Simple past tense…
You are in happy expectation, everything is in the sign of your child growing under your heart. You dream about the future; will it be a boy or a girl, who will look like it and what kind of a character will it have? You work with love on the baby room, gently stroking the beautiful bedding, there your darling will sleep. You are hopeful, but also anxious and worried if everything will go well. You already love this child, from the very first moment you knew you were pregnant. Together you make up names, together you talk with family and friends about the miracle that awaits you.
Your hands are regularly on your stomach. Together you prepare for the arrival of your child.
Unfinished past tense - Empty hands
And then suddenly it goes wrong and collapses into your world. Your baby dies in pregnancy and is stillborn or dies around the birth or in the days after the delivery and all your dreams are brutally beaten. The grief is enormous and incomprehensible. You wanted to welcome this new life and now you have to give it up again before you get to know your child anyway. You wanted to surround this child with love, want to give the best care and together want to raise a beautiful person. And now you are left empty-handed, your child is born and died at the same time. You have become parents of a baby of whom you have to say goodbye at the same time. The pain associated with this is unbearable and immeasurably large.
Tears along your cheeks ...
You hold the lifeless body in your arms, close to you. Your stomach shrinks, your breath lingers in your throat. The tears run down your cheeks and drip on the little face. You are intensely sad, but also deeply filled with pride. Because what is that little person beautiful ...
Gently stroking the tiny fingers and admiring those little perfect nails. You stroke the soft hairs and smiles when you see that funny snub nose. The tears stop streaming for a moment when you see so many beautiful things, until you realize that you have to say goodbye. Saying goodbye to a part of yourself? But that is not possible at all?
Parents of that time
Unfortunately, there are parents of deceased children who have never had the chance to arrange a farewell for their baby, not even having the opportunity to say goodbye. Moreover; who have never even seen their baby after birth! Do not even know where the burial is! Those parents at that time were left behind, overwhelmed by intense sadness and painful loss. Mourning rituals were simply not there. Your baby was immediately taken away from you and that was it. You can hardly imagine worse. Completely contrarian and unnatural.
Until the mid-eighties of the twentieth century, it was assumed that you could not have an emotional bond with a child you had never known.
The idea at the time was: what you never knew, you can not miss. That the opposite was true was proven by the great sadness of the parents. For these parents, the loss of their baby remains forever: Unfinished past tense.
Even in the animal world, you see in social animals with a high intelligence that there are rituals that belong to death and farewell. Dead-born babies are sniffed and sometimes completely clean. The gorilla mother shows restless behavior and shakes her dead young back and forth, as if she wants to live in it again. When the young elephants become a stillborn baby, the mother will continue to give her soft pushes to the lifeless little one, to move it to get up. Here she can continue for hours. When it finally penetrates that the young will never stand up, the entire elephant family will give support to the mother by coming close to her. Often in silence together, but also booming ween sounds are known. Together they stay around the corpse for days. It is even tried to lift the young and bury it.
Mother without proof
In this time you can hardly imagine that your own flesh and blood is taken away from you without mercy. They had become mothers without being able to see the proof of that. The grief of these parents is extra large because of all unanswered questions. What did our baby look like, who looked like it, how small it was, did it have a lot of hair, was it all right? You will have countless questions if your baby is born dead and is immediately taken away. They never received the answer on one question. The lack of sight of your child hurts terribly. Immediately after the birth, just like every newborn mother you came to lie in the maternity ward. There were happy mothers with their newborn babies and you were lying there with your great grief, in all your loneliness. You were in mourning and they were celebrating. As soon as possible, you were discharged from the hospital and you could go home. Your baby was left in the hospital because they would take care of it further. Which meant that they took care of the burial or cremation of your child. Further information was not provided.
You were the same woman for the outside world. You were no longer pregnant. You were expected to continue living as you did before. In the transition from a pregnant woman, back to the woman you used to be, the most important thing was ignored!
You had become a mother in the meantime!
You had a birth, a child was born and the hormones were flying through your body. Your stomach was empty, the bed was empty, your hands were empty and your heart was hollow. Your husband had become a father and even less attention was paid to that fact. For the outside world there was a taboo on the birth of a stillborn baby. There was barely talked about. The entire subject was silenced. Further than: 'next time better', they did not come. If you were lucky you got some support from the family but the general statement was that you had to forget it quickly.
All items that you had so lovingly purchased for your child or made yourself were immediately cleaned up. It happened regularly that family members did this while you were still in the hospital. When you got home you got another bang, everything you had prepared with love was already cleaned up! The only thing you remembered about your baby and your pregnancy was gone. However well-intentioned, it felt like a pot of salt was being turned over in the fresh open wound. As if your entire pregnancy was stashed away, together with your child. Surrounded by all the baby stuff you could have given in to the pain inside you. Had you been able to mourn, cry or scream with sadness. But the last proof of your motherhood was now gone. At that time everything was done to leave the whole event behind you as soon as possible and to continue with life. On to the next pregnancy! Of course you shared this sadness with your husband, but as a rule he had to provide for a living and therefore had more distraction than you. How you experienced this grief, gave it a place in your life, was something you had to do yourself.
Concept of the past
Perinatal mortality (baby dies before, during, or just after birth) was dismissed in scientific literature until the mid-eighties of the last century as a 'non event', an event that you should not dwell upon. There were no protocols for medics, no guidelines that stated how to accompany the parents. There was only one rule; the parents do not charge their dead child. Incidentally, this certainly did not result from harshness. But from a genuine belief that they acted correctly when they paid little or no attention to it. The parents soon had to forget everything and focus on a next pregnancy. It was automatically assumed that there was no emotional connection between parents and a newborn, that bond was only built up from birth. So there could be no great grief in a stillborn child, let alone in a miscarriage. Even if your child had lived for a short time, the time was insufficient to build up a bond.
Spirit of time
In the past it was assumed that seeing or taking a dead child in the arms was something terrible for the parents. Something you had to save them, something they could not handle. Seeing your dead child would strengthen the grief, parents would never come up again. Suppose they were going to attach themselves to a dead child! They presented themselves with frightening scenes. The gynecologist was expected to ensure that the parents would not see the child. That is why they immediately put a sheet over the baby and took the child as soon as possible when it was stillborn or died shortly thereafter. Parents at that time had a lot of grief but did not know any better. They went along in the spirit of the time, assuming that the 'gentlemen doctors' would know better.
Nowadays people know better. It is precisely when parents have not seen their child that it appears to affect the processing in an unfavorable way. The same goes for the ultrasound scan if it is clear that the child is no longer alive. Even then it is better to give the parents the opportunity to watch, instead of turning the screen away.
In recent years, more and more monuments have been built for deceased children throughout the Netherlands. This is to meet the grief of parents who have lost their child in the time that it was not yet customary to arrange a funeral or cremation yourself. Dead-born babies or children who died after giving birth were buried anonymously in the cemetery, sometimes with several at the same time. If you were lucky you got a number and you could know about where your child was. In the case of cremation, the ashes were scattered somewhere on the premises of the crematorium. As parents you did not know as a rule where your child was buried, or where the ashes were scattered.
Nowadays there are more commemorative places for children who died in the pregnancy period of before 24 weeks. These children usually stay behind in the hospital and are cremated with several at the same time. In the past, this was no different, but they were then simultaneously buried (cremation was not an option before 1955). Only those parents could not say goodbye to their child. Some cemeteries have now placed a memorial tree. There, parents hang symbolic leaves on which the name and date of their deceased child are located. A butterfly tree is also such an initiative, the name of the child then adorns a beautifully decorated butterfly. For parents now, but certainly for the parents of the time, this helps in the processing of their grief.
Late last century
From the nineties of the last century, more and more attention was paid to the grief of the parents and how to deal with them. NVOG, the Dutch Association of Obstetrics and Gynecology, reported at the time:
"Piëtitsvollevolne with perinatal mortality, even in case of loss of child for 24 weeks, is paramount". Soon afterwards there was an official and comprehensive protocol with rules of conduct for the medical staff involved, which clearly shows that farewell and grief processing is extremely important. Yet it still took until the beginning of this century before parents could say:
My child had a dignified farewell, in the way that we as parents wanted. In all our grief we have left valuable memories of that short time of saying goodbye.
Roman Catholic Church - Unborned babies did not belong in the past
From the Roman Catholic Church babies had to be baptized to come to heaven. The command to baptize children began to gain a foothold in the second and third centuries. This was not the case for infants (!) It was necessary to have your baby baptized as soon as possible because at that time children were extremely vulnerable because of the poor living conditions.
According to the church, these children were burdened with the original sin and the gate of heaven was opened only to those who had received baptism. If your baby was stillborn then it did not come to heaven but it was forever in the 'porch' around wandering and should never see God. The front porch, also called the 'limbo', was the area between heaven and hell. This was a specter for parents, which had to be prevented at all costs. In addition, these children were not allowed to be buried at the church on sacred ground. Desperate parents secretly buried their child against the edge of the church, under the drain. Hoping that the water of the drain would serve as baptism.
Roman Catholic parents with an unbaptized, stillborn child were in principle extra punished; their child was not recognized because there was no grave in front of them in the cemetery, not even a tile, nothing at all. The little innocent baby was punished together with his parents for something they could not influence. When your baby died shortly after birth and it was allowed to receive baptism, it was given a funeral. It became an 'angel' in heaven. If not, your child did not exist for the church and ended up in the taboo sphere. She was not even granted a final, beautiful resting place on sacred ground. Often they were buried near the cemetery without the parents knowing where. Usually that was a corner behind a hedge, or in the bushes between other graves. Here too, change did not take place until the beginning of the eighties of the last century!
Rikie (56 years) tells the mum of Cindy
1978, the birth of Cindy
In my pregnancy protein was detected in the urine and there was not adequately responded to by a replacement midwife, so I got a severe pregnancy poisoning. With seven months I got contractions and was sent by my own midwife to the hospital. No heart tones could be heard there. The contractions were further raised and at three o'clock our child was stillborn. They were holding a cloth so that we could not see anything, I did not even know if it was a boy or a girl. My husband saw a chance to look over the cloth and thought it was a girl. Our Cindy was immediately taken away and I was allowed back to the room. There we were told that hospital would take care of it and arrange the funeral. And that was it. You do not think about grief and you do not know how to act.
Now you would refuse this and first want to see your child, nowadays it is fortunately arranged differently.
Buried at the hedge
After six weeks we only got to hear that it was actually a girl who had died in my stomach because of a pregnancy poisoning. She had been dead for a week at the delivery. Cindy was otherwise healthy and weighed only 750 grams.
We did not know where she was buried at all, my husband searched at the cemetery for the place where he had just been dug. This was at the hedge in uncharted soil. He has put a flower in the hedge. We were also still looking together, even a few times, but it was too painful to stand there at that hedge. Together we gave Cindy a place in our hearts and we were happy to talk about it.
The outside world reacted in two ways; people turned their heads away when they saw me, quickly walked the other way. But most people were not able to say more than: "Oh, you're so young, there will be more children." But I was worried about Cindy and was not busy with a next pregnancy at all. I even got very angry once in a store where the saleswoman once again came up with the story that I was still young enough for more children. I have avoided that store for a long time afterwards. Fortunately I had more support for my family and my husband.
In 2004, the cemetery was redecorated and the children who were lying on the ground would be dug up and put down somewhere else. Together with another mother, I have raised this with the municipality. We did not agree with this. We have long campaigned for a commemorative monument, where all those affected can reflect and remember their "unbaptized deceased child". Thus, forty-five children, including our Cindy, received an official reburial in a beautiful white and blue box. We as parents were given a memorial cross and after that a small monument was placed on that spot. Unfortunately, my husband has not been able to experience this anymore. Luckily I was there with my other children and other family. Since then, Cindy has finally had a beautiful, final resting place and I am a place to remember.
Saskia (47 years) tells the mother of Bas
It seemed like a normal pregnancy, everything went smoothly until we ended up in an outright nightmare. I was pregnant for several months and had to go to the hospital for a check-up and ultrasound. We had taken our two daughters with us so that they could see the baby in my stomach. The person who made the ultrasound was busy for a long time and very quiet. At one point she asked if we had ever heard of an umbilical hernia. We had heard of that. Something that could be solved with a small intervention, we thought.
The diagnosis "Omphalocele" was made. The baby had an open belly. The intestines lay outside the belly in a membrane. The doctor said the deviation was very serious. The chances were that the baby would die during the delivery. And even if the baby survives, a hospital admission of at least six months would be required. Multiple operations should take place and there was a high risk of hospitalization. The baby would get used to the hospital too much and thus be unable to build up a bond with the parents. It was clearly said: "realize that you have two more children".
And then you fall into a deep well. Because you get to hear that you have to make a decision. Continue with pregnancy or termination of pregnancy? Making such a decision, is not that an inhumane task? A terrible week followed. Crying up and then take care of the children and go to bed crying again. And ask yourself what decision you should take. And everything just went on, we even held a children's party that week. At school a mother came to me, who said; "I see it well, are you pregnant?" We finally made the decision to have the baby born.We felt that he or she, no dignified existence was waiting. We could not bear the fact that such a little baby had to suffer so much pain and sorrow. However, the decision also meant that the baby would be born at 21 weeks, so it would not be viable. The fact that the doctors were behind our decision was a meager consolation.
I was introduced in the morning and I would not have to suffer any pain. In the afternoon the pain of inducing the contractions became untenable and I got a spinal puncture. Then I became very ill, I vomited on a piece. Injections against nausea did not help. At the beginning of the evening it was decided to continue the next day. But in the middle of the night the membranes broke and Basje was born, he weighed 360 grams. At first I was very scared to look at, with such a nasty diagnosis you expect a very strange picture. But Basje was very beautiful. With all the trimmings, but also with a huge ball on his belly. Very small, almost translucent yet, and yet he already had characteristics of his sisters when they were born. He was taken away and then the nurses brought Basje with us, in a wicker basket with white cloths. They had made a footprint of plaster. We then said goodbye to him and took pictures ourselves. We were not familiar with the death of your child during a premature birth. We did not even know that there were any possibilities, as far as farewell was concerned. We agreed that autopsy (autopsy) should be carried out and that the hospital would take care of the cremation. The nurses of the delivery rooms were very good to us. One has even stayed to accompany me, she was a huge consolation.
I was placed in a single room to rest and my husband went home. I only slept for a few hours and when I woke up I did not see anybody from the nursing. Much later a gynecologist came with the announcement that we had made the right decision. I was asked if I wanted to see Basje. I did not do that, we had already said goodbye to him and I could not bear to look at his cold body. Fortunately, my husband and my sisters came. I got a golden heart from one of my sisters on a chain. I still wear that necklace. That way Basje is always with me.
And then you go home with a few sleeping pills and medication to stop the drive. And the appointment is that they call you from the hospital after a few weeks. The whole house was full of cards and flowers, the condolences of everyone are doing very well. But the grief is terrible. And every day you think; How many days would I have been pregnant now? The due date was a bad day.
Protect for a too heavy existence
After that, after a very heavy pregnancy and a heavy birth, I became a mother of a son. His second name is Sebastiaan, named after his brother. Now I still often think of Basje and the whole happening around his birth and death. The plaster print of his foot hangs in the living room, he still belongs to it. We also talk about it with the children. In this time it would have been very different if you experience something like that. In my opinion, I am still behind the decision that we have taken. We have saved Bas from being overweight. Only I would not leave my child in the hospital anymore. I feel guilty about that. There are so many other ways of saying goodbye. But at such a moment your head is a mess.
What I missed is good aftercare. I was still eligible for maternity care, but what do you have to do with that? I still had a list of books, but I did not do anything with it. I would like to have contacted other parents who had gone through the same. I am glad that there is now much more help for parents who have lost a child. Also that it is accepted that the child always remains a part of yourself.
The O & G (Obstetrics and Gynecology) nurse (41 years) speaks
I started working in the maternity ward in the early nineties of the last century. Fortunately, I have never personally experienced that children were immediately taken away from the parents when they were stillborn. A lot has changed over the years. In my early years, when the child wanted it, a sheet was laid over his legs so that they could not see the baby being born. Many parents also thought it was scary to watch their dead child after the birth. We took the baby separately and told the parents what it looked like. Usually they wanted to see it then. The fear of looking was often greater than the actual sight.
We then also followed the right rules and offered appropriate care, valid for that time. At that time children were not taken home so quickly. The possibility was there but less use was made of it. Photographs were taken by the hospital. They received the parents when they returned after about two weeks for a follow-up interview.
Unfortunately, I also know the stories of patients who, for my time, brought a stillborn baby into the world and where the circumstances were distressing. You hear those stories when these ladies happen to stay in the gynecology department. They then tell about the hidden grief of what happened to them in the past.
We have been working according to protocol for years now. This contains all agreements about the death of a baby and the rules of conduct that apply. But also all investigations to determine the possible cause of death. There are several aspects that play a role in the guidance of the parents, such as naming, taking a footprint and / or a lock of hair, if this is possible. The involvement of the parents in the care of their child also plays a role. In addition, there are also considerations that have to be made and in which we offer guidance:
- Baptize or not
- Taking photos and / or having them taken
- Burial or cremation (from 24 weeks of pregnancy)
- Discuss the options for a pregnancy period under 24 weeks
It is always sad when a baby is born dead or dies around the birth, so we give the best possible guidance to the next of kin. We also talk about it ourselves as colleagues and it is important that the case is (after) discussed with the medical staff involved. There is a lot of attention for this topic, colleagues write theses about this or give presentations. There are also many articles written for nurses in this area.
As far as grief processing is concerned, I personally find it very important that the parents create "memories" of their child as much as possible. You mention, for example, a specific, physical feature that strikes you, such as a crooked clove. If it turns out that father also has this then you put this on the picture. You have only a short time to officially say goodbye and everything you can capture now is a reminder for later. I encourage the parents to touch the baby, to hold it and to name it. That is why I am also very much in favor of raising the child at home and involving family and friends, so that they too can get to know the child.
In the past thirty years, much has improved in terms of mourning in the case of perinatal mortality. Parents have plenty of time to say goodbye to their baby and have plenty of room to say goodbye in their own way. This benefits the grief processing. Time is limited and you can never repeat it again. The parents who were not allowed to say goodbye would do anything to get it done. To get the chance to give their child a dignified farewell. They will always remember with grinding heart the abruptness with which their baby was taken away and the lack of a decent farewell. For the rest of their lives: simple past tense.