Our Bodies, Ourselves (101 page)

The news of the trophoblastic tissue put me into high gear. Keep busy. Or sleep. Can't stop to think, can't stop to cry. I feel driven. I need to stop and mourn, but how can I feel it necessary to mourn when there wasn't even anybody in there!?

Pregnancy loss is more likely in multiple-gestation pregnancies—those with two or more embryos or fetuses. There has been a dramatic increase in the number of multiple-gestation pregnancies because more women are conceiving after age thirty and because more women are using infertility treatments, both of which increase the chance of having a multiple-gestation pregnancy.

Because of the level of early testing in standard prenatal care, women sometimes learn about a multiple-gestation pregnancy only to later discover that one fetus, or more than one, has died. If this occurs in early pregnancy, it is sometimes called vanishing twin syndrome and may be associated with some vaginal spotting during the first months.
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It can be hard to know how to acknowledge and mourn such a loss.

Early on in my first pregnancy, I found out I was pregnant with twins. The news was overwhelming and scary but also exciting. Then one twin stopped developing. I had no signs or symptoms of miscarriage, and eventually the fetus was reabsorbed by my body. Most people don't know what to say when you tell them you've lost a baby. Several people said, “Well, you were only trying for one.” That was not at all helpful to hear. I was worried about the health and viability of the “healthy” twin and about what had gone wrong in my body. I was thrilled and relieved when I gave birth to my son six months later, but I think sometimes about my son's twin and about the anxiety of that pregnancy. It's taken me a long time to acknowledge how that loss affected me
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Multiple-gestation pregnancies, particularly those with more than two fetuses, are far riskier than single pregnancies for both mothers and babies. In some situations, women must decide whether to selectively terminate one or more of the fetuses to increase the chances of the remaining fetus or fetuses surviving.

Some of us choose to end a pregnancy after discovering that we are carrying a fetus with severe impairments or a fatal abnormality. Loss from terminating a pregnancy is different from other pregnancy losses because it arises out of our own decision, but it can be just as painful and difficult.

Religions, cultures, communities, and individuals vary widely in their beliefs about the ethics of ending a pregnancy in these circumstances. Those of us who experience this kind of loss may not speak openly about it for fear of being judged. Support from other women with similar experiences can help many of us come to terms with our decision. Honoring the loss, even when it stems from our own choice, and acknowledging the validity of grief can also help the healing process.

There wasn't one moment when it became clear that we were going to terminate the pregnancy. It was just something that slowly, and very painfully, came to feel like the right thing to both of us. . . . I was deeply upset by the loss of the baby and felt like the only way to get back on my feet was to get pregnant again. I got pregnant again about four months later and gave birth to my second daughter. Sometimes when I see my children, I have this vision of the boy we didn't have being with them. He is really present in our lives in these unexpected ways, and I imagine he will stay there for a long time
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Stillbirth, a loss after twenty weeks' gestation, is much less common than miscarriage; in the United States, it occurs in about 1 out of 160 pregnancies.
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This figure varies with a woman's age, with women under 15 and over 40 having the highest rates. Race is also a factor. African-American women face a significantly higher chance of stillbirth than Hispanic or non-Hispanic white women, with stillbirth occurring in about 1 out of 89 pregnancies.
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(For more information, see
“Disparities in Loss.”
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Stillbirths are generally divided into early loss (between twenty and twenty-eight weeks) and late stillbirth (twenty-eight weeks or greater). The most common causes of early loss are congenital anomalies, placental problems leading to bleeding and fetal growth restriction, and preterm infection in a fetus too young to survive. Stillbirths after twenty-eight weeks often involve apparently healthy fetuses but may also be due, as with earlier stillbirths, to placental problems such as poor fetal growth or premature separation of the placenta.

Some factors that put women at increased risk of stillbirth include being over age forty or under age fifteen, having a multiple-gestation pregnancy, obesity, smoking, and using drugs. In addition, babies with chromosomal anomalies and nonchromosomal structural impairments are also at higher risk of stillbirth.

Most fetal deaths are detected before labor begins, usually at a routine prenatal check or when a woman notices an absence of the usual kicks and movement. An ultrasound will confirm that the baby has died. If a stillbirth is detected, you will need to make some decisions about how to proceed. If there is no medical need for immediate delivery, you can either wait for labor to come naturally or have labor induced. If possible, take time to prepare yourself
for the experience and to gather your support network.

Emilio III was stillborn at almost twenty-four weeks. I was going to go through labor knowing that I wouldn't have a new life in my life. It was the worst eight hours of my life. The labor was painful both physically and emotionally. In the end we delivered a beautiful baby boy. At the nurses' urging, we agreed to see and hold him. We got to hold him for a long time. We have pictures of him and share them with our daughter, who was born a little over a year later. She talks about her big little brother all the time, which reminds us that he is a part of our family
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After the birth, you will need to decide whether you want to see and hold your baby. You may want to name the baby if you haven't already done so, take photos or have a professional photographer do so, and take some time to say your good-byes. It may seem at first that seeing or holding the baby will be too much to handle, but many women later feel grateful to have done so. Such acts help to acknowledge the infant's existence and to preserve her or his memory. Some hospitals now offer a memory box to bereaved parents; it can include footprints and handprints, along with any items that were in contact with the baby, such as a blanket. If you will be staying in a hospital for more than a few hours after childbirth, you should consider whether you would prefer to be in a hospital ward that is not filled with pregnant women or new mothers.

You will be faced with a number of difficult and pressing decisions, including how you wish the baby's remains to be handled and whether you want to have an autopsy performed. In some cases, autopsy can provide important information about the cause of the stillbirth, provide information for future pregnancies, and help researchers figure out how to prevent stillbirths in the future. Unfortunately, even after a thorough evaluation, in more than half of stillbirths a cause cannot be determined.
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If you choose to have an autopsy done, the person performing it should be a pediatric or neonatal pathologist or be working with one. If the person is not, you may want to ask for a referral to a pathologist with the necessary expertise to review the findings. It can take up to six weeks to schedule and get the results from
an autopsy. If you do not want an autopsy done, ask whether X-ray or CT scanning of the baby can be performed as an alternate way of getting information.

For women who experience stillbirth, an additional pain can come when our breasts fill with milk for a baby who will not be drinking it. Talk to your health care provider about ways to cope with your milk. Some women choose to pump and donate the milk to other women who need it, through breast milk banks and organizations. For more information, see the website of the Human Milk Banking Association of North America (hmbana.org).

When a baby dies during the first twenty-eight days of life, it is called neonatal death. Some babies die during or shortly after childbirth, due to impairments that may or may not have been previously detected, to something that goes wrong during labor, or to unknown causes. The shock of a death that comes so quickly after birth is hard to bear. It is devastating to meet a baby only to lose him or her so soon.

Depending on cultural norms, newborn babies who die can be given the same rites and ceremonies as other people who die, though arranging funeral services for a tiny baby can feel very cruel. Ask for others to step in to help with arrangements, meals, care for older siblings, and whatever else you need to get you through this time.

Losing a pregnancy or a baby evokes many emotions. You may feel buffeted and torn by confusion, relief, shame, anger, sorrow, fear, powerlessness, or despair. You may need to withdraw at first, or feel numb about a reality that seems too much to bear. Some of your friends and family may not be able to handle the loss. Others may offer platitudes such as “You'll
have another baby” that can fail to comfort you or to acknowledge the importance of your baby's existence.

Most people didn't know how to give me support, and perhaps I didn't really know how to ask for it. People were more comfortable talking about the physical, and not the emotional, side of miscarriage. I needed to talk about both. It was also difficult for my husband, because people could at least ask how my body was doing. Unfortunately, he would sometimes be completely bypassed when someone called to talk with us, despite the fact that he, too, was in deep emotional pain
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A tremendous void and a sense of loneliness often follow a loss. If you have a partner, your feelings may differ from his or hers in strength or content. Grief may be mixed with guilt; both can cause tension between you. You may blame yourselves and wonder if either of you did something “wrong” (too much activity, too much sex, not enough good food, etc.), but this is rarely the case.

I had so many people to celebrate with when the test was positive, but now that I was unpregnant I was more alone than ever. I felt like a little baby's soul had rejected me. That maybe I was just too lame for the soul to cling to or maybe I wasn't enough of a parent for it to thrive. Maybe my anxiety had killed it. Maybe it was the lack of red meat in my diet. Maybe . . . well, it could have been anything
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