Stillbirth: grieving without shared memories

“Everyone asks me how I am. Nobody asks me what his name was.”

This is a sentence that, in one form or another, many parents whose baby was stillborn say out loud. The people around them pay attention to the mother — to her body, how she is feeling, her recovery. But the child is treated as if he never existed. There are no photos on the fridge, no stories from the first weeks, no first smile that anyone could mention. There is a name people don’t say, because they are afraid of hurting the parents. And there is a silence that hurts more than any word.

Stillbirth is a loss in which birth and death happen at the same moment. This piece is not about medical causes — those belong with the doctor who looked after the pregnancy and the birth. It is about how you grieve for someone with whom you had no shared life to remember, and what that does to a couple, a family and the people around them.

A child only she knew

Stillbirth is not as rare as we would wish. According to United Nations estimates, around two million babies are stillborn worldwide every year. Most of them in countries with less access to healthcare, but no country is free of it. Even so, almost nobody talks about it. Parents who go through it often say that until then they had no idea it still happened these days.

One of the hardest layers of this loss is the imbalance of memories. The mother carried the baby for months. She felt when he was lively and when he was still, she knew which music he responded to, what time in the evening he kicked. That acquaintance was real — but almost nobody else shared it. The father felt the baby through her skin, the grandparents knew him from stories, friends knew him as a bump in photos.

When the baby dies, the mother grieves for someone she knew. The people around her grieve — if at all — for someone they never met. That imbalance can be very isolating. The mother feels she is the only one who knows who has been lost.

Birth and death in the same moment

In stillbirth there is no dividing line between birth and death, the line we take for granted in other losses. The mother goes through labour — with everything labour brings — and at the end she hears no cry. A room that was prepared for joy becomes a room of silence. Staff who are used to offering congratulations have to find other words.

The body, however, does not know the baby is gone. It prepares to breastfeed, it bleeds, it heals as after any birth. This is one of the cruellest layers of the loss: the body carries on with a motherhood for which there is no longer a child. Everything to do with physical recovery after birth is a question for your gynaecologist and midwife — but emotionally it is worth knowing that these bodily reminders are not something that ought to pass without tears.

Research gathered in a special series of The Lancet on stillbirth shows that this loss has long-lasting consequences — for the parents’ mental health, for their relationship, for brothers and sisters and for any subsequent pregnancies. Stigma often appears too: parents report that people began to avoid them, or acted as though nothing had happened.

Grieving without shared memories

When someone we lived with dies, grief has material to work with. We remember conversations, habits, arguments, holidays. We tell stories, others add theirs, and through that telling the loss is slowly woven into life. With stillbirth there is almost none of that material. Parents grieve for a future that never happened — for a first step, a first day at school, the adult this child might have become.

For a long time the goal of grief was thought to be to “let go” and move on. In the 1990s the researchers Dennis Klass, Phyllis Silverman and Steven Nickman proposed a different view, which they called continuing bonds: grieving people do not sever the bond with the one who died, they reshape it. This view matters especially for the parents of a stillborn baby. The bond with the child existed before the birth; it does not have to be broken in order to go on living.

A common fear among parents is that they will forget the child — or that when they laugh again one day, they will betray his memory. I have written about this fear in Carrying on after a loss: the fear of forgetting him. What grief actually is, and why it does not follow stages, is also briefly explained under grieving in the knowledge base.

Hours in the maternity ward: decisions you cannot make twice

In the hours after the birth, parents often find themselves facing questions they are not prepared for. Do you want to see him? Hold him? Dress him? Would you like a photo, a footprint, a lock of hair? Who from the family should come? All these questions arrive at a moment when you are in shock, exhausted after labour, and have no idea what will matter in a year’s time.

Research on whether contact with a stillborn baby is good for parents is not unanimous. A British study by Patricia Hughes and colleagues from 2002 found that mothers who had held their stillborn baby had more symptoms of depression and post-traumatic stress in the following pregnancy. Later studies, among them a Swedish study by Joanne Cacciatore and colleagues, reached different, partly opposite conclusions. And studies that asked parents how they look back on those hours show that most parents who chose contact valued it afterwards.

What can be drawn from this is not a rule but a principle: contact should be offered to parents, not imposed on them. What matters is that they have time, that they are properly informed and that they can change their minds. Some parents choose not to have contact and regret it. Others choose it and regret it. But most come to terms with their decision over time, as long as it was truly theirs.

If you are now, looking back, tormenting yourself over what you did or didn’t do then, know that you were deciding in one of the hardest moments of your life, with everything you knew and could manage at the time. That thought belongs to the guilt that grief so often carries with it, and you can read more about it in Guilt after a loss: “I could have done more”.

Why the name matters

Many parents give their stillborn baby a name. For some it is a name they had chosen beforehand; for others a name they find only afterwards. A name makes the child a person — someone who can be talked about, not just “what happened”.

That is why it is often so painful for parents when others don’t say the name. People avoid it because they think it would bring the parents pain. But the parents think about their child all the time. Hearing the name does not bring a pain they are not already carrying. What it brings is confirmation that the child exists for others too.

If you are a friend or relative of someone who has been through this, one of the smallest and most important things you can do is to mention the child by name. You will find more on what helps and what doesn’t in What to say to someone grieving, and what not to. Losing a child in the broader sense — including why there is no special word for parents who lose a child — is the subject of When a child dies: the loss language has no name for.

The father who “has to be strong”

With stillbirth, the attention of those around almost always goes to the mother. That is understandable: she carried the baby and gave birth. But the father is often the one left with no room for his own grief. A review of research on fathers after stillbirth or neonatal death by Willem Badenhorst and colleagues found that fathers experience a great deal of distress, but often push it into the background in order to support their partner — and that people rarely ask them how they are.

The father is often the one who deals with the paperwork, phones the relatives, organises the farewell, goes back to work. Others see him as the pillar, and he often sees himself that way too. His grief is therefore postponed — sometimes for months, sometimes for years.

“You’re so calm. As if you don’t care.”
“Someone had to call your mum. Someone had to sign.”
“There’s nothing left to sign now.”
“I know. But if I fall apart now, who’s going to hold you?”

(The dialogue is composite; it is not about a real person.)

When a couple grieves differently, it is easy for each to misread the other: she reads his calm as indifference, he reads her grief as something he must not add to. Grieving as a couple looks at why each partner grieves differently and how that need not break the relationship. In relational family therapy, in which I am training, it often helps simply for each partner to have time to tell their loss — not the shared one, but their own. Co-regulation plays an important part here: two people being able to calm down alongside each other, even when both are hurting.

Brothers and sisters

If the family already has children, the parents face another difficult question: what to tell them. Many would rather protect their children from the pain, so they don’t talk about it. But children sense that something has happened, and if they have no words for it they often explain the story to themselves — sometimes in a way that makes them feel guilty.

It is good to tell a child the truth in a way that suits their age: that the baby was in mummy’s tummy, that he died before he was born, and that nobody is to blame. You will find concrete guidance by age in How to talk to a child about death – by age. Children born later can learn about the brother or sister who died before they were born as part of the family story — without secrecy, and without the burden of having to replace him.

The first year: the dates that come

With stillbirth, calendars are especially cruel, because they hold dates nobody else can see. The due date, which arrives weeks after the birth. A birthday that is also the day of death. The first holidays, when the baby would have been a few months old. Many parents don’t know why a particular day knocks them flat until they look at the calendar.

It helps to know these dates in advance. Not in order to “prepare” so that they won’t hurt — that isn’t possible — but so that they don’t take you by surprise, and so you can decide how you want to spend them. Some parents take a day off, some go to the grave or out into nature, some invite those close to them. You will find more suggestions in Anniversaries, holidays and the empty chair.

Exercise: a box that holds his story

Because there are so few memories, each one is precious. This exercise is about gathering the small traces in one place, where you can visit them whenever you wish. You can do it on your own or with your partner, in one evening or over several weeks.

1. Choose a container. A box, a folder, a notebook — something you like and can put away somewhere safe.
2. Gather what there is. Scan pictures, the name band from the hospital, a photo, the cards you received, the name written on a sheet of paper. If there is something you don’t have, that is fine too.
3. Write down what isn’t in the pictures. When did you first feel him move? What was he like when he was lively? What did you and your partner imagine? Write down at least three things only one of you knows.
4. Add a letter. Write him a few lines — what you would like to tell him, what you are sorry for, what he meant to you. It doesn’t need to be beautifully written.
5. Decide when you will open it. On the anniversary, on the due date, or whenever you feel the need. The box is not meant to be open all the time, but to give grief a place you can return to.

If your partner doesn’t feel this need or doesn’t want to do the exercise, don’t push. Some people grieve through objects and words, others through actions and silence. Both are grief.

Where this piece does not apply

No two couples are alike and no two losses are alike. Some parents don’t want memories, boxes and rituals — and that is not a sign that they are grieving “wrongly” or that they didn’t love their child. Some grieve mainly through faith, others through work, others through caring for their other children. Please don’t read this piece as a to-do list.

Equally, not all distress after a stillbirth is “just” grief. If after several months you still cannot rest, cannot manage basic everyday tasks, images from the delivery room come back as if it were happening again, or you feel that nothing makes sense any more, talk to your GP or a psychiatrist. This kind of distress can be treated. When grief doesn’t pass and When loss needs professional help may also help.

If you are ever overwhelmed by thoughts of not wanting to live, call: in Slovenia, the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am), the Samaritans helpline Samarijan on 116 123 (24 hours a day), or in an emergency 112.

Questions about why this happened, what the results show and what it means for a possible next pregnancy belong with the doctor who looked after the pregnancy and the birth. The answers matter, but not all of them will come — and even when they don’t, grief needs room. Pregnancy loss: the grief others don’t acknowledge looks at pregnancy loss in general, and Pregnancy after loss: the fear that lasts until birth at the fear that comes with the next pregnancy.

What to remember

• Stillbirth is a loss in which birth and death happen at the same time — and in which there are almost no shared memories to carry the grief.
• The mother often grieves for a child only she knew; that imbalance can be very isolating.
• Contact with the baby after birth should be offered, not imposed — research is not unanimous, and what matters is that the decision belongs to the parents.
• Saying the child’s name does not bring the parents new pain, but confirmation that the child exists for others too.
• Fathers often grieve later and more quietly; both partners need room for their own loss.