Written by Zoe Lent, for Still Aware

When my daughter died, the level of grief, trauma and distress I experienced was compounded in ways I can only begin to describe, by someone who had a duty of care and responsibility to me and my well being. Someone whom I needed for professional support and guidance to make it through such a harrowing event – my obstetrician.

The indifferent and at times incomprehensible care I received from this OB was in direct contrast to the sensitive and supportive care I received from the midwives who worked under him; the midwives who helped me birth my little Avery and survive those distressing first days of raw, excruciating grief without my baby girl. For this I will always remember them fondly, and be grateful to them, because they were the first people to honour my sweet baby’s life and tell me how much she mattered.

Perhaps clinicians don’t realise how much of a lasting impact their language and conduct in response to the tragic event of child loss has on the bereaved family.

What I want clinicians to know is that bereaved parents will replay the moment of their child’s death over and over in their minds for years to come, maybe for the rest of their lives. Whether health professionals involved are comfortable with this truth or not, they are now a part of the family’s story, their words will forever remain seared onto our hearts, the features of their faces imprinted on our brains. Because unfortunately, they are the ones who have delivered the news that has ripped our lives apart, in traumatic moments we can never forget. Moments that play on a loop, and knock the wind out of us on the most unexpected of occasions.

So I will always remember that obstetrician, who responded to the death of my daughter in such unusual ways. Who used inappropriate language by referring to my baby as dead tissue, and who told me not to give my daughter a name I could use in the future on a living child. Who didn’t acknowledge I was scared, broken and afraid, overwhelmed with grief and fear about the prospect of giving birth to my dead child. Who made jokes upon entering my hospital room. Who didn’t consider I needed to prepare myself mentally and emotionally for the enormity of the labour and birth that I was yet to get through, and instead snapped at me that he didn’t have a crystal ball when I asked him how long a stillborn birth was likely to take in his experience; instead of gently discussing potential outcomes and helping me prepare as much as possible. Whose bizarre reaction to a tragedy became something else I had to deal with on the worst day of my life, creating additional distress and pain in my already broken heart. Whose very presence every time he entered my hospital room added a sense of fear and helplessness to the swirl of painful emotions I was already experiencing, instead of being a source of guidance, safety and support. Whose reckless and fathomless words, whose lack of respect and empathy, still impact me to this day.

Equally, I will remember the midwives who treated me like a person, a mother. A mother who was processing the loss of her sweet child, instead of someone they were too uncomfortable to be around, or someone they were just killing time with out of obligation until they could get back to their other patients, with living babies and happy endings. The midwives who were patient and comforting toward me, who explained how I would get through the next few hours because they could tell I needed to understand. Who went over potential scenarios of what would likely happen to my body and my baby, who held my hand while I birthed my child, who bathed my child when I couldn’t bring myself to. Who gently talked me through my options once my baby arrived. Who gave me the strength and support to ask for another, more sensitive OB halfway through my labour. Who took photos of Avery for me, some of the only photos I have to show the world that she was here. Who took prints of my daughter’s little hand and foot prints and lovingly wrote her name on the card. Who told me Avery was beautiful. Who came to her memorial service. Who visited me at home in the weeks that followed and offered genuine compassion.

The significantly conflicting levels of care I received within the very same hospital still astound me to this day, and serves to illustrate the stark contrast in approach to care between individual care providers, and the impact that this  approach can have. Under the care of that particular OB, my levels of distress only continued to increase until he was removed from the situation, however the midwives’ approach was soothing, something I could cling on to, a little beacon of light in the distance that I could see, that was guiding me, that I could slowly move toward while navigating through this fresh hell. Though nothing they could do could make it better or bring Avery back, they certainly weren’t adding to my family’s pain and trauma. They were trying to stop the bleeding, metaphorically speaking, where as the OB had already called time of death on his relationship with me now that my baby was no more in his mind.

Clinicians, along with clinic or hospital’s upper management, need to be aware that poor conduct or dismissive or unhelpful language can cause further and significant pain to the parents and add complicated layers to their already overwhelming grief. While I certainly hope that most bereaved parents have not had such a damaging experience with their obstetrician as mine, within the loss community I have heard of many offhand and painful comments made by care providers following a baby’s death that stay with the parents forever, common ones being “you’re young, you can have another baby” or “it’s just one of those things”.

Due to the lasting impact of these sorts of comments, it is imperative that clinicians are trained in bereavement guidance and support. The fact is, unless a doctor or midwife works in a high risk environment, they are unlikely to be exposed to much loss. But as we know stillbirth, as well as miscarriage and neonatal deaths, don’t discriminate and can strike anyone in any walk of life. As such, all care providers need to be educated on appropriate responses, respectful and compassionate care and the potential impact of careless language and conduct on the parents.

Feeling safe and supported is paramount to parents who have suffered a stillbirth. Empathetic guidance through the process is crucial, as is answering any questions in a compassionate yet professional way and giving the parents time to process their situation and ask questions.

Health professionals should maintain an understanding that giving birth is scary enough, but giving birth to your much loved and not alive baby is a soul shattering and terrifying prospect to a mother – it is a living nightmare. The parents are the ones who have suffered the loss, and their needs need to be considered above all else. They deserve respect and compassion at this time, and nothing less than the best care.

As a mother who has been there, this is what I would want any healthcare professional caring for a bereaved family to remember:

• Stay professional but compassionate, show empathy
• Answer questions in a respectful manner, and be mindful of language. Give the parents informed options regarding viewing their baby, what the baby may look like, whether a post mortem is recommended etc.
• Treat the parent’s loss as the loss of a much wanted child, not a medical occurrence. Similarly, treat the baby as a family member, not a deceased foetus or an “almost” child
• Follow the parent’s lead. They may want to know every little detail about expected outcomes for labour, delivery and after the child has arrived. They may want to know nothing. Try to respond sensitively to what they are asking you. They need to find a way through this, a way to survive, and you are supporting them through the first steps of that journey.
• Offer advice from your professional medical point of view, don’t offer platitudes or offhand advice about how the parents should/shouldn’t feel or react, what they should say or do, it’s their prerogative to respond and survive this tremendous loss however they see fit
• Be respectful of religious and cultural beliefs and rituals
• Understand the parents may not be thinking clearly and maintain a delicate and patient approach

Most families are unprepared as stillbirth is most often unexpected. Have information on hand to support them through the process, as well as connections to both local and national support groups.

 

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