Stillborn: how the pastor can help

What can you do to help the family whose hopes have been put on hold by a stillbirth? An experienced nurse shares practical advice.

Nancy Beck Irland, a registered nurse, free-lance writer, and composer, writes from Cornelius, Oregon.

During a stillbirth delivery the nurses and doctor are the primary caretakers of the family. But in the hours after, when reality starts to sink in, the family turns to close friends and the pastor for emotional support.

Many pastors are unfamiliar with the causes and ramifications of a stillbirth, yet they are expected to support and guide the grieving family through this experience. Parents of stillborns have special needs and questions that pastors must be familiar with if they want their hospital visits to be more than just routine bereavement calls. Often the parents don't know why their baby died (they may never know), and the raw emotions of the stillbirth experience are still fresh in their memories when the pastor comes to be with them.

What the parents have experienced

A stillborn delivery is a quiet one. Unlike other deliveries, in which the nurses and the husband encourage the mother with smiling eyes and eager voices, the mood is somber when the baby is born dead. Almost apologetically the nurses, rather than the father, coach the mother during the labor, for often the father, who would otherwise be an eager coach, is too grief-stricken to offer support to his wife. In a way he too is a patient.

When the baby is born, the doctor states simply, "It's a boy" or "It's a girl," after which the parents cling to each other and sob.

If the parents want to see the baby right at birth, the nurses wrap him, warm from the uterus, in a blanket and place him in their arms. Unlike a live baby, who turns pink as he cries, the stillborn retains his purple birth color, his lips and eyelids a bright cherry red from congestion caused by his upside-down position before birth.

If the baby died several days before his birth, his skin may have started to peel, and the cranial bones may be soft, disfiguring the shape of his head. He may not be very pleasant to look at. But if he died just shortly before the birth, he may be a beautiful baby. (Bruises, which may not show up immediately after birth, appear within an hour or two, growing more pronounced as time passes. Because of this, the parents are encouraged to see and hold the baby as soon after the birth as possible.)

If the parents don't wish to see the baby right away, they may want to see him once the mother is in the recovery room. So that the baby has to be brought to them only once, some parents want their pastor to come right away and be with them at this time for a dedicatory prayer or infant baptism. Since it is hard for the parents to call their pastor and say, "Our baby is dead," it is most often the nurse who notifies the pastor of the baby's birth and the parents' request that he call on them.

During the pastor's visit the baby needn't stay in the room any longer than the parents desire. In most cases the nurse who brings the baby (in a warmed blanket) is willing to stay in the room as long as the baby is there. She can take the baby out the moment the parents request it.

Secrets of a welcome visit

Once the pastor is notified that the baby has been born, it is best that he come as soon as possible. If his wife can come with him, it seems to bring added comfort to the mother, but of course this is not always practical or possible.

Some pastors have an innate sense of what to do to make their visit go smoothly and fit in with hospital routines. In general, they seem to follow the four steps outlined below:

1. Call the patient first. The parents want to know when you're coming. People who are grieving often feel that they have lost control of events in their lives. If you call to suggest a choice of times ("Would you like me to come now, or in half an hour?"), it allows them to choose the most convenient time for them and helps them feel that they have a little bit of control.

2. Call the nurses. Once you have agreed with the parents on the time you will come, let the nursing staff know when to expect you. Particularly if your visit is during the daytime or evening hours, the nurses appreciate your call so they can take care of any treatments or checks of vital signs that must be done ahead of time, or help the patient prepare for your visit by straightening up the room. In addition, the nurses can notify any visitors in the room that the pastor will be coming in 20 minutes, so they'll need to leave at that time. This way you won't be kept waiting while the nurses clear the room.

When you call, let the nurses know of any special arrangements you have made with the parents, such as your seeing the baby, taking a picture of him for them, and so forth. Doing so allows the nurses to check it out with the mother while you are coming.

3. Don't stay too long. When a pastor is making a bereavement call, nurses and other hospital personnel generally stay out of the room to allow for privacy. In a way, the patient is "abandoned" by nurses during that time. Because of this, it is imperative that the pastoral visit not extend much past half an hour. In general, when the topic shifts naturally from the baby to the funeral, to spiritual matters, and then to mundane chatter, it's a good indication that the pastoral visit has served its purpose and must come to a close.

I will never forget the patient whose pastor did not know when to leave in spite of nurses unintentionally interrupting the visit after the first hour! Eventually we left the door open so we could see when he left.

He was quite a sight, slouched down in the easy chair intended for the patient's husband (while the husband stood beside the bed), his raucous laughter floating down the hall as he related an incident from a football game he had seen earlier that evening.

When he finally left, the patient, in tears, called for a nurse. "He stayed for two hours!" she cried. She had been embarrassed by having to ask him to step out of the room while she went to the bathroom. Then he had returned for another half hour to talk about the football game with her husband. His visit, rather than helping, had been a burden to her.

4. Let the nurses know when you leave. Nurses like to know when the pastor comes and when he goes, for his leaving is their signal to pick up the role of caregiver once again. A grieving patient does not usually request much from the nurses, so we must take the initiative in checking on her. It helps to know when the pastor has gone. As you leave you might mention briefly any specific concerns the patient has shared, so the nurses can give relevant emotional support.

What to take

In addition to the standard things the pastor takes on a bereavement call, there are three special items you might consider taking to the hospital for a visit to the stillborn infant's parents:

1. A certificate of dedication. When a stillborn baby of another faith is baptized, the priest or pastor sometimes leaves a certificate of baptism with the parents. Seventh-day Adventists practice infant dedication rather than infant baptism, and believe it involves an act of dedication on the part of the parents as well. A certificate of dedication with the baby's name on it is a thoughtful remembrance of the baby as an individual and of the parents' decision to be with him in heaven.

2. A camera. If the parents choose not to see the baby, they may wish for someone to take a picture of the baby for them or to describe him to them. Some hospitals keep a Polaroid camera in the maternity department for this purpose, and the nurses are more than willing to photograph him for the family.

In the event that the parents did not bring a camera to the hospital because they didn't expect to want to take pictures, the pastor might bring his own camera for the parents to use.

Sometimes the parents are reluctant to have a picture taken or to see the baby. They need to know that wanting to see or hold their dead baby is not macabre; in fact, it is encouraged. They need to know that others have found that later they wish they had seen the baby and that one picture of their dead child may become more precious to them than all their pictures of their living children.

3. A gender-specific vase of flowers. This is not always possible for a spur-of-the- moment visit in the middle of the night. But a blue or pink vase of flowers, according to whether the baby was a boy or a girl, is a treasured gift. Since the family may not have another baby of the same sex, they will later treasure gender-specific mementos they received.

If nothing else, a living plant is a thoughtful gift and is something the mother can nurture long after she gets home, to keep the baby's memory alive.

What the mother wants to hear

A pastor is probably more versed than many nurses in what to say during a bereavement call. However, he may not know some specific things that mothers of stillborn babies want to hear.

1. She wants to hear that you and her friends know she did not kill her baby, that you do not condemn her. The strongest underlying emotion the grieving mother feels is guilt. One way or the other, her mind will try to convince her that the baby's death was her fault. She needs to be reminded that the reasons a stillbirth occurs are, more often than not, as much a mystery to her doctor as they are to her. This is what makes her grieving different from others': there may be no logical reason for her baby's death. Over and over again until she believes it she needs to hear that the baby's death was not her fault.

Some specific statements that bring comfort are: "You were healthy for your baby and did everything right. We don't know why he died, but they tell me it was not your fault. " Even then, knowing she did everything right doesn't make it hurt any less.

2. She wants to hear that you and her friends know she loved this child. Particularly if the pregnancy was unplanned, the mother may feel guilty if during the pregnancy she spoke of the baby as an "accident." She needs to know that her friends know she still loved this baby and was ready to accept it. You might say, "Even though you called this baby a surprise, I know you loved him very much and he will always have a special place in your heart. "

3. She wants to hear that you and her friends will never forget this baby. To make it easier for the family and friends to talk about the baby, we encourage the parents to name him. It's better for them to give him the name they had chosen for him were he born alive than to save that name for another child. With a name the baby assumes a real identity that makes him a real person, which he is. As you talk about the baby, say his name instead of just "the baby" or "the baby you lost." This can be especially meaningful weeks or months later if the subject comes up. The mother knows you have not forgot ten about her baby if you say his name: "Robert will never be replaced in anyone's heart. We will always remember how you loved him. " 

4. She wants to know that some one realizes how she feels. If you have not lost a child yourself, you should not say, "I know how you feel." This alienates you from the patient, for if you have never lost a child, you don't know how it feels! The need to be with others who know how it feels has spawned a national self-help group known as The Compassionate Friends. Made up of parents whose children have died, this group has local chapters all across America. Often the maternity unit keeps business cards or a phone number for this organization, and it may already have given the patient the information she needs before you arrived. Find out before you see the mother (when you call the nurses), and take the information in with you if she does not already have it.

Besides "I know how you feel," some other statements people make that are meant to help but actually alienate are "You can always have another one," "God knew what was best, " and "Look at all the other people who are hurting more." 

5. She wants assurance that she can trust the staff. Sometimes during the pastor's visit a patient shares concerns about her hospital stay, voicing such things as doubts about the sympathy of the nursing staff. Often these doubts arise in regard to necessary postmortem procedures that must be done.

Because breakdown of the baby's delicate tissues takes place rapidly, the hospital staff must take pictures, complete paperwork, and take the baby to the morgue as soon as possible after the birth — often within two or three hours. This rush to get forms signed can seem cold and heartless to the grieving parents. They may withdraw from the nursing staff and in so doing alienate themselves from a sympathetic ear.

The pastor can help to prevent resentments toward the hospital staff from building by his reassurance to the mother that things must move along at a swift pace but that the staff does care. Also, a brief word to the nurses about the patient's concerns can help the nursing staff be more aware of where the patient is most sensitive.

6. The parents want to hear suggestions for making the baby's funeral or memorial service special. Some parents may prefer not to have a funeral. They need not be forced into it. But if they decide to have a service, it can be delayed until the mother is released from the hospital, even if she has had a cesarean section. The funeral is their last chance to say goodbye to their baby.

The parents may not be aware of all the options related to the funeral available to them. You might ask them:

a. Do you have a special outfit or blanket you want to dress the baby in?

b. Do you want to dress the baby yourself?

c. Do you have a special toy to place in the casket with the baby?

d. Do you want a picture of the baby after he is embalmed? A mortician friend of mine says that often parents are pleasantly surprised by how natural the baby looks after he is embalmed. The embalming process, he says, brings a more natural skin color to the baby's face. Many parents hold their babies just before the funeral starts.

e. Do you want a special baby blanket draped over the casket during the service?

f. Do you want a special song sung during the service, or any explanation of the significance of the baby's name?

During the service itself the family and friends need to hear the same reassurances that you offered in the hospital: (1) that the mother did everything right to ensure a healthy baby, (2) that the parents loved this child, and (3) that this baby will never be forgotten.

7. The patients may not know that the nurses can collect some special keepsakes for them at this time—a lock of hair; a set of footprints; the plastic arm bracelet that identifies the baby; a record of the weight, length, and head and chest measurements of the baby on a crib card that would have been on his crib were he alive. If the parents do not show an interest in collecting keepsakes at this time, they will appreciate it later if their pastor has collected these keepsakes for them and kept them until a follow-up visit a month or so later.

Grieving takes time. As Chaplain Larry Yeagley says: "The pain of grief is an indication that healing is in progress." But fortunate is the family who brings from that bitter experience as many meaningful remembrances and as few regrets as possible.

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Nancy Beck Irland, a registered nurse, free-lance writer, and composer, writes from Cornelius, Oregon.

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