Philippe Barrette is a psychotherapist, workplace facilitator and former Assistant Clinical Professor at McMaster University, Department of Psychiatry.
David Streiner is Professor Emeritus in the Department of Psychiatry and Behavioural Neurosciences, and the Department of Clinical Epidemiology and Biostatistics at McMaster University; and Professor of Psychiatry at the University of Toronto.
Halfway through, Roma, the 2018 award-winning film set in the early 1970’s, the audience is suddenly confronted with witnessing a stillbirth. The scene elicited audible gasps from some viewers in a screening we attended, when the perfectly formed, dead baby was removed from its mother’s womb.
In the film, Cleo, the nanny and domestic worker for a middle-class family living in Mexico is rushed to hospital following an emotionally draining 9 months. Cleo’s boyfriend abandoned her shortly after learning of her pregnancy, and the family have endured marital tensions and a separation.
After an initial examination the assisting physician at the birth says, “I can’t hear a heartbeat," a phrase he repeats every few seconds. Tension builds. Finally, the baby is released from the womb. There's no sound. There are no cries. The umbilical cord is cut in silence. The medical team’s attempts to resuscitate the child are unsuccessful.
The baby is washed and wrapped in a type of swaddling. The attending physician then asks the mother if she would like to meet her baby. At that point during the screening, a woman in the cinema yelled out, “Don't, I wouldn't!” Cleo does not hesitate. She wants to hold her child. But within seconds, the nurse attempts to take away Cleo’s baby. A heart-breaking physical tug of war ensues with the nurse winning. Cleo’s nine-month wait to greet her child lasts less than one minute before the baby is forcibly wrenched from her arms.
Cleo is left alone in an empty room with no child and no one to comfort her. Deafening silence has replaced her maternal expectations. With death comes isolation and abandonment. With no one to talk to and no evidence of her loss, she is left to consider that the whole incident was perhaps a figment of her imagination.
Today, a mother who has been bereaved by stillbirth might experience a range of responses to her loss, from unconditional support to avoidance to being judged and blamed for being a failure or in rare cases, considered a criminal.
Best practices learned over the past 50 years include how important it is for the bereaved parent to get affirmation that a mother who has experienced stillbirth has truly lost something. If people avoid mentioning the stillbirth it only adds to her mental discomfort and questioning of her self worth. Failing to bring mention of her baby, or ignoring her altogether, greatly adds to her confusion.
We now know that holding or touching the baby, getting photos, a lock of hair or footprints, are helpful to establishing proof of the loss. The mother and family are encouraged to spend time with their dead child, for days if necessary as opposed to seconds. Fathers, too, require validation and the opportunity to share dreams of what his child might have become. Often fathers' grief is hidden and consequently, discounted, ignored or treated as an afterthought.
So, how should we respond?
When a child dies people might be lost for words and not know what to say. It's better to say, “I am sorry your baby died,” than, “It was God’s way,” or “You already have children, focus on them”. These latter comments are well intended but only serve to disconnect the mother from her feelings of loss.
Another common piece of unsolicited advice is, “Why don’t you try getting pregnant again?” a suggestion that implies that short-circuiting or bypassing the grief work is possible or desirable. This route has its own perils. If the mourning process regarding the stillbirth child is thwarted, the ‘replacement child’ may be assigned to carry this psychological burden. Mothers can remember their stillbirths to the day twenty, thirty or forty years later. No child born before or after will block out that memory and attachment. People need to find their own way at their own pace. It is best to lend an ear than offer unsolicited advice.
The General Practitioner and Ob/Gyn can play an important role in providing social support. Since these practitioners are involved in prenatal care, their presence and continued support is critical following a stillbirth. Their absence may tacitly underscore a mother’s feeling that she has 'failed' to give birth successfully. Post-partum visits to their baby-filled offices require a special sensitivity and compassion on the part of such practitioners. Since these physicians have been trained to deliver life, not death, they may have their own feelings of loss, sadness, guilt or possibly self-blame. Taking the time to deal with these feelings allows them to be more fully present to deal with the patient and to support mothers who experience stillbirth in the future.
Pregnancy loss remains a difficult subject to address openly, and to embrace and integrate into our culture. Films like Roma can help us to reflect on such sensitive subjects, identify with the experiences of others and to develop compassion.