Death Before Birth
( Excerpts from chapter of Living with Bereavement )
Death before Birth The confirmation of pregnancy can be the most fulfilling and exciting moment of a woman’s life. The feelings of anticipation and expectation generated at this time are unlike any she has experienced prior to this moment. Some pregnancies are not so welcome and for some the news may be devastating. They may decide to terminate the pregnancy, either for reasons of a personal nature or on medical advice. Some women experience a sense of relief following their termination, but for others it may be an emotionally painful experience. Whatever the decision or circumstances, all women need the opportunity to acknowledge their feelings and address any issues raised by the decision. When a woman is glad to be pregnant and happy with her condition she begins to plan for her child and for the bright and exciting future ahead for her and her family. The baby growing inside her has already been given a personality and more of the expectant mother’s attention will be paid to the other people’s children, as in her own mind she relishes her impending motherhood. Some expectant mothers feel an almost instantaneous connection with their growing child and clients who miscarried early at 10 or 12 weeks have told me that they already knew in their minds what sex their baby was and how they would look. Miscarrying a baby is a traumatic experience, both emotionally and physically and many women often feel further distress by hearing their baby referred to as a ‘foetus’, a ‘cluster or bunch of cells’, a ‘miscarriage’ or a ‘missed abortion’. The medical professionals usage of correct but insensitive language can make the grieving mother feel disregarded and forgotten in her need to acknowledge the little life that was developing inside her. She may be experiencing feelings of failure, guilt, self-blame and redress.
“When I started bleeding, I went to bed, I tried tilting my body so that my lower half was higher, I thought that might hold him in. I couldn’t stop it, I just bled and I felt so alone. I sat on the loo just crying. It seemed too awful that my baby was disappearing down the toilet. The doctor said he’d admit me for a scrape. That word felt so brutal. No-one talked about my baby like he was a baby, but to me he was very real. I used to look at books photographs of developing babies and think “Ah this week his little hands are growing”. I don’t think anyone knew what to say, someone said it’s probably for the best ……… I felt alone. I kept thinking “Why me – what had I done wrong?” , then I thought it was because I’d had a drink at my friend’s wedding . It was only one drink but I wish I’d been more careful. I called my baby Steven. I can’t just forget him. Giving him a name makes it easier somehow, like although everyone else thinks he was just a blob, I regarded him, loved him, wanted him and I won’t forget him.’
The misuse of language can cause added pain and distress to the bereaved parents and in particular, the mother. Words of support offered by well-meaning friends and family such as “You’ll have another baby”, or “It’s nature’s way “makes the mother feel that her loss is not being recognised as a bereavement and her grief often remains unexplored and in isolation. The hormone levels in her body are still telling her that she is pregnant and her body’s return to a pre-pregnancy state can take several weeks and cause side effects.
“I was thrilled when I was pregnant …. It was my first time and I felt so special. I was so shocked when the doctor said he couldn’t see a heart beat on the scan and in one moment my world was devastated. I wanted to get home and be with my partner but the doctor admitted me for a D&C (Dilation & Curettage). I had never had one of those before. He said I’d had a missed abortion ……… I didn’t understand his language really. I was admitted to hospital and in the next bed to me was a woman who was pregnant with twins and on the other side was a young girl who had had a termination. I was in the middle. I was alone and I had to wait until morning for them to take me to theatre. I felt like everything was out of control and I had no choice. I didn’t ask too many questions because I thought they’d think I was a nuisance. Strangely I didn’t feel any different … I still felt pregnant. I wondered if they’d made a mistake. I was shaking and sobbing as I went down to theatre and I felt totally patronised by the nurses who referred to me as a big, brave girl. Afterwards a doctor said my baby had died at least two weeks before and that this happens sometimes …. I should go home and in a while try again. What about my baby ………where was it, I felt pretty helpless and as if asking anything was inappropriate. It was important though for me to know about my baby. I couldn’t see it but I wanted to know where they had disposed of it. I was haunted by these thoughts of it being kept in a jar somewhere. I felt very low. I couldn’t talk to anyone about it and as days went by I began to feel as though I was engulfed by black. I lost interest in everything and I couldn’t cry. I felt numb. A vicar came to see me and I told him I wanted to know about my baby. I was 14 weeks gestation when it died. The hospital told him that they put the remains of my baby in the sluice. I was very distressed but then the vicar said the sluice would eventually go to the sea and in that I found a little hope. I was depressed for almost a year and life lost its joy for me. I will never forget how I felt. I have two children aged 15 and 13 now, but I feel I really had 3 and still think of that baby and the life it never had”.
Many thoughts and feelings are so often left unspoken and the lack of acknowledgement and importance may lie beneath the surface causing resentment and stress within the relationship. Whilst acknowledging that both partners are affected by the death of their unborn child, it is the feelings of the woman governed by the hormones released in her body during pregnancy, who suffers the ongoing symptoms that can affect her in ways that her partner may not be able to understand or relate to. Some women may yearn to be pregnant again almost immediately and experience a sense of frustration if she is told by her doctors to wait a while or if her partner seems hesitant.
“After we lost the baby my partner was really supportive for the first few weeks but after that I could tell he was getting fed up with me talking about it. I was still feeling so empty so sad and so very cheated. He said he felt sad – sorry that we weren’t going to have the baby after all but that we would have a baby one day. I really wanted to talk about this baby, the one I was expecting. I know people say, that they aren’t babies at 14 weeks, but I felt like mine was. I was sure it was a boy and I used to look at pictures in magazines and try to imagine what he’d look like. I felt I’d lost my child and no-one really wanted to know. In the end I just kept my feelings in. It took ages for me to fall pregnant again and I have a daughter now aged three but I want my unborn child to be acknowledged too.”
For some couples the desire for a child can become the focus of their life and this often brings added stresses and pressures to the relationship, and in particular to the sexual aspect of the relationship where anxieties about conception can create impotence and cause once enjoyable and relaxed lovemaking to feel contrived, planned and clinical.
“We used to have such a fantastic sex life ….. it was spontaneous and exciting . Since losing our baby we have been trying for another and ‘doing it ‘at certain times – I’ve been taking my temperature and keeping a chart so we know when I’m ovulating. My partner often finds arousal difficult. I have felt like we are not as close …… I didn’t expect this to happen and now he says he thinks we should stop thinking about another baby for a while …….. I can’t. It’s causing lots of arguments. No-one seems to understand”.
The loss of a baby in the early weeks also often causes the expectant mothers to blame themselves or experience a sense of failure. It is important to explore these feelings and to validate the experience and its impact on the mother, the relationship and the ripple effect on all areas of life.
“I had just attended my first ante-natal class …. I was 14 weeks and my friend was also pregnant, we had planned to do so much together and life seemed complete. When I lost the baby, she was upset and afraid for herself. I felt angry that she was concerned about herself, her pregnancy. It seemed so unfair that this happened to me. She stopped coming round – she told my husband that she found it hard that she felt guilty for still being pregnant. I was glad that she stopped calling. I didn’t want to hear about her or see her getting bigger. It was like part of my life was taken away …. My plans. Also I noticed other pregnant mums and thought ‘Why couldn’t it have been you?’ I felt guilty about that and angry too”.
Often for the mother this might be her first experience of loss and the extent and depth at which she is impacted will depend not only on the level of support and understanding she receives but on past experiences. Her recovery may be helped or hindered by the care she receives at this crucial time. Bereavement can often cause other fears to rise to the surface and may be a trigger for the release of past emotional turmoil. On the Internet there are several websites where the unborn are remembered and grieved. Many women express their innermost thoughts and feelings on these websites, women whose babies have not survived into life and are holding their feelings of loss within themselves. They write of their grief at the lack of society’s acknowledgement of their child’s existence and death, the lack of understanding of friends, family, neighbours and work colleagues during the struggle to come to terms with their loss and their overwhelming feelings of emptiness because some mothers feel that a part of them has died with their child. All deaths both before and after birth needs acknowledgement and acceptance for only then can those who are bereaved feel they have permission to mourn.
“ I started to get this really bad pain in my stomach. I phoned the doctor, he said It sounded like food poisoning and if I wasn’t better in 24 hours to call him again. Within a few hours I knew I was having contractions, I was 7 months pregnant. I phoned my husband, but by the time he got home they had stopped. I went to my doctor he couldn’t find a heart beat and admitted me to hospital. My baby had died but I had to deliver it. I was so shocked and I couldn’t believe that my baby had died. I thought they had made a mistake. I was hoping that once labour started they’d tell me it was ok. I had lots of pain relief and the staff at the hospital were very kind after just a few hours my baby son slipped silently into the world. He looked perfect. I didn’t want them to take him to perform an autopsy but they said they would need to establish why he died. I was horrified that my baby was going to endure yet more, his perfect little body. I was so alone, so useless and heated. The hospital took photos of him for me and I named him but they didn’t offer anything else. I left him at the hospital and I often wonder what they did with him”
In many hospitals there seems to be the assumption that the reason why a patient doesn’t ask a question it is because they do not want to know the answer. My experience is that often the patient does want to know but perhaps does not know how to ask for information. They are frightened that these capable and efficient people who are caring for them may think they are a nuisance, that they are morbid or strange and that they may not like them if they make a fuss. All of these comments have been said to me at some time during counselling sessions. All people are individuals with their own ways of feeling and behaving, but yet we expect them to all conform to acceptable and emotionally straight jacketed behaviour at a time of enormous mental and physical turmoil and distress. Perhaps it is because we are afraid that if we experience the real and raw emotion of another person’s distress, we will be unable to control or contain our feelings which will then escalate and magnify beyond our control. Some hospitals are only too aware of the depth of grief and distress experienced by bereaved ‘death before birth’ parents and are willing to spend time with them and try to answer their questions honestly without recourse to jargon and consider their requests sympathetically. Unfortunately though there are many hospitals who suffer staff and money shortages so they have neither the time or facilities to provide this comfort to bereaved ‘death before birth’ parents who leave the hospital taking a huge number of unanswered questions and confused thoughts home with them.
Birth and Death
In some circumstances a woman who has had a healthy pregnancy may tragically lose her child during labour or due to complications in vitro (inside the womb) her child dies just prior to or during labour. For these mothers the complications and trauma of giving birth and watching their baby die are so very distressing and many tell me that they felt alone, misunderstood and unsupported. The mother is often returned to the maternity ward where she may then endure the added distress of hearing other mothers give birth and the cries of their healthy and living babies.
Most hospitals now recognise and accept that the bereaved parents may wish to be with their stillborn baby and for them to have time alone in this way is extremely important. Many hospitals encourage mothers to hold their deceased baby, take photos, hand prints or footprints and allow the parents private time with their child. It is not unusual for mothers to want to dress their baby, cuddle it and love it. The tangible evidence of photographs, hand prints or footprints gives the parents in the months and years ahead, confirmation of their child’s existence and that their experience was real.
“Everything was fine with the pregnancy; I had been so well and felt really good unlike my first pregnancy where I felt ill most of the time. When I think back I did feel uncomfortable about going over my date. I was a little anxious but my GP said it was fine and I did feel good. Things just went so very wrong. I still don’t know exactly what happened. It seems the cord was around my baby’s neck and she died before they could deliver her. Afterwards I held her, so tiny and perfect. I dressed her and wrapped her in the little pink outfit and blanket that I had hoped to take her home in. I felt very calm at the time, I remember thinking it was a dream. I tucked her under my arm and slept, when I woke up I thought ‘I’ve had my baby’ and I felt excited, then I started to realise that she had died and there she was alongside me, blue and cold. The worst part was leaving her there in the hospital. I put her tiny body into her crib and said goodbye but I just couldn’t bear to leave her. Looking at her lying there I tried to take in every detail. I thought I have to make this last me a lifetime. I told her I was so sorry and I loved her. Finally a nurse and my husband took my arms and turned me away I could barely walk. The pain with each step that I felt as I left her alone there in the hospital was agonising, my heart really felt as though it were breaking.”
Leaving hospital can be a mixture of complicated feelings. The expectant parents had entered the building with the expectation of new and family life. The building may now feel like a place of limbo and disconnection where the reality of all that has happened has still to be accepted. It can feel safe within the hospital. The reality of going home without the baby can be overwhelming. Leaving hospital empty armed and childless is the first, full impact of reality. Some parents have told me that they would have liked to have taken their baby home with them.
“I wanted to bring her home, to keep her at home until the funeral. I just wanted her to feel wanted, not discarded ‘Baby Jones’. I wanted my little girl to have known that she had a home, a crib, a room, a family. It felt bizarre to think this. I didn’t mention it not even to my husband. A long while after he said he thought about that too, but we both didn’t share our thoughts because we felt that they would be thought of as morbid, that the hospital would refuse us the right or that they might think we were crazy”
Many bereaved parents have told me of their feelings of not having any rights, of their baby becoming in some way the property of the hospital or funeral director, of being unable to ask for more time with their child and of wanting to do as they wish with their baby including taking it home. There must come a time when we, as a community of considerate and caring people, start to help our fellow human beings to work through the acceptance of the death of their loved one and their tragedy in their own way without inflicting on them our assumptions or judgements. In some hospitals counselling/support services are available and it is beneficial to the bereaved parents for them to have an opportunity to talk through their feelings both before and after leaving hospital. Where this service is not available supportive and listening family and friends can be of huge assistance. It is very important to recognise that the couple whose child has died have experienced circumstances which are beyond their control and where they had no choices whatsoever. It is therefore essential that they are encouraged to make choices and to feel that some areas of their life are still within their control, even in these early grief stricken days where the energy to make choices and decisions may be limited
There may also be many issues surrounding mother and child care during the final stages of gestation and in labour e.g. on-going investigations and legal procedures and evidence may need to be sought by solicitors and other professionals. This coupled with the trauma, the tragic death, stresses and anxieties can affect the relationship between the couple. Feelings of resentment, failure, guilt, anger and depression are all usual, but communication between the couple can become fraught and there are many issues that may cause a vast change in the relationship. The loss of the way things were and the lack of hope for the future coupled with the loss of self.
“I go over and over it, I comb through every detail, I lay in bed every night thinking it through, sometimes I try to focus on one of the doctors or a nurse, I wonder did they cause it to happen? I think about my wife and sometimes I blame her for not being more able, if she had worked harder at the delivery. I hate myself for blaming anyone but there has to be an answer – doesn’t there?”
“I feel a failure, I let my baby down, I should have told them to perform a caesarean, I should have known, I should have protected my baby. I hate the nurses – when I think it through I keep hearing this one nurse talking about a night out and I feel angry that she was not as involved with me “.
“I want to hate the midwife who made a mistake in my delivery but I can’t. Right now I feel so sad it’s like my heart beats pain and is heavy”
The couple may at first be comforting to each other; both feeling isolated and lost within their nightmare but as time passes their individual feelings of loss rise to the surface
. “I feel cheated. At first I felt grief for our baby, now I feel grief for me. I don’t feel the same anymore about anything and my world feels uncertain. I feel lost”
“I couldn’t talk to her, tell her what I really felt it was too devastating too punishing. I hated her, but I felt such sadness for her too, all at the same time. It was totally unexplainable to feel such deep feelings of hate and resentment for the woman I loved and felt so devastated for. I also felt I’d let her down, failed to protect her. In my hating feelings, I wanted to leave her, to run away from it all. We couldn’t have any more children now ……… I had always wanted a large family. All I had planned and worked for was stolen. I often looked at her and thought she had changed. I couldn’t understand the diversity of my feelings, I felt like I didn’t want her near me. Not only had she changed emotionally but physically she put on a lot of weight and she wasn’t bothered it seemed about how she looked. I felt less of a man. I felt people thought I was a failure. I thought they were secretly blaming me. She was a living reminder of what we’d been through. At the same time I felt totally sad for her, protective of her vulnerability and, though unable to show it, a deep sense of love and guilt too for all she’d been through”
“Our relationship was changed forever; we had been so very excited about the baby, so happy, in love, a future that seemed great. Now we were devastated, lost and unable to communicate. I was so angry at everything but unable to put it anywhere”.
“At first we were close; there was a time, for a while, of huge understanding. I felt cared for, he was so attentive and comforting. But then it started to change, I felt it was my fault, I also felt angry with him for not doing more at the birth but I knew in reality there was nothing. I felt empty, loveless, like when our baby died part of me died too. He didn’t want to talk about it. I used to go and sit by the crib and gaze for hours trying to remember every detail of our baby. My hospital bag was still unpacked, I just couldn’t put things away. He used to get irritated with me, I felt like everything died with our baby – even us. There seemed to be no hope”.
The death of the baby had changed everything for this couple. Initially they were able to comfort each other and the support and understanding of those involved enabled them to grieve openly. It was acceptable for them to be shocked, tearful and at a loss, but as time progressed the divisions in their once easy relationship became more apparent as the reality of their baby’s death affected every part of their life. Family and friends of the couple can help by making themselves available and simply listening to them talk. Professional grief counselling, either individually or as a couple, will be of huge benefit and slowly the two people may start to talk and listen to each other and once again become a couple with shared experiences. Everything has changed and it is important that this is acknowledged so the relationship can move forward. The death of a child is so life changing and the pressures felt by the child’s parents are so enormous that many couples cannot see the way forward together. A separation following bereavement is not uncommon, the bereaved couple who may be experiencing an overwhelming sense of failure as parents, now have to cope with appearing as a failure as a couple as well. They may try and protect family and friends from the truth and become burdened with the added stresses of putting on an appearance of managing their circumstances and emotions. Their feelings are very real, but their difficulty is in accepting the lack of control or choice in the recent turmoil of their life.Even the couples who are able to talk openly to each other about their emotions and manage to retain their relationship need acknowledgement of their trauma and its ongoing ripple effect and to enable them to forge, on the foundations of this communication, a stronger and closer bond. Experiences change us and alter our perceptions. The death of someone we loved makes us question all that we trust and hold dear. Plans are changed as future hopes come crashing down around our ears. Death is common to each and every one of us, but each experience is unique and creates change within us, and it is important that this change is recognised and used positively and not allowed to cloud our vision and hopes for the future.
Funerals for still born babies
Where the parents hold religious convictions, most church leaders will visit the parents if requested and, in most cases, a blessing can be given to the baby. The bereaved parents then have the difficult task of arranging the funeral and also the dilemma of who to invite. It can feel uncomfortable for those invited to such a funeral, especially where other couples are expectant or have infants or small children and can sometimes create a break down in relationships with friends. It is important that the bereaved parents do things the way they wish and are able to do whatever gives them comfort. The most helpful family member or friend will be the one who asks ‘What do you want to do and how can I help you to do it?’ If the couple wish to bring their baby home the funeral director will advise them about keeping their baby until the funeral. Keeping the baby at home can be extremely beneficial as it provides the parents with private opportunity to be with their child. It takes away the feeling that the child belongs to the hospital or that they might be being observed or judged. It permits other members of the family, especially siblings, to share time with the baby and an opportunity, depending on their age and understanding, to grasp what has happened. Preparing the baby and experiencing feelings of wanting to make him or her comfortable or cosy are usual. Special outfits can be chosen and it can be a comfort to the mother to care for her child in this way. Photographs might be taken and letters written and placed in the baby’s casket. Parting with the baby should not be a rushed event and parents encouraged and allowed as much private time as they feel they want. No amount of time is ever enough, but they will be aware of eventually having to say goodbye to their child. The parents may find comfort in the funeral service and the presence of family and friends, but in the coming weeks and months the reality of their loss will become stronger and it is at this time that more support may be needed. For many parents the first anniversary of their baby’s death can be incredibly painful. There are other areas of their lives too that will be emotional, the birth of new babies to friends, christenings, family occasions, the first birthdays of any children born to other couples at the same time as their little one and watching other children grow coupled with thoughts of how their child might have grown up and looked. Their grief is not only for the loss of their child but also for their future and their hopes and dreams. Friends and family, by being aware of these emotional milestones in a bereaved couple’s life and by making themselves available in supportive, listening roles, will help the couple move through their grief towards an acceptance of their loss and to carry on with the life that had turned out differently from their original plans.
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A list of supporting agencies may also be found on our support page
UK charity providing support for bereaved parents and their families.www.miscarriageassociation.org.uk/helpList of UK support groups for those who’ve experienced pregnancy loss