH, as a well as free downloadable patient education materials.
These resources are intended to supplement clinical care, not replace it; and they can support your efforts to provide more informed, proactive, and equitable prenatal care. Stillbirth is not inevitable. Other countries have reduced their rates dramatically by adopting straightforward, cost-effective interventions to save thousands of lives. We can do it, too.
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I mean, this is really more story about, well, if you can't sleep, don't feel awful about it because there are so many shaming stories about people, whatever solutions people seek out. I do talk in the beginning about the way that the modern world absolutely conspires against sleep, that it just lays waste to your circadian rhythms. That people work two jobs, 16.4% of us work non-standard hours. If you're a white collar kind of professional, you've got these woodpecker like peck, peck, peck, incursions into your life all night and weekend long from your boss's work sort of never ends. I mean, we're just no longer yoked to the rhythms of the earth anymore. We're just part of this whirl of a wired world. Taylor Wilson: In the course of doing your research, was there something in particular that surprised you most about the problem? Jennifer Senior: I'll tell you what surprised me most, just generally. Whenever I interviewed any expert about this, and it didn't matter what species of expert, they could be an epidemiologist, they could be a neurologist, they could be a psychiatrist, they could be a clinician. Most of them said the same thing. There is a slight misconception that you need eight hours of sleep. There is some data saying this. There is another equally robust data set saying 6.5 to 7.4 is associated with the best health outcomes. Now it's very hard to tell. These studies are observational. They're not randomized. There was all sorts of confounds and problems with this, but this one study in particular had a million people in it. It's been replicated. There are plenty of people who believe this data and people vary. And over the course of a lifetime, your individual sleep capacity could change. In a funny way, that was what surprised me most. Right? This mantra, which is kind of a tyranny, get eight hours or else. Taylor Wilson: Well, you talked Jennifer about the modern world conspiring against us and our sleep, and I guess let's try to outline a few of the possible causes of what you call a public health emergency, right? What can you share with us here on this? Jennifer Senior: About other causes, you mean besides the kind of modernity itself and kids working on... Kids being assigned homework online, kids socializing online. I mean, adolescents are desperate for sleep. They're so hungry for it, and modern high schools and middle schools have them waking up preposterously early when their circadian rhythms are pitched forward. We've got a substantial sandwich generation that's taking care of young kids and their elderly parents. That's going to conspire against it. These are all immutable things. Also, there are elevated levels of anxiety now in our world, and anxiety itself is a huge source of... Or can be a source of sleeplessness, certainly can make one prone. So I mean, those are additional examples I suppose. Taylor Wilson: Let's talk through your story a bit here. When did you first realize that you had an issue with sleep? And walk us through your experience with insomnia. Jennifer Senior: It was 25 years ago and it was a very mysterious onset. I cannot tell you what brought it on to this day. It is a mystery. I had this extremely well-regulated kind of circadian clock. I fell asleep every night at 1:00. I woke up every day at 9:00. I lost my alarm clock. I still woke up at those times. I didn't have to buy a new alarm clock until I had an early flight one day, and yet sometime very close to my 29th birthday when virtually no circumstances in my life had changed one iota, I had a bad night, fell asleep at like 5:00. Thought nothing of it until they became more regular, and then I started doing all-nighters involuntarily, and I felt like I'd been poisoned. 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I listened to a meditation tape that a friend gave me, did not work. I listened to another one that was for sleep only that did not work. I ran. I always was a runner, but I ran extra, did not work. Gosh, changed my diet. I don't remember. I did all sorts of things. I tried different supplements, Valerian root, all these things. Melatonin, nothing, nothing. Taylor Wilson: You wrote in depth about one therapy that was recommended to you, and that was CBTI. That's cognitive based therapy for insomnia. Jennifer, first, what is this? And second, did you find any success by using this? Jennifer Senior: So cognitive behavioral therapy for insomnia, as you said, is the gold standard for treating insomnia. It's portable. You can take it with you. It's not like if you leave your sleep meds at home. The main tent pole of it, which is sleep restriction, which I'll get to in a minute, is very hard to do. 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If you had only five hours of sleep, but you're in bed for nine hours, you have to choose a wake-up time. Let's say it's 7:00 and then you have to go to bed five hours earlier, 2:00 to s7:00. That's all you can give yourself, and you cannot stop with that schedule until you've slept for the majority of those hours. That's very hard for a sleepless person. And then once you've succeeded, all you get to add on is 15 more minutes of sleep, and then you have to sleep the majority of those hours for three nights running. This is always for three nights running, and the idea is to build up a enough sleep pressure to regularize yourself. You basically capitulate to exhaustion and you start to develop a rhythm. I couldn't stick with it. I was so kind of stupid and depressed with sleeplessness by the time I started it that it probably was impractical and I refused to take drugs to help me fall asleep at the exact right hour, which many clinics recommend. If you're going to go to bed and sleep from 2:00 to 7:00, take something at 1:30 so that you fall asleep at two. But I was afraid of being dependent on drugs, and you can really wean yourself if you do it for a limited amount of time. You can wean yourself anytime really, if you're shrewd about it and if you taper. But I think that I would tell people to try it and to try it sooner rather than later, and to be unafraid of doing it in combination with drugs so that the schedule worked. Taylor Wilson: Well, I am happy you brought up drugs. I did want to bring that up just in terms of what experts are saying about their impact. Even just drugs and alcohol kind of writ large, but sleeping pills specifically. What did you find in researching this in terms of drugs and alcohol? Jennifer Senior: Well, there's a real stigma taking sleep medication, and I'm frankly a little sick of it. I'm not sure why this is so very stigmatized. Like, oh, they're drug addict. They're hooked on sleeping pills. It's framed as addiction, and no one says that someone is addicted to their Ozempic, even though a lifestyle change could perhaps obviate the need. No one says that they are addicted... Oh, that person is totally addicted to their blood pressure medication, even though maybe a change in lifestyle would help change that. Or that they're addicted to their statins, So I sort of bristle. And those who prescribe these medicines say like, look, if the benefit outweighs the risk and they're used properly, sometimes the real side effect is just being dependent on these drugs, and there's a difference between dependence and addiction. A surprisingly small number of people who take these drugs regularly, like benzodiazepines, like Ativan and Ambien and Klonopin, all these things, a surprisingly small number, like 7% increase their doses if they take it every night. So that's very small. However, there are cognitive decrements over time... Or not decrements. It can interfere with your memory and it can increase your odds of falling as you get older. And those are, to me, the real persuasive reasons to get off. Taylor Wilson: I want to back up a minute here to talk about something many may not be aware of, and that's that historically, at least in some eras, people used to sleep in two blocks. What do you know about this? How did this function and really why did this kind of sleep pattern work for some folks? Jennifer Senior: Well, it was sort of, I think, natural. It seemed that this is, and it has not been proven everywhere, but there's plenty of both historical evidence and also some in a lab by this wonderful guy named Tom Ware that shows that if you sort of just put someone in a room, 14 hours of darkness, what will happen is that their sleep will naturally split into two. They'll sleep for a phase, wake up for a phase, and then sleep for a phase again. And historically, there's all sorts of evidence that people would sleep for a phase, get up and read for a while, do some quiet things, do light tasks, maybe sing, maybe have sex, and then go back to bed. So there seemed to be two phases, and this was much easier to do when midnight was actually midnight. You were going bed when the sun had set, or just after were you were tethered to the rhythms of the earth as opposed to a wired electricity run world. Taylor Wilson: What is something you wish you knew when you first started on this journey? Jennifer Senior: To get on it earlier and to not be as afraid... Cognitive behavioral therapy is, I think, often done in conjunction with taking something like Klonopin or Ativan or Ambien, and I was so petrified of becoming hooked on them that I didn't... I refused to take them and I couldn't get my sleep to contract as a result of it. My body was so completely dysregulated and confused about it was so all over the place that I really needed something to regularize it and stabilize it, and I flipped out, and I think if anybody goes and tries CBT, I and their practitioner says to them, and I'm going to have to be on their recommendation, do this in concert with a drug, because you really need it. Don't sit there and freak out and think that you can't or shouldn't, because it happens a lot and people freak out a lot. Taylor Wilson: All right, Jennifer Senior, thank you so much for coming on the Excerpt. Jennifer Senior: Thank you so much for having me. Taylor Wilson: Thanks to our senior producers, Shannon Rae Green and Kaylee Monahan for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@ Thanks for listening. I'm Taylor Wilson. I'll be back tomorrow morning with another episode of USA TODAY's the Excerpt. This article originally appeared on USA TODAY: Insomnia is a global epidemic. How do we fix it? | The Excerpt
