Stillbirth causes a grief that hurts unlike any other
Is there ever a right way to deal with the devastating loss of a stillborn child?
IT is a small and ragged piece of brown paper towel. On it are scrawled the words "twin one" and "twin two", followed by the weights of two babies, stillborn more than 25 years ago.
Preserved between the pages of a Bible, it is the most precious possession of Fiona and Iain Murray, from Glasgow; apart from three grainy Polaroid photographs, it is all that they have to mark their children Hazel and Gayle.
By the time Mrs Murray went into labour, just hours after she had been dismissed by a consultant as “an over-anxious first-time mother”, she had been told that neither child had a heartbeat. As proud fathers queued for the pay phone in the corridor of the maternity unit, her husband was left to gather his own 10 pence coins and inform their parents of the devastating news.
All around Mrs Murray, the sounds of crying newborns could be heard.
Briefly, she held the twins; a memory faint amid a fog of valium and the epidural she had been given to get through the labour. She was barely present when she was given forms to sign; forms that would authorise a hospital funeral for the babies, to which the Murrays were not invited. Months later, the couple found out where their children were buried, in a shared municipal grave.
Many things have changed since December 1986, including public attitudes to stillbirth, as well as the care and sensitivity shown by health care professionals to those who endure such a loss. Campaigners welcome the shift towards greater emotional openness. They say attempts to hush up – or brush aside – such bereavements failed too many distraught parents who felt, as Mrs Murray puts it, “cut adrift” by society, with some friends crossing the road to avoid them.
Last week, the musician Gary Barlow and his wife Dawn announced that their fourth child, Poppy, had been delivered stillborn on Saturday. In a public statement, he said: “Our focus now is giving her a beautiful funeral and loving our three children with all our hearts.”
Immediately, the Twitter account of the Take That star and X Factor judge was inundated with messages of sympathy, with the musician later using the same social media microsite to describe the kindness of the public as “overwhelming”.
The silence that used to greet stillbirth has been broken; these days, bereaved parents are encouraged to commemorate their loss. Much of the shift in this country is the result of the campaigning efforts of two women, the journalist Bel Mooney, and Hazelanne Lewis, a psychiatric social worker, after both lost babies in the mid-1970s.
“Lost?” In 1976, Ms Mooney, then married to the broadcaster Jonathan Dimbleby, wrote powerfully about the euphemisms used to describe the brutal bereavement, railing that her son had been born dead, after 16 hours of labour, and had not been “lost” in the way one might lose an umbrella.
After Ms Mooney and Ms Lewis wrote about it, bereaved parents contacted them in droves, and the organisation that was to become the stillbirth and neonatal death charity Sands was created in 1991. It produced the first guidelines for healthcare professionals on how they could help parents.
Most significantly, they recommended that parents should always be offered the chance to hold their child. Until then, many midwives had whisked the baby away, believing that contact would traumatise the mother.
Sheena Byrom, who last year published a best-selling memoir of her 35 years as a midwife, remembers the ethos well. “There was a blanket of silence over stillbirth,” she says. “I remember feeling desperately upset for the mothers, but we were discouraged from talking to them about it because the view was that we would upset them.”
Today, NHS hospitals routinely offer parents a memory box containing reminders of their child, as well as the opportunity to see and hold the child, to take photographs with siblings and other family members, and to hold ceremonies and funerals.
Sands bereavement expert Judith Schott says that efforts to “create memories” of a life unlived – hand and foot prints, photographs or a lock of hair – help parents to feel that their child has been recognised, and holds a place in their family.
“When an adult dies, there are tangible memories and reminders,” says Mrs Schott. “When a new baby dies, parents feel they have been left with nothing.”
The shift in attitudes during the 1990s were part of a move towards “emotional openness” in society, says Mrs Schott. This was most significantly marked by the outpouring of grief that followed the death of Diana, Princess of Wales in 1997.
Despite this progress, there has been remarkably little research on this most difficult of topics: how best to support parents through stillbirth.
Dr Patricia Hughes, Professor of Psychiatry at St George’s, University of London, carried out a study in 2002, expecting to find that the chance to say goodbye to a child, along with rituals such as holding a ceremony or a funeral, helped parents come to terms with the loss.
In fact, the research showed the opposite. Mothers who held their stillborn child were more likely to suffer depression in a subsequent pregnancy than those who only saw the infant. Those who had no contact with the infant were the least likely to suffer depression, and the least likely to have problems bonding with subsequent children.
Nor was there evidence that ceremonies and rituals to mark a stillbirth helped the bereaved mother.
In the paper published in The Lancet, the researchers speculated that “rather than creating memories which help the recovery process, seeing and holding the dead infant further traumatises a woman who is already intensely distressed and physically exhausted.
“Furthermore,” the psychiatrists warned, “we note some women are left with images that haunt them afterwards.”
The findings were met with outrage, with campaigners warning that the study, based on just 65 cases, could set back their cause. Today, Prof Hughes speaks very carefully about the findings.
“At the time, the guidelines from the Royal College of Obstetricians and Gynaecologists were advising that parents should be encouraged to see and hold their baby, even if they didn’t want to,” she points out. “We were saying that this was hard to justify; that the choice needed to rest with the individual, and that no one should be encouraged to go against their instinct.”
Current guidelines make the same point, though parents are often advised that others have been helped by holding or seeing their child. Prof Hughes says the “cultural movement towards emotional openness” in recent years has put extra pressure on those already shattered by grief.
“There is a tendency now to ask people who have been through a deeply personal experience to express how they feel very openly,” she says. “That was not the case 20 years ago, and it can place expectations on people to act in ways in which they are not comfortable.”
Sarah Hughes says she “became an adult” last year – at the age of 38 – when she held her dead daughter, Iris, in her arms. She was 35 weeks’ pregnant and living with her husband and two young children in New York when she was told that the baby’s heart was not beating.
After delivery by Caesarean section, she was sent home from hospital with a memorial box containing a set of the child’s footprints, a bloodstained blanket and a tiny hat.
The family moved back to London. Just six weeks ago, the experience was echoed when the writer experienced a late miscarriage at 20 weeks. For all the sensitivity shown by professionals, closer to home, the most innocent comments can be the most brutal.
“My daughter, who is five, will tell strangers that another baby has died and will ask me, 'Why is it they keep dying?’ That can be a bit hard,” she says, with understatement.
She describes the grief for a stillborn child as being left “grasping at something permanently just out of reach”.
“It’s different because there are no happy memories to sustain you, no sense of who that person was and what they meant to you.”
She would have been “absolutely devastated” if she had not had the chance to hold Iris in her arms. “I’ve heard the view that the whole thing has become too emotional, that it in some way makes it worse. I just don’t think you can say that unless it has happened to you.”
A grief untold, is no less a grief, she suggests. Her own grandmother only revealed on her deathbed that she had suffered a series of stillbirths.
If attitudes towards stillbirths have changed in recent years, the proportion of deliveries that end in tragedy have not.
In the UK, around one in 200 births are stillborn, with 17 stillbirths and neonatal deaths each day. Last year, a global study concluded that Britain’s figures were among the worst in the developed world, with only France and Austria recording a higher proportion of stillbirths.
The study also put paid to popular assumption that babies delivered stillborn have something wrong with them, that they are “never meant to be”. Just five per cent of the 2.6 million babies stillborn worldwide in 2009 had a congenital abnormality, with far more occurring when signs of distress in pregnancy went undetected.
Carla Poole, 31, a charity worker from Letchworth, Hertfordshire, had enjoyed a “textbook” first pregnancy, and was at 37-and-a-half weeks when the baby stopped moving and she felt pain.
“I thought it was the start of labour,” she says. She and her fiancé went to Lister Hospital in February last year. To their relief, monitors detected the baby’s heartbeat, but it was slow. Fearing the infant was in distress, doctors ordered a Caesarean delivery.
“All of a sudden the heart stopped beating, the line went flat,” says Miss Poole. “I was rushed into theatre, I could hear them shouting, 'We’ve got to get the baby out!’ That was the last thing I heard.”
Attempts to resuscitate the infant failed. When Miss Poole regained consciousness, she knew immediately what had happened. “We saw the baby, we named her Daisy. I held her,” she says simply. “The chaplain came and we had her blessed, in front of the rest of the family. That was important to us, we needed to say goodbye.”
The couple was given a memory box containing a lock of hair, photographs and Daisy’s hand and footprints, which they had made into a silver charm bracelet, worn by Miss Poole.
“I take great comfort from the fact that Daisy has not gone forgotten.”
In Glasgow, Fiona Murray, now 53, and her husband Iain, 54, struggle each December as the anniversary of their twins’ stillbirth approaches. “There is no ceremony, we just give each other a cuddle, and get through the two days: the day we found out their hearts were not beating, and the day of the labour,” she says.
Mrs Murray, a secondary school teacher and mother to Kirstin, 24 (born a year after the twins were delivered), and Frasier, 23, says: “I would cherish anything that says the twins were here, and they are mourned; a lock of their hair, a print of their hands. It was very different then.”
She pauses, and takes a breath. “You have no idea how precious a bit of brown paper towel can be.”