Posted by: Zsuzsanna | June 22, 2008

Some thoughts on baby loss

My pregnancy is progressing well, and there are no reasons to be concerned at all. Yet, I am often reminded that this 9-month journey does not always turn out the way parents expect it to, something that is very little talked about. The following text in red is a “copy and paste” from the blog of the midwife that I had with Miriam (who has since moved to Mexico to train local midwives there). Please do not read this post if you are currently expecting and this would worry you too much.

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“Midwives don’t really talk about death…” Janis wrote me, and my first reaction was to defend my profession and peers. As my fingers hit the keys with all the reasons why a midwife wouldn’t talk about death (our pregnant moms would be too freaked out if we did?), I realized that I was writing excuses. Janis is right. Midwives DON’T talk about death much, not even among other midwives. We are always so busy and at times have superstitious or other beliefs that cause us to avoid this topic. Too, with the midwife persecution that occurs, we may worry that acknowledging baby death will have folks question our abilities or feel validated that birth with midwives or home birth is dangerous. Sometimes it plays into our own fears, too. I once had another midwife who had lost her own baby after a difficult home birth be angry at me and tell me she was offended by me in front of a room of midwives (years after her loss) because I had brought up some random legislation that reminded her of her experience – and, this was a birth I was nowhere near and had nothing to do with at any point. I was shocked at her outburst but recognized that this midwife had never healed appropriately – and, with the lack of support for women who lose babies, that is no surprise.

Parents always ask me about my skills and what emergencies I have or haven’t seen. I know what they are really asking me is if I can save their baby’s life. But, the few times that I have been honest and said, “Well, you know that death is a part of life. Babies die in the hospitals but you never hear about it…” the looks on the expectant parent’s faces are ones of shock and instant distrust, betraying that they didn’t want me to acknowledge this very real fact. Sometimes, I just get tired of always having to be ultra-sensitive to the ultra-sensitive nature of pregnant women. When my well-off clients (to me, well-off is someone who has enough money to buy expensive organic food and be able to purchase unnecessary stuff at whim) have deep episodes of anxiety because they are SURE their babies will die, I sometimes have to hold back the urge to give them a reality check: “YES, your baby REALLY can die. Death and Life are intertwined as part of the mystery and it does happen, although the likelihood of your well nourished, organic fed, vitamin given, yoga enhanced, first world baby dying is not the foremost thing you should to worry about and, indeed, worrying about it often does not change the results…” No, they want me to reassure them that it will not happen. Sometimes, I can’t dig deep enough to reassure women who have ‘everything’ that they will, also, have a perfect baby because I know that the truth about birth is that it happens in the shadows of death. I now work in a world where women expect pain and death to be a part of life (and birth), and they find deep joy in their lives (and births) regardless. Oh, now, really…don’t get angry at me for writing all of that – I’m not being mean. I know that women must receive reassurance in a world that always plays on women’s fears (especially from her insensitive midwife!). I experienced the fear, too, that my babies would not be a part of my life story when I was pregnant. […] This is, after all, a precious baby. So, I say nothing to my fearful clients of all these realities but give many reminders about how safe birth really is and how the will of babies to live is very strong – that, mainly, we need to trust our babies. Enough said. So, no, I don’t often talk about the deaths I see as a midwife.

I asked Melissa if I could write about her story, and she wrote: “Hi Marinah,
That is ok with me to use my story on your blog. Thanks for offering and asking. We are doing ok. We just lost our 5th baby since Brock in February; he was born at 15 weeks. He was born at home as well, and I was by myself for most of my delivery. We had to wait about 3 weeks for him to come, after he died. I am glad I got to have him at home. We are looking into international adoption since we think the chance of us having a baby is very slim. We thought we had figured everything out. I was diagnosed with Thyroid disorder, and MTHFR gene mutation and Protein S deficiency, and even with twice daily heparin, baby didn’t make it. So, I am done as far as I know…”

When I met with Melissa the first time during her pregnancy with baby Brock, she and I talked a long time about her previous birth. She had lost twins at 20 weeks due to a rare twin complication. She shared her story of going to the hospital after being told one twin was dead and having the other die while in labor. Her contractions were augmented and she was given an unusual amount of medications that made her labor a nightmare of interventions. The one detail that was most significant to her was that the hospital took her twins and did not allow her to see them. In many states, if your fetus is less than 21 weeks or a certain amount of weight, the fetus is considered tissue – or, hazardous waste. Often, hospitals will also keep and use the placenta (and, sometimes the fetus) for testing if they don’t throw it away. She was not allowed to see her babies or to take them home and she still felt so much sadness at this trauma she sobbed telling me the story. She wanted me to know right off the bat that, no matter what, if this baby was to die she would stay home to birth her baby.

It was during a prenatal that we didn’t hear a heartbeat. When all the tests were done it was confirmed that Brock, as she had named her baby boy, was no longer alive. My firm belief in herbs for women and her loving belief in me led us to use herbs to help her body start the birthing process. We thought maybe that she would birth Brock in a few days after taking an intense combination of herbs. It didn’t happen. We spoke often and she found the strength to continue her intense herbal regimen and weeks went by – the waiting was painful but Melissa knew the alternatives and did not want the drugs, the hospital environment, and the lack of choice. Finally, she called to tell me she was in labor.

Her labor was intense and beautiful and peaceful. Brock was born in his shiny bag of waters and his placenta followed shortly afterwards. Melissa had me take lots of photos and we measured him and touched him lots and welcomed him. Melissa had chosen a supportive funeral home in the weeks before her birth and, when she was ready, I called them. When the man and woman arrived, they were so lovely – there is no better word. They collected the baby with words of kindness and sympathy. They took the baby from my hands (Melissa elected to remain in her room when they came) and wrapped him so carefully…it was like watching my midwifery teachers or the traditional midwives who have the hands of 35 years of births lovingly touching a newborn. That moment will always remain imprinted in my memory. They took Brock and Melissa was finally able to rest. The tears came when she heard them leave the driveway and she wept and wept.

There was a beautiful funeral and Melissa told me weeks later that after a powerful Miss Foundation conference on baby loss that she jumped the gates of the cemetery in the middle of the night to see her baby’s grave. She was so glad she had a place to visit her baby and that she had made the decisions around her birth. She also taught me that I needed to say that the baby DIED. Not, passed away or moved on or whatever, but DIED. “Use dead and died,” she said. And, I understood that for mothers it is true DEATH when her baby will never be in her arms again. Five months later, she had another baby die.

[…]

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Babies die at home, and babies die at the hospital. They can die during pregnancy, birth, or any other part of their life, and as mothers any of these scenarios would probably be equally painful. It is something that we can pray about, but in the end have little control over.

Women will go to great lengths and have “socially accepted” hospital births only to be somewhat freed from the stigma that comes with having a baby die. When a baby dies, other mothers who want to deny that death is a part of life, and who don’t want to think it could happen to them, silently ask questions like “Was it the parents’ fault?” or “Could anything have done to prevent this?” At least with the “normal” hospital birth, you are absolved from most guilt and shame.

I am reminded of a baby loss that occurred on my husband’s side of the family about 10 year ago, a story that was told me over and over when I was considering home birth to show me why it was not a safe option. This lady had a baby die in the 9th month of pregnancy from an infection because, unbeknownst to the Mom, her bag of waters had broken. It was not a gush, just a minor trickle (because the baby’s head often acts as a cork), and it was in the midst of a hot, muggy summer. At her next checkup a week later, there was no heartbeat. The baby’s death had been blamed for years on the fact that the lady was cared for by a midwife. Even my husband used her as a bad example, back when he was skeptical of home birth. My immediate thought was wondering what would have been different with a doctor – they only have weekly checkups at that point. If the Mom didn’t suspect anything was wrong, something I can very well relate to, why would the doctor call her in for an unscheduled checkup? The truth of the matter is that women want to defend their choices surrounding birth, so they will attack the “opposite” side in an attempt to make them look bad, while covering their own backs should something go wrong for them.

In reality, about the same amount of babies and moms die in the hospital as at home. Some statistics say the mortality rate is higher at the hospital. A lot of that has to do with the midwife’s expertise, since they are not all equally knowledgeable and experienced. Basically, the worst midwife will have mortality rates close to that of hospitals, and the better the midwife the lower the death rate. But it is never zero. Yet, if one of our babies would die during a home birth, everyone would be sure to ask us about every painful detail, to either prove or rule out that it was our fault. Such is not the case when a death occurs at the hospital. People might ask those questions behind closed doors, but they would show the parents nothing but compassion and support.

The main difference between hospital and home births lies in the number of interventions and complications, both before, during, and after birth. Recovery at home is faster, safer, and better. Intervention rates are drastically lower, and women walk away from birth feeling confident that they can care for the child they just gave birth to without outside help.

I am not opposed to all hospital births. I understand that there are some VERY RARE circumstances where they would lead to a safer outcome because of some problem with the mom or baby. These problems can be detected during pregnancy, though, when there is still plenty of time to switch to a hospital. Sending all women to the hospital “just in case” is as ridiculous as saying “Let’s give all women hysterectomies because some women will otherwise develop uterine cancer”. I don’t think women who go the hospital are bad moms, or that they are not concerned about their child’s safety. I feel sorry for them because they have bought into the lies propagated by mainstream medicine, and they will be victimized by the doctors to some extent.

From the day I found out that I was pregnant for the first time (a baby that we lost), I have kept the knowledge in the back of my mind that things do not always turn out well. “Cautiously optimistic” would best describe how I feel about pregnancies, and about the lives of my children. The feeling never eases, only intensifies as there are more and more children to love, care for, and – yes – worry about. I am convinced that it will be with me until I die.

But instead of having it become a paralyzing fear, one that will make the helpless victim of a medical discipline that is 90% dominated by male perverts (= male ob/gyns), I have chosen what I believe to be the safest alternative.

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Responses

  1. This was hard. Babies do die from time to time for a variety of reasons. One of my friends’ mom had a stillbirth baby and I know that it was in a hospital setting.

    I feel like the ob/gyn field should be reserved for female only. Some women prefer to have their babies in the hospital and that is fine, but they need to make sure that their ob/gyn is a female. Every woman who has a baby in the hospital should demand that everyone in the room is female except for their husband. Men have no business being male gynecologists. If it is okay for men to be gynecologists seeing naked women and examining their private parts, why is it not okay for men in other occupations such as teachers, pastors, firemen, lawyers, etc. to do intimate examinations on women who they are not married to? Male gynecologists are humans and not morally above other men. I wish that all male gynecologists would be kicked out. If they care a lot about babies, they could go into pediatrics where they would care for critically ill babies.

  2. I would absolutely love to pick your brain on what you think my changes of having a VBAC would be after having 2 c-sections. My daughter’s twin died at 16 weeks in utero, and we were told to abort her because her birth defects would be incompatible with life. Of course, aborting her went against our beliefs, and would you know she is 3 years old, sleeping peacefully in her bed upstairs! 🙂

    Our son is 1, and I had a repeat c-section with him. I have been told that a VBAC is not even an option any more. I am on hormonal birth control but would love to hear some more of your insight on all of this. I need to get to bed though, so will close this comment up. 🙂

    I am interested in reading more of your blog soon!

  3. Pipsylou,

    Thank you for your interest in my opinion.

    I really can’t say what your chances of having a VBAC are after two C-sections because C-sections vary greatly. A medical professional could tell from your patient records what kind of sutures were used, which I know plays a role in this. Unfortunately, many doctors today do the quick, less safe stitches because they know that almost no doctor will allow VBACs any more, so there’s no point to do the better, safer stitches (at least in their opinion).

    I seriously doubt that you would be able to find an ob/gyn that would let you attempt a VBAC, although I wouldn’t rule it out. The reason for this is not that VBACs are less safe. Rather, doctors have to have legal insurance covering them against malpractice suits. About 5 years ago, these insurance companies changed their policies. They will now not cover doctors for lawsuits stemming from VBACs any more unless the doctor was on the same hospital floor as the laboring mother from the time she was admitted until the time the baby was born. Doctors simply do not want to have to be bound by such a rule, so most have abandoned doing VBACs. The fact that they make about twice as much money on a C-section probably had something to do with that decision, too. I don’t even want to start guessing what policies surround a VBAC after 2 C-sections.

    In Europe, where I am from, the term VBAC does not even exist. The notion “once a C-section, always a C-section” doesn’t even cross people’s mind. Uterine rupture, although a remote possibility, mostly only affects women who have very bad diets, abuse substances, or generally are unable to take care of themselves during pregnancy – but even then, it is very, very unlikely. I think it is a problem blown out of proportion by doctors who like to make money. There are way too many ob/gyn’s per capita (more than any other medical field) so they kind of have to fabricate problems to keep their paychecks flowing in.

    You should, however, be able to find a midwife who would attend your birth if you are able to obtain your old records and she can see what kind of incision was made and how it was sewed up. Chances are, you would still be a “good candidate”. Of course, that means having to have a home birth. I have had 3 of our 4 children at home, and this 5th is also a planned home birth. There are many other posts I have written on the benefits of home birth (you can find them by clicking the label on the right side of the screen). If nothing else, you should at least go for a consultation with a midwife who can evaluate your specific case. If you met one you would quickly realize why they are so superior to doctors. In a nutshell, doctors fix problems, midwives prevent them.

    Not to condemn or criticize you, but you may have read that I oppose all hormonal birth control. I came to this conclusion after having been on the pill myself for the first 3 months of our marriage. When I discontinued them (because I was now covered by my husband’s health insurance) I got pregnant immediately, and shortly thereafter miscarried. As I started reading about what could have caused that, I learned that birth control pills do not always stop a woman from ovulating (releasing an egg). The combination pill has a “breakthrough ovulation” rate of about 5-10%, while estrogen-only methods (minipill, injections, patch) allow you to ovulate about 60% of months. That is why all hormonal birth control methods also work by hardening and thinning the lining of the uterus to prevent a newly conceived baby (7-10 days old) from nestling into the womb. The baby then dies and is simply “washed out” with your next period, without you ever knowing. This is the reason why women on the pill experience much lighter periods, because there is much less lining to shed. It takes about 3 months for this toxic effect on the uterus to wear off, and for the lining to build back up. Some doctors recommend women to wait for 3 months after coming off the pill before trying to get pregnant. My miscarriage was probably caused by the fact that although the baby was able to attach a little, it was not enough to sustain it in the long run, and the baby died.

    I have since learned about naturally spacing my children through exclusive breastfeeding. I would say that I am more fertile than the average woman, yet this has worked very well even for me. There is a very lengthy and detailed blog post on that topic as well. Here’s the link:

    http://stevenandersonfamily.blogspot.com/2007/12/natural-child-spacing-through.html

    Thank you for your comments, I hope I answered your questions somewhat.

  4. I just noticed the link was to long to post. You can find the article by going to December 2007, it is called “Natural Child Spacing Through Lactational Amenorrhea”.


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