A midwife's perspective on perinatal loss
Updated: May 5
Co-Founder and Vice President of Possum Portraits Annika Reinboth, who also goes by Jascha, is a practicing midwife. As a perinatal caregiver, Jascha experiences the joy of childbirth every day. But in this role of provider, she is also a much more frequent witness than most people would ever choose to be to the terrible and numbing reality of perinatal loss.
In this post, Jascha gives us a perspective on stillbirth from a caregiver's point of view.
I’ll always remember the first stillbirth I attended as a student midwife. The couple were first-time parents-to-be, and their baby’s due date was approximately two weeks away. The mother went into labour quite abruptly at home in the early hours of the morning, and they made their way to hospital. When they arrived, my colleagues could not find a foetal heartbeat. Labour was already well under way when the parents-to-be had to be informed that their baby would be with them soon; and yet that it would never take its first breath.
This was, of course, impossible to comprehend. To digest. Even for us, as medical caregivers, these situations have an absurd quality. They are grotesque, off-balance, unreal. Death is a part of life we humans always have trouble grasping, and even more so when those who die are so young. We want explanations, but in some cases, there are none. In this instance, there was no time for the parents to come to terms with this capsizing of their world, their future, because the contractions kept coming. The baby was on its way, and the pain of labour was augmented and amplified by the pain of grief.
I arrived at work a few hours after that first moment, that first stillness on the ultrasound screen. I spent hours of that morning with the parents, in the darkened and quiet delivery room, being there and assisting as best I could. The mother began to push quite soon, and when her little boy arrived, we laid him onto her bare chest. She held his pale body close and, tucked under a small blanket, he looked as if he had merely fallen asleep.
The most lasting impression, the most defining memory I have of this birth, is the stillness itself. A stillbirth is just that. Quiet. Noiseless. Suspended and surreal. Everyone present in a dazed state of disbelief and sorrow. The air inside the room heavy and stationary, the world outside forgotten, as everyone’s eyes watch the new baby.
Even though we providers encounter these situations repeatedly throughout the course of our careers, even though they are not as painful for us as for anyone related to the angel baby, and even though we develop mechanisms for dealing with the loss, stress and pain as natural consequences of these experiences, these moments are always unforgettable and highly emotional. The indisputable and ubiquitous atmosphere of love that resonates at most births resonates at stillbirths also: and we midwives can (and do) get caught up in its awe.
For what it’s worth, I would like to offer a few thoughts from a healthcare provider’s point of view.
I think there is no way we can make these moments better. There is nothing anyone can say or do to help; not in these moments of sorrow and pain. At the same time, I am sure that there are things one could say or do that would make everything worse. The caregiver’s credo of “First, do no harm” has a more urgent meaning in this case, and it is on my mind at these moments, perhaps more than at all others. One important consideration for stillbirths is always the question of analgesia. When someone is in great emotional pain, there is a strong urge to alleviate any physical pain with medical means. Many studies have shown, however, that recovery after stillbirth is often more manageable if the mother gives birth without an epidural. These are ongoing debates in the obstetric community, and (if there is time to make these decisions before labour begins) time should definitely be made to have conversations with the grieving parents about how they want the birth to proceed.
Sometimes attending these births, these moments, I (and other providers I have spoken to) feel grateful to be in the right place at the right time. We value the opportunity to be there for others, for our fellow human beings, in the hardest moments anyone could be asked to endure. For us, one of the most successful strategies for getting through these experiences is to do our best for those in our care. To make sure that parents have photos to take home with them, and that we have information about support services at hand. To make sure that parents feel someone is there throughout the birth to provide space, acknowledgement and respect for their unspeakable grief.
Because first, do no harm.
Born To Let Die
by Annika Reinboth
An egg and a shell
Fire and flame –
in a hospital freezer.
A small, round, white dwelling
with handle and lid,
a sticker on the outside wall,
Curl up and drift off,
and sweet dreams.
Dreams for a lifetime,
a lifetime unlived.
Ingredients all added,
the dough left only to grow
to become a small person
who was born to let go.