By Dr. Richard Mogeni
Why should anyone care about a baby who never cried, never drew a breath, never went home? Because the way we respond to stillbirths reveals – often uncomfortably – how much we value women, motherhood, and life itself.
In labour wards across Kenya, a familiar pattern unfolds. Once an intrauterine fetal death is confirmed, something changes. Urgency softens. Monitoring slackens. Conversations fade. Attention shifts elsewhere. The baby is gone — and, quietly, the case seems finished. But it shouldn’t be. A fetal death is not the end of care. For the woman, it marks the beginning of one of the most vulnerable moments of her life.
Take Imani* a 24-year-old woman in Kisumu County. She arrived at a crowded county referral hospital after prolonged labour, exhausted and anxious. When no fetal heartbeat was detected, no one explained what would happen next. She waited for hours, her pain unmanaged, her fear ignored. When she finally delivered, there was no privacy, no counselling, no clear plan for follow-up. She went home physically weak and emotionally shattered, convinced – wrongly – that she had failed. Her story is not exceptional. It is routine.
Stillbirths matter. They count. And they deserve more than silence.
Globally, nearly 2 million babies are stillborn each year. More than 40 percent die during labor, a time when timely, skilled care can mean the difference between life and death. While deaths among children under 5 have declined by about half over the last two decades, progress in reducing stillbirths has lagged. Over the same period, global stillbirths declined by roughly one-third. That gap should trouble us.
Kenya loses an estimated 35,000 stillbirths every year— about 96 families grieving every day. More than half happen during labour itself. These are not random or unavoidable tragedies. They point directly to gaps in fetal monitoring, decision-making, staffing, referral systems, and the overall quality of intrapartum care in our facilities, particularly in high-volume county hospitals.
The clinical details matter. Stillbirths are classified as either fresh – when death occurs during labour – or macerated, when death occurred earlier. This distinction is not academic. Fresh stillbirths force us to confront what is happening, or failing to happen, in our labour wards. They demand accountability.
Beyond the numbers lies a deeper problem : attitude. Stillbirth is often treated as inevitable, a tragic but “natural” outcome of pregnancy. This belief is not only wrong; it is dangerous. Many of the leading causes –maternal infections, hypertensive disorders such as pre-eclampsia, placental complications, prolonged or obstructed labour, and inadequate fetal monitoring – are all well-known, and largely preventable . Effective and affordable interventions exist. What is missing is their consistent application, and accountability when standards are not met.
When care stops after a fetal death, it is the mother who pays the price. Retained placenta, severe bleeding, sepsis, uterine rupture, and long-term psychological trauma are real risks. Pain and anxiety do not disappear when a baby dies; they often deepen. Delivering bad news is not a courtesy – it is a clinical skill. Respectful maternity care does not end when a fetal heartbeat stops.
There is also an uncomfortable truth that must be stated plainly: unless there is a clear obstetric indication, intrauterine fetal death is not a reason for caesarean section. Surgery driven by fear, convenience, or poor counselling exposes women to unnecessary harm — both immediately and in future pregnancies.
Kenya has committed to the global Every Woman Every Newborn Everywhere (EWENE) agenda, which calls for every maternal and perinatal death – including stillbirths – to be counted, reviewed, and acted upon through Maternal and Perinatal Death Surveillance and Response. Counting stillbirths is not about assigning blame. It is about understanding why they happen – and preventing the next one.
So what must change?
First, counties must count and review every stillbirth, with particular attention to deaths during labor. Second, labor wards need adequate staffing, functional fetal monitoring, and reliable referral and transport systems, especially in high-burden counties. Third, health workers must be supported and trained in compassionate communication and bereavement care. Fourth, women must be protected from unnecessary surgical intervention through clear guidelines and enforced accountability.
Finally, editors and policymakers must keep stillbirths visible. Silence enables neglect. Public reporting, candid review, and sustained attention save lives.
A baby may be stillborn. But our response must never be still.
*Name changed to protect identity.
Dr. Richard Mogeni Mogaka is the Deputy Director of Reproductive Health and Head of the Maternal Fetal Medicine Department at Moi Teaching and Referral Hospital, and Chairman of the Kenya Obstetrical and Gynaecological Society-North Rift.
