by Raichal Reed
When I first started working in birth work I never understood why bereavement did not have as much emphasis and groups where people talk as pregnancy, birth, and postpartum groups. Death happened early in my life due to me being raised by my grandmother and so as I got older I learned to cope with it better. My maternal side of the family has obstetric complications and so miscarriages and stillborn were also a tragic, but normal event. There is a thin veil between life and death and so also it is a troubling subject there is no way to talk about life with death and loss.
To clarify on miscarriage/abortion versus stillborn it really comes down to when it happens. A miscarriage is defined as a loss of conception before 20 weeks gestation, after that it is considered to be a still born. Most miscarriages occur around 7 weeks gestations and so most people capable of conceiving have probably had a miscarriage and didn’t even know. Ten to twenty percent of known pregnancies end in miscarriage, while 1 in 100 pregnancies end in stillbirth.
There are different types of pregnancy loss:
- Complete: all tissue leaves the body
- Incomplete: only some tissue leaves the body (usually dilation and cottage occurs after)
- If not, the tissue left could become infected and lead to sepsis
- If the pregnancy ends and the products do not leave the body then it is “missed”
- Inevitable: symptoms cannot be halted, and miscarriage will occur
There is also the case of “threatened” miscarriage where there is severe abdominal cramping that may or may not be accompanied by bleeding. These pregnancies can be maintained with proper care, bed rest, and sometimes medication. There are risk factors to miscarriage and stillbirth (over 35 years old, smoking cigarettes, obesity, low socioeconomic status, etc.) but the highest risk factor of pregnancy loss is a history of pregnancy loss.
Now that we have gotten those definitions out of the way I want to continue this piece talking about bereavement. Death and loss effect people in different ways and so their way of coping with it varies from minimal to extreme. The first thing when it comes to pregnancy loss is the acknowledgement. It is important to do this because the birthing person and family has to know who they are grieving and to come to the realization that although this child is gone they were and are still a person. They should feel that even if for a moment their child was here and now they are gone. It is easy to displace grief for something or someone when you have no sentimental holdings of them like photos or blankets. With the first child, it can sometimes be an overwhelming experience because there is a sense of blame, sometimes from other people and sometimes from themselves, set on the birthing person for not being able to carry the child to term.
I do find that these people do have an easier time after a while of realizing that the child is still with them and become more proactive in their next birth as their “rainbow” baby grows within them. A rainbow baby is a fairly modern term for the next successful delivery of a child following a loss. Whether or not testing should be done on the causes of the loss of pregnancy if up for debate and varies person to person. I think one benefit is that if it was something she could control we know what to do from this point, but the bad outcome is that if nothing comes of it then she could feel even more helpless to the situation. The first menstruation following a loss of pregnancy can be equally as jarring as the event. Anything leaving the vagina can be shocking and also a reminder of the loss that occurred, especially if the pregnancy had progressed so far that she had gone months without menstruation. It can also be upsetting because it can bring up the idea of having another baby which some women may not be ready for. In the same mindset, the menstruation could be a happy sign that her body is not broken due to her previous loss and that her and her partner can try again.
It is important to meet people where they are and help them find their way through this ordeal. There can also be a loss of one of a set of multiples and it is important to keep focus on the other one or multiple children left in utero but also to acknowledge that one of them is no longer there. It can be normal for them to wish the others would die as well, and it can be normal for them to not acknowledge the one that is missing. Research shows that bereavement is actually better for the entire family when they are allowed to speak of the sibling, child, grandchild, etc. that did not make the journey outside the womb. Children who were aware of the pregnancy should be allowed to grieve for their sibling and when and if another child is born allowed to remember that gap in the number of children. If they were the third born child then their number should stay and the next child be the fourth.
When going to a hospital it can be appropriate for those who are present with the birthing person to still receive a baby blanket and hat even if the child did not survive. Others choose to deliver their stillborn or miscarriage at home and even then it is good to have baby items with the babies name if they had them or objects that were bought for the child. There are machines called “cuddle cots” that usually are located at larger hospitals that keep the child warm a little bit longer so the birthing person can stay with their baby. It is also appropriate to ask that the birthing person not be moved to another room until they are ready because it can be painful for them to hear crying children or see other babies.
This is not only an opinion piece on bereavement, but also solutions that can and should be taken not only by those personally impacted but by the ones who help them through it as well. I received my training on bereavement through Stillbirthday and encourage others to read more on the subject. Find out what funeral homes in your area have special circumstances and procedures for miscarriages and stillbirths as well as what hospitals have protocols for the birthing person to take the remains home or to be left in the hospital extended time to grieve properly. There are local groups that handle loss in all facets but it is important to find commonality with those who share a similar story.
Raichal Reed – ” So my name is Raichal Reed. I am a 24 year old, fourth year student midwife originally from South Mississippi now residing in Central Texas. I’ve always been in love with the birthing world ever since childhood and decided in the second grade I was going to work with women and children. Coming to Texas I found that midwifery was regulated and decided to take that route instead of medical school after receiving my Bachelors in Sociology/Pre-Med. I am the current volunteer director for Giving Austin Labor Support, a non profit of volunteer doulas, and a midwife student to two wonderful Midwives (one CPM and one CNM).”