Stillbirth and Newborn Death

The birth of a child is one of life’s greatest celebrations. Especially during a multiple pregnancy, parents fantasize about their babies, about walking them, showing them off to friends and family, trying out names and how they sound. When the outlook is positive, those close to the couple share in the journey as excitement and anticipation mount.

Yet when one, more or all of the babies dies by miscarriage or stillbirth, parents at times are encouraged to consider a miscarriage or stillbirth as something less than a “real” death. People around you often want to help, but find it difficult to understand the special circumstances of your loss. Information from Multiple Births Canada and other resources mentioned in this article can assist them say and do things that are helpful and avoid those that are hurtful.

If you do lose one, more or all of your babies, you may wish the birth and/or death certificates to reflect the fact that your baby(ies) was part of an appropriate multiple birth set, i.e. loss of one triplet does not make it a “twin birth”, loss of two quadruplets does not make it a “twin birth” and so on. You may need to be vocal about your wishes as some hospitals may record only the surviving baby(ies) and not your accurate multiple birth.

Stillbirth and Newborn Death

For women carrying multiples, prematurity remains the leading cause of death. Approximately 10% of all perinatal deaths are multiple birth children (Multiple Births Canada’s Fact Sheet, Multiple Birth Facts & Figures, 1998).

In spite of our best precautions, premature birth can still occur. There are no guarantees against the early delivery of your babies. Even in spite of appropriate and timely intervention by hospital staff, a loss of one, more or all of the babies may still occur. If such is the case, you will no doubt be:

grieving for your baby(ies);
grieving the loss of a unique type of parenthood;
feeling shocked, empty and alone with disappointment, anger, sadness and grief;
wondering how this could happen and fear that you might not have other children.

The loss of one baby from the multiple birth set, can present complicated emotions to deal with:

why this baby and not the other?
Did I resent or fear the thought of looking after two, three or four babies and thereby cause this to happen?
Did I “wish” one or more babies “away” and cause this to happen?
Did my preference for one sex cause this baby to die?
How will I tell the survivor(s) about her sister and when?

While these thoughts are normal, they also increase the burden of guilt and grief. Don’t leave these feelings bottled up inside of you. Talk to a grief counsellor, good friend, hospital staff, your partner or religious support person, in order to assist you in putting your feelings into perspective.

Losing one, more or all of your babies leaves the parents and those who care about them to deal with complicated issues. Some of these issues are:

Not only have you lost a baby(ies), but you have also lost a unique parenting experience. Seeing other people with their multiples is a painful reminder of your loss, and may trigger feelings of envy, anger, failure or sorrow. In addition, when there is (are) a surviving child(ren), it can be difficult to resolve the conflict between the two extreme emotions that you are feeling – that is, the joy of the birth of a baby(ies) and the sorrow of the death of a baby(ies).
Your feelings may include rage, shock, numbness, guilt, panic, being out of control, powerlessness, confusion, and/or denial. You are adapting to a new reality and it takes time to adjust. In fact, we are never the same after the death of a child(ren). We adapt and go on, but we are not the same. Grief is a journey, not a destination. Expect powerful feelings to resurface at different times as you walk the rocky road. It is healthiest to allow yourself the neeed time to experience them as they arise, rather than suppressing them.
You may not wish to be touched or held for a period of time after your loss because of a fear of losing control of your emotions. At work or in social situations, you may not wish to discuss your children or your loss, afraid that you will break down in tears and be unable to stop the flood. It helps to tell family, friends and co-workers what you do and don’t want to talk about. Every parent is different. While some want and need to talk about their distress with anyone who will listen, others wish to keep their personal pain separate from their social responsibilities. It helps to tell family, friends and co-workers what you do and don’t want to talk about.
You may find that people pay more attention to the live baby rather than the fact that one (or more) died. They may feel that dwelling on the dead baby may make things more uncomfortable for you. Feel free to speak up if you wish to speak of your dead child(ren). Others will be more open about their thoughts if they know you are happy to hear your dead baby’s name and consider him or her to be a special part of your family.
On the other hand, you may wish, yourself, to push all thoughts of the dead baby(ies) out of your mind and concentrate on your surviving baby(ies). You might wish others would stop reminding you of the baby(ies) you have lost. You need not feel guilty about this normal reaction. Parents can only cope with so much at once. With newborns, especially when they are premature or ill, it is common for parents to devote their energy to their living children and delay grief until a later time. In due course, you will find the right way to acknowledge the child who died.
Parents often hear inappropriate comments that are meant to comfort them but in fact, do exactly the opposite. To hear “It’s not the same as losing a baby, this one never drew breath.” or “You are young, you can have other children” is devastating, even if the comment is well intentioned.”At least one survived.” [I am truly grateful, but one crib is still empty.]
“It’s God’s will. They’ve gone to a better place.” [There is no better place for babies to be than with their parents! ]
“It’s for the best, she/he would have been disabled. [Death of a child is not “good” and not necessarily easier to handle than disabilities.]
“You have a healthy baby, just forget the other and get on with your life.” [You have 2 legs. If one was amputated, how would you feel if I said “you have one healthy leg, forget the one you lost and move on?”]
“You could never have handled quadruplets.” [Death of a child is not easier to handle than mounds of diapers or huge grocery bills!]
Communication is important, and a counselor may help bereaved parents avert losing relationships with family or friends. People often call two surviving triplets or quadruplets “twins”. They need to know what you want to call them. Likewise, one mother reported one of her twin daughters was born very ill and died in the hospital after a short life of two months. Her mother-in-law focused on the surviving, healthy baby, sending the parents a card congratulating them on the “birth of their daughter”. The dead sister was never mentioned, even though she lived for two months, was named and given a funeral. A rift developed between the mother and mother-in-law, with hurt, anger and hostility at the lack of acknowledgement of one grandchild’s birth and death.
Recognize that you will have limits. Your pain may be so intense that you will have nothing to give to the rest of the family or spouse. Be honest and let them know when you need some space for the time being.

Memories

It can be very helpful for parents to see, hold and touch their dead baby or babies. I feel very strongly that we cannot say “Good-bye” until we have said “Hello.” No parents have ever expressed to me their regret at having seen and held their babies, but several have expressed regret that they did not. Sensitive and caring hospital staff can encourage parents to hold their baby(ies), and bathe them if they wish. You can take photos of the deceased babies separately and together, with any surviving babies from the multiple birth, and with other siblings if you desire this. Hospital staff are often exemplary in supporting families at this difficult time, making it as easy as possible for you, although they cannot change the tragic reality of death. Parents are often given specially designed Memory Boxes, one per baby, which may include: the blanket the baby was wrapped in, a lock of hair when possible, plaster hand and foot prints, an outfit the baby wore, hospital bracelets and several photos of each baby. Such special items are cherished as tangible evidence of the reality and value of a baby who did indeed live, even if only in dreams.

There are companies and artists who can create drawings of your babies, or unite separate photos of babies with computer imaging to create a group picture. These tasteful and precious photographs or sketches can provide parents with much comfort. As one Dad put it “.it [the photograph] proved to the world that our son was real.”

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England http://www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press