Aust. Paediatr. J. (1978), 14: 3-5
Loss of a Baby HUGH J 0 LLY Department of Paediatrics, Charing Cross Hospital Medical School Fulham Palace Road, London, W6 8RF (First given as a "GUEST OF HONOUR" lecture for the Australian Broadcasting Commission on August 21, 1977.) In the course of my work as a consultant paediatrician in the U.K. I have become increasingly conscious of the lack of understanding shown to the parents of stillborn babies by doctors, nurses and others. I do not think U.K. is alone in this but rather that the Western world in general has failed to study the needs of such parents so that they can receive the help they require. I must emphasise that it was not a special interest in the subject which led to my investigations but that in taking the routine history of the family of sick children, I frequently learnt of a previous stillborn baby. I n a sense the frequency of the discovery should not have surprised me since about 8,000 stillborn babies are born each year in Britain. What really did amaze me was that in many instances the loss of the baby, after many years previously, was still so acute that the mother burst into tears when she told me of this event. Clearly, she had not been able to work through her grief and the baby was sti I1 u n mourned. It was usual to find that the baby had been named but the mother's sense of failure was expressed by her remarks: one mother said that she felt she had created death; another one said she had not given birth but death. Many felt guilty that the baby's death was the result of some wicked action on their part such as the temporary consideration to terminate the pregnancy or sexual intercourse late in pregnancy. All this led me t o write on the subject of stillbirths in one of my regular articles in The Times. An avalanche of letters from parents followed. These were mostly from mothers expressing feelings which had been pent up for years. 'Your article made me feel for the first time since it happened that my feelings are not unnatural, as I'd feared'. Another wrote: 'It is only now after
34 years that I have been able to ask my husband where out son is buried'. A schoolteacher, reading The Times in the staff sitting room, had to rush out in tears because of the memories brought t o the surface. A devout Catholic mother had recovered enough after t w o days t o plan her baby's funeral. She was too late, the hospital had burnt her baby. Many told me that their marriage had broken up after the birth of the stillborn baby. This in part related t o the differing reactions t o the event of the father and the mother. Husbands expected their wives t o forget about the baby and were angry when they didn't, being quite unaware of the feeling of failure that their wives often felt. Several mothers told me that they were tempted t o steal other people's babies from prams. James, an older brother, thought his mother had got rid of the baby on purpose. Many felt bitter towards the hospital staff who appeared to them callous. Others were rightly aware that this apparent lack of sympathy resulted from the feelings of inadequacy experienced by the doctors. Doctors are mostly bad at coping w i t h the feelings surrounding the death of one of their patients. They have been trained to cure so that death may be felt as personal failure and arouse feelings of guilt. Nurses also made hurtful remarks without realising what they were saying or doing. One mother described h o w she tried to get up t o see her dead baby but was pushed back by the nurse w h o not only would not allow her to see her baby but refused t o tell her the sex. To this day, she does not know whether she had a son or a daughter. One mother was told that what you haven't seen you don't miss and yet the vast majority wished they had seen their baby, even if he was deformed.
4 Many were told t o have another baby as quickly as possible so as to replace the dead one. I was frequently told what it felt like not t o have a grave t o visit. Some went t o the cemetery looking for a grave, only t o find a barren strip of land instead of the headstone they had hoped for. I would again emphasise that my involvement in this problem arose solely from my routine work as a paediatrician. One mother of a newborn baby was unusually anxious-it was only discovered after this baby's birth that her previous baby was stillborn. I remember talking t o her and learning h o w her husband, in order, as he believed, t o spare her feelings, had never told her where the baby was buried. The next day I was able to talk to him and his wife-he could see his wife's needs and told her the name of the cemetery which they then planned t o visit as soon as she left the hospital. Her anxiety over her new baby largely vanished. A six year old boy was brought t o see me for attacks of abdominal pain. This turned out t o be related directly t o his mother's anxiety resulting from the earlier bereavement of a baby of w ho m the boy had n o knowledge. I have described the problems as they affect the parents of stillborn babies but it is clear that many of those with earlier miscarriages have similar internal feelings of loss. Mothers have helped me t o realise that a miscarriage is physically painful, sometimes as much as the delivery of a full term baby, and the loss is likely t o be followed by the same amount of depression. Much of all this suffering can be prevented if hospital staff and the public in general are aware of the feelings of parents and help them t o mourn their loss. The mother should be told before delivery if her baby is dead and every step taken t o ensure that her husband is present during labour t o comfort her and t o ensure a sharing of grief. One father was kept out of the labour ward when his wife was delivering their stillborn baby and described himself as being locked in another room. After the delivery he was allowed t o g o t o the labour ward, passing an open door to the sluice on the way. There, lying on the sluice among the dirty tea cups, was his dead baby. One mother whose baby was known to be dead, told me of a charade acted by the staff whereby they listened t o the baby's heart and said everything was going fine. When the baby was born dead, without warning, she screamed and was immediately given an injection to knock her out. When she came round from this, she went into hysteria.
AUSTRALIAN PAEDIATRICJOURNAL Parents should be helped-not forced-to see their dead baby so that they have someone tangible t o mourn. Doctors and nurses must be trained to be able t o do this. Recently, a young woman house surgeon at Charing Cross Hospital delivered a stillborn baby from a young single girl without any relative present. She did not want t o see the baby so the doctor removed him from the ward. Ten minutes later she asked for the baby and the doctor brought him back. She sat on the mother's bed, placing the baby on the bed. Slowly she was able t o get the mother t o feel the baby's hands and feet and then t o touch him all over. At this point she left the room since, as she told me, she n o w felt superfluous. She returned ten minutes later to find the baby being held by his mother in her arms. She held her baby for one hour during which time she was joined by the baby's father and her sister so that together they could mourn the dead baby. Even if a baby is deformed it is better that parents should see the baby. If they are not allowed t o do so, they will be haunted by the possible monster they have created which is always worse than the real thing. Even the most severely deformed baby can be sensitively shown t o parents so that the feelings of horror are reduced by the skilful use of drapes t o cover the deformed parts for a time. Parents should be helped t o plan a funeral to take place when the mother is well enough t o do so. The other children in the family, whatever their age, should also take part. The funeral should not be confined to those legally termed stillborns, i.e., 28 weeks gestation or more but should take place for younger babies if this is the wish of the parents. Whether t o discharge the mother quickly from hospital can only be worked out on an individual basis. There is a tendency for hospitals t o try to get rid of the mother as quickly as possible because she makes them feel uncomfortable; but this may not be the best answer, especially if she is going t o be left alone a t home to brood. It is not a good idea that she should spend all day in a single hospital room but permission from her should be obtained so that the other mothers in the ward know of her loss and can talk appropriately t o her. This is usually preferable to sending her off t o a gynaecological ward. Most important is to provide the father w i t h a put-up bed in the mother's room so that he can always be with her during the lonely hours of the nightwhether or not he has to be away at work during the day.
LOSS OF A
BABY
Every member of staff must be trained to understand the feelings of the parents, w h o need time to mourn and are deeply hurt by the suggestion that they should have .another baby quickly as a replacement. These feelings were summed up for me by one mother w h o wrote 'The baby is an achievement and one of your family'. On-going help must be provided by someone appropriate-a doctor, nurse, social worker, priest
5 or some other trained counsellor. Such help will enable parents to work through their grief, thereby reducing the length of the inevitable period of depression and guilt which is a natural accompaniment of bereavement. A child quoted in Nannette Newman's 'GOD BLESS LOVE' helps all this to make sense: 'When my daddy was driving w e saw a fox lying on the road and nobody stopped. You should always stop and say goodbye to dead things' .
Loss of a Baby HUGH J 0 LLY Department of Paediatrics, Charing Cross Hospital Medical School Fulham Palace Road, London, W6 8RF (First given as a "GUEST OF HONOUR" lecture for the Australian Broadcasting Commission on August 21, 1977.) In the course of my work as a consultant paediatrician in the U.K. I have become increasingly conscious of the lack of understanding shown to the parents of stillborn babies by doctors, nurses and others. I do not think U.K. is alone in this but rather that the Western world in general has failed to study the needs of such parents so that they can receive the help they require. I must emphasise that it was not a special interest in the subject which led to my investigations but that in taking the routine history of the family of sick children, I frequently learnt of a previous stillborn baby. I n a sense the frequency of the discovery should not have surprised me since about 8,000 stillborn babies are born each year in Britain. What really did amaze me was that in many instances the loss of the baby, after many years previously, was still so acute that the mother burst into tears when she told me of this event. Clearly, she had not been able to work through her grief and the baby was sti I1 u n mourned. It was usual to find that the baby had been named but the mother's sense of failure was expressed by her remarks: one mother said that she felt she had created death; another one said she had not given birth but death. Many felt guilty that the baby's death was the result of some wicked action on their part such as the temporary consideration to terminate the pregnancy or sexual intercourse late in pregnancy. All this led me t o write on the subject of stillbirths in one of my regular articles in The Times. An avalanche of letters from parents followed. These were mostly from mothers expressing feelings which had been pent up for years. 'Your article made me feel for the first time since it happened that my feelings are not unnatural, as I'd feared'. Another wrote: 'It is only now after
34 years that I have been able to ask my husband where out son is buried'. A schoolteacher, reading The Times in the staff sitting room, had to rush out in tears because of the memories brought t o the surface. A devout Catholic mother had recovered enough after t w o days t o plan her baby's funeral. She was too late, the hospital had burnt her baby. Many told me that their marriage had broken up after the birth of the stillborn baby. This in part related t o the differing reactions t o the event of the father and the mother. Husbands expected their wives t o forget about the baby and were angry when they didn't, being quite unaware of the feeling of failure that their wives often felt. Several mothers told me that they were tempted t o steal other people's babies from prams. James, an older brother, thought his mother had got rid of the baby on purpose. Many felt bitter towards the hospital staff who appeared to them callous. Others were rightly aware that this apparent lack of sympathy resulted from the feelings of inadequacy experienced by the doctors. Doctors are mostly bad at coping w i t h the feelings surrounding the death of one of their patients. They have been trained to cure so that death may be felt as personal failure and arouse feelings of guilt. Nurses also made hurtful remarks without realising what they were saying or doing. One mother described h o w she tried to get up t o see her dead baby but was pushed back by the nurse w h o not only would not allow her to see her baby but refused t o tell her the sex. To this day, she does not know whether she had a son or a daughter. One mother was told that what you haven't seen you don't miss and yet the vast majority wished they had seen their baby, even if he was deformed.
4 Many were told t o have another baby as quickly as possible so as to replace the dead one. I was frequently told what it felt like not t o have a grave t o visit. Some went t o the cemetery looking for a grave, only t o find a barren strip of land instead of the headstone they had hoped for. I would again emphasise that my involvement in this problem arose solely from my routine work as a paediatrician. One mother of a newborn baby was unusually anxious-it was only discovered after this baby's birth that her previous baby was stillborn. I remember talking t o her and learning h o w her husband, in order, as he believed, t o spare her feelings, had never told her where the baby was buried. The next day I was able to talk to him and his wife-he could see his wife's needs and told her the name of the cemetery which they then planned t o visit as soon as she left the hospital. Her anxiety over her new baby largely vanished. A six year old boy was brought t o see me for attacks of abdominal pain. This turned out t o be related directly t o his mother's anxiety resulting from the earlier bereavement of a baby of w ho m the boy had n o knowledge. I have described the problems as they affect the parents of stillborn babies but it is clear that many of those with earlier miscarriages have similar internal feelings of loss. Mothers have helped me t o realise that a miscarriage is physically painful, sometimes as much as the delivery of a full term baby, and the loss is likely t o be followed by the same amount of depression. Much of all this suffering can be prevented if hospital staff and the public in general are aware of the feelings of parents and help them t o mourn their loss. The mother should be told before delivery if her baby is dead and every step taken t o ensure that her husband is present during labour t o comfort her and t o ensure a sharing of grief. One father was kept out of the labour ward when his wife was delivering their stillborn baby and described himself as being locked in another room. After the delivery he was allowed t o g o t o the labour ward, passing an open door to the sluice on the way. There, lying on the sluice among the dirty tea cups, was his dead baby. One mother whose baby was known to be dead, told me of a charade acted by the staff whereby they listened t o the baby's heart and said everything was going fine. When the baby was born dead, without warning, she screamed and was immediately given an injection to knock her out. When she came round from this, she went into hysteria.
AUSTRALIAN PAEDIATRICJOURNAL Parents should be helped-not forced-to see their dead baby so that they have someone tangible t o mourn. Doctors and nurses must be trained to be able t o do this. Recently, a young woman house surgeon at Charing Cross Hospital delivered a stillborn baby from a young single girl without any relative present. She did not want t o see the baby so the doctor removed him from the ward. Ten minutes later she asked for the baby and the doctor brought him back. She sat on the mother's bed, placing the baby on the bed. Slowly she was able t o get the mother t o feel the baby's hands and feet and then t o touch him all over. At this point she left the room since, as she told me, she n o w felt superfluous. She returned ten minutes later to find the baby being held by his mother in her arms. She held her baby for one hour during which time she was joined by the baby's father and her sister so that together they could mourn the dead baby. Even if a baby is deformed it is better that parents should see the baby. If they are not allowed t o do so, they will be haunted by the possible monster they have created which is always worse than the real thing. Even the most severely deformed baby can be sensitively shown t o parents so that the feelings of horror are reduced by the skilful use of drapes t o cover the deformed parts for a time. Parents should be helped t o plan a funeral to take place when the mother is well enough t o do so. The other children in the family, whatever their age, should also take part. The funeral should not be confined to those legally termed stillborns, i.e., 28 weeks gestation or more but should take place for younger babies if this is the wish of the parents. Whether t o discharge the mother quickly from hospital can only be worked out on an individual basis. There is a tendency for hospitals t o try to get rid of the mother as quickly as possible because she makes them feel uncomfortable; but this may not be the best answer, especially if she is going t o be left alone a t home to brood. It is not a good idea that she should spend all day in a single hospital room but permission from her should be obtained so that the other mothers in the ward know of her loss and can talk appropriately t o her. This is usually preferable to sending her off t o a gynaecological ward. Most important is to provide the father w i t h a put-up bed in the mother's room so that he can always be with her during the lonely hours of the nightwhether or not he has to be away at work during the day.
LOSS OF A
BABY
Every member of staff must be trained to understand the feelings of the parents, w h o need time to mourn and are deeply hurt by the suggestion that they should have .another baby quickly as a replacement. These feelings were summed up for me by one mother w h o wrote 'The baby is an achievement and one of your family'. On-going help must be provided by someone appropriate-a doctor, nurse, social worker, priest
5 or some other trained counsellor. Such help will enable parents to work through their grief, thereby reducing the length of the inevitable period of depression and guilt which is a natural accompaniment of bereavement. A child quoted in Nannette Newman's 'GOD BLESS LOVE' helps all this to make sense: 'When my daddy was driving w e saw a fox lying on the road and nobody stopped. You should always stop and say goodbye to dead things' .
