EAGLE MOUNTAIN, Utah — In the final weeks of Jessica Serdar’s first pregnancy, she said “everything was perfect.”
She’d gotten past the first trimester – which she believed to be the most dangerous time – without any complications. Doctors were asking her and her husband, Adam, about baby names. And the couple was busy putting up the crib and decorating the nursery with little stickers.
But at 34 weeks and one day, their lives “changed in an instant” when Serdar woke up in the middle of the night and noticed her daughter – who had been “so active” up to that point – wasn’t moving.
At the hospital, they received “that horrible confirmation” of their worst fears, Serdar said.
“I'll never forget the doctor trying to find the heart rate, trying to find the heart rate, and the look on his face was becoming more frantic and trying to find it,” she recalled in an interview with FOX 13 News. “And just those six words that he said, it was like: ‘There are no fetal heart tones.’”
Their daughter, Ruth Vivienne, was delivered stillborn the next day, on October 8, 2024.
No one knew exactly why.
"We'll always have the question of, ‘Why did this happen to us?’” Serdar said. “Ruth Vivienne should be here. We should have a toddler, and we don't.”
The Serdars are among nearly 24,000 families across the United States who experience a stillbirth – when a baby dies at more than 20 weeks of pregnancy – every year. About 275 of those cases are in Utah.
Despite medical advancements, U.S. stillbirth rates have remained stubbornly stable for the last 20 years and are much more common here than in other high-income countries. Yet little is known about why these deaths occur or how to prevent them.
Dr. Bob Silver, co-director of the Stillbirth Center of Excellence at the University of Utah, said there isn’t a single reason why stillbirths are more prevalent here. But he notes that these deaths have received relatively little attention as a public health issue until recent years.
“We just haven’t valued it the same as other countries have valued it," he said in an interview. “And so we haven’t tried as hard. Because in trying hard, you almost always do better.”
WATCH: Dr. Silver explains why stillbirth rates remain higher in the United States than in other countries with similar resources:
Addressing a ‘complex’ challenge
The Stillbirth Center is among the leading institutions in the country that is trying to address stillbirths, through a multi-pronged approach that includes training, research, education, advocacy and in-clinic care.
“These challenges are complex,” Silver said. “And so we really need to have several different approaches, all of which dovetail together.”
One of the center’s goals is to slash U.S. stillbirth rates in half by 2035. It’s also working to halve racial disparities, which are particularly pronounced in Utah.
Black women are twice as likely to experience a stillbirth in the United States compared to white women. In Utah, the numbers are even more stark. Black women are three times as likely to have a stillbirth here, according to a recent article in the Utah Women’s Health Review.
Dr. Michelle Debbink, a maternal-fetal medicine specialist who works on health equity issues at the University of Utah’s Stillbirth Center of Excellence, said that stems not from biological differences but instead from of “a host of structural concerns or barriers to health opportunities,” including a lack of access to health care.
Similar factors also play into Utah’s higher rates of stillbirths in rural communities.
Data shows Salt Lake and Utah County have relatively lower rates of stillbirth, while rates are “much higher” in Daggett, Duchesne and Uintah counties, according to the Utah Women’s Health report. The report points to a lack of access to obstetric services, hospitals and birthing centers in those areas.
"When people’s pregnancies are more complicated, that puts them at a higher risk of stillbirth and we want to watch more closely with certain testing or extra ultrasounds for baby’s growth,” Debbink said. “And when you live far away from a hospital, that becomes very challenging.”
The university provides training to nurses, midwives, psychiatrists and other health care workers across the state to help them better tend to women with a history or risk of stillbirth.
Debbink said that when providers and the public recognize that the impact of stillbirth is not spread evenly across communities, “we can do better.”
"If we all are understanding that these things exist and there are people in our communities, neighbors of ours who may not have what they need to protect their pregnancy or protect themselves during pregnancy, then we can all work together to try to help support and lift up people to get the access that they need,” she said.
WATCH: Dr. Debbink explains why stillbirth rates are higher for women of color in Utah:
‘Finding a cause’
As providers at the Stillbirth Center work to cut stillbirth rates and address racial disparities, researchers there are also focused on better understanding the root causes of stillbirths when they do happen.
Currently, more than half of these deaths remain unexplained, leaving families like the Serdars without answers and leading to worse mental health outcomes for some. The Stillbirth Center’s goal is to ensure at least three in four deaths receive a comprehensive look for potential causes.
"Finding a cause of stillbirth is incredibly important,” Silver said, noting that the lack of a clear reason can lead to “a lot of self-blame” for families. For physicians, outstanding questions can make it harder to prevent other deaths.
Silver’s research shows at least one in four stillbirths could be prevented. But he believes there are “many, many more that are potentially preventable with even more rigorous medical care,” as well as medical discoveries and advancements.
Perinatal autopsies provide one avenue for researchers to better understand why stillbirths occur. But Silver said only about 20% of all such deaths in the U.S. undergo an autopsy, compared to 80% or 90% in other countries.
That's due in part to the fact that there aren’t many pathologists trained to perform these autopsies here, Silver said. But he noted that families can also be hesitant to pursue an autopsy in their grief.
“They often have certain images and ideas that may not be true,” he said. “But it’s their beliefs and we don’t take the time to explain things to them.”
The University of Utah has developed a guide for patients and providers after a stillbirth that stresses that families have “several options to help you understand why your baby died.” While tests won’t bring back the child, the guide notes, they can help get answers.
"If we know what happened, we can do a much better job of trying to prevent it from happening again,” Silver said.
Families can choose to have a complete or more limited autopsy and can also pursue genetic testing or examination of the placenta.
Serdar and her husband didn’t pursue an autopsy after Ruth Vivienne’s death. But "in hindsight,” she wishes she would have pursued those answers.
“We didn't have enough information at the time as to what that involved,” she said. “I didn't want our newborn baby to be cut into invasively and all of those things. But I don't even really know what a newborn autopsy involves and looks like. Our doctor at the time wasn't familiar with it as well. He was pretty new in his career, and so it kind of was a lack of information on both sides.”
'We can try again’
After Ruth Vivienne died, Serdar grieved.
She began seeing a therapist who specializes in pregnancy loss and started keeping an “anger journal.” She and her husband went on a lot of long walks together and set up a Thanksgiving turkey fundraiser in their daughter’s name. They started visiting her grave every month.
"The people that are going through stillbirth have gone through a great shock and a great loss,” Serdar said, reflecting on her own experience. “And it's like their life has been… like the rug has been torn from under them, and they're trying to rebuild, right? Rebuild from the ashes of their loss.”
When Serdar and her husband learned about the Stillbirth Center, it provided a glimmer of hope.
“It changed the trajectory of our lives,” she said.
They went in for a consultation with Silver, who she said estimated their risk of another stillbirth was about 1%.
"It was everything that I needed to move forward and be like, ‘OK, we can try again. We can have a baby that we are able to bring home,’” she said.
Still, Serdar said she lived in a state of "constant terror” throughout her next pregnancy that she would have to go through the emotional and physical trauma of another stillbirth.
“When you’ve had a baby die inside your body, any time that movement stops, you think it’s happening again,” she said. “And so there were moments where I was like, ‘OK, this is it. This is going to be the time where we go in and they tell us that she doesn't have a heartbeat.’”
The university provided extra monitoring of the pregnancy, as well as increased emotional support and reassurance. That extra level of care “made all the difference,” Serdar said.
After nine long months, their daughter, Margaret Hope, was born on April 10.
She and her husband wish Ruth Vivienne was here to see her little sister grow up. But they’ve been doing their best to cherish every moment – even the 2 a.m. wakeups.
“It’s not a hassle or a burden,” Serdar said with a smile. “It’s something that we get to do rather than something we have to do.”
Speaking to FOX 13 News from her home in Eagle Mountain just weeks after giving birth, Serdar said she’s grateful stillbirth is getting more attention and resources.
Ultimately, she hopes the work at the University of Utah will mean more families get to bring their babies home.
“I think in society, we don’t want to talk about it because we don’t want to think that babies die,” Serdar said. “But babies do. They’re humans, just like everyone else. And unfortunately, there are pregnancies that end in loss. And we just don’t address it as much as we should."