Stillbirths: What a grieving mother wants you to know
“They seem to think that a mother should simply sweep the death and the pain under the carpet and quickly get her act together. They seem to imagine that after all, you had not developed a bond with this baby since you did not carry her in your arms. They seem to think that telling you to have another baby very quickly is encouragement enough. But it is not!” Alice from Kampala, Uganda narrates.
I got to know Alice (not real name) when my child joined her class early this year (2019). Alice 26, was expecting her first baby. Given my passion for maternal and neonatal health issues, I took interest in her. She was visibly heavy, but it appeared that she still had some time left to giving birth. So it came as a surprise when my child told me that her teacher (Alice) had given birth. I decided to call her to find out how she and her baby were doing. I was surprised when someone else picked up her mobile phone and as if to address my surprise, they told me Alice had lost her baby. It was chilling!
A week later, I called again and this time, I was able to speak to Alice, who briefly narrated her ordeal. I waited for her to get better and talked to her in detail when she reported back to work. It all started when she was not feeling well. Her pregnancy was 32 weeks, just a month away to being full-term. When she went for a check-up after experiencing intense back pain, the doctor told her the baby was tired and it was necessary that she gets induced so that the baby comes out.
“I was successfully induced. The baby came out well and the nurses showed me the baby and told me it is a girl. I noted that the baby looked like me. I was relieved that everything had gone well,” Alice recounts.
Moments later, Alice says she overheard nurses empathizing with each other about a dead baby and how the mother does not know that her child is dead. At first, she did not think too much about their grief-stricken conversation. She was certain they were talking about another baby since she had just been showed her baby. The nurses continued to gossip in hush tones. The nurses were speaking a language that they did not think Alice understands since her name suggested that she comes from another region in the country.
As Alice continued listening to the dead baby conversation, it suddenly hit her that she had not heard her baby cry, a characteristic signal of life at birth. Being a first-time mother, she had not paid critical attention to this all-important sign. She was only remembering it as an after-thought. She started panicking. Could the dead baby be hers? All kinds of thoughts flooded her mind swinging between the possibility of her precious baby being the subject of gossip and quickly moving to denying this since she had just been shown a baby that she thought looked okay, and in fact looked like her. When Alice could not contain the confusion that her thoughts had become, she asked the doctor about her baby. The doctor kept comforting her that the baby was tired and that she would cry after some time. He did not break the news to her immediately. Moments later, she again inquired from the doctor if her baby was dead. When the doctor asked her where she was getting that from, Alice said she’d overheard the nurses discussing a dead baby. It is at this point that the doctor broke the news to Alice that her baby had died way before birth. Alice fainted!
“When I regained consciousness, I was told that the baby had already been taken for burial by my husband. I was gripped with grief at the loss of my baby, but I was also hurt that I had discovered about the death of my baby through gossip. It is clear that the doctor was probably composing himself to deliver the bad news. It is also clear that the nurses innocently imagined that I couldn’t understand what they were discussing. But that does not make the pain any better. The agony I went through in that moment trying to relate the conversation and allusion of such a terrible occurrence with myself was unimaginable,” Alice says.
Telling a bereaved mother that she will have another baby is no consolation
Despite this mishap by the nurses, Alice is grateful that she had an opportunity see her child which gives her some sort of memory. She is also amazed at all the love and compassion she has received from her family and her in-laws. Alice’s baby’s clothes were taken away by her cousins to avoid bringing back bad memories whenever she saw them, something usually done to grieving mothers like her in the community.
However, Alice does not seem to understand the people who try to console her by telling her that she will have another baby. Some go ahead to encourage her not to wait too long. Some even tell her that she’s lucky she had not gotten to know the baby, so the loss cannot be that bad. “What do they mean? Do they think this baby was not important to me?” Alice painfully questions. While she appreciates the good intentions of people who want to comfort her, she feels that most people seemingly dismiss the pain a stillbirth has on a mother.
“They seem to think that a mother should simply sweep the death and the pain under the carpet and quickly get her act together. They seem to imagine that after all, you had not developed a bond with this baby since you did not carry her in your arms. They seem to think that telling you to have another baby very quickly is encouragement enough. But it is not!” Alice says.
Alice and her husband waited for four years to have this baby, so they were really looking forward to their first child. So, what most people put across as encouragement only seems to upset her further. She requests that mothers of stillborn babies should be comforted like any other mothers that lose a child because the death is just as real. Mothers develop this strong bond with their children right from conception and consoling them this way only makes matters worse. While Alice does not seem to know what could have killed her unborn baby, she grieves with other mothers who keep losing their children this way.
The alarming numbers of stillborn births!
According to Prof. Peter Waiswa, a renowned researcher at Makerere University School of Public Health, 4,000 perinatal deaths are registered annually in Kampala and 64% of these are stillbirths. Prof. Waiswa shared these statistics during an April 2019 workshop for the Kampala Slum Maternal and Newborn (MaNe) Project, of which he is also a principal investigator. With stillbirths contributing the greatest percentage (64%) to perinatal deaths, many women like Alice (who also delivered in a hospital in Kampala) get to suffer the consequences of waiting to see their babies only to end up disappointed, empty and bereaved.
“These figures are higher than those for many other deaths in the country yet not many people seem bothered or concerned or even aware about what is going on,” Prof. Waiswa said, adding that 90% of these deaths are preventable.
In his blog, Why should Ugandan women carry a healthy pregnancy for 9 months, only for it to turn fatal in the end?Prof. Waiswa states that; “…Can you imagine a woman is pregnant for nine months but she goes on to die or lose her baby in a short time she goes into labour yet we have the knowhow and resources to save her?…This will entail transport, access to skilled health workers in an environment that provides quality care, and when referral is needed, it is provided…”
According to Doris Kwesiga, a researcher at Makerere University School of Public Health, it’s estimated that there are 5,700 maternal deaths, 36,100 newborns deaths and 34,150 stillbirths in Uganda every year. (Healthy Newborn Network March 2019).
The World Health Organization reports that 2.6 million babies are stillborn every day across the world. Yet these deaths can be prevented with quality health care during pregnancy and childbirth. Prof. Waiswa adds that to reduce still births, there is need to provide better antenatal care and to also improve labour and its management. He adds that proper nutrition for expectant mothers, women arriving at health facilities on time, quick intervention by health personal and with inadequate skill to provide emergency obstetric and newborn care, will go a long way in reducing stillbirths.
Doris Kwesiga says the role of academia in ending stillbirths cannot be over emphasized. Through their research, they [academia] can generate data needed to inform policy changes. They too have a critical role to play in training health workers and raising awareness about stillbirths including the causes to women.
However, it is also important that the public is sensitized about the reality of the grief for the bereaving parents of stillborn babies. This will go a long way in offering victims like Alice the comfort they need to better cope with their loss.
Written by Faridah Luyiga Mwanje – Member of the Scientific Committee of the International Stillbirth Alliance Conference 2019.