the sounds of anguish

When I tell people that my profession is a birthing room nurse, the response is always something like "Oh you get to work in the happy place!" for the most part, this is true. I am honoured to be part of the most joyous days of parents lives; life changing, life memorable days. However, being the Capricorn personality that I am, I work in the area where there is no grey: I am part of the very best and the very worst parts of peoples lives. Yes, when everything goes well, it is the very best. But then, there is the very dark, very bleak part of my job: helping a woman bring into the world a baby that will never take its first breath. It doesn't happen very often, but when it does, it sheds a pall on the entire unit; none of us go untouched, no matter who is the actual nurse caring for the family.

I have attended over 10,000 births in my long career. As you can imagine, I have difficulty remembering a handful of them. But, I can describe in detail every stillbirth I ever delivered. At my first one, I learned why they are deemed a "stillbirth." after all, there are many more medical, more appropriate names. But like so many parts of working in childbirth, the history of the art comes into play. A birth is joyous, loud, noisy, filled with laughter, tears, and baby cries. We shout out: its a boy or its a girl. Mothers and fathers are weeping tears of joy with laughter, and I love yous. The physicians are busy telling us to do the things we have done a thousand times, but still, need to be said out loud. We are chatting about our own lives and our own family experiences and welcoming this wrinkled, red, new citizen into our world.

A stillbirth is just that: still. No one says a word, we move slowly, not quickly and silently, moving with a slow rhythm, as if trying not to alert the mother that her child is here and will not ever really be here. No orders are said because they are not needed; no chatter, no laughter, just the silent weeping of a heartbroken father, the stream of tears from our sympathetic hearts and the clicking of the hospital clock.

The one sound that breaks the stillness is spine chilling. It is the bitter wailing of a mother, that will never mother this child and a woman, who until the very moment that the baby was born without life, was so sure we were wrong and that this life she had nurtured inside her was still there. When the baby slips from her limp, and still, she knows the horrible truth. This baby will never go home, never grow live. The medical people were right all along: this baby is gone.

That wail, that cry that the mother gives is primal, something from long ago, lost from our civilized consciousness, yet still hidden deep within our soul. It is truly the sound of the heartbreaking.

We overuse that expression in our modern world "heartbroken," but until you have heard a woman's heart shattering into pieces over the loss of her baby, it is meaningless. All of the pretenses and crocodile tears of our modern society fall away amid that sound.

When I was young and starting my career, I was so naive. I did not understand why we would spend so much time and effort with parents who had lost a child rather that being with the ones whose child was being born. There is a long protocol to follow, with things that some people would consider morbid, trying to get some kind of memento for the parents, such as a lock of hair or foot and handprints.

It is amazing to me now that I could have ever, ever been so stupid. But I was young and extremely pragmatic, and most of all, I had not raised Connor.

Then in one of those light bulb moments that Oprah talks about, I learned something that would forever change my thinking. A perinatal bereavement instructor shared with us this thought : When you have a child, you have a lifetime of memories to look forward to, growing, first steps, first day of school, etc. when there is a stillbirth, those moments, those hours are the only memories that those parents will ever have of that child. It is not their fault that their child never took a breath and will never grow. That baby will always be their child, and as Nurses, it is our job to make sure they have as many memories as possible to take with them.

That small thought changed everything and how I now approach my care, trying to give the parents as much as we can to take with them.

The parents often want to know why? Why them? Why this baby? Only very infrequently can we tell why a baby that survived so much just to come into existence would perish so close to its birthday? If we can tell that it was something like a cord around them or a bleed, it rarely makes a difference.  No matter what the reason, their baby is still gone. Grandparents are notorious for wanting to know why. Sometimes, I believe that it is so they will have someone to blame, sometimes I think that it is just something they say because they do not know what else to say.

I have heard the heartbroken wail another time in my life. It was when the doctor told us that Connor would never walk or stand on his own. Max was devastated, and his cry was heart-wrenching. I think most people assumed it was because he was disappointed for himself; after all, he comes from a family where success is based on your physical ability. It wasn't that. He was mourning the loss of the son we thought we had while trying to process the son we now had; and Max being Max, was feeling "bad" for all the things that Connor would be missing out on, never imagining what this new road would bring us too. And as with the stillbirth family, everyone wanted to know why? What caused this? Why Connor.

Elsie (my mother) was particularly relentless in her pursuit in trying to find an answer to the why? Part of me thinks it because she wanted to blame me--after all, I was the last one who was there!--part of me thinks she was planning on using my physician, something Max and I dismissed very early on.

I can tell you that knowing why never solves the problem and sometimes introduces a whole other set of problems into your life. The peace that I finally got on the why me question came from a colleague who had a child with a severe genetic disorder; she passed away at age three. I finally got up the nerve one night shift to ask her a question that had been burning in my mind, "Rita, did you ever ask, Why me God" her answer was simple and blissful, "No, Linda, I didn't, I just figured, Why not me? What makes me so special?" there it was--Why not us? We were loving, caring, and Connor was our son. Looking back, we were the perfect choice of whatever power decides these things-- fate, Karma, God, the universe--after all, we had been together for many years, I was a nurse with pediatric background and training and Max was a weightlifter with a soft heart. Why not us? And truly would know why Connor was the way he was, why he had cerebral palsy changed anything? There is no cure; there are all the same treatments regardless of why the cerebral palsy occurred, and sitting around knowing could lead to bitterness and stagnation. The last thing Connor needed to succeed in the world was a set of bitter and stagnant parents. And as light bulb moments happen, I know now that it was meant to be. Things do happen for a reason; they are not always happy reasons but for reasons nonetheless. If we hadn't been Connors parents, who know what life we would have had. If we hadn't raised him there would be wonderful people missing from our lives; I am not even sure we would still be together as it would have been easy to quit our marriage if not for the shared care of our wonderful sons. And I am very happy that it turned out this way. As I told my sister in law this week, I would not change a thing, and I would not have missed it for the world.

I know that in the moments of grief and heart-wrenching pain, it is so hard to think past it, but things do happen for a reason, and there are no mistakes. For the mothers who lost babies, they will never take a single breath their next child takes for granted, they will never push away from a hug, or not stop what they are doing to listen to their toddler babble or their teenager rant. Sometimes, that reason has to be enough.