The topic I’m presenting today on Oopsi is rarely discussed here. It seems to me that we Slovenians are still too closed off and find it difficult to express our emotions, even though many mothers who find themselves in this situation might wish to pour out all their grief at the top of their lungs. I spoke about babies who never cried with certified midwife Nastja Pavel, who shared with me how she feels when she helps bring a stillborn child into the world.

The work of a midwife can be compared to art. In her work, she must use all her senses, be intuitive, have empathy for others, be energetic, decisive. “To do her job well and connect things, she must have a broad spectrum of knowledge. The work is dynamic. One woman is not the same as another, one case is not the same as another. With every woman/couple/family you grow and learn. Why did I choose this profession… well, I’d say it’s because the midwifery profession was well presented at the information sessions and I thought, this is so cool, I want to become a midwife. Midwives are really cool and mainly because I’ve always wanted to work with people.”

There’s nothing more beautiful than hearing a newborn’s first cry, right? I was curious about the feelings when you’re part of that magical moment, when you bring a new life into the world? “Every time I get goosebumps and I can’t believe I witnessed a new birth. You are actually the first touch of the child. And every time I hold them in my hand, these little beings, I say to myself – and you were still in your mother’s belly just a moment ago. As if I still can’t believe this miracle of nature. And I can’t say that ‘I’ am the one who brings new life into the world. That’s the mother. And I don’t want to take away that right and glory. Yet being present and helping in the birthing process is a wonderful feeling.”

Unfortunately, many pregnancies also end tragically. The Perinatal Information System of the Republic of Slovenia for 2010 reports 100 stillborn children in Slovenia. 6% died during labor, the rest before labor. “I don’t have newer statistics. Every one is too many.”

I’ve often wondered why a child dies in the womb. Nastja told me: “A fetus can die at any time during pregnancy. Before the 22nd week of pregnancy we speak of miscarriage, after the 22nd week of pregnancy we speak of intrauterine death. There can be several causes, and sometimes the death remains unexplained. It can be due to maternal illnesses (infections, preeclampsia, HELLP syndrome, poorly controlled diabetes, etc.), the cause can be with the fetus (congenital abnormalities, genetic abnormalities, infections such as cytomegalovirus…), it can be a placental cause (placental abruption – premature separation of the placenta, fetomaternal hemorrhage, umbilical cord problems…). Risk factors also include maternal age, obesity, maternal infertility. There can be many causes, yet sometimes parents are left without an answer. Namely, only in 1/3 of cases can a specific cause of death be determined.”

The feelings when a stillborn baby is born cannot be described, says Nastja. “The gynecologist must confirm the death by ultrasound. And when you stand there, when you look at the ultrasound and you know that something should be beating there, you’re left breathless. I think that in that moment words are unnecessary and that a squeeze of the hand and a hug mean more. Or you can meet the woman in the delivery room. I can’t say what’s harder. Encouraging a woman during labor, where you know that at the end you won’t hear the baby’s cry, is difficult. So I believe that empathy plays a big role here.”

Parents’ reactions to the birth of a stillborn child vary. Usually the most immediate response to a child’s death is shock – including numbness, confusion, disbelief, and various feelings of unreality. “ We can say it’s a kind of protection from reality. In mothers this is more pronounced, which is why they also cry later. I also see that fathers cry more quickly. I observe this response most often. The next response can be denial, non-acceptance of reality. The consequences that a child’s death brings are enormous, so parents truly need professional help in the grieving process. Help for themselves as individuals, help for them as a couple, and more broadly for the entire family. Because with appropriate help, the risk of adverse outcomes is reduced. The first contact is usually with doctors, midwives, nurses, who are here for their support and help. Then also a clinical psychologist, and if needed, a social worker is also involved. It’s right that after birth we encourage couples to look at the child, hold them, name them, photograph them. They need to be given the time they need to say goodbye, even if it’s so very quick and too soon. To tell them what they have to say. And usually they do.”

In Maribor, parents have the option of a group burial at the Field of White Roses or an individual funeral in a coffin or urn. “It’s difficult because all the bureaucracy is still present. Both for us and for them. You encourage them to seek the necessary help, because they will need it. Even if they hold up well in the maternity ward, it’s so much harder when they leave the maternity ward. And here I believe they need a lot of help and support from family and friends who will understand them, listen to them, stand by their side. Seneca, the Roman philosopher, said: ‘We do not fear death, but the thought of death.’ Death still remains a taboo topic. When we talk about the death of newborns, children, the topic is even more pressing. In all these cases I would say once again: empathy, empathy, empathy.”

For all those facing tragic loss, midwife Nastja Pavel recommends reading the book Empty Cradle, Broken Heart. Although this pain probably never heals, it may make it easier for someone, at least for a moment.

You can read the true story of a mother who suffered this terrible loss here”