The childbirth crisis

Beth* was distraught. She sat on the bed in the labour ward heaving, her eyes swollen and red. Her husband sat quietly by her side, arm draped over her shoulder. He was sobbing silently too. They were devastated.

Earlier in the week, Beth had had an ultrasound at her 39 week-appointment at the clinic. The baby wasn’t quite right, with reduced movements though all other parameters were fairly alright. She was advised that her baby would require immediate delivery to assure a good outcome.

However, Beth felt rushed and bargained that since all other parameters were fine, she would go home and consult with her husband then come back. She could not be forced to stay and was encouraged to come back the same day for the delivery to be initiated.

This was three days down the road. Beth was back in hospital with her husband. A repeat ultrasound had already confirmed the worst; the baby was no more. What a blow. We all felt the loss. Now the excruciating process of delivering the little angel gone too soon had to be set in motion. The couple was going through the most harrowing nightmare. We had to tuck away our pain and step in to the huge shoes required to walk with them though this most difficult journey.

Beth was awash with guilt and regret. It was a most difficult time for all, trying to provide emotional and psychological support for her through the difficult labour. She wept through the 14 hours, talking to her angel and repeatedly lashing herself for failing her. The grief counsellor had her work cut out for her. This was not going to be a walk in the park.

The little one finally came in the wee hours of the morning. She was swaddled and handed over to Beth. She was named Hope. The whole family was allowed time to meet Hope and say goodbye in privacy. As a family, they chose to lay the little angel to rest at the local public cemetery. Beth wanted the assurance that she could easily visit at her convenience. She was able to attend to the burial ceremony.   She would continue with therapy for the foreseeable future.

Most expectant couples anticipate an easy pregnancy and a healthy baby. Unfortunately, sometimes nature doesn’t always play ball. Each of us may have experienced such a situation one way or the other, personal or not.

This is a birth crisis; a circumstance where there is an unexpected bad outcome of pregnancy, which may vary from a mother being ill, requiring lifesaving surgery or losing the baby in the course of the pregnancy; whether a miscarriage, a stillbirth or losing the baby after birth. Other outcomes not always contemplated may include the baby being born with abnormalities or where the pregnancy is terminated due to abnormalities that are incompatible with life. We collectively feel and grieve the loss.

It is during such moments that the parents deserve compassion and empathy. They are scared, they may feel that they have lost their future, or that they have failed. This leads to profound and lasting grief.

Even as a couple, the parents may grieve differently. One may be stoic and the other may be completely falling apart. Let us not forget that these parents remember with clarity the words used at the time of crisis. Telling a grieving parent that they are at fault, or that it was God’s will, or that this was not their time, or that they will get another baby so they should not worry are some examples of the toxic, dangerous and detrimental statements that one may carelessly make.

These phrases leave long-standing psychological trauma to those affected. The parents need to feel their healthcare providers genuinely care and that they are not rushed for time. They need a safe private place and environment to have the news disclosed to them and allowed time to internalise the information. They need to know it is okay to grieve, to cry, to wail and to show emotion. It is also okay to be silent. Where appropriate, the extended family members may be involved, at the behest of the parents. Adequate emotional support and grief counselling is critical. The parents need ample time to meet their baby and say goodbye. The necessary information needed by the parents should be provided, in verbal and written form. It is important that the family is informed of the need for the baby autopsy before decisions regarding interment are made.

The family is given an unbiased option with regard to how they would like the final rites of their baby performed. Guidance and resources for the funeral arrangements or memorial services should be part of routine care.

Finally, the bad pregnancy outcomes equally affect healthcare providers who care for the patient. It is important that they also grieve and debrief. Psychological support for these service providers must become part of routine staff wellness support. This is no longer a luxury, but an absolute necessity recognised as a critical pillar in patient safety.

‘And ever has it been that love knows not its own depth until the hour of separation’- Khalil Gibran

Dr Bosire is an obstetrician/ gynaecologist