Before I get cracking with this post I want to commend my friend Chantal Lockey, CEO of the Infant Loss Foundation. Chantal is a powerhouse of a woman who brings her own experience of her daughter's death into passionate education for students and midwives. I did a training day with her a few weeks ago and if you ever get the chance to go, do (taking your biggest emotional capacity and a box of tissues).
I remember my Uni giving me a comprehensive study day on supporting bereaved parents.
It was tough, we cried, but we had an idea of the kind of care we’d be giving when that situation came up in practice.
But my inbox suggests this training isn’t given to every student midwife.
This is an issue, because right from the beginning of your training if you’re involved in this care, you have responsibility on your shoulders.
In this post, I’ll go through some of the things you can do to help. Or if you’re a mentor or more experienced midwife, reviewing the basics can be helpful, especially if you have a new student learning with you.
Back when I was a student, here were the questions I had around bereavement care:
• I’m not religious, what if a family is and I fail them in their needs?
• What if I use all the wrong words?
• What if I somehow make it even worse for them?
I bet you’ve spotted my problem already - look at all the ‘I’ statements!
I was making bereavement care all about me.
The one thing I needed to start doing was sending my attention outwards to the parents going through the experience, like shining a torch out instead of in.
There was plenty I could have been doing to make the experience even a tiny bit better as like most student midwives, I had empathy and compassion in spades.
Start by actively listening.
Active listening isn’t just about understanding the meaning – it’s about hearing the choice of words, taking in body language, maintaining supportive eye contact if appropriate, and trying to work out what’s there but is not being said.
Midwives should do this in every type of care but if a baby has died it’s even more important.
If you actively listen you’ll be able to match your language choice to the family's, and pick up on any specific needs, like cultural traditions, or whether they just want a safe haven to make memories with their baby.
Active verbalising can be helpful too.
This is about validating thoughts and experiences – if they say ‘I feel like this is all my fault’ instead of saying ‘it’s not’ straight off, you can echo ‘ok, you feel like this is all your fault…’ to show them they’re being listened to and this isn’t a silly thing to be feeling.
Then you can go on to say ‘but what’s happened to your baby is tragic and is absolutely not your fault.’
However, stay away from ‘at least’ statements.
Even the most experienced of staff can sometimes slip into saying ‘at least you got to meet them’, ‘at least you can get pregnant’, most horrific, ‘at least you didn’t get to know them before you lost them’.
Any attempt to frame things more positively is likely to cause more pain.
Remember however much your mentor prides themselves on being a ‘tough old bird’, the death of a baby is always a tragedy, so ask them if they’re ok.
There’s plenty you can do in terms of basics, like making sure linen is clean, there are enough pads, drinks and snacks keep topped up and buzzers are answered promptly.
Volunteer to get your mentor a brew or do the clearing up so they can have a few minutes. They might chuckle at you as you’re less experienced but caring for all members of your team is always the right thing to do!
Remember the partner, especially if they’re a guy.
Men often report feeling lost and powerless in the best of labour ward situations, and I’ve heard Dads call the death of their baby ‘hell on earth’.
As a student, you’ll often have a bit more time and may be able to make all the difference for them. While care always must have the woman at the centre, caring for Dads is a huge part of holistic midwifery.
Listen to what they have to say. Get them involved in the care of the baby if they want to be, things like dressing them, changing their nappy, taking photos or taking a lock of hair. Treat them as all important, because they are.
Do your own preparation at home.
Early in your training, or while you’re an aspiring midwife, spend some time on YouTube looking at the many videos on the topic of infant loss. We're in a privileged time, bereaved parents have made us many resources to learn from, for free.
It will be especially useful to see what babies look like at different gestations or who are in poor condition. This experience will help you as it’s a shock the first time you see a deceased baby, and when you’re caring for parents you want your emotional energy to be spent on them rather than your own reaction.
This dramatisation is an amazing teaching tool, there are some good elements of care and some terrible to identify.
Find something beautiful to comment on. I once looked after a woman who had a traumatic and complicated stillbirth and the baby was in poor condition, but he had beautiful eyebrows and eyelashes. She lit up when I commented on this.
Finally, it’s ok to cry. You don’t have to be an automaton. Crying with parents is sometimes the best care you can offer as it validates that what they’re going through. Of course you can’t make it all about you – parents should never be comforting you! But showing your emotions is part of building that mutual respect which all midwifery care should be based on.
To quote my friend Chantal: 'I think if you do not care or feel anything at times such as these, then really you're in the wrong profession.'
And on that wise note, I challenge you to leave me a comment.
What's the most important thing you've learnt to do for bereaved parents from this post?
Or, if you have personal or professional experience of infant loss, what's the most important lesson you wish all staff knew?
As always, thanks for reading and caring about these midwifery topics and getting involved with such enthusiasm here and in The Secret Community For Midwives In The Making on Facebook.
Your insight could be exactly what a student needs to hear to give outstanding infant loss care.
Until next week, Ellie x
i am hopefully going to start a midwifery course in 2017 but this has always been the one thing I’ve been stuck on, how to appropriately care for the parents, if they lose their child. so thank you for writing about it
I experienced my first lose with a 21w 5d baby. I say with mum and family as they said goodbye as she wanted me there. All the family was crying and I kept telling myself be professional ! Later when I went to see the mum she was obviously I’m a bad way so we cuddled and she cried like a child in my arms I still said keep professional !
Later that night the family requested to see baby boy so I took him to the room and within seconds they were all screaming and crying and saying take him away take him away. Later that week mum was admitted to the mental health ward so I went to visit her as we had built up a relationship. She looked right through me and wouldn’t talk to me. I left there and cried. I felt liked I had failed her. Only in that moment did I think why did I know
Show her that her loss had affected me too. Why didn’t I cry with her? Why didn’t I tell her?
I now look back and realise I did show her and her family by all the cuddles we shared and all the things we said to each other. I just wish I would have realised at the time it’s not unprofessional to show your a human and have emotions too.
Great post !
Stay with the family. I am an independent midwife. We lost a full term baby and I felt blame so I stayed away than I hospital pushed me away. It was all a disaster. Stay and grieve with the family. Show your emotions. Remain involved and don’t let yourself be pushed out of the way.
Thanks for sharing and I hope you’re ok. That’s so awful. Thanks for sharing your experience and giving candid advice to us. Ellie.
I attended my first baby loss today (last day of my first job as a midwife) . I feel so so bad for that mother and that family. Not finding the heart beat was awful and I can’t stop think about it.
Hi there Eli, thanks for your comment. I remember feeling very similar. It’s lovely that you care. Do drop me a line on ellie@midwifediaries.com if you need a chat, or come and The Secret Community For Midwives In The Making here: https://www.facebook.com/groups/1502481079993917/?fref=nf
Hope you’re doing ok x
I looked after a muslim family that lost their first baby at 34 weeks due to PET. I did a lot of research on how to care for their religious and cultural beliefs as I was so worried I might offend them, when the reality was that they just needed me to sit and listen and hold their hand through their tragic experience. I learned a lot from this brave family and it still brings tears to my eyes thinking about it now. What I would say to others is don’t get too caught up in religion or cultural differences because our hearts all break the same way and we all need love and support which is universal.
I really appreciate this post so much, and the video link was also very helpful. Thank you so much.
I am a Mom of a loss (Vivian 10-21-15) at 34 wks, an L&D nurse and a student nurse midwife… My eyes were opened to so much after I experienced my loss on the unit I worked. We are not trained as nurses in HOW to support a family with a loss. We only know what we know and I think we become stuck in the sadness. We 1st must sit and let the family share their story of what their baby meant to them, to share what their hopes were and what they were looking forward to. The conversation & story that unfolds can be a huge tool for guiding the care going forward as you know the connection, the love. Understanding and entering into their story will help remove a bit of the awkwardness. This goes beyond how we’re trained as providers, since our comfort lies in tasking. Be brave enough to listen and engage in the family’s story. It shows empathy, compassion and will help guide the rest of the care you provide.
This is a beautiful page and message. Has given me confidence to ask to look after a grieving family at my hospital.
I’m a midwife and also a mum to Phoebe who was stillborn at 39 weeks in December.
This is a fantastic post! I know when I first qualified as a midwife I avoided bereavement care because I was worried I would do something that would make it worse.
Having seen it from both sides now I would just like to encourage midwifes and say that if you are kind, you show the parents that their baby matters to you, and you remember that all of the physical basics of midwifery still apply to a stillbirth then you really can’t go wrong. A stillbirth is always going to be sad but it doesn’t have to be traumatic. Phoebe’s birth was as beautiful as she was.
One big thing that I would like to make sure midwives consider when caring for these women is that the fact that their baby has died doesn’t stop it being their birth. They may still have a plan for how they would like it to happen. I found that the only birth plan discussion I had was being offered lots pain relief when I had actually dreamed of a hypnobirth. Although I did manage to have the birth I wanted, I felt like I really had to convince staff that I didn’t just want to be numb!
Each women will be different and have different desires (the same as in every other part of midwifery care!) If in doubt, just ask them what they would like!
This post has really helped me. I have the worry that such a traumatic experience like losing a baby would be very upsetting and was worried that having a bit of a cry would make me less of a midwife. After reading this post, I really feel like I could absolutely help a family through such a tough time and that brings me a lot of comfort (I hope that’s doesn’t sound strange)