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When Baby Dies—A Guide for Doulas

By Lindsay Dougal, CD(BAI), RYT

A sometimes hard truth to swallow is the fact that death is a part of life. Even harder to acknowledge is the truth that babies are among those who die. In the United States, 1 in every100 pregnancies end in stillbirth (fetal death after 20 weeks gestation)—roughly 24,000 babies every year.1 Another 20% of pregnancies end in miscarriage (fetal death before 20 weeks gestation). And an additional 23,000 infants die each year before their first birthdays.2

These numbers are scary. These numbers also mean that there is a great likelihood each of us will encounter loss in our work as doulas and birth professionals. Because we are scared or feel ill-equipped, we may inadvertently silence those experiencing loss. It’s understandable. Pregnancy and birth is an exciting time in the life of a family. From the minute those two lines appear, we are new. We have hopes and dreams for the future of our children and our families. We tend to keep things light and happy, as we don’t want to consider the possibility of not bringing baby home—of losing that future with that child. For the great majority of families, baby is born healthy and makes that beautiful trip home. But for many families, loss is the reality. Silencing these outcomes brings stigma and limits opportunity for support.

So, what can we—as birth workers—do to support families experiencing loss? As both a bereaved mother and birth and bereavement doula, let me offer up seven practical tips for supporting families experiencing loss:

  1. First and foremost, hold space for the expression of grief: Feelings associated with grief may not be shared if the person does not feel safe and supported. Let the family know you are willing to just be with them. Words may be spoken, they may not be. It’s important to be okay with either of these expressions, and not expect a certain reaction. Simply having a calming presence in the room means so much to a family.
  2. Get comfortable being uncomfortable: I’ll be the first to admit death is uncomfortable. Many of us aren’t exposed to death until much later in life, and don’t know what to say or how to interact with those who have lost. Remember, you will be uncomfortable for a few hours; the grieving parents will live with some level of discomfort for the rest of their lives. Don’t shy away from offering love, validation, and support.

  3. Labor and birth support: Physical and emotional support during the birthing process is so important. Try to make the birthing experience as “normal” as possible by offering encouragement. As appropriate, remind the birthing person of their birth preferences and help them understand which parts of the birth plan can still be fulfilled. If imagery, visualizations, and affirmations are used, make sure they have a positive tone and reflect the situation appropriately.

  4. Encourage parents and family to bond with baby: Memories made in those few precious hours or days will need to last a lifetime. Encourage parents to hold baby, and to allow other family members to meet and bond with baby. Maybe they were looking forward to reading a certain story or singing certain songs to their baby. They can still do these things. Offer to take photos of the new family. Facilitate the creation of keepsakes (hair clippings, hand/footprints, molds of hands/feet, etc.). They may not want to see them right away, but there will come a day when they do. The hospital may have resources to help with some of this, so check with staff to see what is and isn’t available.

  5. Use baby’s name, and congratulate parents on the birth of their baby: Bringing a baby earthside is hard work and deserving of congratulations and commendation, no matter the outcome. It may feel counterintuitive to congratulate, but remember that this baby is a beloved member of the family. You may say something like, “Arthur is a perfect, beautiful boy. He is so loved.”

  6. Attend memorial service and/or celebration of life: If the family invites you to attend the celebration of their baby, go. You are one of a handful of people who met and beheld their child. That—in and of itself—means so much. Having you at the service adds another level of love and support. Consider taking a card or letter sharing your beautiful memories of the day baby was born.

  7. Connect the family to resources: Educate yourself on the services for bereaved families in your community—grief support groups, postpartum depression groups, counseling services, children’s grief support providers, bereavement specialists, etc. Families may not be receptive to this information right away. Respect that space and be prepared for when they are ready.

The death of a baby is a profound loss, and it is important we recognize the need for families to mourn their babies. The loss of a baby is the loss of a person and a future. Every person grieves differently. As we learn more about the experience of loss and work on our own feelings and emotions surrounding death, we become better able to provide meaningful support during birth in any trimester and in any outcome. 

 

 

References:

1. “Facts about Stillbirth.” Centers for Disease Control and Prevention. Center for Disease Control and Prevention, 16 Aug. 2018. Web. 23 Oct. 2018.

<https://www.cdc.gov/ncbddd/stillbirth/facts.html>.

2. “Infant Health.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Mr. 2017. Web. 07 Apr. 2017. <https://www.cdc.gov/nchs/fastats/infant-health.htm>.

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Honoring the Postpartum Period After Loss

By: Raquel Alfaro

For any family, the postpartum period is a time of adjustment and change.  Sleepless nights and demanding days.  It is no less so for you parents experiencing the loss of a pregnancy, the loss of your baby.  It is compounded by not only dealing with the changes of the postpartum period, but also the whirlwind of grief, shock, and dismay while still being required to make important choices, give explanations, or plan events such as a funeral or ceremony for friends and family.

Your mind may be pulled a thousand different directions, your feet may no longer feel like they touch the earth. Your heart, your hopes, and dreams may feel pulled right out of your chest.  I see you.  I honor you.  I honor this journey of pain and longing.  Of hopelessness, powerlessness, and regret.  I see you.  I honor you.  And because I know how simple day-to-day choices, like what to eat for breakfast or how to get dressed are suddenly overwhelming, I’ve made a day-by-day guide for you to begin honoring yourself, your partner, your baby, your emotions, your process, and your body through the first 30 days of your lifelong journey.

Take one day, one hour, one minute at a time.  Follow this in order, or skip around.  It is your journey.  It is your baby.  I see you.  I honor you.  I walk with you, one day at a time:

Day One: I Love You

No matter the amount of time you get to spend with your little one, from minutes to hours, this is your time to meet and say first, “I love you,” before you say, “Goodbye.”  If you are able to hold your baby for a while (no matter how little baby is), send a family member or friend to get two stuffed animals, one large and one small.  The small one will stay with the baby and hold your love inside.  The large one will stay with you in your arms as a tie to each of you and a witness of your love. (Tip: This is the day to consider what may be done with your placenta.  For more ideas, see Day Seven).

 

Day Two:  I love you.  I miss you.

My arms miss holding you.  My lips miss all the kisses I have stored up for you.  My womb is heavy and still.  Hug your partner.  Cry together.  Share, and then, listen.

Day Three: Nourishment.

Allow yourself to be nourished.  Accept meals from friends and family, or order in.  Even if you don’t feel like eating, taste everything that is brought or offered to you.

“Even in my darkest hour, I can nurture myself.”

Day Four: Honor your body.  

Your body carried your baby for weeks or many months.  They were connected within your womb.  You have experienced changes in your body to open and accommodate this beautiful child.  Your body has given strength, nourishment, space, and vitality.  In honor of this gift, schedule (or have a friend schedule) a belly binding session to help tie up the loose ends and bring you into your space.  

“Honor the body.  Honor the womb.  Honor the journey.”

(Tip: Look for an SBD or another bereavement doula who also does belly binding to teach you or a partner or friend to do the binding so you can continue binding for a full 40 days, or however long you choose).

Day Five: Facing the Milk

In the wake of your loss, it can feel cruel to see your body making milk (if you carried beyond 21 weeks this is likely).  How can it not know your baby is gone?  How does it not feel the heaviness and emptiness in your breast?  You can decide to dry up your milk while acknowledging the tears you both cry, some clear, some white.  You can decide to pump and donate it to another baby in need.  If you decide to donate it, add a special touch like your baby’s initials or name on every bag.  “From my baby to yours.”

Day Six: Connection.

Connect to your partner.  Share a couple ways you thought they would make parenting fun and special for this baby.  Hold hands while you share and look each other in the eye.  Let the intimacy of connection guide you.

Day Seven: Token of Love.

Look into (or ask a friend to look into) making or having memory beads made from your dehydrated placenta, some of your baby’s ashes, or your pumped milk.  You can wear this in jewelry or can place simple ashes inside your stuffed animal in a special container as a continued and personal connection.

Photo from: https://www.milkandhoneykeepsakes.com/

Day Eight: Walk Together.

Take a walk outside.  Go as far as you feel comfortable going.  Imagine what it would be like to take your baby on this walk with you.  Think what you might show them, the colors they would see, the way they might feel the sun or the wind across their skin.  In quiet moments, like this, you can hold your dear baby close inside your heart.

Day Nine: Ceremony

If you held a funeral for your baby, you will likely have had the ceremony before now.  If you are not planning a funeral, consider creating a ceremony for yourself, or you and partner, or even include close friends and family.  It can be anything that is meaningful to you, from burying the placenta while music plays in the background, to planting a tree, to holding a salt bowl ceremony, to creating an altar of love at home or in the mountains.

For more ideas visit: https://stillbirthday.com/farewell-celebrations/

Day Ten: Silent Truth.

Though you are far from me, you will be with me forever.  

Day Eleven:  Bath

Take time today to take a steaming hot bath.  Add epsom salt, a favorite essential oil, and some flower petals if you have any handy.  Light some candles and turn off the lights.  If you still have some lochia or postpartum bleeding, just allow yourself to be okay with sharing space with this powerful connection to your body, baby, and journey.

 “I release into the water any thoughts of blame towards myself or others.  I am enough.  You are enough.  We work together to create kindness and compassion.”

Day Twelve:  Puzzled

Get your hands on a 1000 piece puzzle.  When you are ready, begin to set it out in a place where it can stay and be worked on over time.  This is a reminder to be gentle with yourself during your journey.  When you dump out 1000 tiny pieces onto the table, you do not expect it to gather itself up immediately and be whole.  It is a broken metaphor for your journey.  Even if you unite one piece of the whole each day, you will begin to see that over time you make progress.  Your journey is no different.  Only one thing a day to walk towards healing and finding meaning and someday you will begin to feel progress as the pieces come together to guide you.  “I am gentle and kind with myself on my journey.”

Day Thirteen:  Gratitude

Get a piece of paper and write down something you are grateful for about your partner, and put it somewhere they will find it during the day.  “You are a part of me.  We may walk different roads, but we are on the same journey.”

Day Fourteen: Breath and Release

Take some time alone today.  Put on some quiet, relaxing music, and sit or lay down in a comfortable supported position.  Place one hand over your heart and the other over your uterus. Focus on your breath lifting and moving both of your hands.  Allow your body to release any tight thoughts or emotions that come forth and focus back in on the breath.  “With each breath, I release and feel calmer and more at peace.”

Day Fifteen:  Earth and Sky

Go outside and lay down on the earth.  Bundle up if it is cold.  Lay down and watch the sky.  See if you can feel the space where the sky and earth meet.  Breath into this space as you imagine you might be able to either sink into the earth or float up into the sky.  Take at least 20 deep breaths before you begin to sit up slowly.  “I breath the breath of healing up from the earth and down from the sky.”

Day Sixteen: Poetry

Write or read a poem that speaks to you.  Here is one by Rabbi Nina Beth Cardin from her book, “Tears of Sorrow, Seeds of Hope: A Jewish Spiritual Companion for Infertility and Pregnancy Loss

Be gracious to me, O God,

For I am sorely wounded.

My eyes, my soul, my womb

Are consumed with grief.

I am like a broken vessel.

Day Seventeen: Kindness

Look for one small way you can share or give a kind act for another person close to you or even a stranger.  You never know the battles other people are also facing.  

Day Eighteen: Date

Plan or ask your partner to plan a simple date night to share.  Go out if you are up for it, or make popcorn and watch a funny movie together.  Take time to simply connect and share some designated “we” time together.

Day Nineteen: Reach out

Find a connection with someone else who has experienced loss.  Read a story, find a group on social media, or open up to a friend who has walked this road.  

Day Twenty: 20 Second Hug

Hugging for 20 seconds releases oxytocin into the body, which can help reduce anxiety and boost feelings of calm and happiness.  Throughout the day connect with your partner as often as possible in a prolonged embrace: at least 20 seconds.  It may feel unnaturally long at first but allow your bodies to melt towards each other in kindness and compassion.

Day Twenty-One:  Flowers

Take some time to find flowers, either on a walk or at the store. Absorb yourself in the small details of these delicate and lovely plants.  Look so deeply into the color that you can see the elements of the petals.  Inhale the scent slowly while you close your eyes and try to remember the last time you had this scent in your nose.  If you feel inclined, take some home to keep on the table and reconnect with these flowers several times.  “I allow my senses to take in the beauty around me.”

Day Twenty-Two: Gather Rocks and Materials

Go to a stream or other natural area and collect medium-small, flat rocks to be painted. Consider taking a friend with you.  Take time to breathe the air of the plants around you.  Take time with each stone to feel the weight of it in your hand.  Put it in your plans to pick up some paints (or ask a friend or family member to get some) for painting the rocks.  You’ll need permanent paints and very small brushes.  Some rounded sticks, like the flat end of some toothpicks, work well too. Modge Podge works well as a sealant.

Day Twenty-Three: Painting and Hiding

Consider inviting a friend to join you in painting the rocks you gathered.  Choose any colors, design, or layout you wish.  It is more about the process than the final picture.  On the backside of each rock, paint your baby’s name or initials and birthday.  When they are finished go out into some favorite spots the city and “hide” the rocks for other people to find.

Day Twenty-Four: Warming Foods

Incorporate warming, healing food into each of your meals.  Ginger, cayenne, garlic are great additives. Also, hot soups and teas are great for warming.  Miso soup is warm, comforting, and nutritious.  

Day Twenty-Five: Walk Lightly

Today is a reminder to take thing slowly and deliberately, no matter what you do or with whom you engage.  Walk Lightly through your day.  Walk Lightly with your partner. Soft words and actions.  Walk Lightly with yourself.  Loosen your expectations of yourself and allow softness to seep into you like a gentle wind.  “I allow tightness to melt into softness.  Tight words, tight thoughts, tight expectations for myself and others soften and melt away.”

Day Twenty-Six: Sun Therapy

If it is warm enough outside take time laying out in the sun in a swimsuit or as bare as possible. Let the warmth of the sun soak into your skin and revitalize your systems with its touch.  Be aware of time, so you don’t burn your skin.  Setting a timer works well, and rotating if the skin begins to feel uncomfortably hot.  If it is not quite warm enough to be outside, do some indoor sun soaking using the sun coming in from a large window.  Add a space heater to keep you extra warm and simply feel the sun touching your skin as much as possible.  “Even though my world has been spun upside down, the loving presence of the sun reminds me I am loved, I am supported, I am cared for.”

Day Twenty-Seven: Honor the Birth Order

Whether you include your loss when people ask how many kids you have, or whether you count it to yourself, I encourage you to find some way to honor the birth order and hold space for the importance of this baby in your heart.  It could be something simple and unspoken such as a wall hanging with leaves for each of your children, including this and any other losses.  It could be finding a way to remember this in an annual way, through a donation of time or money to a cause that drives you or helps you or your family remember and honor the loss of this special family member.  It can be as quiet and private as you would like, or as open and inclusive as feels comfortable.  “I hold space for you in my heart.  You are with me forever more.”

Day Twenty-Eight: Curl up with a Book

There are many fantastic books written by other parents who have experienced loss.  Sometimes seeing and connecting to what others have gone through, that also mirror our experience, is very comforting.  It helps to know that you are experiencing a normal reaction to a difficult experience.  Here are a couple recommended by other parents:

Empty Cradle, Broken Heart, by Deborah L. Davis

Healing After Loss, by Martha Hickman

When There are No Words, Charlie Walton

The Shack, by William Young

Day Twenty-Nine: Honor each other

Find a way that you and your partner can honor each other.  You can request what you would like, and your partner can request what they would like.  Be open to whatever your partner may request.  Things to consider: a foot rub, a love note, a walk in the mountains together, an hour of cuddling in the nude, a night out.  “As you honor each other, you allow the stress of your loss to fall away as you absorb the gift you bring to share.”

Day Thirty:  I Light a Candle for You

Get a glass candle and decorate the outside in a way that is meaningful to you.  Tie ribbons around it, paint it or draw on it, but make it something that connects you in thought to your little baby.  Each time you find yourself in a dark space of sadness, or heaviness, intense longing, blame or wanting to connect, light your candle.  Acknowledge the light and allow this small flame to open your heart and warm and comfort you.  There may be dark days and dark moments yet to come but know you are not alone on this journey.  I bless you to be gentle with yourself, with your partner, and with your process.  May you find peace as you search for meaning and connection.

“I walk forward with gentleness and kindness to myself and others.  I allow myself to be in the process of healing, of discovering strength, of grieving, of walking forward deliberately and lovingly.”

Everyone handles loss in their own unique way.  It is a process that takes time.  It takes kindness and gentleness for yourself and others around you.  Now that you are through the first thirty days, continue the softness and gentleness you have practiced.  Go back through the list if you find it helpful, as many times as you need to, or whenever you need a little extra guidance along the way.  If you are here looking for ways to support a loved one experiencing loss, I hope you have found some simple and gentle ways to let them know you love and honor them and their journey.  

Raquel Alfaro is a certified bereavement doula (SBD) through StillBirthday and a Certified Advanced Doula (CAD) through the Midwives College of Utah.  You can follow her on Instagram as: @starlightdoula or on Facebook at Starlight Doula Services.