I’ve spent 25 years in the field of midwifery and I’ve come to know it as a world full of joy but also sadness, with not much grey in between. Most days the sun shines and the light of life is wondrous. Other days seem like big black holes.
The sound of stillbirth is no sound. Instead of a crying baby or excited parents asking if it’s a boy or a girl, there’s silence. That quiet, in the moments after a stillbirth, is the only time some parents will get with their child. There’ll be no birthday parties, first days at school or family holidays in the future. This is it.
“And so a midwife must learn to live with that acute silence and respect it. ”
Today we educate midwives as much in being as doing. Emotional intelligence and resilience is every bit as vital as midwifery education, especially so with stillbirths. Turning emotion on and off is hard but it’s what a midwife must do.
We ease the students into it slowly. At first it’s sharing true stories and footage, talking them through real-life experiences. Ultimately it’s about them taking a deep breath, finding their courage, stepping into the darkness, and immersing themselves in the experience by showing a deep and fundamental humanity.
It wasn’t always so. As recently as the generation before ours, a stillborn baby was often whisked away by a midwife. A birth was registered, that was about it.
Fortunately we know now most women don’t want that. Stillborn babies today are given names and proper memorials. Midwives, supporters and families take beautiful photos, capturing little hands, making clay molds of feet or clipping precious locks of hair.
Although stillbirth is becoming more visible in high-income countries, in low income nations the stigma of a stillborn child endures. If it’s acknowledged at all it’s as a shameful event. Mothers are made to feel responsible for the tragedy, even told they carry a curse. Midwives too are very frightened they’ll be blamed.
Unfortunately there are still many mysteries surrounding stillbirth. We certainly know more than we ever did, but there are also some things we will never know. Right now we’re trying to reduce stillbirths by 20%, but it’ll never be 100%.
Good research has given hospitals and staff the courage to be more humane and for mothers to take control of their birth experience. Midwives and doctors will always do the best they can but even in her grief a mother can be proactive. This is her journey, her child. She can direct the experience, take control, own it. I’ve seen women refuse epidurals because they want to feel absolutely everything.
After two decades in midwifery, I thought I got it. Then, in 2006, my niece Harper was stillborn. Not until then did I realise the long-term impacts of stillbirth on mothers, fathers and families. People would say to my brother and his wife: Get over it. Move on. But you never do. You just learn live with the loss and a different way of being.
After a stillbirth in Africa, I watched a group of village women arrive, gently wrap the infant in a colourful scarf, and walk home in solidarity with the mother. And sometimes that’s the best thing you can do to support a family: don’t walk away. Ask the baby’s name. Say you’re sorry. Walk into the sadness with them.
Caroline Homer is a midwife, Co-Program director of Maternal, Child & Adolescent Health at the Burnet Institute in Melbourne and Visiting Professor of Midwifery at the University of Technology Sydney.