Daniel: Stillborn at Home


 Trigger Alert: This post contains information and details about a stillbirth.

Daniel

Preamble

In 1996 and 1997 I was enrolled in a Graduate Diploma of Midwifery with La Trobe University. I was a mature aged student studying midwifery at the age of 32 with 3 children of my own.  As the course could be done part time I was able to work towards my career dream, with 3 children, commuting weekly from Wangaratta to Melbourne, working part time.

My youngest child had been born at home and I always intended to be a homebirth midwife myself. During my midwifery training I had the amazing opportunity to work with a homebirth midwife Meg in Northeast Victoria. I attended 9 homebirths with her as I studied and learnt more from those experiences, her mentorship and the birthing women than all of the rest of my studies put together

This is the story of the birth of Daniel, stillborn at home one hot summer’s day in country Victoria, early 1997. The names of the birthing family members and dates of events have been changed to protect their privacy.

 

Birth Day: 1pm.

I was shopping for groceries when the call came. With her due date just 6 days away, I was not surprised when it was Jane on the phone but I was not prepared for what she said. “I’m ringing with bad news I’m afraid. The baby has died.” I was stunned, shocked and so disappointed for her. She went on to explain how she had not felt the baby move for a couple of days, gone to her GP who could not detect a heartbeat, then gone onto Wangaratta to have the inevitable confirmed by ultrasound.

Her doctor suggested an ARM (artificial rupture of membranes) to start labour, where she could come into his surgery to have at any time, he remained happy to support her in the decision to have a home birth even if she needed a syntocinon drip. (Note: a syntocinon drip is intravenous medication given through a drip to artificially stimulate contractions. It is used in hospital to induce labour).

As the conversation continued Meg then asked me if I still wanted to be involved, which I did. I strongly support any woman’s right to the birth of her choice. Meg and I had agreed to be with her whatever the outcome or sequence of events and I was not going to back out of my commitment.  It was nice of her to offer me an “Out clause” though. I told Jane I would go home, organise my kids and would be available to come whenever she wanted, during which time I would wait for her call in the coming hours

I went home, collected the children, and packed their bags for them to go to my mother in laws, put my bag in the car and let my husband know what was happening. I was wondering what was going to happen. All sorts of scenarios went through my head. I could visualise a failed induction, days of waiting and possibly after all of this we could still end up in hospital. How would I cope? Would I be an asset or a liability to Jane?

I rang Meg so that we could talk before arriving at Jane’s home. I wanted to let her know that while I wanted to be involved, this was all new and foreign to me. I had never been involved with a still birth before. With Meg’s experience and knowledge I was quite surprised to learn that neither had she. With approximately 6 still born babies a day in Australia I assumed she wold have had more exposure. (Stillbirth Foundation)

Birth Day 3pm.

I rang Adrienne for moral support (my University lecturer/mentor). I am so glad I did. She reflected my concerns about the ARM. While we don’t know for sure what triggers labour, the adrenal involvement of a live baby is thought to be involved. Ruptured membranes alone my not trigger labour but they would certainly increase the risk of infection. She also reviewed the process of maceration with me and how the baby may look and mentioned that it may also have malformations.

(Note: Maceration is the softening of tissues after death. The skin may have begun to separate and slip and peel a little from the body. It becomes more pronounces and reddened the longer that baby has been deceased).

Adrienne shared an early experience of a still birth as midwife and how she had felt , listening to her experience was a benefit in my own preparation . Finally then, she gave me permission to grieve in whatever manner to follow. That got the better of me and I began to cry. My fear of “how would I cope?” and “What can I possibly do?” had started to build up over the past couple of hours. Her advice was even if all you do is sit quietly in a corner and cry. To have just been there will have been useful. You don’t have to solve anything or, make it right. It was reassuring to have her moral support and know she would be thinking of me this gave me strength and courage.

She also asked me about my own support network. For this situation I had my husband to take over my practical responsibilities and to just be there, I had Mum and Barb ( a fellow Midwifery student and friend) I almost rang Barb then for a bit more emotional support but knew she would be asleep due to night duty. I had wanted to connect our thought waves. But it was 3:30 by then and I had to get my older two kids from school and take them into Wangaratta.

Labour begins: Birth Day, 5pm.

Jane finally rang. This news was good. She had gone into spontaneous labour, 5 minutely contractions of moderate strength. Meg was there and it was time for me to come, I was in Wangaratta and would be there in 30 minutes.

Birth Day: 5:30. I pulled up at the house and took a number of deep breaths before heading in, having taken several doses of rescue remedy on the way I was surprisingly calm. Paul had placed a sign over the driveway saying “No visitors please”.

Not wanting to disturb Jane in case she was in the middle of a contraction I quietly tapped on the front door and was let in by her mother Edith. There was a quiet flurry of activity. Paul was filling the birth pool in the lounge. Sarah (almost4) was moving from room to room. Edith was in the kitchen writing down contraction times and making coffee. Several pots of water were on the stove. Meg was rubbing Jane’s back with sweet scented oil as she stood leaning forward onto the kitchen table, her head burrowed into a pillow. She seemed to be in strong labour.

Jane had strong back pain with and between contractions. We massaged her continually. Meg spoke to the doctor Andrew, to let him know Jane was in established labour. He offered to visit over the course of the evening. Jane declined, saying she would ring him later if he didn’t mind what time, which he didn’t. What a rare specimen!

Although there was a quite sadness in the house, there was plenty of normal activity and tempo of labour almost allowed us to forget there was not going to be a happy outcome on this day. We could momentarily pretend that his was a regular birth…….almost. Activity cloaked our anxiety.

As labour progressed, Jane became more vocal, talking to the baby, coaxing him down the birth canal. “You’ve got to come out baby”, “Come on baby” and “I can feel you moving down baby” in a tone somewhere between singing and crying. She was also apologizing to him. “I’m so sorry baby, I’m so sorry. Come on, you have to come out. Come on baby.” The pain of the contractions was a great time to release tension and grief. While it was an anguished chant it seemed therapeutic. We could only stand by and listen. Just being.

The only drama was the birthing pool. It wasn’t filling quickly enough! Jane’s labour was advancing more quickly than the water level, wondering at times through some intense contractions if the baby might be born on the kitchen floor. Jane tried, at one point to get into the pool although it was still shallow but was gripped with a contraction and quickly returned to the security of the kitchen table where she knew she had been managing the contractions. She had become increasingly anxious about not being in her pool as planned and once we finally got her in, although it wasn’t really deep enough to calm her so she could regain control, and continue with the birth as she had planned. I didn’t note the time but it was just before or after 6pm.

And then the pool was too hot. WOW was it hot! My feet stung bright pink.  We turned the cold on through the hose and the buckets of cold water started coming. I measured the temperature. It was almost 42 degrees. This increased Jane’s anxiety. In fact she became quite cross. Why couldn’t we just cool it down? Meg explained that we were throwing in cold water as fast as the taps would go. Jane understood then and concentrated on the job at hand. She became focused. She leant forward during contractions and lay down, floating on her back relaxing in between. Her back pain continued and we rubbed her back during contractions and splashed water over her peri. She wanted to feel water there doing its job, helping her to relax, soften and open.

Jane was on her knees leaning forward onto the pool edge with her mother at her shoulders, Paul and Sarah on one side watching. Meg was at Jane’s feet ready to receive. I had got in and out several times getting things and was halfway between Jane and Meg so I could help Meg, pass her things and was accessible to Jane to rub her back. The pool was too large to work from outside so we needed to be in it together.

We could tell birth was imminent from Jane’s tone and behaviour. The contractions were a little further apart and had changed from the intensity of transition contractions. Her voice was deep and guttural, there was an almost unperceivable arch of her back as the involuntary urge to push took over and I could feel her energy succumb to the change in pressure I knew form my own experience she was feeling.

Second Stage

Meg gently encouraged her to push a little and told her the head was just there. Somehow she managed the courage to push ever so gently. A job she did, yet did not want to do. She began to sob as well as push. The baby was facing up at us with his eyes closed. The very first obvious feature was his severe cleft lip and palate. Meg held his head very gently; obviously reluctant to pull in case she damaged him. She tried to gently lift a loop of cord from around him but it broke. I got out to get a clamp to put on. With another contraction and hard push Daniel was finally born. It was 6:40 pm

Jane stayed leaning over the edge of the pool with her back to the baby, quietly crying with her mother’s arms around her. Meg cradled the baby in her arms. I moved a little away from Jane as her mother held her and put my hand on Meg’s knee under the warm water. I will never forget those first few moments of Daniel’s birth as his death was finally confirmed for us all. He lay silent and still, cradled in Meg’s arms as she rocked to and fro in the water with tears silently sliding down her cheeks. Jane’s quite sobbing was the only sound in the house. My heart ached with sadness and tears trickled down my cheeks too.

Paul sat on the couch with his daughter by his side watching the whole thing just inches from the pool. Watching these women and his son. He waited quietly, said nothing but obviously keen to hold his boy. Leaning forward, crying yet supporting us all.

It took Jane several minutes to turn around to us. Without her glasses she sees poorly but could see Meg holding her dead baby and fresh gut wrenching sobs broke from her. We offered her the baby but she said, “No, not yet” I got out and fetched a fresh towel and we ever so carefully passed Daniel out to his waiting father.

Naming Daniel

The water had started to cool a little so I put the pots in to boil and continued to replenish the water for several hours. I took several photos. After a little while Jane put her glasses on and inspected her son. It was incredibly sad to witness the family’s grief and there was our loss and grief too. Meg asked his name. Daniel was the name they had chosen for a son and they wondered if it should be reserved but they decided that yes, this was their son, alive or not so Daniel it was. Daniel Joseph.

The naming brought a fresh stab of pain to my heart. “That’s just not fair” I thought. Daniel was the name I had given to the baby I lost in 1993. I had not associated that event with this one until this moment. I had not thought of my own loss for some time and now it resurfaced. I said nothing at the time but was sad, sad for all losses of this family and mine. This moment where birth and death are cruelly brought together is very hard.

During the somewhat lengthy wait for the completion of third stage Jane asked her mother if she appreciated the significance of a home birth, of being totally in control. Her mother did and was glad to have been involved. Jane’s mother was happy to support her daughters birthing choice but like most people who have never attended a birth outside of the mainstream system could not possible understand the positive emotional and social benefits of a home birth until they have actually experienced one in person themselves.

I felt total admiration for Jane and Paul, for their courage in sticking to their plan of action and having Daniel at home. It meant they were totally in control and accountable for the whole process. It meant they chose to confront their emotions and reactions to Daniel’s birth and death without intervention or interference from any strangers within an environment that felt safe and secure. I am sure that if we had been transferred to hospital for whatever reason we wold have been able to have a fair degree of control and the staff would have meant well but staying home maintained the family unit and the sacredness of the whole event.

Big Sister

Little by little, Sarah, secure in the loving atmosphere that everything was OK although it was a sad, even tragic situation moved closer to her brother. She touched his extremities and counted his toes. She commented on his funny mouth and his perfect hands. She didn’t fear him but seemed to just accept this was her brother. She went to bed quietly.

As the evening wore on, Edith shared her birth experiences and the stark contrast they had been to Jane’s. She laboured twice by being put to sleep by her doctor and waking later from a foggy sleep with a baby in a nursery. The labour just did not exist. She went to sleep pregnant and woke later as a new mother. She said that just the way it was with that particular doctor. For two subsequent labours in a different town, with a different doctor she experienced labour which was a shock to her. Husbands were not involved. You had no contact with the baby except for feeds and you remained in bed for the duration of the hospital stay.

Third Stage

Although there were obvious signs of placental separation, it was not until just after 9 pm that Jane finally let go of the placenta. She spent all of that time in the pool. There was minimal blood loss, her fundus was firm and contracted and we could see and feel the complete placenta hanging from her vagina. We just let her be until she finally decided it was time. This was a significant moment for Jane. It meant the labour was finally over. Complete. Without the business of labour at hand it meant it was finally time to confront her grief. She retreated into a corner of the pool. Paul came to the edge on the outside and they embraced with Daniel between them as she gently eased the last of the membranes away and cried afresh. It was all over.

The placenta and membranes were complete. I held them out flat for Meg to show Jane and Paul. Jane and Meg then got out and Meg checked Jane. She was completely intact, which for her was a nice bonus. We then had something to eat. It was after 9pm by this stage so we were all a bit exhausted and hungry.

I then had the opportunity to hold Daniel myself, which was a comfort and Paul took a photo for me. I had handled him in the course of the evening but it was lovely to have a quiet little cuddle.

Jane said it was wonderful to have been able to birth at home and to have been supported by professionals in this decision. She was glad to have been able to act naturally, to let her mind and body go and do what she wanted. She was glad not to have been patted on the back and told “there there, everything is OK”.

Jane was getting around to ringing her GP when he phoned her. He then came to the house to offer his support to us all. He examined Daniel on the kitchen table. The only visible abnormality was the cleft lip and palate. He said to Jane and Paul there was the possibility of other associated problems and answered their questions regarding autopsy, cremation and the possibility of keeping Daniel at home until the funeral. He was very supporting, sensitive and unassuming, never forcing his opinion or advice. He stayed for almost 3 hours joining in the anointing service later.

Saying Goodbye

Jane rang their priest and while he was on his way they rang the funeral director to ask about details for a funeral. Initially Jane was keen to have the funeral as soon as possible. We convinced her as a group that it was valuable to wait at least a couple of days. As it was now late Friday night, the crematorium would not be open until Monday, and the priest of her choice was not available until Tuesday she settled on Tuesday morning. She was later very glad of this time because they kept Daniel at home until the funeral. (Note: after some negotiation with the funeral director due to the hot weather)

The priest said a brief prayer and anointed Daniel, and then the rest of us in turn, which brought fresh tears again and we sat and listened sadly as Jane said a prayer out loud. Soon after, Andrew the doctor left. It was getting quite late and Meg had decided to stay. Jane said I was welcome to stay also but I felt it was time to give them some space. I was also exhausted. Ever practical Jane fetched my fee which we had agreed on at the first visit all those months ago. She also gave me a copy of “Water Birth” which she inscribed. That book is never loaned out from my library. I promised to ring and visit on Sunday.

It was midnight when I left. I felt almost guilty leaving Meg to continue on with the caregiving role on her own but there was also a feeling of relief to go home, away from the intensity of the whole experience. Home, where I could retreat and kiss the foreheads of my perfect, living, sleeping children.

 

Comments

Not all data is created equal. You may have read in media or medical articles the perils of homebirth resulting in a still birth. Tragically some babies do die just before, during or after birth, both in the hospital setting and home setting. Daniels birth and death would have been recorded as a home birth related death. Of course that is not a true reflection of the alleged risk of birth. Daniel did not die as a result of negligent care, nor did many others recorded as such. Remember this when evaluating data.  Food for thought

This birth story is an exert from a book I am currently writing on homebirth in Australia. Your feedback is most welcome.

 

How are you doing?

Seven babies are still born every day in Australia, impacting 2,700 families every year. Chances are you know someone who has experienced a still birth in their close circle of family or friends. You yourself may have experienced a still birth. If this story has affected you please access support from your caregiver or one of the links below.

 

 

References and information

Bears of Hope: Stillbirth Information

SANDS: Miscarriage, Stillbirth and Newborn Death Support

Still Birth Foundation

Stillbirth and Neonatal Death Alliance