After week 12-14 women enter their second trimester of pregnancy. You may begin to experience noticeable differences during this time including your own physical changes and the baby’s growth. You may be less nauseous and less tired, your breasts may hurt less, but continue to grow – especially the aureole. The baby, as it grows and takes up more room in the uterus may begin to gently move around and you will start to notice slight fluttery feelings in your abdomen. These movements may not be felt at all until a bit later (18-20 weeks gestation) especially if this is your first pregnancy.

During visits to the doctor and on ultrasounds you will begin to see the baby develop – in particular his/her limbs and some facial features. The strongest indication of your baby’s healthy development is a strong heartbeat.

And then it happens …. you may go in for a check up, ultrasound or 20-week level 3 and suddenly, unexpectedly, there is no heartbeat. DEVASTATION! DISBELIEF! THIS CAN’T BE HAPPENING TO ME!!

Hopefully you are not alone when you receive this news. Some women always go to their appointments with their partner, relative or friend; others may go alone since there is no reason to expect that there would be a problem. Wherever you are and whomever is with you, this is devastating news to discover at this stage in your pregnancy.

Because you are not always aware of movement during the 2^nd trimester you may feel that you are to blame that you didn’t get to a doctor sooner. You may feel that you let the baby down by “not taking care of him/her” because you were unaware that something was wrong. YOU ARE NOT AT FAULT!!!

How to Deliver the Baby

Hopefully your physician will fully and carefully explain the options to you at this point. You want to make a well-informed decision. It is HARD. It is hard to make a decision and understand how you will feel by making choices that are offered when you just want this nightmare to end.

1. You may be induced with certain medications. This will bring on labor and a vaginal delivery of the baby (usually not alive).
2. You may be given the option to have a D&E. Dilation & Evacuation is a surgical procedure that is done under an epidural or general anesthesia. This procedure involves surgically removing the baby through the vagina. Medical equipment may be used to make a full evacuation and the baby may be taken out in parts. It is vital that you have this information since it will effect your post-delivery options and your peace of mind vis-a-vis the baby. Not all physicians fully explain what takes place when you elect to have a D&E.

Post-Delivery Options

1. In most hospitals now you are given the option to see and/or hold your baby. If this option is proposed to you prior to the delivery you may not be ready to make that decision since you may think that you will not want to see or hold the baby. Many sensitive nurses understand that you may change your mind after you deliver and they will offer you again the chance to see your baby. Hospitals will keep the baby on the unit for an hour or two just for this reason before sending it to the morgue or pathology department.
2. For some women/couples seeing and or holding your baby seems like a natural experience and have no qualms at all about doing this. Others may initially feel that it is a strange thing to be offered and to do, but after careful consideration, decide to do it. There has never been a women/couple whom I’ve counseled who has regretted seeing or holding her baby. There have been some who have regretted not doing it. That does not mean that it is for everyone. For some families it is not something they would ever consider and it is definitely an acceptable option to say no to this offer.
3. Many hospitals will make keepsake folders or memory boxes for you to take home as a memento of your baby (footprint, hand print, locket of hair, pictures). Some hospitals will ask if you want this done and your initial response may be no. Some places will make these keepsakes for you anyway since they know that perhaps in the future you will change your mind and want a memento of your baby.
4. Autopsy – an autopsy is offered for every fetal death. There are different levels of pathological investigation that can be done: from just an outside examination to a full-fledged autopsy. This again depends on your wishes. It is important to be aware that the results of this testing can take up to 10 weeks post delivery depending on the depth of the testing. You can usually get initial results within the first 2-3 weeks. It is very important that you find out from whom to get the results. Usually it’s from your obstetrician, but if you happen to deliver at a hospital where your physician does not practice (this can happen if you are hospitalized suddenly or transferred to a hospital where you can get more care), you may need to request your pathology results from the physician who delivered the baby.
5. Naming your baby – Many women/couples have chosen a name for their baby by this stage in the pregnancy. It is natural to want to name your baby. Some people initially feel that they want to save that “favorite” name for a live child. But if you had a name picked out for this baby, it is recommended that that is the name you give him/her. It is also perfectly fine not to give your baby a name. Some people do not name their baby immediately. There is no required time frame to naming your baby. You can choose to give this child a name years later.
6. Burial/cremation options:
   1. There are different regulations in each state about when you are responsible for taking care of arrangements after your baby’s death. Some states require parents to make arrangements after 20 weeks gestation; whereas others require after 24 weeks. You may make your own decision regardless of state rulings even if your gestational age is under the designated law.
   2. Should you decide to bury your baby you will need to make your arrangements through a funeral home. There are many cemeteries that have sections set aside for babies. These sections have uniform markers that you can personalize with your baby’s name and birth/death date. You may also choose not to have a marker and still bury in the baby section.
   3. Another burial option is to purchase a private plot where you can then put your own marker or stone.
   4. Some families may decide that the baby will be buried but that they do not want to be present, and the funeral director will notify them when it is completed.
   5. Funeral directors will be your most helpful resource for this information. Expenses for a burial can be kept to a minimum if you choose to do what’s called a “direct burial” – this means that the funeral home will pick up the body from the hospital and transfer it directly to the cemetery where you can have a grave-side service. In general funeral homes will usually greatly reduce their costs when it comes to burying babies.
   6. If you have chosen to cremate, you can have the ashes in an urn, or you can decide to disperse the ashes in a favorite location. Some may choose to bury the ashes in your personal garden.
   7. If you are not required to bury or cremate the baby – depending on gestational age – you may be interested to know what will happen to the body. Hospitals will cremate the baby’s body on the premises of the hospital, but those ashes are, in no uncertain terms, available to you.
7. Memorial options:
   1. You may choose to remember your baby in different ways: if you have buried your baby you can have a small stone placed at the grave or other memorial piece.
   2. You may decide to do a memorial service for your baby. You can find appropriate poetry, musical selections, prayer material, etc. at your local library or on the Internet. If you do this at the funeral home there may be an additional fee involved. Many people choose to do a graveside memorial service. You can invite family and friends or you can decide that you and your partner will be the only ones present. Some families decide to have a service at a funeral home first before going to the cemetery. For cremation you can decide to have a small service at the crematory prior to the cremation.
   3. Some people decide to plant a tree in their baby’s memory. This can be done at your home, in your yard, or at a special location that is meaningful to you and your family. Along a similar line, you may want to plant a garden in your baby’s memory.
   4. Other memorial ideas include having a ceremony where you send a balloon (or bouquet of balloons – please make sure they are environmentally friendly!) into the sky in your baby’s memory. You may want to include a letter to your baby, cremation ashes, or drawings from the baby’s siblings inside the balloon.
   5. You may want to invite family and friends to your home and have a little ceremony to remember your baby that could include stories about your pregnancy, showing ultrasound pictures, and mementos that you’ve brought home from the hospital.

WHEN EVERYTHING’S SAID & DONE- GRIEVING YOUR LOSS

An important and at times overlooked aspect of a pregnancy loss is how you feel physically. You must give yourself time to heal following the physical stress of an induced labor, D&E or D&C. Another physical manifestation is lactation. Many women feel this is an additional blow – an insult to injury to have their milk come in when there is no baby to nurse. An antidote to lactating is to put fresh cabbage leaves on your breasts – this will help stop the flow of milk.

And then comes the hard part -YOUR GRIEF. It is an understatement to say what a difficult time you may be facing following the loss.

You began planning for this child’s entry into your lives many weeks or months prior to this loss. Suddenly you are left to confront a major detour in your lives. You will need to take time to psychologically and emotionally recover from this experience.

It is not uncommon to be sad for a long time – how long is not something that can be predicted nor is there a natural time-line of grief and healing that is prescribed. Everyone is different and needs to heal at her/his own pace.

There are some important things to keep in mind:

1. Since everyone grieves and heals differently, you and your partner may be in different places during this after-phase.
2. Whatever way you are personally grieving, the grief may manifest itself in different ways: some people find crying to be the best outlet, others may find spending time alone, reading, writing, or doing research is what helps them; others may want to take a trip and get away from everything for awhile before returning to a routine; and yet others may find that returning to work and a routine is exactly what will be best for them. Again IT IS COMPLETELY AN INDIVIDUAL EXPERIENCE.
3. Most important – allow yourself and your partner to experience your “own thing”, but…
4. Communication – try hard not to keep everything bottled up inside – your tears, your feelings, your anger, and your experience. This may mean talking to your partner, your family members or friends – whomever understands and will not judge you for your feelings. Some may find that writing in a journal is the best way to express what you are going through. Whatever is happening between you and your partner let each other know where each of you is at and give each other permission to experience your own thing even if you think the other may be “wrong.” Keep the lines of communication open!
5. Join a support group – try to find something in your area – there may be private therapists or clinics that have support groups specifically for pregnancy and infant loss, and some hospitals also run support groups. It is very comforting to be in an environment with others who have experienced a similar event – it is a place where you will feel safe and understood.
6. Find private counseling – a support group is not for everyone. Look for someone in your area who has an understanding of this type of loss, or at least works in the field of bereavement. As good as a therapist may be, many do not understand the nuances of perinatal loss.
7. Try to get some physical activity – it is always a good idea to move your body. As soon as you are feeling up to it physically, try to get out and take walks. It may be hard to see families, so pick a place and time when you will least likely run into many families with children.
8. Family events and holidays – Many people wonder how they are going to get through the Thanksgiving-Xmas season or Mothers’ Day/Fathers’ Day seasons intact. GIVE YOURSELF TIME AND DISTANCE from these family gatherings if you feel it is not the right place or time for you to be there.
9. The bottom line is YOU! You have permission at this most difficult time to declare what is right for you and what your needs are. It may be hard to figure out what those needs are – if so, seek assistance from a safe and supportive source.
10. Considering a subsequent pregnancy – as stated, everyone heals from this experience at a different pace. Some women want to get pregnant right away – others wait 6 months or a year until they are ready. Again, there is no right way. Physically it is imperative that you consult with your doctor. Emotionally it is imperative that you consult with yourself (and your partner).