This article is intended for anyone who has just lost a child during pregnancy or after birth, but also for relatives or friends who want to better understand what happened, what can be done, and how they can help.
The most characteristic aspects of this event are described in detail.
It covers the important things to know and consider in the difficult, confusing and painful moments after the death of your baby.
The content of this article is the result of the work done in many countries of the world together with thousands of parents like you and me and specialized operators. I wrote it thinking not only of what is possible after diagnosis, but especially of what many parents regret months after the loss of what they did not do..
Every aspect mentioned on this page is a possible and legitimate option, for every bereaved parent, in every Italian hospital. It would be advisable for you to be able to ask for clarification and support from the staff who are assisting you.
In case of need, contact us here, one of our operators will be able to help you. If you want you can also print this page and take it to the hospital for further clarification from the doctors or let them contact us in case of need.
What still can be done, despite the pain, shock and fear.
What is important to know from diagnosis to discharge in case of perinatal death.
The death of our children is a dramatic and difficult event to face: in a few moments everything changes, and we find ourselves forced to make many unexpected and painful decisions.
As soon as they told you the news, a thousand emotions could have gone through your head: disbelief, confusion, rejection, fear, anger, pain, both physical and psychological (many mothers say they felt like a boulder crush their chest, or like a knife in the heart). Many parents feel guilty towards the child : you may feel that you have not been able to protect him, that you did not notice what was happening in time, and / or that you made some mistake that caused his death. All of this is perfectly normal and legitimate, part of the psychological trauma related to bereavement.
It is very important to take some time to understand what has happened, some time to discuss with the doctors what can be done and, if you need to plan the birth, to discuss this important commitment appropriately.
Despite the excruciating pain there are many important things to know, to discuss, and to do when our beloved child dies. Every parent should be able to make all the necessary decisions in this difficult time.
Sometimes operators are in trouble in the face of our bewilderment and pain. However, most of them are there for us and will try to do their best. Together you can do good and meaningful things, despite bereavement.
After the diagnosis
If you have been diagnosed with your baby’s death, at any gestational time, or after birth, and you are lonely (sometimes bad news is given to dads in the absence of mum), ask immediately to be able to call someone who can give you comfort. in such a difficult time .
Whether it is a relative or a friend, it does not matter, the essential thing is that you parents are not left alone to face this difficult moment.
If you have gone to the hospital for a routine check-up and have brought your other children with you, it is possible to arrange with the staff to go home (in the absence of acute and serious situations, such as placental abruption or an infection, or preeclampsia), accompany the children to a safe place, and perhaps take the pregnancy record and all necessary information.
In the absence of any immediate needs, which can be assessed with a blood sample, an ultrasound and a visit, you parents can decide to spend the night at home , if you wish, and go to the hospital the following morning. Just as you might decide to give birth in a different hospital than where you were diagnosed. Take the time to consider what is best for you.
When the baby dies before birth, and not from acute pathologies that compromise the mother’s health (placental abruption, gestosis), parents and staff can decide the best way to plan the baby’s “birth”. Childbirth is a very important moment in the history of a woman and a couple. It remains important even when the baby is dead. Being able to give birth safely and supported by competent midwives is a central step in mourning. If you have lost your first baby, your fears of childbirth may overlap with pain, and you may feel that you are inadequate, or unable to give birth. You may think you are the most incapable woman on earth. It is not so. We can give birth, even a dead baby. We can give birth, in the position we prefer, with the people we prefer around us, the body of our baby. We can choose, together with the staff, the type of delivery and the analgesia. We can face the despair of pain and the anticipation of labor. Many midwives in recent years have also worked in Italy to ensure the best possible birth experience for women and couples affected by stillbirth.
The ward room
What is the ward for grieving mothers?
This question is sometimes unanswered, often for purely administrative reasons. In fact, in many hospitals, women affected by stillbirth are hospitalized in obstetrics, rarely in gynecology, away from other mothers, depending on availability. The presence of other mothers, with their children alive can be really painful for mothers in mourning, and it would be advisable to find the best possible solution to meet this problem. For example, it might be helpful to be in a room with few beds , and it is advisable for the ward to take action to find the most sheltered and protected bed in the ward. The expected hospital stay is usually one and a half to two days for normal deliveries, three to four days after a caesarean section, in the absence of complications. Having an adequate space for your needs is very important. You can ask and obtain to have someone stay with the mother, if the mother wishes , for the entire duration of the hospital stay. In some hospitals they arrange a room in adjacent wards, where available. Talk to your midwife and doctor to figure out what’s best for you.
If the baby died in the first trimester of pregnancy , parents and doctors can decide to wait a few days and try to avoid the curettage procedure – discuss with your gynecologist what is best for you, both physically and psychologically, before making a decision. .
If the baby has died from the 16th week of pregnancy onwards , spontaneous delivery is usually induced. Delivering a dead baby seems like a cruel joke, and it’s always a very critical decision to make. However, compared to other types of interventions, such as caesarean, natural childbirth when possible (excluding the emergency situations mentioned above) has better guarantees for the mother’s health , allows a better psychophysical recovery, and, through the production of specific hormones, allows a greater reaction of “detachment” from the pregnancy itself (as if ideally closing the circle of that pregnancy, in a way the physiological as possible). You can decide the timing and methods of delivery by talking to the doctors and midwives, in order to determine what is best for you. For the mother, especially if struggling with the first pregnancy, it is very important to spend the hours of this labor with a trusted person next to you (husband, mother, sister, friend), in order to be able to face this experience, poignant and precious together, as well as possible. Most mothers report that the choice of natural birth proved to be successful because it allowed them to “do something concrete”, “a gesture of a mother”, for their children, and report a great satisfaction in having been present. and vigilant during all phases.
The Italian guidelines on stillbirth establish the indication for analgesia during labor and delivery , so you can ask for epidural analgesia if you wish. Keep in mind that the pain of the child’s death very often results in physical pain, and some women have felt deep, dull pain despite the epidural. In any case, also based on your personal history of pregnancies and births, you can choose what is best for you.
You may feel very anxious and very frightened about this experience so far from what was expected and dreamed: they may offer you some tranquilizing drugs, especially after childbirth. Also discuss it thoroughly in relation to how you feel: it is normal to feel confused / desperate / fearful / sad, and living these moments in full mindfulness and with the support of your loved ones and staff can be a great opportunity for your grieving process. . Sedation, whether light or deep, is generally not recommended , unless there are precise clinical indications (panic attacks, history of previous psychiatric pathology, etc.). You can request an interview with a specialist and discuss with him what is best for you.
Where to start and finish labor
You can agree with the midwife and the doctor to do the labor in the room (if you are in a protected or single room), to avoid coexistence and proximity with other women in labor. If this is not possible, you can ask the staff to place you in a labor room away from the delivery room , in order to remain as calm as possible. Induced or spontaneous labor has a variable duration, it is therefore appropriate that the environment in which you find yourself is suitable for this very particular phase. Agree with the midwives in case of special needs or special wishes related to labor, or at the time of delivery.
The fact that your baby is no longer alive does not mean that he deserves less care , just as it does not mean that your birth is a less intense and meaningful time than the birth of a live baby .
In the experience of many CiaoLapo mothers, good support from the staff, and good proximity to the couple, or between the mother and her companion, has allowed a good labor and a birth experience comparable to normal births. Consequently, the meeting with the child was also important and precious.
At the birth , it is possible and advisable for the father to be present, or a close relative of the woman, or a friend, if the mother so wishes (but also her private midwife or the woman’s doula); there is usually plenty of time to make arrangements, find closeness with the midwife and discuss with her what to do after the baby is born.
The birth of a baby who doesn’t cry is a painful time for parents, and often for hospital staff as well.
The silent birth confirms what happened without the possibility of appeal. It is therefore a delicate moment, to be lived calmly, without clumsy attempts to soothe the pain or speed things up. As in all mourning, it is important to be able to greet the person who is no longer there. Also in this case. Even when an expected and desired child dies that we have never seen, and that we can only see now.
The small lives of our children leave a big footprint on our families. Not always and not just painful or excruciating. It really depends on us, and on the space we will give to this experience and to our children. In any case, we parents will never forget their passage, just as no important life event is forgotten. It is for this reason that it can be of great importance to live this meeting in an opportune way, without fears or false prejudices.
After giving birth… the baby
It is important to take the time to read these few lines and reflect together on what is best for your couple. Sometimes parents to protect each other, despite having completely opposite ideas between them, tend to decide automatically and try to impose their decision on the other, without reflecting on what is really important to them.
It would be advisable to talk to each other as a couple, or with other relatives, or with other bereaved parents, to clarify your real needs. Postpartum is one of the most important and precious moments, e many parents after many years have many regrets for not being able / willing to make some small gestures to get to know and greet their child. Nothing is mandatory for anyone, so don’t be afraid to make your decision, one way or the other , but first discuss it together, several times and for a few hours, to avoid more pain later. In the experience of other parents who have faced premature births, stillbirths, therapeutic interruptions of pregnancy, or intrapartum deaths like you today, the meeting with the child was of absolute importance for the well-being of the father, mother and the whole family, and the few parents who did not want to meet the child, often because they did not find support in the hospital staff in this delicate phase, then lasted more difficult to mourn. However, there are personal reasons that could lead you to decline this meeting, and they must be considered and welcomed with respect.
Why you might want to say NO to meeting the child : Some mothers and fathers feel fear , rejection or annoyance , sometimes anger towards the child who has gone away, and often refuse to see him at first. These emotions are linked to the very first moments of diagnosis, and almost always in the following hours and days they change, even radically, leaving mothers with an ugly and desolating feeling of emptiness and nostalgia for their child . Many mothers have said that they felt like “on another planet” and did not think “it was happening to them”: this mixed emotion of confusion and pain does not allow you to be fully aware of what to do, and it may happen that you do not understand what it is. better for us, and at the same time to have a great fear. This sense of fear is amplified by the embarrassment or fear of hospital staff, who are not always prepared to face situations like ours.
Because you might want to say YES to meeting the baby : because it is your baby! As painful as it is to admit it, as emotionally very difficult as it is, even if it is no longer physically with you, your baby is and will remain your baby , of that pregnancy and that part of your life, whether you know him or her. decide not to see it. What could be missing later are the memories of him, of his physicality, of your sharing. This is why it would be important for at least someone from the family to meet the child . Ideally, parents, siblings if present, close relatives and closest friends should be able to meet and pay homage to the little child.
The meeting with the child
“Being looked at by a mother is like being generated twice”
Despite the extreme pain, the loss of your child does not erase the moments you have shared together, which will take on great value over time for your grieving process – it could be of great comfort to you, your partner and other family members. , meet and be able to greet your child adequately, so that you have appropriate memories of his presence among you. Even for your other children, or for your grandchildren.
If you as a parent so desire, there are many things you can do after your baby is born, even when he is very young, such as in the first half of pregnancy, or seriously ill. Also keep in mind that after giving birth the baby is warm and soft for at least half an hour , so there is plenty of time to get to know him with the utmost naturalness.
Ask the staff what the baby might look like, also depending on the gestational age: keep in mind that if the baby has been dead for a few days, his skin may have a different color than normal. If the baby is very small, then in the first trimester of pregnancy, or its growth has stopped many weeks earlier, it may not be possible to see its little body. In this case it is still possible to request the burial, with simple forms available in every hospital, and to carry out some small rites of passage, such as filling a small box with souvenirs symbolizing his presence (see the Memory Box section below). .
Take time to think about all of this and decide what is best to do. Remember that you can get help from the staff in the “meeting” with your child; if you can’t look at it, or if you’re afraid to pick it up, don’t feel obligated, but ask for some time to reflect and try to talk to someone who can reassure you about this. Alternatively, ask the staff to collect some memories of your baby for you .
Ask the midwife to guide you in getting to know the baby, and to act as an intermediary between you and him.
Between memories you might like there are: the prints of the feet and hands, some photos of your child (which can also be taken by the midwives, if the family members can’t do it), the identification bracelet, a lock of hair, the birth certificate, a folder with his weight and height. Try to communicate what you feel and what you think to the caring staff, remembering that in such a difficult moment it is normal to be confused and have many things to ask, change your mind and feel the need to be informed and reassured. In many hospitals there is a booklet to collect the memories that we have called “The memories of a Little Prince – The memories of a Little Princess”, which allows you to have a lot of information gathered all together.
Taking one or more photos of your baby is a way to create memories , and imprint not only his absence, but also his main characteristics in the mind. Many parents find it tremendously beneficial to having taken or having photos taken of the baby, or with the baby, with the baby in his arms or next to his crib. Having a memory makes this mourning less bitter and more elaborable, and creating small memories is a precious opportunity.
Usually in Italy the child can stay in the parents’ room for a few hours at the most. It is important to inquire about the customs of the department and to agree with the staff on your actual needs.
Once some diagnostic samples have been taken on the baby after birth, there is no rush to get the baby to pathological anatomy or the morgue. It is important that you discuss this with the staff, also considering that you may want to show the baby to close relatives who come from out of town.
Even siblings should be able to greet the child , especially from a certain gestational age onwards, and bring him drawings or gifts if they wish, so as to take note of the event and at the same time know the features of the child in order to be able to represent him. best when needed. Children have a great need to know things as they are and to give them the right name and the right weight, so don’t be afraid to ask the staff for help in facilitating the meeting between your children.
You can wash , dress , wrap your baby with a blanket . You can do these tasks yourself, or get help from the midwife or nurse.
Taking care of the baby’s body is a way of exercising one’s role as parents, for some it is very important to be able to do this.
If your baby is too small for a standard onesie, the association offers white sheets, small blankets made of wool, fabric or fleece , designed for very premature babies and specially made by the hands of our volunteers.
Once you say goodbye to your baby, ask the midwife or doctor how and when you will be able to see him again after his autopsy exams, and consider whether or not you want to organize a small farewell ceremony.
On the autopsy
When a baby dies in utero, during childbirth or after birth, it is very often necessary to carry out diagnostic investigations on the mother, placenta and body of the baby , in order to identify what caused the death, the triggering cause and any other contributing factors. .
Studying these mechanisms is essential to define exactly the events that occurred in pregnancy and also to be able to prevent them in subsequent pregnancies.
Many intrauterine and perinatal deaths occur with no apparent cause . However, a correct diagnostic finding allows us to identify a cause in at least 70% of cases . This result is possible only when the work takes place in a multidisciplinary manner, and appropriate tests are carried out on the mother, father, placenta and baby. All parents should be able to take advantage of this diagnostic possibility
In general, the examinations on the mother are carried out at different times: some at the time of admission, others two months after the birth. The tests on the baby and on the placenta also have different timings: some tests are performed immediately after birth (for example, taking some skin cells, taking blood), others in the following weeks.
Usually the diagnostic check takes place a few days after the baby’s death, and aims to examine the whole body of the baby, in order to identify the possible causes of death, and to analyze the placenta, often implicated in many pathologies.
After the autopsy, the parents can take back the child’s body, which is carefully arranged by the pathological anatomy technical staff and carry out, if they wish, the religious or secular ceremony for burial or cremation.
What is the perinatal autopsy used for:
- To confirm a previous diagnostic doubt
- To identify situations not yet diagnosed
- It can exclude factors such as malformations, infections, growth retardation not detectable during pregnancy
- If the baby died before birth, it can tell us approximately how long ago he died.
- It can allow you to identify a genetic pathology, and therefore also be useful for other family members.
The legislation in Italy
The decree of 9 July 1999 (published in GU 170 of 22/7/1999) requires an autopsy on all children who have died in utero ; its purpose is to search for the presence of malformations or some genetic diseases. It is important to know that the child’s body is always respected and treated with care by all staff; any doubts can be discussed with the treating staff.
It usually takes about eight weeks to complete all diagnostic investigations . This time may be longer in the case of further investigations; in any case it will be the staff’s responsibility to respect the times and make an appointment with the parents to discuss the results, and the parents can in any case stay in contact with the gynecologists and pathologists to understand how things are progressing.
On the burial
Italian law regulates the burial of stillborn children within 27 weeks plus six days and those of stillborn and stillborn children from the 28th week onwards with precise instructions. This page of the CiaoLapo Onlus website summarizes and explains the Italian laws on the burial of children who died in the prenatal period.
It is always possible to proceed with the burial / cremation of the child at any gestational age , as long as the parents request it on the appropriate form (download the facsimile ); under 28 weeks, Italian law says that the hospital company can ex officio bury all stillborn babies or dispose of them as hospital waste, depending on internal regulations. Finding out about the current practice in your hospital and in the regions (excluding Lombardy, where all children are buried) allows you to make a truly informed choice about what you prefer as parents.
On the memory box – memories that heal
The memory box is a box used to keep important memories (box of memories is the literal translation), a “place” useful for remembering and honoring the memory of small and precious lives.
Each memory box belongs to its family and above all to the child you want to remember, and each family chooses it in the most appropriate size and color. In our association there are small and essential memory boxes, memory boxes full of plush toys, wooden and cardboard memory boxes … there are memory boxes full of life, and memory boxes that told a beautiful story, and others simply full of love, or photographs, or letters.
What is the memory box for?
Making room for memories, and putting together the most significant ones of the time spent with our children is an operation that can be truly therapeutic; There comes a moment, in mourning, when parents feel ready to reopen drawers and suitcases, and to create a personal space for that pregnancy and for that child, in which to collect objects, thoughts, and small gifts.
The memory box: a way to fill the void
In the experience of the parents of our association, the emotion that most often accompanies us in the first long months of mourning is the oppressive sense of emptiness and the physical lack of tangible traces of the passage of our children.
For some parents this emptiness is even more unbearable than illness and death , because, as often happens, these losses of ours become a nothing to forget. Nobody asks us if we want to remember, nobody gives us help to reconstruct the memories in an adequate way, yet in many places it is considered bizarre to perform the funeral rite or take photographs.
Thus, many of us find ourselves full of tragic and very ugly memories , linked to death, but without tangible (and loving) memories of the lives, even if small or in utero, of their children.
And so, it happens, that this emptiness in the heart and in the hands, screams in despair and asks to be at least partially filled.
Collecting the memories of this passage in its own time , reconstructing the small existential path of our children could serve in the first place to allow ourselves to begin to work on death and therefore on mourning.
You can find more information about the memory box on this page .
The return home, to the “routine”, is very difficult. Each of us clearly remembers the psychological and physical fatigue of returning to the normal world, with the feeling of having lost everything and that nothing makes sense anymore.
Parents often describe this coming home with empty arms, as the moment when the pain of grief appears clear for the first time : it’s all true, it’s all over, my baby is dead.
The first months after the loss are very delicate, also because few people know about grief and its manifestations and also without wanting to hurt you, they may force you to react and “come back as before”, without showing any understanding for you, and without giving you the right time to orient yourself after the tsunami.
If you feel like it, you can download for free and read the first edition of the booklet Piccoli Principi , written a few years ago by Claudia Ravaldi, a few months after Lapo’s death, which retraces all the passages of mourning, in a sort of “map” to orient oneself, or Going through mourning , a small but comprehensive text that relatives and friends should read to better understand what is happening.
Furthermore, on the association’s website, there are numerous testimonials that can be an extra help to not feel alone and to be able to reflect on the most important aspects of your pain.
You can consult the where we are section of our site and locate the CiaoLapo section closest to you.
what to do now
This page is only a concise guide, a practical and emotional first aid for the first moments of pain and disorientation. For more information, to download useful material and to read the experiences of other parents and share yours with them, you can visit the website www.ciaolapo.it.
In the hope of having been of help,
a hug, and a kiss to your baby.
The CiaoLapo Onlus Association