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MIDWIVES: CHECKLIST TO ASSIST GRIEVING PARENTS
1. Birth Options (If baby dies in utero):
a. Place of Birth: home or hospital, what ward of hospital, NOT maternity.
b. Medication.
c. Supportive Network: This should be began right after birth/death of baby and continued for a time afterward.
2. The Immediate Crisis:
a. Make sure the baby is held by mother and father.
b. Give second opportunity to see baby.
c. Offer to bathe and dress infant.
d. Take pictures.e. Encourage naming baby.
f. Offer to contact clergy, baptism, etc.
g. Give tangible mementos: fetal monitor strip, footprints, crib card, lock of hair.
3. Frequent postpartum communication and contact between family and midwife (i.e. daily in the early weeks).
4. Community resources:a. Supply information so that family needs for counseling and support for ongoing grieving process are readily available.
GRIEVING: FOR PARENTS - A WAY TO HEAL
The death of a baby - whether before or after birth - is a profound tragedy. If you have lost a baby at any stage of pregnancy or during or after delivery, you are going through an emotionally painful time. Not only is this kind of loss usually sudden, but to many parents, it also seems so unfair that the baby they have been hoping and waiting for should be taken from them.
The grief you feel over the loss of your baby is a natural process of healing. The impact of this loss may be as great as the death of a spouse, parent, sibling, or older child. The memory will always be with you and should not be downplayed or denied.
The information given here is meant to help you face your baby's death. it lets you know what to expect and ways in which you can get support and reassurance. While this information provided here cannot replace communication between you and your partner, your family, your health care provider and/or midwife, or possibly a counselor, it may help you to understand the intense and confusing emotions you are feeling now and well be feeling for some time.
FEELING THE LOSS
Grief is a normal and necessary response to the loss of your baby. Through grieving, you gradually learn to let go of the ties you have formed with your fetus or newborn and go on with your life.
For a mother, this bond can be very strong. It often begins well before birth, sometimes even before conception, and grows throughout pregnancy. Your baby becomes a person in your mind. You imagine who the baby looks like and what the baby will be like. This bond is often greatly strengthened around 16 to 20 weeks of pregnancy, when you first feel your baby move. Techniques such as ultrasound (in which sound waves are used to create a picture of your fetus) may have enhanced this bond by letting you actually see the fetus.
A father can also feel a strong tie to his unborn child. His feelings may be different from a mother's, because he does not experience the pregnancy in the same way, but a father also feels the death of a baby as profound loss.
Both of you may have intense feelings of grief, even if you lose a pregnancy in the first few months.
MoonDragon's Pregnancy Information: Miscarriage
THE STAGES OF GRIEF
The grieving process that follows the death of a loved one may last anywhere from 6 months to 2 years or more. This process often follows a common pattern in many people, although certain stages or phases of grief may overlap or repeat or not always follow the same course. Each family member who goes through the grieving process will heal in her or his own way.
SHOCK & NUMBNESS is the mind's way of protecting itself when first faced with a great loss. Parents often think, "This is not really happening" or "This can't be true." Your first reactions to the news of your baby's death may be denial, a complete lack of feeling, or an inability to grasp what death means. Even though you and your partner may be together physically, during this phase, you may, each feel a very private sense of being alone or empty.
SEARCHING & YEARNING begin when the initial shock phase of grief has begun to pass. You begin looking for a reason for your baby's death. You search for who or what caused the death. This is often a time of intense guilt. You may imagine that you were somehow responsible for your baby's death, but this is seldom the case. Still, you may blame yourself for things you did or did not do. You may have dreams about the baby and yearn for what might have been. During this phase, you may feel you are going crazy. Mothers often feel anger toward their partner, the health care provider or midwife, or the hospital staff, or they may question their religious beliefs. They may also direct their anger toward a woman who has had a healthy baby. Anger becomes unhealthy when it is turned inward and directed toward oneself.
DEPRESSION & LONELINESS are a part of the next phase, during which the most intense emotions begin to ease. You may feel tired and run down, sad, disoriented, and helpless. You may have trouble getting back into your normal routine. The support from friends and relatives that was available before, may be gone now, when you still need reassurance, kindness, and understanding. But somehow, you slowly begin to get back on your feet and accept your loss.
ACCEPTANCE is the final phase of grieving. You begin to have renewed energy, and your baby's death no longer dominates your thoughts. Although you will never forget your baby, you begin to think of her or him less often and with less pain. You find yourself resuming activities and social contacts, laughing with friends, and making plans for the future.
OTHER SIGNS OF GRIEVING
As you grieve, you may have other feelings or physical symptoms that are also natural and normal:
- Aches and pains in the breasts and arms.
- A tight feeling in the chest and throat.
- Heart flutters.
- Headaches.
- Trouble sleeping, nightmares.
- Loss of appetite.
- Tiredness and fatigue.
- Loss of memory, inability to concentrate.
- Fantasies about and preoccupation with images of the baby.
Grieving mothers often feel as if their bodies have failed them. At first you may want to ignore your health or appearance. These feelings may be heightened if you have problems healing physically from the birth.
At any time you have concerns about what you are feeling, either emotionally or physically, do not hesitate to talk with your midwife and/or health care provider about them. During this difficult time, you need to take special care of yourself, take time to enjoy favorite pleasures, and allow yourself time to heal, both physically and emotionally.
YOU AND YOUR PARTNER
During the first year after parents lose a child, there is often stress on their relationship. You and your partner may have trouble communicating. One of you may feel hostile toward the other. You may find it difficult to resume lovemaking or doing things together that you used to enjoy. Be patient with one another. Let each other know what you are feeling. Take time to be tender, affectionate, and close. Make an extra effort to be open and honest. Talk.
Throughout the grieving process, you and your partner may not respond in the same way to your baby's death. He may feel different things at different times than you do. Or he may not be ready to talk about the loss when you are. When a baby dies, the father is sometimes pushed into the role of being the decision-maker or the protector of his partner and family. This perceived need to be strong may make it hard for him to express his feelings, but it does not mean that he does not care or does not hurt. It is important to allow your partner to grieve in his own way. Try to understand and respond to his needs and feelings as well as your own.
MAKING DECISIONS
You and your partner will face a number of decisions during and after delivery. These choices will have an important effect on your healing. They focus on finding meaningful ways to define your baby as a special person. By doing so, you can accept both the attachment and the loss and can go on to say goodbye in a way that will ease any later regrets.
SAYING GOOD-BYE
One of the most important decisions you will have is whether to see your baby. Although this may sound scary or morbid at first, the experience of other bereaved parents strongly suggest that seeing your baby will be very helpful to you. Seeing and touching your baby can help you realize your loss more fully and make it easier to let go of her or him. It also creates a very personal memory of your baby, a memory you will carry with you the rest of your life.
If your baby has been born with less than perfect features, it is just as important to consider seeing him or her. Most parents find that the truth is far kinder and gentler than their fantasies.
Giving the baby a name is another way of acknowledging the baby's identity. You may want to use the name you had first chosen or use another one.
MEMORIES
Parents usually treasure remembrances of their baby. Consider asking the midwife or nurse to give you a lock of hair, a handprint or footprint, or an ID bracelet or crib card from your baby, if they are available.
Photos can also help establish the reality of your baby. Even if you do not think you will want pictures of your baby, have them taken anyway so that you can get them later on if you change your mind.
AUTOPSY
Whether you baby was delivered at home or in a hospital at the time of death, an autopsy (an exam of a deceased person) is usually performed by a pathologist to determine the cause of your baby's death. Although it may be impossible to tell why your baby died, an autopsy can help answer questions about what has happened and may provide information that will be useful in any future pregnancies. Many parents express relief at knowing the cause of death. Others are relieved to know that no special problems were found.
FUNERAL OR MEMORIAL SERVICE
You may wish to have the baby baptized or have a "Rite for the Dead" ritual performed or arrange a religious or memorial service. For many parents, it is a great comfort to have family and friends acknowledge the life and death of their baby and to express their sorrow at a special service.
You will also need to decide about what will be done with your baby's body. You may wish to contact a funeral home for burial or cremation. Some parents find it comforting to have a grave site they can visit. Or if you prefer, the hospital where your baby is autopsied may be able to arrange for disposition of your baby's body. In most cases, this will involve cremation and the remains will not be available to you later.
GOING HOME
Whether the baby was at home and then taken to the hospital or was in a hospital at the time of death, it is hard to go home after the death of a baby with empty arms and face an empty nursery. It may also be hard to deal with the reactions of family and friends. Although they do not mean to hurt you, people fail to understand the pain involved in losing a baby, especially if the baby did not live long. They may make well-meaning but hurtful remarks, such as "You're young, you can try again," "Be grateful for your other children," or "Some things happen for the best." Other people may avoid you or may avoid talking about the baby because they feel awkward.
At this painful time, it is important for you to put your own needs first. Let people know what you want from them and how you are feeling. There is no need to force yourself to be polite or brave just to please others. Some of the awkwardness and discomfort of telling other people about what has happened may be eased by sending out announcements of the baby's birth and death. You should also be prepared to respond to casual acquaintances who see you are no longer pregnant but may not know about the loss of your baby.
If you have other children at home, it is best to tell them directly that the baby has died. Trying to shield children from death does not work. They can sense your sadness, anger, and fear, and they will feel left out. When telling young children about what happened to the baby, it is very important to avoid placing blame. Make sure they understand that the baby's death is not their fault. Children often feel anger and jealousy toward a new baby and the news of the baby's death may make them wonder if their thought and feelings somehow caused it. It is not unusual for children to fear that they or their parents may also be in danger of dying. You need to reassure them that there was nothing they did to cause the baby's death and that there is no risk to them. Whatever their reaction, children respond to loss in different ways, depending on their ages and personalities. Let them know you recognize and understand their pain over the baby's death and that you feel the same way. Be sure to include children in any funeral or memorial service.
SEEKING SUPPORT
As you go through grieving, you will feel very vulnerable at times. The pain of your baby's death can remind you of hurts from the past, such as other losses and deaths, infertility, or family problems. Often these old hurts can return and interfere with the healing process.
It will be important for you to gather support around yourself right after the baby's death and in the months that follow. There are many individuals and groups with the skills and understanding to help. Many grieving parents have found community support groups to be very helpful. These groups are made up of parents who have gone through the same tragedy that you have. They can provide support, understanding, compassion, and respect for your feelings.
Professional counseling can also help to relieve your pain, guilt, and depression and help you understand and accept what has happened. You may wish to seek counseling for yourself, for you and your partner, or for your entire family, depending on your needs. Some reasons for seeking help may be:
- Getting "stuck" in one phase of the grief process, so that you are having trouble working through certain problems alone or with your spouse. You may experience not only grief from the loss of your baby but it may be compounded by postpartum hormonal fluctuations associated with postpartum depression.
- Severe physical or emotional problems that prevent you from functioning, such as inability to return to work, loss of interest in health and appearance, inability to sleep, fatigue, aches and pains, and/or staying in bed all day.
Talk to your health care provider or midwife if at any time you are concerned about what you are feeling, either physically or emotionally. Your health care provider, midwife, nurse, or clergy can provide you with the names of support groups or therapists who specialize in counseling bereaved parents.
ANOTHER PREGNANCY?
Before thinking about having another pregnancy, allow time for you and your partner to work through you feelings about this baby and allow time for your body to heal from the pregnancy. After the loss of a baby, couples often will feel a need to have another baby right away. They think it will fill the emptiness or take away the pain. Of course, a new baby cannot replace the baby that was lost. Grieving takes a lot of energy and some time is needed for the process to occur. The process of healing is not helped by another baby too soon after the loss. Having another baby too soon can also make it hard for you to appreciate the new child as a separate and special individual. Talk to your midwife, health care provider, or counselor about any future pregnancy plans before making any decisions. Should you decide another pregnancy, it is important for you to know that the chances of losing another baby are almost always very small (depending on the cause, if it is known). Still, you may be very anxious and concerned during you next pregnancy. It is important for you and your midwife or health care provider to talk about the reason for the first baby's death, what the chances are it will happen again, and what can be done to reduce these chances. Your midwife or health care provider may recommend certain tests before or during your pregnancy to find any possible problems as early as possible.
FINALLY...
The loss of a baby is a traumatic event. Grief is the normal reaction to such a loss, and through grieving you can come to terms with your baby's death. You will heal better if you can face your baby's death squarely rather than trying to avoid it, or postpone it, or pretend that your baby did not exist.
Everyone grieves in a different way and at a different pace. The various steps in grieving may occur or reoccur in any order or may be triggered under stressful situations. It may take take anywhere from several months to a few years to learn how to cope with a loss. Counseling can greatly help you and your family come to terms with this sad and painful event and go on with your lives.
This hurt will never vanish completely, but it will not always dominate your life and your thoughts. Eventually you will be able to talk and think about the baby more easily and with less pain. And one day you will find yourself doing more of the things you used to do, such as enjoying favorite activities, renewing friendships, and looking forward to the future.
RELATED LINKS
Dr. Cacciatore's Life and Death Blog
When a Child Dies
Changing the Way Our Culture Mourns
Dr. C's Research Page
Stillbirth Policy Advocacy
Information based on "Silent Birth....If your Baby Dies" by Sharon N. Covington
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