If a baby dies
Today, in the Western world, the number of babies who are stillborn after 24 weeks or who die within the first few weeks of life has fallen to about one per cent, largely thanks to improved obstetric and paediatric care.
Why babies die?
There are three main groups of perinatal deaths: stillbirths - babies who die before labour begins; intrapartum deaths - babies who die during labour; and neonatal deaths - babies who die within four weeks of birth.
About 45 per cent of perinatal deaths are stillbirths, and in about one-third of these cases the precise cause is not known. Of the rest, the most important causes are severe fetal defects and a placenta that's not entirely healthy. Less common causes of stillbirth include Rhesus incompatibility, and maternal diabetes that is not carefully controlled.
The first thing that happens when a baby dies in the uterus is the almost complete disappearance from the mother's blood of pregnancy hormones - oestrogen and progesterone. As a result, many of the signs and sensations of being pregnant fade quite quickly. Another early sign may be lack of fetal movement. If doctors or midwives suspect that a mother's baby may have died, an ultrasound scan will be done in order to look for the baby's heartbeat.
Labour usually starts within two to three days of a baby's death, although many women want to have their babies delivered as soon as they find out that they have died. If you find yourself in this unhappy situation, your wishes should be respected; usually doctors will suggest induction. It may seem very hard, but it is less risky than a Caesarean section and less likely to affect any subsequent pregnancies.
Babies who die in labour
This is exceptionally rare, but the death of a baby during labour is usually caused by a lack of oxygen as a result of a problem with the placenta. Another possible cause is injury to the baby during labour and delivery. This is far less common than it was in the past, thanks to high levels of modern care.
Death of the newborn may be caused by breathing difficulties, especially in babies born preterm (see Special Care Baby) or who are suffering from severe fetal defects. Fatal neonatal infections, once a significant cause of the deaths of newborn babies, are now very rare because of improved hygiene standards and modern antibiotics.
Coping with death
It's very important for both partners to come to terms with their grief, to be open about the death of their baby, to accept it, and to go through the grieving process together.
It's absolutely normal for bereaved parents to feel isolated, angry with themselves, each other, the staff, or the unfairness of life, and often guilty about something they did or didn't do. However, accepting that everyone involved did everything possible and that nobody is to blame, while also acknowledging how you feel, will help the healing process.
Parents are encouraged to hold their stillborn baby for a while after the birth, and most are very glad of this later. Having a photograph of the baby can also be a great comfort in the future. It helps to give the baby a name, to bury the baby formally, and to be present at the burial.
Another important form of solace is to get in touch with other parents who have had stillbirths or neonatal deaths (see Addresses). Details of support groups are usually available from your hospital and you can also try sharing your experiences with other parents on Internet forums. Don't be afraid to ask for help from a counsellor if you need it.
The emotional and physical effects on the mother are due not only to the shock and grief of losing her baby but also to the sudden withdrawal of pregnancy hormones. This can affect her mood, bringing on tearfulness, depression, insomnia, appetite loss, and withdrawal, as well as loss of milk from the breasts. The milk can be suppressed with drugs. The comfort and support of her partner, family, and friends is vital. It helps if both partners are open with each other and share their grief so that they can give each other support and comfort.
Getting pregnant again after a baby's death
Parents need to allow plenty of time to grieve before another pregnancy is contemplated. Many women, however, find the key to normality and a return to happiness is through conceiving again. Once partners have decided to try for another baby, they may find that worry about losing this baby will be hard to shake off. The risk of a recurrence is very slight, but where there has been a predisposing cause, subsequent pregnancies are carefully managed.
A father's reaction
When a baby dies, both parents grieve. But a father may express his grief very differently from his partner, and this can lead to tension in the relationship.
If a father grieves in a different way to his partner, it doesn't mean his grief is any less intense. Some men try to hide their grief and throw themselves into work in order to find some relief from the pain they're feeling. Fortunately, all of us are learning that it's better for us to be open to feelings and express them. Hopefully, men will be more encouraged to let their true feelings show, especially to their partners.
Support groups for bereaved parents can put fathers in contact with other men who have lost their babies. Being with other men who've been through the same experiences may help a bereaved father express his grief, anger, and all the other possible emotions he may feel, in whatever way is best for him. What's important is that he's allowed and able to express his grief in his own way.
Losing a twin
The death of one twin (or triplet) is just as tragic for the parents as the death of a singleton, and carries additional problems.
The loss of one baby in a multiple birth leaves parents with a complex emotional situation - they are mourning the death of the lost baby, while celebrating the life of the surviving twin or triplet(s). Faced with this impossible mix of emotions, many parents postpone their mourning. Others find they cannot attend to the needs of their living baby or babies properly because of the intensity of grief for the dead baby.
The loss of one baby may also cast a shadow over the life of the surviving twin or triplet(s), and birthdays may be particularly difficult for the first few years.
It must be stressed that a mother who's had a multiple pregnancy continues to think of herself as the mother of twins or triplets, regardless of whether any of the babies have died.
Parents who have lost a twin or a triplet may be told that they are “lucky” because they've still got their other child(ren). No other parent is expected to find comfort for the death of a child in the survival of its siblings.
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