Emotional Impacts of Stillborn Births

Each year countless names and faces are added to the growing list of those born too soon as the result of stillbirth.  With every child lost a new mother begins the arduous task of grieving and what Dr. William Worden, founding member of the Association of Death Education, calls the four tasks of mourning as they struggle to accept the reality of their loss, experience the pain of their grief, adjust to the environment they would have shared with their child, and learn to live again by reinvesting in life and those relationships around them. 

From the spirited highs of a positive pregnancy test and decorating the nursery to the darkest pit of despair in the dimly lit corner of the ultrasound room and hearing the words “we’re sorry, your baby has no heartbeat,” the pain of stillbirth is one of the deepest, most unbearable pains expectant parents will face.  Stillbirth defined is the death of an infant between 20 to 28 weeks gestation.  It is usually diagnosed during a routine ultrasound or after a mother seeks assurance from her care provider after noticeable cessation of fetal movement.  If a baby has died the mother will be medically induced or allowed to let nature take its course and the birth proceed on its own without medical intervention. 

 The typical scenario begins with a dazed bewildered mother whisked away to an unfamiliar sterile delivery room to be delivered of the lifeless child inside of her.  A wash of emotion and confusion can be expected at this time.  How and why are two of the questions that will surface repeatedly in her mind.  Gone is the tiny soul of her baby to be.  Along with her baby go the hopes and dreams that she held for her child’s life. Gone now, too, a small portion of herself.  Her reality now becomes that instead of having a baby she will be having a funeral.   This new reality can be overwhelming, intolerable, bleak, and filled with questions that, for her, no one can answer. It is at this very delicate moment in time that steps be taken to aid and facilitate the mother’s grieving process.  The first step after the initial shock of the news of the death of her child and delivery is to help her accept the reality of her loss.  How is this done?   In the Psychosocial Aspects of Death and Dying author John D. Canine asserts “In any death, however, acceptance of the reality of the loss is facilitated by seeing or being with the dead body.”  In helping the mother move forward into acceptance, a grief facilitator should encourage the mother to hold her child, bathe her child, give the child a name, and perhaps take keepsake photos of her baby.  A grief facilitator may even encourage the mother to reflect upon the face of her child and ponder family resemblances. Does the baby resemble them? Does it resemble their other parent, a sibling, or maybe some other beloved family member that may be living or departed?

As the mother contemplates the reality of her loss and begins to move through the acceptance phase into the phase of dealing with the pain of the death of her child she will inevitably experience a wide range of emotions.  She may experience physical symptoms as well as emotional symptoms.  In Ralph Klicker’s Funeral Services Psychology and Counseling, such physical and emotional symptoms may include crying, appetite loss, fatigue, trembling, sleeplessness, and confusion.  She may experience numbness or speak about having full breasts and the sensation of empty aching arms. While experiencing these symptoms may be distressing and upsetting they are normal and to be expected.  To help the mother progress through this stage the grief facilitator should encourage the mother to speak about the death and provide her with the necessary tools to move the grief from within herself to the outside.  Journaling is a great method to do this as it will help provide a more personal, private outlet for the mother to express feelings she may be otherwise unable to vocalize.  The grief facilitator may suggest a support group for the mother who feels alone as it may prove beneficial for her to be with other mothers who have experienced stillbirth.  In assisting a mother to obtain the necessary tools she will need during this stage a grief facilitator should reinforce to the mother that there is no right or wrong way for the her to grieve. She should know that there is no set way, no standard responses, no standard behaviors, no set amount of time in which she should “let go” or move forward.  She should also be made aware that health care providers, hospital social workers, grief counselors, spiritual leaders, and other grief facilitators are available to answer her questions.  If there is a known cause for the stillbirth death of her child she should know that healthcare providers are on hand to meet with her, her spouse, and family to discuss the loss and what transpired during the pregnancy that led to the demise of the baby.  Knowing the cause of death, in some cases, can prevent such tragedies from recurring in subsequent pregnancies and may also alleviate the misconceptions the mother may have about being responsible for the death of her child.

Now, is when the next part of the journey begins. The mother is home. The funeral has taken place, her child has been laid to rest, and all phone calls and well wishes have dwindled away.  Everyone’s life has returned to normal except for hers.  Now what happens?  What is the next step? Where does she go from here?  This is the part of the process where the attention must turn to adjusting to the environment in which the child will no longer be part in the physical sense.  This is a very crucial point, but it is a necessary part of the grieving and healing process.  It is time to face the nursery.  This is where the door to the nursery is opened and the mother is confronted with the sight of the empty crib, baby clothes, equipment, and shower gifts that were received and left lying throughout the nursery to be put away in anticipation that her baby would someday use these items. Some are packed, some are unpacked. There are clothes hanging in the closet. There are drawers stuffed with tiny diapers and baby socks.  Shelves are stocked with lotion, shampoo, body wash, and every necessity a mother could want or need for her baby.  Feeling overwhelmed and tearful a mother may ask herself, “Where do I begin and what am I going to do with these things?” VeryWellFamily.com contributing author Elizabeth Czuka says, “It’s your decision alone – There is no right or wrong!”  She further states that a mother should always trust her instincts and make clear to the family what plans she has for the child’s belongings. If a mother is unsure what to do, Czuka offers such helpful suggestions as letting a close friend or family member clear out the nursery.  If not, maybe the right choice at the time would be to leave the nursery and the belongings untouched.  Other suggestions are to store the items or donate them to a charity or simply sell the items even if they have been opened.  She suggests that gift items may be kept or returned if too unbearable to keep them.  However, it is important to note that major decisions should not be made while in an emotional state.

 Whatever the decision, it is a personal decision, and one that should be done in the best interest of self-care.  It is even ok to turn loose of some items and keep others as personal mementos or keepsakes to serve as a reminder of the life that was.  The main concern is that the nursery does not become a shrine to her dead child nor a place in which the mother stores or discards pieces of herself and locks the door behind her.

Lastly, one of the hardest tasks of mourning is the ability to withdraw emotional energy and reinvest it into life and relationships with those still living.  This is the part that some mothers fear the most.  This is the heartrending step of letting go.  This is the part where the mother needs to reclaim her life from the grief that defined her life up to this point. This is where the mother to living children returns to the tasks of caring for those children.  This is where the mother needs to return to the task of being a wife to the husband that needs her and has endured his own personal journey through the grieving process. She may even consider returning to work.   This is a critical juncture.  Mothers need to know and be assured that letting go does not mean she is forgetting.  To forget would mean to erase the mind of the event as if it had never occurred. Letting go means accepting and making peace with the loss and being able to form a new relationship with the cherished memories of the child that has died.  Letting go means opening the door of the nursery to allow the sun in and no longer being defined by and consumed with grief.  Letting go means moving from the dark to the light. 

Stillbirth is a silent epidemic that robs the bellies and arms of mothers around the world. It leaves in its path inexplicable grief and heartache to be felt and experienced by parents and all of those awaiting the arrival of the baby to be.  For everyone whose lives are impacted by stillbirth, to successfully manage their grief, they, too, will proceed through the inevitable tasks of mourning in which they will have to face the reality of death, experience their own pain, and learn how to live in the environment from which the baby is missing.  In doing so, they they will find a way in which to focus their lives on those still living while remembering those little ones born too soon.

Bibliography

• Canine, John. The Psychosocial Aspects of Death and Dying. Appleton & Lange, 1996.
• Czukas, Elizabeth. “How to Handle Your Baby Shower Gifts and Nursery After Miscarriage.”    Verywell Family, 22 Oct. 2018, www.verywellfamily.com/what-should-i-do-with-my-nursery-after-stillbirth-2371775
• Klicker, Ralph L. Funeral Service Psychology and Counseling. Thanos Institute, 2007.