Mind & Spirit

How to cope after having a stillbirth

By: Kathy Gebel

Author: Canadian Living

Mind & Spirit

How to cope after having a stillbirth

By: Kathy Gebel
This story was originally titled "In the Stillness of My Heart" in the November 2008 issue. Subscribe to Canadian Living today and never miss an issue!

It's Sept. 17, 2007, the day my daughter would have turned six months old. I sit in the bedroom that she was supposed to share with her older sister and imagine what the room should look like. There should be a second crib along that wall, another dresser over by the door and double the laundry in the hamper.

I stare at the precious photos taken after my baby's stillbirth and my mind drifts back to a much happier time. I'm answering the phone on that beautiful July 2006 morning. I hear my doctor's secretary tell me that I'm pregnant. I remember feeling a mix of joy and disbelief that it had been so easy.

This was to be my third child. My first came back in 1993, when I was barely out of my teens. My son and I moved from Peterborough, Ont., to Hamilton, where I met my husband. We were married in 1999, and after many years of trying to conceive again, Emily was born in March 2005. When Emily turned one, we decided that we would welcome another baby, but only if it happened naturally. I knew I couldn't go through the fertility treatments again – the constant charting of ovulation, the fertility pills and the pain of watching other women get pregnant while we failed would all be too much to bear.

When that phone call came within just a few months, we couldn't believe our luck.

A trip to the hospital
My pregnancy progressed well. The morning sickness had subsided by five months, and I gained weight at a healthy pace. The only real issue was that the baby was in a footling breach position (both feet first) and was showing no signs of turning around. My obstetrician explained that it was too dangerous to deliver a baby in this position and scheduled a caesarean section for March 21.

A few days before that date, I was baking a cake for Emily's second birthday party when I began having strange pains. They weren't like labour pains; they were sharp and dull sensations that came and went. I brushed them off, telling myself that the baby was just in an awkward position. But the pain got worse and more frequent. Something was wrong.

We decided to go to the hospital. There, a smiling nurse hooked me up to the fetal heart monitor. She commented that she had felt the baby move and asked if I had, too. I nodded, hoping that this lie would erase my fears.

Throughout my last trimester, my baby's little head would push up against my ribs. I would gently rub it to try to get her to move so I'd be in a more comfortable position. My heart skipped a beat as I realized I hadn't had to do that since the previous evening.

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A tragic discovery
The cheerful nurse put the monitor on and quickly found a heartbeat. I saw a smile come over my husband's face and felt the tears coming again. I had heard my baby's heartbeat many times and I knew this wasn't it. It was my own. The nurse confirmed my fear as her smile turned to a concerned look.

Everything was pointing to a disaster. It was at this time that my mind seemed to split from my body. Perhaps I couldn't cope with what was happening. It was as if it weren't me lying there on that bed; it was like watching a scene from a movie. My thinking changed, too; instead of instinctively knowing that something was wrong, I started believing my baby would be OK. The mind can play some very strange tricks when you're in distress.

My physician, Dr. Raj Ramanna, placed his stethoscope on my heart while the nurse took my pulse. I was barely conscious at this point. I remember them saying the number 98 over and over again. It was only one heart rate – mine.

They finally stopped counting. The doctor looked into my eyes and said, "I'm so sorry, there's no heartbeat."

"No!" I shouted – not out of despair, but to inform him of his colossal error. My baby might be in distress, but she is not dead, I thought to myself. I watched the kind doctor console my husband and felt almost smug as I pictured how shocked they would be when they heard my baby cry.

'I was physically and mentally numb'
The C-section went ahead that day. Upon the delivery, I held my breath and waited for the cry that I was convinced would come. I was wrong. The room stayed silent until I heard the doctor say quietly, "Cord around the neck." He told us later that the cord was wrapped around her neck six times and that it had probably been wound ever tighter since early in the pregnancy.

I was physically and mentally numb. Ramanna asked me if I wanted to hold my baby. I flatly refused; if I didn't hold her, this whole nightmare would not be real.

A nurse took us to a dark, private room, where we were joined by my husband's parents, brother, sister and grandparents. They all took turns holding and rocking our baby. It was beautiful to watch them all fall in love with her.

But I couldn't hold her. My husband sat beside me cradling our little bundle, and I looked at her face for the first time. She seemed so beautiful and peaceful wrapped in a blanket and wearing a pink knitted cap. Her hair was dark like mine, but with her round face and fine features, she was a miniature version of her dad. We named her Elizabeth, after my beloved grandmother.

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'I will literally die of a broken heart'
Ramanna returned and asked me if I had held her yet. I told him I hadn't. He gently told me how important it was to hold her and to say goodbye. But how do you say goodbye to your hopes and dreams? To the future you had imagined and to this child that you loved so much? It felt like I had been hit by a truck as I realized that I would have to live the rest of my life without my daughter. I won't make it, I thought. I will literally die of a broken heart.

With Ramanna's help, I finally gathered the strength to hold my little girl. No words can express my gratitude to him for helping me find that strength. I now understand that I didn't want to hold her because it would inevitably lead to me having to let her go. As my husband placed Elizabeth in my arms, I felt the last remnants of numbness leave my body. I hugged her and kissed her perfect face and tiny lips, just as I had done when I held my other children for the first time.

My husband and I stayed in the room with her for hours, until the time came to say goodbye – forever.

We had planned a full funeral. I am so thankful that everyone I care about had the opportunity to say goodbye and to pay tribute to Elizabeth's short but very meaningful life.

Supportive friends and family
The weeks after her funeral were a blur. Most of our friends did their best to comfort us any way they could.

But not all of them. The social worker at the hospital had tried to prepare us for the possibility that some friends would not or could not be there for us. This was sadly the case. Some friends didn't know what to say, so they said and did nothing. Pregnant friends turned away – perhaps fearing that a baby's death is contagious.

Some friends even told us that we were lucky we never got to know our baby. It's a common myth that parents of stillborn babies don't miss their children because they never took a breath outside the womb. We miss our baby just as any parent misses a child who was born alive.

The days following Elizabeth's funeral were unbearably long. My arms ached to hold her, and I awoke each morning and prayed that I would look down and see my pregnant belly. I was living a nightmare, and even though I was getting lots of exercise and eating well, I had to resist the urge to drown myself in a bottle of Merlot. I couldn't stop crying and felt totally hopeless.

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I finally admitted to myself that this was something I couldn't handle on my own. I started taking antidepressants; after only a few months the grey fog that was burying me started to lift and I was able to think somewhat clearly for the first time. This new stage of grieving was still agonizing, but bearable. I started to believe that I might actually survive.

It was my son's Grade 8 graduation in the spring of 2007 that helped me realize I might do more than just "survive." During the ceremony I heard his name called to receive the award for most improved student. Amid the loud cheers from his fellow graduates, I was overcome with pride.

But the true breakthrough moment came while driving alone later that night. I caught a glimpse of myself in the rearview mirror and realized that I was smiling. It wasn't a forced smile – the kind you put on when people are around – but a genuine smile that only comes with true happiness.

I will always feel sadness over the loss of my daughter, but I hope that as I carve out a place for her to live forever in my heart, it's a sadness that won't bind me. I am forever changed, but it would be a great disservice to Elizabeth's memory if I allowed that change to be a negative one. I will honour her by embracing the softer, more empathetic person that I have become and by being the best mother possible to her brother and sister, and any other children that may come.

Stillbirths: Causes
In about 20 per cent of stillbirths, the cause is unknown; in the rest, a number of factors can contribute to the death. Sometimes there is more than one cause.

Among the known causes are:
• Birth defects. About 15 to 20 per cent of stillborn babies have one or more birth defects. Nearly half of these have chromosomal abnormalities, such as Down syndrome.

• Chronic health conditions. About 10 per cent of stillbirths are linked to conditions such as high blood pressure, diabetes or kidney disease in the mother.

• Umbilical cord problems. Accidents involving the umbilical cord (for example, a knot, blood clot or multiple loops) may contribute to about 15 per cent of stillbirths.

• Placental abruption.
This is a condition in which the placenta partially or completely peels away from the uterine wall before delivery.

• Infections. Bacterial or viral infections involving the placenta, the fetus or mother (for example, genital or urinary tract infections) are involved in about 10 to 25 per cent of stillbirths.

• Obesity. Women who are significantly overweight seem to be at increased risk of having a stillborn baby.

Risk factors for stillbirth include:
• Smoking;
• Drinking alcohol; and
• Using street drugs during pregnancy.
These are often linked to low maternal education and poverty.

Page 4 of 5Remembering the stillborn child
Talking about stillbirth – defined as a death occurring after 20 weeks gestation – is uncomfortable, but staying silent just adds to the pain of an already devastated family. Here are some tips from my own experience, with some input from the Bereaved Families of Ontario.

• Don't use clichés. Don't tell the family that this is for the best, that the baby is in God's hands (they want the baby in their own hands!) or that an angel will be watching over them. Just tell them you're sorry and give them a hug.

• Don't pretend it didn't happen. Parents know you're aware that their baby was stillborn, and it's hurtful when you don't acknowledge it. Our baby is never far from our minds, so don't be afraid to bring it up out of fear of upsetting us. Talking about the baby may cause a few tears but, remember, it’s the baby's death that upsets us, not talking about her.

• Take pictures and mementoes (footprints or handprints, plaster cast, clothing, etc.) in the hospital. It may seem strange at the time but these items will be priceless in the future – and the parents may not think to gather these mementoes.

• Say the baby's name, please!
It lets the parents know that you think of the baby as a person.

• Don't tell the parents that their feelings are illogical or irrational. Grief comes in many forms and stages. If the parents are angry, sad, bitter or feeling guilty, don't judge them; just support them. They don't want to feel this way, they just do.

• Understand if the parents don't want to participate in anniversaries or other important events.
The baby never had a chance to celebrate holidays and special occasions, but that doesn't make those occasions any easier to bear. These times are strong reminders that there is someone missing.

• Don't shy away from the parents just because you're pregnant or have a new baby. You'll know if they can't handle seeing you. Don't take it personally. You can still call or send e-mails. The parents may not respond in the early days, but that doesn't mean you shouldn't continue to reach out.

• Remember the dad.
He lost a baby too.

• Check out websites that have tips for grieving parents of a stillborn baby.

Read more:
An overview of trimesters
10 things to do before you get pregnant
Pre-pregnancy precautions

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Mind & Spirit

How to cope after having a stillbirth