The Skin of Your Stillborn

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Preparing to deliver and to meet your stillborn baby can be an extremely overwhelming time.  It can also be very unsettling to discover that he or she has skin changes or a physical appearance that you were not anticipating.  The information provided in this article serves to work in conjunction with our How to Bathe a Stillborn Baby article.

Preparing for what to expect in the appearance of your baby can be very helpful – but it can also be painful.  Please know that the information in this article may be upsetting.

Maceration (from Latin macerare  —  soften by soaking) includes all the changes which occur in a fetus retained in utero after death – in a stillborn baby, prior to birth.  The appearance of your baby’s skin and features can help determine the time of your baby’s death.  Changes take place to your baby’s skin within a few short hours after his or her death.

Macroscopic appearance (How your baby may appear to you):

  • Skin  —  the earliest sign of macerations are seen in the skin 4 – 6 hours after intrauterine death.The epidermis separates from the dermis on applying a pressure (skin slipping). Bullae (bubbles) appear with collection of fluid beneath the epidermis. The desquamation (skin peeling) regularly progresses in time to extensive skin separation on the face, neck, abdomen, limbs and external genitalia exposing red and moist dermal surface.
  • Lips – your baby’s lips may be a bright cherry red, or a deep purple color.  This can be due to birth asphyxia, or due to the baby’s blood pooling after death has occurred.
  • Head  —  collapse of the skull with overlapping bones, cranial bones become separated from the dura and periosteum. Widely open mouth and eyes are frequent with progressive maceration.
  • Internal organs  —  uniform reddish discoloration due to progressive hemolysis, yellow-brown discoloration occurs with retention for several weeks, dystrophic calcification is possible. Organs most severely affected by autolysis are those from abdominal cavity (liver, spleen, adrenals) and brain which is very soft or semiliquid in severe maceration
  • Softening of all organs and connective tissues, laxity of joints.
  • Exudation (leaking) of fluid and hemolyzed blood into pleural (lungs), pericardial (heart) and peritoneal (abdomen) cavities
  • The fetus looks edematous (hydrops-like), later progressive loss of fluid results in mummification.
  • Placenta  —  remains viable after fetal death in utero. Placental abnormalities can be found in many cases (infarction, retroplacental hemorrhage, cord accidents). Placenta should be always submitted to postmortem examination with the baby.

Classifying stages of maceration:

  • 0.  —  parboiled, reddened skin
  • I.  —  skin slippage and peeling
  • II.  —  extensive skin peeling, red serous effusions in chest and abdomen
  • III.  —  yellow-brown liver, turbid effusion, mummification

Estimating the time of death in stillborns:

  • Desquamated skin measuring 1 cm or more in diameter and red or brown discoloration of the umbilical cord correlated with fetal death 6 or more hours before birth.
  • Dequamation involving the skin of face, back or abdomen (12 or more hours)
  • Desquamation of 5% or more of the body surface (18 or more hours)
  • Moderate to severe desquamation, brown skin discoloration of the abdomen (24 or more hours)
  • Mummification is seen in fetuses who had died 2 or more weeks before birth

Additional damage to your baby’s skin can be caused by:

  • Asphyxia (depletion of oxygen) causing Hypoxia (causing skin to either appear a light blue or a deep cherry red)
  • Instrumental delivery (forceps delivery can cause damage to the baby’s skin)
  • Vaginal breech delivery
  • Macrosomia
  • Prolonged or rapid delivery
  • Cephalopelvic Disproportion (CPD) (fetopelvic disproportion)
  • Bathing your stillborn baby incorrectly (see our article on How to Bathe Your Stillborn Baby)

You can have an idea of what to expect when you meet your baby by viewing our photo section of babies, all donated by mothers of miscarried and stillborn babies.

You can learn about how your baby appears now, in Heaven, by viewing our devotionals section.

Parts of this article were borrowed from the Atlas of Neonatal Pathology

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Comments

  1. King's Daughter says:

    thank you for posting this article. when my baby was born i longed to know why she was bright red. she had died around 48 hours before delivery. the photos generous moms have posted and this article have been very helpful in letting me know it wasn’t because of her Turner’s syndrome or gestational age as much as it was just time after death till birth. THANKS for being a resource to help me get answers.

  2. Thank you for posting this information .
    I recently lost a granddaughter.
    I was curious as to why she had skin tears and her very red lips.
    thank you for helping me to understand this.
    May God bless all who has lost their baby!

  3. Karissa L Hatter says:

    This is very accurate and helpful. My 32 week gestation stillborn, Elijah, had fluid filled blisters on hands and wrist and on his ankles. He died on 11/10/15 & was removed by Csection on 11/15/15. little face was beautiful. I Googled and this site prepared me for what I was going to see. Thank you.

  4. I lost my baby boy on New Years Day, 2009. Full term, I’m haunted til this day. Zaire Shebar Reid.

  5. It hurts so bad.

  6. noreen Salm says:

    thanks for this information. I was wondering about the bubble on his neck. This is my grandchild. I am devastated for my daughter and son in law. Such a terrible loss 2 days before due date. I cry everyday.i find it so hard to believe with technology today they could not see a true knot in cord.

  7. Bhagwan singh says:

    Our healthy baby was delivered stillborn at 41weeks and 2 days, it shattered us. She was soft and all her skin was peeling….. The nurse informed me she could have been dead for 5 days…..

  8. my cousin is in hospital. its now two weeks her baby died and she has not delivered. now she is in so much pain . is it normal for a still born baby to stay for almost a month without being removed

  9. The Dr. That delivered my sleeping baby did not allow me to see or hold my baby . He informed me that it was a most strange request ,and said I should talked to the Hospital .Physiaciatrist . I got scared and was hemorrhaging . I was back on the floor that the nurses took me from to have the DR. take the baby who he said he was Still Born . About 45 min later two family members visited me and my bed was covered in blood and streamed onto the floor. I have at various times tried to get records of my admission to the 2nd floor ,why not the labor section and no record of me being in that Hospital.. It all bothers me sometimes and the tears still flow . A confused Mom of a sleeping baby .

  10. mbalenhle phala says:

    when i gave birth to my baby boy the nurses that deliverd my baby allowed me to see my baby told me that i should take out my feelings and they evn allowed m to take a photo of my baby boy i was relieved bt sad but the most part that makes me happy is that i had his picture and even though he was no longer with us but i had smthng to rembet him about and i love him

  11. Mrs. Rizwan says:

    I lost my baby boy 2 months before….my first baby mysteriously died with no reason….Allah knows…. why his skin turned blue

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