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On Stillbirth: An Open Letter
to the Clergy
ELIZABETH KIRKLEY BEST, PH.D., KENNETH R. KELLNER, M.D.,PH.D.,SHARON GOULD, M.S.W., WILLIAM DONNELLY, M.D.
University of Florida, Gainesville, FL 32611
ABSTRACT
Presents suggestions from a medical team of nurse, physicians, and a social worker about how a minister, priest or rabbi might be helpful in aiding parents thourgh a stillbirth. Focuses on grief and aftercare as the most important areas for the functions of the clergy.
From: The Journal of Pastoral Care, 1982, Vol. XXXVI, No.(1).
If any death in our culture goes unnoticed, it is that of a stillborn child. Societal indifference to the event of stillbirth is reflected in the problems confronting the parents of a stillborn son or daughter. Parents of stillborns often feel obligated to push aside theirdeep feelings of giref, as though the mourning of a stillborn baby is abnormal or uncalled. A high percentage of these parents choose in-hospital cremation for their infants,instead of private burials.1 The choice of cremation in and of itself is not unique,but this choice is almost alwas accompanied by the choice of no memorial service of any kind.This effort to cease grieving the stillborn baby is fruitless and sometimes has devastating consequences.
As members of a professional team which provides crisis intervention and information to these bereaved parents, we have become particularly concerned by the lack of social support available to most of these famiies. While crisis intervention has its benefits, a hospital usually has neither the staff nor the resources to provide the emotional support so critical to these families. Unfortunately,in too many cases relatives and friends may do more to hinder parental grieving than to facilitate it. Members of the clergy, especially those who have had contact with a family before the death of their baby may be the only source of support available to the parents. A caring Minister, Rabbi, or Priest may play a crucial role in the adjustment of families of stullborns. For this reason, we would like to share what we and others have learned from working with parents of stillborns, and offer suggestions to aid clergy in this difficult task.
Grief at Stillbirth: What We Know
While some people may assume that parents are not attached to a child dead at birth, nothing could be further from the truth.Intense grieving responses to stillbirth have been noted by all who work with these parents. 2 The same processes of mourning which characterize all adult bereavements are found in the responses of parents to stillbirth. 3
Several factors have emerged which greatly affect grief at stillbrith. Naming the baby, keeping artifacts of the baby (such as photographs,footprints, etc.) attending the funeral, all seem to have a facilitating effect on the grieving of these families. Perhaps the most important decision is that of seeing or holdiing the infant. While to some, the proposition may seem morbid, seeing and/or holding their infant is usually the only opportunity these parents have to meet, and say good-bye to their son or daughter. This even, though painful, pronounces the reality of the death and enables parents to successfully work through their grief. There is evidence that seeing and holding the infant is more frequently associated with the choice of burial. 4 and with open expression of grief.5
Other conditions which affect the mourning of a stillborn include the reactions of others and autopsy reports. Nurses, physicians, and family members may try to say things which though well-intentioned place an even greater stress on these parents. Included are comments such as "It was probably for the best, " or " You're young, you can have other children. " These parents do not want "other" children---they grieve for the loss of a particular child. While the autopsy report may aid in the relief of guilt, the reactions of others may do much to perpetrate parental guilt.
The Risks of Grief at Stillbirth
Any major bereavement may predispose an individual to a variety of medical and emotional problems. Because of the nature of stillbirth bereavement, especially the degree to which it is repressed, certain of the emotional problems may be particularly pronounced. Psychological difficulties fall into two general categories: chronic grief, in which there is an unrelenting and gross intensification of aspects of normal grief, and delayed or absent grief , in which thegrieving process may take on an variety of distortions.
Chronic grief is characterized in stillbirth prents most often by symptoms of guilt, anxiety, or depression so pronounced as to interfere with the mother's life without any remission. Guilt, anxiety and dpression are all normal components of the grieving process: they point to maladjustments when over many months they do not subside at all. Sometimes these symptoms may intensify. When these emotional reactions are this severe, the normal mourning process is halted, and professional help is often required.6.
Delayed or absent grief is probably the mosre worrisome of the two "abnormal" course which grief may take. Parents adopting this strategy, often with the encouragement of others, try to dismiss the pain of grief, throwing themselves into overactivity. Unfortunately, the most common manifestation of delayed or absent grief is the rush to become pregnant again, often within months of the death, or to adopt a child as quickly as possible. This "replacement child" strategy may have devastating consequences not only for the parents but for the child as well who begins his or her role in the family in an atmosphere of mourning. The new child is often covertly compared with the dead child, and in extreme cases may irrationally be held responsible for the death of his or her sibling.7
Regardless of the path which the mourning may take, the one member of the community most likely to detect problems is the clergyperson. Neither psychologists, psychiatrists, social workers or other professional counselors are as likely as members of the clergy to have continuous contact with the bereaved parents. Even in the most usual event where mourning takes a normal course, the support of these parents is critical, and the Pastor, Rabbi, or Priest is in a position which lends itself most readily to this supportive role. In our work with these families, we have come to realize the benefits in enlisting the aid of the clergy.
The Role of the Clergy
In the hospital perhaps the most important role clergy may play is in recognizing the urgency of the situation. While many hospitals have their own chaplains, families may often seek comfort form their own pastors, especially at a time when they feel ill-equipped to deal with strangers, however compassionate. One family, with who we worked, was inconsolable at the loss of their son at twenty weeks gestation. Ther only request was that the baby be baptized*, and there was recognizable relief when a priest with whom they had had prior contact was summoned and the ceremony performed. While a baptism or a visit cannot be expected to alleviate the intense grief at the loss of a stillborn son or daughter,sometimes just the presence of a caring person may allow full expression of that grief, which in time allows the family to accept the loss.
A member of the clergy may in some instances instill more confidence than hospital staff members. When this is the case, it is important for the clergy person to inform the parents of the normal nature of grief at stillbirth. A trusted person may also aid in making arrangements for a funeral, or in the event of cremation,a memorial service. By his or her very presence, the clergy person gives the mother and father permission to grieve, a permission that is sometimes sorely needed.If the family is particularly close to the clergyperson, and if the loss affects him or her as well , the clergy should not try to hide his or her feelings,but express them openly with the parents. This expression of grief indicates to the parents that their grief is indeed legitimate, and that their baby was worthy of their mourning. It does not indicate weakness or an inability to deal with the crisis.
After the mother leaves the hospital, the clergy is often the key contact person for support and recognizing risk. The clergyperson need not wait for the parents to contact them as it is often difficult and painful to seek out support in grief. the Pastor, Rabbi or Priest may wish to set up a visit in which the parents become aware that he or she is available for support. Even a simple, caring phone call has been noted to have beneficial effects.8
In the first few months following the death of the child, clergy may be called upon to act as a buffer between the bereaved family and well-intentioned relatives and friends. If the relatives live close by and attend the same parish, church or synagogue, a separate meeeting with these relative may be useful. The event of stillbirth and the sometimes accompanying unspoken blame needs to be recognized by clergy and dealt with openly. The assignment of blame to the mother, father, or a third party, when not dealt with openly has resulted in marital discord and dissoultion, and the destruction of family relationships.What has been offered here is information regarding stillbirth bereavment and the role of the clergy in aiding parents who must experience this tragedy. Those who would like fruther information are encouraged to explore the literature on stillbirth. A Review of the Literature on the psychology of Stillbirth may be found elsewhere. 9 Undoubtedly, the clergy can contribute greatly in ensuring normal grieving processes in the parents of stillborns.
2
P.F.Giles, " Reaction of Women to Perinatal Death," Australian and New Zealand Journal of Obstetrics and Gynacology, 1970, Vol. 10, p. 207;
3G. Davidson, Understanding Death of the Wished-For Child"( Springfield, IL: OGR Publishing Corp.,1979);
5J. H. Kennell, H. Slyter, and M. H. Klaus, " The Mourning Responses of Parents to the Death of a Newborn Infant", New England Journal of Medicine1970, Vol. 283, p. 344.
6E. Kirkley-Best, " Attachment & Grief". Unpublished Manuscript. University of Florida,
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