Birth versus stillbirth
I want to talk about how hospitals treat families with a stillbirth or fetal demise or however the hospital lists it. Versus when they’re there with a baby that is expected to live. Well, if I’m being honest, I don’t want to talk about it. There’s no easy way to discuss pregnancy loss and stillbirth. Want to or not, I need to talk about it. The discrepancy exists and I feel I would be doing a huge disservice to my clients and anyone else who talks to me about birth if I don’t explore it.
I attend births at any gestation. If my clients ask for me, I come. Many of the births I have supported have been bereavement births, and they are always so special. I had an epiphany recently. A while back, I attended a stillbirth. I had attended births at other (insert healthcare company brand name) hospitals and I know that the policies about certain things are pretty standard between them. While this stillbirth was my first birth at that particular hospital, I know that my client’s experience was not how an (insert healthcare company brand name) hospitals do things.
They bent the rules and it made a horrible situation marginally better. The compassion and care with which they approached my client’s health needs was so. much. better. than what I see with babies that are expected to live. It really broke my heart for this family that to “qualify” for that compassion and kindness and care, they were losing their baby.
It infuriates me that to get compassionate care in our broken system, you have to lose your baby. Hospital births aren’t the devil nor are they bad. Some people enjoy their hospital births. They have a great experience and get very lucky. They have great nurses and have providers who listen to them. I personally didn’t mind my hospital birth with my second baby. As a birth worker though, I’ve seen the good, the bad, and the ugly of the hospital system.
There is definitely some good. But.
We have to talk about consent
I’ve been at hospital births where the “dead baby card” is played. Now, what I mean by that is when a hospital provider of some sort, whether it’s nurse, doctor, or midwife, says something like “if you don’t do XYZ intervention, you will have a dead baby”.
That never sits right with me, and not just because it is textbook coercion.
I am someone who attends births for living and dead babies. The implication is that we have some control over that and therefore that the clients who are there with a dead baby did something to cause that outcome. That is almost never the case. There’s nothing anyone could do in many of these circumstances. Sometimes it’s a routine ultrasound and there’s no heart beat. Sometimes it’s an almost viable pregnancy, and the water breaks too early and if you had just another week, you might have better options.
When it comes to loss, even in cases where there are no “good” options, options are still laid out. They’re laid out compassionately. They (the medical staff) give you time to talk. They give you time to pray or consider or whatever you need to help you make a decision, but only if your baby is dead or expected to die.
In a case of a baby who is alive or expected to live, you often aren’t given time for conversations. You don’t get the compassion and informed consent. The doctors don’t tell you, “there are no good options but here are the options I can give you”. They tell you, “this is your only option and you need to make up your mind right now”. They tell you, “if you do not do this, baby can die”. Or, on the flip side, “if you do that, baby will die”.
They scare you with things that sound factual but are often not evidence based. I can’t count the number of birth videos I have seen where someone has requested delayed cord clamping. In many of these, the OB tells them that “the blood will go backward into the placenta and your baby could bleed to death through the umbilical cord”. Because sure, that’s how circulation works, apparently, to someone who has gone through medical school. It’s a bit ridiculous.
Coercion is not and will never be consent. Coercion is not supportive.
So- what does support look like?
It always gives me pause when I attend a birth with a provider who I know is not very doula supportive, but when I’m there for a loss, I’m invited into the room and I’m part of the team. The medical staff looks to me to help make decisions. And that’s never the way I’m looked at as a doula for a live birth. I’m sometimes looked at from providers as an interference or as a difficulty, an obstacle they have to work around to give care to my clients. I’m often seen as “just a visitor”.
The issue is not that people are choosing to hire doulas. It’s that the people choosing to hire doulas often would have been “difficult” patients to begin with. I say that with a lot of love because these are people who are making decisions that are against the status quo, people who are kind of bucking the system. Maybe they still need to be at the hospital for one reason or another, maybe it’s just financial, but they wanted a home birth or at least the experience of a home birth. But they’re trusting their hospital providers to give them compassionate care and it just so often falls far below the bar that is already on the floor.
I truly wish more hospitals understood how abandoned people can feel when they birth in a hospital. I had a client recently who had hoped for a home birth, dreamed about it, but ultimately chose to give birth at the hospital. Her partner expressed how scary it was to be left alone for hours at a time, nurses only checking in to change bags of saline or perform vaginal checks. We saw their doctor three times before pushing began.
Considering this couple had been planning for the presence of a midwife quietly in the corner, this came as a bit of a shock. I don’t blame the provider- that’s just how hospitals operate.
I really wish more hospitals understood how traumatic it can feel to be left alone in these big moments. Even in the case of stillbirth, there are long stretches where I am alone with my clients. And while that is okay, my clients often feel a little wary of calling for the support they desire. One of my clients was afraid to call the nurse to check in on her, even when she really could have used the reassurance a medical professional can provide, because she was afraid that while the nurse was in the room to check in on her, they would also want to do a vaginal check.
It’s one of the crummy things that transcends both live birth and stillbirth: the accursed internal exam. Those can be very painful, especially at the gestation my client was at. Her body wasn’t ready to go into labor and so her cervix was pointing toward her tail bone and was very high and hard to reach. Checks were incredibly painful to her. While she understood the need to check and verify, it still hurt.
It feels a bit frustrating to me because I don’t have much need for the “information” provided by internal exams. There is so much more I can learn by just watching the person who’s in labor, by sitting quietly with them for twenty minutes.
I know most nurses don’t have the time for that. They may have four patients to one nurse, an emergency happening in another room, or any number of other things that keep them out of the room. Nurses are amazing as a whole and this post is not about disparaging any one person or group of people. It’s a plea for nuance. For understanding how to honor people’s journey no matter the outcome of their pregnancy.
After the birth
The discrepancy in how my clients are treated does not stop with labor. Let’s talk about postpartum time after a stillbirth versus a live birth. I know this can vary wildly, but I’ve seen some very touching postpartum times for my bereavement clients. One birth I attended recently was so beautiful. The hospital staff honored my client’s time with her baby so. much. That baby did not leave her sight even once.
Mind you, she had some postpartum complications and it was not a pleasant time by any means. But even with all that, she didn’t once have to ask for her baby. Nobody rushed her. At that hospital you typically have an hour or two in your birth room before being moved to a postpartum room, but she stayed in her birth room for four or five hours with her baby. Nobody was barging in to check on her (well, besides the awful fundal massage).
Once she finally made the move to the postpartum ward, she got to carry her baby with her. The hospital had a Cuddle Cot (a refrigerated bassinet that can keep babies close to their parents while slowing any decomposition), and she had time with her baby. I am so grateful for the compassionate care she was given, the gentleness with which they handled the baby.
But. The wild discrepancy in treatment enrages me when I think about all the live births I’ve been to where babies are manhandled and being roughed up. Births where baby is taken across the room to be measured and weighed, despite my clients asking for their babies. It infuriates me that to get compassionate care in this system, you have to lose your baby.
We have to do better. I cannot safeguard my clients against coercion and I should not have to. My job is to support my clients in their goals, and it helps when their providers hold that goal as well.
Maybe one day, providers will trust their patients to make the best decisions for their babies regardless of outcome.