What to Expect When You're Expecting a Dead Baby

I had no idea what to expect when I found out my baby Jeremiah had died. Knowledge is power, especially in a difficult circumstance. Here's some basic useful information on what to expect when you've just found out your baby has died beyond the first trimester of pregnancy:

Having the Baby

When most people think about pregnancy loss, what comes to mind is early miscarriage.  Often nature will take care of things, and if that doesn't work or you just want to get it over with, you can have a D & C. I haven't had an ectopic pregnancy, which sounds particularly awful. I did have an early loss myself (5 weeks along) and was pleased that nature took care of it, making it merely devastating rather than traumatic. Win!

With late loss there's a much bigger baby that has to get out somehow.  There are three unattractive options -
A) Waiting,
B) D&E - dilation and extraction, or
 C)induce labor

Generally, your choice depends on how big the baby is. If it measures about 16 weeks, your choice will probably be between A & B. If it's larger, you may be able to choose between A & C. If you're within a couple weeks of that guideline, you may be able to choose between the three.

A) Wait for labor to start on its own

Pros:

• You don't have to have invasive medical procedures
• You can be at home instead of in the maternity ward

Cons:

• It's unlikely to happen in the short time you'll be allowed to wait; most doctors don't want you to wait more than a few days because of the risk of infection
• If you have the baby at home, it's harder to get all the testing you may want done if the cause of death isn't something obvious
• You won't be able to function at all while you wait

B) Have the baby removed by D & E

Pros:

• It's quick
• Although you can't see the baby (unless you absolutely insist on it and have a strong stomach), you can have it cremated and choose what to do with the remains

Cons:

• Possible side effects - hemmorhage, infection, uterine perforation, cervical laceration
• You can't see the baby because it is removed in pieces

C) Induction of labor at the hospital

Pros:

• You can see and hold your baby if you want to and you can choose what to do with the body
• Having an intact baby and placenta can give you valuable clues about why the baby died
• Hospitals often give memory boxes, memory books, or some other kinds of mementos to families that lose babies; you could also have photos taken and get the baby's footprints

Cons:

• It can take a long time - plan on about 12 hours.
• It can also be intensely painful, but since you don't have to worry about drugs harming the baby, you can choose whatever pain control works for you.
• The drug used to induce labor, misaprostol, is not FDA approved for labor induction, although it is widely used for this purpose and quite effective.
• Not only do you have to be hospitalized, but you have to be in the maternity ward with all the happy new mothers and their beautiful live babies.
• Possible complication - retained products of conception, meaning everything that should come out doesn't. According to my doctor the risk of this is about 20% and the problem, if there is one, usually is that the placenta or pieces of it have to be removed either manually or by D & C. This happened to me with my first loss. Not fun.

Also, you should know that your hospital bill will be for "labor & delivery" with the charges being the same as if you'd delivered a full-term live infant, even though you won't receive anywhere near the time and care you would have gotten in that case.

What to Do with the Body

Again, three possible options:

1) If the baby is less than 20 weeks gestation (and thus a "late miscarriage" rather than a "stillbirth"), the hospital can handle disposition of the body if you choose. Some hospitals will cremate the baby together with other babies that have been lost (the hospital I went to does this every 3 months) and then the ashes are scattered at a local cemetery. If your hospital does this, it can be a nice option.

Other hospitals toss the bodies in with all the medical waste and incinerate them. I know it doesn't make any difference to the baby, but to me it's disrespectful to dispose of a baby the same way you would dispose of a cancerous tumor or a diseased gall bladder, if you can avoid it. That's why it's important to know your options.

2) If the baby was past 20 weeks gestation, it is a stillbirth and you are responsible for the body. Cremation can be a very practical option to consider.

Pros:

• Removes many difficulties you'd face if you want to bury the baby at a later time or in another state.
• It is easy to transport and bury the urn when and where you choose.
• Some parents keep the urn and will have it buried with them when they die.
• It's pretty inexpensive. In my case, a little over $300.

Cons: Some people, myself included, just don't like the idea.

3) Burial

Pros:

• Many mortuaries provide tiny caskets free of charge to parents who lose babies.
• Having a burial service and a place to go to grieve your child.
• You can have the baby buried at the foot of a family member's grave, saving the expense of buying a burial plot.

Cons:

• Compared to cremation, this option is more expensive and difficult to arrange.
• Others (family, friends, coworkers, etc.) may think you're strange or even criticize you for wanting to bury your baby, especially if you want to bury him/her in an existing family grave.

Other Considerations


Choosing a name: I strongly recommend naming your baby. You will be talking about the baby in the future, if only with your spouse. It's much nicer if you don't have to refer to the baby as "it". This is especially true if you suffer multiple late losses: "It #1, It #2, and It #3?". It could get very confusing. Even if you weren't able to determine your baby's gender for certain, consider choosing a name that could work for a boy or a girl.

Medical testing: Testing to find the cause of the baby's death can cost thousands of dollars, especially if tests for genetic problems are done. Some tests can also be painful and invasive. And after all that, a cause can only be found in about half of all cases! But it's still a good idea to find out what you reasonably can. You'd just better hope you have good health insurance!

Certificate of Stillbirth: If you lose your baby beyond 20 weeks, many states (25 as of now) will issue you a certificate of stillbirth if you submit the paperwork and fee to get one. This at least acknowledges your baby as a human being, much to the consternation of pro-abortion groups. If your state does not offer this, consider getting involved in promoting legislation. Arizona even allows parents to take a state tax exemption for a stillborn child, which is very helpful in offsetting some of the potentially significant expenses of burial or cremation.

Dealing with other peoples' reactions: Generally, you can expect any support you get from family or friends to be directly proportional to how far along you were when you lost the baby. The exception to this is if you've had multiple losses. In that case, the more pregnancies you lose, the harder it gets for you and it seems the less support you get from anyone else. This was certainly true with my two late losses and I have it on good authority that it gets worse from there - by the third or fourth loss people can be downright hostile towards you for trying again.

So, be prepared for the following reactions but hope for better:

1. Being patronized, humored, or even criticized for naming and/or burying your baby or for being sad/depressed about the loss
2. Unless you lost your baby quite far along AND the body was in good enough shape to hold a viewing, the loss is totally intangible to everyone else and thus, is not real. People are very dismissive about it and wonder why you're so upset.
3. People don't know what to say, so you may be avoided and ignored.
4. You will be expected to be back to normal after about 2 weeks. After that people expect you to just be over it and get impatient and upset with you if you aren't.
5. Friends who are pregnant or get pregnant in the future may avoid you and this is just hard for everyone.