The death of any child is always a tragic event, but the death of a baby before, during, or very soon after birth can be especially distressing. 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 percent, largely thanks to improved obstetric and pediatric care.
Why Babies Die
There are three main groups of perinatal deaths: still births babies who die before labor begins; intrapartum deaths-babies who die during labor; and neonatal deaths-babies who die within four weeks of their births.
Stillbirth About 45 percent 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 healthy. It could be that the placenta failed to develop adequately, became diseased in some way, or became unable to continue to support the baby. Whatever the cause, the placenta was unable to provide adequate nutrition for the baby. It might even have begun to separate from the wall of the uterus before labor started. 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-estrogen 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 baby may have died, an ultrasound scan will be done to detect the baby’s heartbeat.
Labor usually starts within two to three days of a baby’s death, although many women want to have their babies removed 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 for a mother to have to go through this, but it is much less risky than a cesarean section-which puts the mother at great risk and is avoided at all costs-and less likely to affect any subsequent pregnancies.
When you go into labor, there will be no physical difference between this labor and a normal one. You’ll need a great deal of sympathy and support, and will be given as much pain relief as you want. Everybody involved will recognize your feelings.
Babies who die in labor This is exceptionally rare, but the death of a baby during labor is usually caused by a lack of oxygen due to a problem with the placenta. Another possible cause is injury to the baby during labor and delivery. This is far less common than it was in the past, thanks to the high quality of modern care.
Neonatal death Death of the newborn may be caused by breathing difficulties, especially in babies who are born preterm, are postmature, or 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 a 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.
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 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. Details of support groups are usually available from your hospital. Don’t be afraid to ask for help from a counselor if you need it.
Emotional effects 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
Grief over the death of a baby should have subsided before another pregnancy is contemplated. This usually takes at least six months and sometimes a year or more. Many women, however, find the key to normality and a return to happiness is through conceiving again. Once partners have decided to try to have 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 predisposing cause, subsequent pregnancies are carefully managed.