On miscarriage and stillbirth
Miscarriage is the word for when a pregnancy ends before 20 weeks. Stillbirth is the word for when a pregnancy ends after 20 weeks. In the United States, up to 1 in 5 pregnancies ends in miscarriage, usually in the first seven weeks. About 1% of pregnancies end in stillbirth. All together, we could be talking about a million unexpected deaths in a year, though when asked, people believe miscarriage is much rarer.
When we hear statistics about miscarriage and stillbirth, we think numbers. But chaplains aren’t about numbers. Chaplains look at parents and babies one at a time. For some, chaplains represent the whole people of God. For others, chaplains represent God in this moment. When we visit with a family, we may provide the only acknowledgment God’s people will offer of this pregnancy, this life, this loss. Because people believe the situation to be rare, they are unaware of how common the pain is. And because people believe that the most likely cause of a miscarriage is something that happened to the mother, there is much shame and guilt.
As chaplains, we have an opportunity to offer comfort and encouragement.
Here’s what we can expect when we see the baby:
- At 15 weeks, you may not need much more than the palm of your hand. But mom and dad may want you to bless their child, to say her name out loud, to let them know that God knows.
- At 19 weeks, you can look at the face and recognize family characteristics. And a mother can want to be present with the child for a long time. Minutes can become hours because this tiny body is carrying dreams and hopes and fears.
- At 25 weeks gestation, a baby is still small. He can live, perhaps, for a day if everything is working well. But life is tenuous at this age. And there were reasons for the incredibly early delivery. Some because of what is happening in the baby. Some because of what has happened in the mother, or even to the mother. And when the mother holds the body of her child, there are no spoken answers that can absorb the pain.
- At 36 weeks, a baby is supposed to be a baby, is supposed to be pink and screaming and contented. At 36 weeks, a father wants to call his fraternity brothers, not a funeral home.
Helping families celebrate pregnancy means being willing to embrace them when the end is not what we desire. In those moments, consider these suggestions.
- Be prepared to slow your heartbeat and your voice to the speed of movement in the room.
- Offer more presence than you offer answers.
- Be prepared to see what the parents wish they saw as much as what has happened in the process of death.
- Look your tiny brother or sister in the face. Sometimes this is hard because of the disorder that brought about this death. Take a deep breath and provide care.
- Ask whether you can hold the baby.
- Offer to bless, to dedicate, to name. In prayer, say the name of the baby out loud.
- Resist, in this moment, the temptation to solve the problem of the death, to pursue diagnosis.
- And be acutely aware of the differences in grief and awareness in each person in the room; every mom, every dad, every grandparent, every friend is of two or three minds about what happened, what’s happening now, and what should happen next. Create room in the room for all of these minds and hearts. You can prevent damage and foster healing months and years in the future.
How long is full-term?
According to the American College of Obstetricians and Gynecologists (The College) and the Society for Maternal-Fetal Medicine (SMFM), a full term isn’t nine months. Or 36 weeks.
- Early Term: Between 37 weeks 0 days and 38 weeks 6 days
- Full Term: Between 39 weeks 0 days and 40 weeks 6 days
- Late Term: Between 41 weeks 0 days and 41 weeks 6 days
- Postterm: Between 42 weeks 0 days and beyond
This actually is closer to nine calendar months.
“Fetal death” means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.
- https://www.cdc.gov/ncbddd/stillbirth/facts.html. Accessed April 29, 2017. ↵
- Jonah Bardos. A National Survey on Public Perceptions of Miscarriage. Obstet Gynecol, 2015, June; 125(6): 1313-1320. ↵
- http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Ob-Gyns_Redefine_Meaning_of_Term_Pregnancy. Accessed 4/2/2017. ↵
- MacDorman MF, Gregory ECW. Fetal and perinatal mortality: United States, 2013. National vital statistics reports; vol 64 no 8. Hyattsville, MD: National Center for Health Statistics. 2015, 17 ↵