According to Reproductive Health, a medical journal that covers adolescent health, female fertility and midwifery, the stillbirth rates in India range from 20 to 66 in every 1,000 births — one of the highest rates in the world.

Stillbirth is defined by the World Health Organization as the birth of a baby without any signs of life at or after 28 weeks of gestation. A normal pregnancy lasts about 36 to 40 weeks.

Unfortunately, one of the most heartbreaking things about those statistics is that a pregnancy can appear to be normal, with no signs of distress, and still culminate in stillbirth. Certain lifestyle factors, like smoking during pregnancy, can contribute to risk, as does premature labor. Pain, cramping or bleeding sometimes do indicate a problem, but not always. Doctors say there is no single known cause for why stillbirth occurs.

“The causes are largely dependent and change depending on the gestational age [how far you are into your pregnancy], while unexplained stillbirth is more common in late pregnancy,” says gynaecologist Dr Sabha Mhatre from Mhatre’s Maternity Clinic in Mumbai.

But if she had to pinpoint one major cause, it has to be lack of quality antenatal care, especially in India, she says.

It is during the antenatal period that women can get screened for potential medical risks such as bacterial, viral and sexually transmitted infections, like chlamydia and measles, and conditions like anemia, malnutrition and hypertension — all factors that could contribute to stillbirth, and do, in about 40% of cases, according to a Scroll report.

“Infections can either happen in the placenta or in the fetus when there is a serious infection in the mother,” Dr Mhatre says. “They are a common cause of death in stillbirths before week 24, and the only way to prevent these is continuous screenings and quality antenatal care.”

During, before and after pregnancy, many women rely on advice from older women in their families and practice home remedies that may or may not eliminate infection and other conditions, Dr Mhatre has observed in her practice. “This is why professional antenatal care is important,” she says.

In some cases, the umbilical cord can be a problem, says Dr Ryan D’Souza, an OB-GYN from Mumbai’s Mamta Maternity Clinic. “When it gets knotted or squeezed, it cuts off oxygen to the developing fetus that may lead to a stillbirth,” he says.

But in the majority of cases, it’s the separation of the placenta, which provides nutrients and oxygen to the fetus, from the womb that may increase the risk of stillbirths, Dr Mhatre says. Symptoms of what is known as placental abruption include abdominal pain, contractions and vaginal bleeding. “If any woman experiences these, it requires urgent action and attention,” she says.

The problem is, because of systemic shortcomings and societal taboos, many women aren’t getting the urgent aid they need.

Related on The Swaddle:

Scientists ID Chemicals in the Blood That May Predict Stillbirth

Some hospitals are not adequately equipped with essential services such as timely Caesarian section or fetal monitoring to deal with emergencies, says Dr D’Souza. Even when a hospital does offer these services, sometimes attitudes prevent a woman from seeking care earlier.

“In India, stillbirth is still a taboo. There’s very little talk about it among Indian public, so the couple is often unequipped about how to deal with it if they see any symptoms,” says Dr D’Souza.

Societal messages that minimize women’s worries may be one reason a woman might postpone seeking care. It is not rare for friends and doctors alike to dismiss a pregnant woman’s concern, or even actual pain, as just paranoia or hysteria. Even if women do notice symptoms, this doubt could cause them to second-guess their need for medical attention.

Related on The Swaddle:

The World Needs More Research Into Stillbirth

While there is no one cause that can explain all stillbirths, and no one giveaway sign, for women who are more at-risk — for instance, who smoke or drink during pregnancy, or who are pregnant with multiples — a lack of fetal movement should be cause for a visit to an OBGYN.

“You can start counting [kicks] at week 28,” says Dr Mhatre. She says women can pick a time of the day when the baby is most active, sit in a comfortable position and time how long it takes for the baby to move 10 times. On average, it will take 30 minutes, but it can take as long as two hours and still be fine, too. The count will vary between babies, but for an individual, will remain roughly the same from 28 weeks onward. If, over time, the kick count changes, or you don’t feel 10 moves in a span of two hours, it’s time for you to call your health care provider.