Sunday, May 31, 2009

What to Expect When You're Expecting a Dead Baby

I had no idea what to expect when I found out my baby Jeremiah had died. So here's some basic useful information on what to expect when you've just found out your baby has died beyond the first trimester of pregnancy:

Having the Baby
When most people think about pregnancy loss, what comes to mind is early miscarriage, where nature often takes care of things or if that doesn't work, have a D & C.  I know how horrible early loss is.  I've been there.  With late loss there's a much bigger baby that has to get out somehow.  There are three unattractive options -

A) Waiting, B) D&E - dilation and extraction, or C)induce labor.

Generally, your choice depends on how big the baby is. If it measures about 16 weeks, your choice will probably be between A & B. If it's larger, you may be able to choose between A & C. If you're within a couple weeks of that guideline, you may be able to choose between the three.

A) Wait for labor to start on its own

  • You don't have to have invasive medical procedures
  • You can be at home instead of in the maternity ward
  • It's unlikely to happen in the short time you'll be allowed to wait; most doctors don't want you to wait more than a few days because of the risk that you'll get an infection
  • If you have the baby at home, it's harder to get all the testing you may want done if the cause of death isn't something obvious
  • You won't be able to function at all while you wait

B) Have the baby removed by D & EPros:
  • It's quick
  • Although you can't see the baby (unless you absolutely insist on it and have a strong stomach), you can have it cremated and choose what to do with the remains
  • Possible side effects - hemmorhage, infection, uterine perforation, cervical laceration
  • You can't see the baby because it is removed in pieces
C) Induction of labor at the hospital

  • You can see and hold your baby if you want to and you can choose what to do with the body
  • Having an intact baby and placenta can give you valuable clues about why the baby died
  • Hospitals often give memory boxes, memory books, or some other kinds of mementos to families that lose babies; you could also have photos taken and get the baby's footprints
  • It can take a long time - plan on about 12 hours.
  • It can also be intensely painful, but since you don't have to worry about drugs harming the baby, you can choose whatever pain control works for you.
  • The drug used to induce labor, misaprostol, is not FDA approved for labor induction, although it is widely used for this purpose and quite effective.
  • Not only do you have to be hospitalized, but you have to be in the maternity ward with all the happy new mothers and their beautiful live babies.
  • Possible complication - retained products of conception, meaning everything that should come out doesn't. According to my doctor the risk of this is about 20% and the problem, if there is one, usually is that the placenta or pieces of it have to be removed either manually or by D & C.
Also, you should know that your hospital bill will be for "labor & delivery" with the charges being the same as if you'd delivered a full-term live infant, even though you won't receive anywhere near the time and care you would have gotten in that case.

What to Do with the Body

Again, three possible options:

1) If the baby is less than 20 weeks gestation (and thus a "late miscarriage" rather than a "stillbirth"), the hospital can handle disposition of the body if you choose. Some hospitals will cremate the baby together with other babies that have been lost (the hospital I went to does this every 3 months) and then the ashes are scattered at a local cemetery. If your hospital does this, it can be a nice option.

Other hospitals toss the bodies in with all the medical waste and incinerate them. I know it doesn't make any difference to the baby, but to me it's disrespectful to dispose of a baby the same way you would dispose of a cancerous tumor or a diseased gall bladder, if you can avoid it. That's why it's important to know your options.

2) If the baby was past 20 weeks gestation, it is a stillbirth and you are responsible for the body. Cremation can be a very practical option to consider.

  • Removes many difficulties you'd face if you want to bury the baby at a later time or in another state.
  • It is easy to transport and bury the urn when and where you choose.
  • Or some mothers keep the urn and will have it buried with them when they die.
  • It's pretty inexpensive. In my case, a little over $300.
Cons: Some people, myself included, just don't like the idea.

3) Burial

  • Many mortuaries provide tiny caskets free of charge to parents who lose babies.
  • Having a burial service and a place to go to grieve your child.
  • You can have the baby buried at the foot of a family member's grave, saving the expense of buying a burial plot.
  • Compared to cremation, this option is more expensive and difficult to arrange.
  • Others (family, friends, coworkers, etc.) may think you're strange or even criticize you for wanting to bury your baby, especially if you want to bury him/her in an existing family grave.

Other Considerations

Choosing a name: I strongly recommend naming your baby. You will be talking about the baby in the future, if only with your spouse. It's much nicer if you don't have to refer to the baby as "it". This is especially true if you suffer multiple late losses: "it 1, it 2, and it 3?". It could get very confusing. Even if you weren't able to determine your baby's gender for certain, consider choosing a name that could work for a boy or a girl.

Medical testing: Testing to find the cause of the baby's death can cost thousands of dollars, especially if tests for genetic problems are done. Some tests can also be painful and invasive. And after all that, a cause can only be found in about half of all cases. But it's still a good idea to find out what you can. You'd just better hope you have good health insurance!

Certificate of Stillbirth: If you lose your baby beyond 20 weeks, many states (25 as of now) will issue you a certificate of stillbirth if you submit the paperwork and fee to get one. This at least acknowledges your baby as a human being, much to the consternation of pro-abortion groups. If your state does not offer this, consider getting involved in promoting legislation. Arizona even allows parents to take a state tax exemption for a stillborn child, which is very helpful in offsetting some of the potentially significant expenses of burial or cremation.

Dealing with other peoples' reactions: Generally, you can expect that any support you get from family or friends to be directly proportional to how far along you were when you lost the baby. The exception to this is if you've had multiple losses. In that case, the more pregnancies you lose, the harder it gets for you and the less support you get from anyone else. This was certainly true with my two late losses and I have it on good authority that it gets worse from there - by the third or fourth loss people can be downright hostile towards you for trying again.

So, be prepared for the following reactions but hope for better:
  1. Being patronized, humored, or even criticized for naming and/or burying your baby or for being sad/depressed about the loss
  2. Unless you lost your baby very far along AND the body was in good enough shape to hold a viewing, the loss is totally intangible to everyone else and thus, not real. People are very dismissive about it and wonder why you're so upset.
  3. People don't know what to say, so you may be avoided and ignored
  4. You will be expected to be back to normal after about 2 weeks. After that people expect you to just get over it and get impatient and upset with you if you aren't
  5. Friends who are pregnant or get pregnant in the future may avoid you and this is just hard for everyone.


foxy said...

Hi Annie,
This is a heartbreaking post. I am so sorry that you had to write it, yet so impressed that you are strong enough to share this information with other. One of the most incredible things about this blogging community is how often I read a post that says things I need so desperately to hear, but can't yet bring myself to ask about.

Thank you for stopping by my little canceled cycle mimosa pity party yesterday. I was overwhelmed with all of the kind words and understanding that poured into my inbox. I am also loving the chance to follow the comment crumbs back to awesome blogs like yours!

I hope that you have a wonderful thanksgiving!
xoxo - Foxy

Anonymous said...

I am terribly sorry for your losses. I lost my baby last Wednesday, and it seems like people expect me to get on with normal life. My husband doesn't really know what to do with me; while he is sad about what happened, he doesn't get it like I do. I was feeling the baby kick everyday, while he never felt her kick.

I agree, definitely name your baby. I was so glad we had found out our baby's sex weeks before she passed and had already agreed on her name. This made things very much easier, but it still aggravates me when people ask "How did you lose "it?".

I wish I had someone who was completely open to letting me talk about all aspects of her complications, labor, and delivery. Those things are perfectly okay to talk about with good friends when there is a happy ending.

Thanks for your post.

Kelsey said...

How long can you hold your baby after the death. My mother held her baby for 3 hours after he died. What is the normal amount of time to hold you baby after his/her death?

Tasha Hill said...

I understand the options now that I am older Mt child edward would have made 13 today and my parents decided to let the hospital take care of everything, since i was only 17 and they did not want to see me suffer. I was 23 weeks and deliver him vaginal, he lived for a few hours, and now i regret not having a cermony for him, this decision have haunted me since forever, i know my parents thought this was best for me at the time, but in the long run every grieve in a different way, by me not holding him, crying, being silent, is a decision i will never forget and have to live with it forever. the crazy part I do not understand he has a social security number, birth certificate, but vital records in Illinois, Chicago say they do not have a death certificate. Therefore i guess i will never have closure and have this empty feeling forever. Thanks for sharing what option women have that I wish I knew before hand.

Anonymous said...

am sorry for your lost
i lost my first baby at 10 weeks and as u said nature took care of things . i was sad and i cried for maybe a week then i was over it
after 5 years am pregnant with my second baby . i was so happy and exited . and before 2 weeks i was 39 weeks and 5 days pregnant . just 2 days far from my due date . suddenly the baby is not moving. i went to the hospital and they told me that there was no puls and the baby died just hours ago and they will give me some kind of drugs to induce labor and i will have a natural birth but instade of giving birth to living baby i will give birth to a dead one
the hardest part was intering the maternity ward and while i was in labor i could hear what was goin in the other rooms
it hurt when u hear women screaming to deliver a living babys while i know i will deliver a dead baby
and hearing their babys crying when i know mine is deadly silent was killing me
i cried when i was in labor for 12 hrs but not becouse of the contractions, the pain i had in my heart was greater than the pain of the contractions
and when i had my baby i was in denile . i huged my baby and kept shaking him to wake him up and i was begging him to open his eyes and cry in that moment they gave me some sleeping drugs and it was the last thing i remember in the maternity ward
it have been 2 weeks and i still cry my self to sleep every night
and i cant look at any baby without crying
i wish that i have been told what to expect when am expecting a dead baby at this late stage of pregnancy , at least i would know what will happen and i wouldnt be that lost and shoked