When Nicci asked if she could share how the loss of a baby can be in South Africa, I said, sure -- if you have a story to tell, we want to read it. As I began reading, though, I realized I had more questions than answers -- when she said "here in South Africa," she really meant it -- her work as a bereavement doula is nothing like any bereavement doula I have heard about in the US. I needed more clarification to see how things are so different, and what can be done to help change these archaic, thoughtless laws and procedures -- I am pleased to see Nicci is helping to make that change happen.
Except for different room numbers, the two doors looked identical. If you could have peeked inside, you wouldn’t have been able to tell the stories apart. Except for their age difference and the gestational age of their pregnancies, they were just two women waiting to give birth. And they did give birth, almost simultaneously.
Behind Labour Room 1 an 18-year old teenager was unsuccessfully trying to take deep breaths to ease the pain that threatened to overcome her young body. She was experiencing severe discomfort with each contraction, and as I held her hand I could almost feel her pain. Annah (all names have been changed) looked at me and asked, “Is this going to get worse?” I had to be honest because this is the one thing I promise my clients: Honesty. I looked at her and told her that yes; unfortunately it was going to get worse.
Her big brown eyes followed me as I walked around the bed and straightened her IV line. She asked again in a strong, clear voice, “How much worse, Nicci?” I took her hand and assured her that it was going to be painful, but it doesn’t last forever and she will forget the pain. I couldn’t tell Annah that while the physical pain would go away, the pain of the memories never leaves. It would have been cruel in the moment, so I just squeezed her hand.
Annah was a normal teenager who had just finished Matric [final year of high school] and she was celebrating the New Year and the beginning of new things with her friends. What happened is still a blur to her, but she fell pregnant the first time she was ever intimate with someone. It was devastating news. But the news was not as devastating as what they learned around 20 weeks along: according to her doctor, Annah’s baby had severe health issues, his condition being incompatible with life. At 22 weeks, Annah’s baby was going to be born.
Lisa, Annah’s mother, is who I spoke with about this birth. “Lisa, it’s Nicci, I am a bereavement doula and I was told that you want to make use of my services?” With relief in her voice she asked me to come immediately, as they were about to break Annah’s water. I rushed to hospital. After reporting to the nurse’s station, I was taken to the Labour Rooms. That’s when I saw the two identical doors...
When I was first introduced to Annah she seemed a bit hostile, but within five minutes we were chatting like old friends. After a while she told me that she was pregnant with a little boy she was going to name Zach. I was so relieved that we clicked. It is extremely difficult to assist someone who doesn’t want you there! In fact, it’s virtually impossible.
Annah starting talking about Zach’s funeral -- she said she wanted a particular casket and elaborated on her plans. Lisa and I both listened as Annah told us about Zach’s name, his casket and a few other details about saying goodbye to him. Annah was complaining about her contractions again and I demonstrated to her how to breath to make things a little bit easier for her.
I left the room to give Lisa and Annah a moment alone, and as I was waiting in the corridor, I couldn’t help to hear the familiar sound of a baby’s heartbeat in the other room. I could hear the nurse telling the mom in Afrikaans “Dit is nou amper tyd” (It is almost time now), and I could hear the laughter and buzzing excitement. The contrast to Annah’s situation was so stark, my breath caught in my throat for a second and I had to concentrate very hard to not let the sadness overcome me.
Lisa came out and we went around the corner to have a quick private conversation regarding the situation, but after five minutes she received a frantic phone call: Annah was ready to push! I was astonished that this woman went from 3cm dilation to full dilation within a matter of not even 20 minutes. We both ran to the room. We were just in time. The doctor arrived as we got there and the next moment Annah’s agonizing screams could be heard echoing down the labour ward’s corridors, surely made worse by the realization of her situation. Between her pauses to take a breath, I could hear a mini commotion next door as well. Unbelievably, both women were giving birth at the same time. Oh, the irony!
The next moment Annah was screaming so loud my ears were ringing, and with a soft push, little Zach was born. But contrary to the celebrations and exuberant exclamations next door celebrating the birth of a healthy baby boy, in this room there was silence as tears streamed down Annah’s face, Lisa barely coping herself. If pain were a picture, I saw it in that room.
The nurse delivered the placenta after the doctor cut the umbilical cord (and subsequently left straight away) and was gently cleaning Annah up. Lisa was standing with little Zach wrapped in a soft white blanket that was embroidered with a white silk bow. Lisa took the baby boy to his young mommy and I quickly grabbed my camera to snap a few photos. Lisa gently handed the baby over to his mom and I could see a thousand thoughts running through Annah’s brain.
“He’s beautiful. He’s so tiny. Look at his perfect little nose. He is so, so beautiful!” exclaimed Annah. I could feel the pesky lump in my throat returning to torture me, and I swallowed very hard to keep my composure. I took a few photos of him, especially his tiny little hands and feet. I wrapped the baby again and gave him to his grandma. Annah insisted to hold him and she stroked her baby’s forehead.
In South Africa, babies born before 26 weeks without taking a single breath, are considered medical waste and treated as such (incinerated with amputated limbs and used needles.) It is something the Voice of the Unborn Baby are trying hard to change. It is the greatest insult to families, during a time of such great loss, to not have their babies legally recognized. Because of this, a doula like me, who is Still Birth Day accredited and trained in perinatal bereavement, has to complete an affidavit (or assist a parent to do so), basically stating that a placenta is being removed from hospital – we just fail to mention that the baby is attached to the placenta...
The nurse motioned me outside and when I closed the door behind me she asked me when I was going to the police station to have the affidavit completed. I told her that the commissioner of oaths was actually coming to the hospital herself -- there was no need for anyone to go to a police station. She looked unsure of herself and then she asked me where the casket was. I told her it was in my car, but if she wanted to see it I would go and fetch it. She indicated that this was indeed what she wanted, so I quickly ran to my car. Our caskets are beautiful little woven baskets that look like a Moses basket and not like a casket at all, so luckily I didn’t upset anyone with it.
When I got back, Annah was sleeping and the nurse had taken the baby. Lisa’s eyes were red from crying, but she was calm and asked me a few questions, which I patiently answered. Luckily the commissioner of oaths showed up and we finalized the paperwork and chatted a bit about Zach’s funeral. Annah knew exactly what she wanted for the funeral -- I was impressed with how composed she was. I had to fill out a report for the hospital stating that I take full responsibility for the “remains,” and that I will dispose of it lawfully.
We put little Zach in a carry cot, and after saying goodbye to Lisa and Annah, we left. They both confirmed that they had said their goodbyes and that they didn’t need to see him again. In these situations we are absolutely led by what our clients want and we respect and carry out their wishes as far as humanly possible. Little Zach was snugly tucked into a comfy carry cot, covered with his embroidered blanket. He looked peaceful at last.
I so wished those two doors held the same thing inside: beautiful, lively little newborn baby boys. But we don’t always get what we wish for, and that is precisely why I do what I do. Because there is a family facing the unfaceable, because the government makes this even more painful by not recognizing these so-called ‘fetuses’ as babies, because someone needs to comfort, answer questions, and hold the hands of the people going through this excruciating pain – this is why I do what I do…because no one should have to walk through that door alone.
Ever since the traumatic birth of her firstborn, the subsequent birth of his brothers, 6 infertiliy treatments, 3 miscarriages and 1 adoption, it has always been Nicci's dream to make a difference in the lives of bereaved parents. She is Birth and Perinatal Bereavement Doula, and a certified SBD Doula®. Passionate about ensuring families of all kinds have the unique support they need, she is a director at Voice of the Unborn Baby, and also Doulas of South Africa. Nicci is an avid writer and has written many short stories on her experiences as bereavement doula. Nicci also wrote a book about her infertility struggles. Besides being a doula, she is also a professional stillbirth photographer. Nicci believes in the power of encouragement, and in building confident and empowered doulas to make a difference in South Africa. She also believes in dreaming big and working hard. She is passionate about people in general and more specifically about the doula profession.
Nicci lives in a leafy suburb at the foot of the Magalies mountains, in the Pretoria area of Gauteng Province, South Africa.
Day 11 brings us a story of hope after pregnancy loss. I love how this family keeps their tradition of visiting the same park every year in honor of their miscarriage. Lovely things can come from great grief and sadness. I am humbled by the stories of loss families have chosen to share with me, and the courage it takes to keep moving forward afterwards.
It’s 6 years since the day we found out we had lost our first baby. I was 12 weeks pregnant and, after experiencing the teeniest amount of spotting, I had an appointment in the Early Pregnancy Unit for a scan. There was a serious baby boom back then and ‘booking’ appointments were happening incredibly late – mine was at 21 weeks – so this EPU appointment felt like a chance to get a sneak peek at our baby. In our innocence, we were giggly and excited, and didn’t for a moment imagine there was anything wrong as we headed into an early morning appointment. We were back on the street a half hour later, our future changed forever after an instant of horrible stillness. Our much-loved baby had become ‘retained products’. It was 8.30am. Where to now?
Missed miscarriage wasn’t something I knew much about – but now I had to decide what to do about it. This was my pre-GentleBirth life. I wasn’t informed about hospitals or maternity services or options. I consulted Google, found a very mainstream pregnancy forum and asked advice from some wonderfully supportive and sympathetic strangers, who had had similar experiences. Everyone said the same thing: have the surgery (ERPC – Evacuation of Retained Products of Conception. Bad enough having it, and the name adds insult to injury). I rang friends – lots of sympathy, but it didn’t help me decide. My gut told me that waiting it out was right for me and my baby – even though my baby had been gone already for around 4 weeks, I instinctively felt my body would be able to take care of business. But then, fear – I had a cramp and completely freaked out at the thought of miscarrying at home. I rang the hospital and booked in for two days time, to have the ERPC.
That left a day in between and for some reason we decided that morning to go to Mount Usher Gardens in Wicklow. It’s a beautiful place and I felt as I had to be sad, I might as well be sad somewhere lovely. I think the trip may have been prompted by good weather, but I have little recollection of the day other than breaking down in the car on the way home and crying about my lost little baby for the first time. I wailed in a way that felt like it would break my body, as though I could literally break my heart.
I think the experience in the hospital is for another post – suffice to say, I was not cared for emotionally in a way befitting of the emotional pain I was going through. The weeks that followed were tough. Why is the devastation of miscarriage not spoken about, when it is so common it is almost a rite of passage as a woman? It changed me in a way I wouldn’t have thought possible and marks me still. The grief went to a place inside me I hadn’t known existed, but I know now that place is motherhood. I wanted to conceive again as soon as possible and although I don’t think my desperation was very attractive, we somehow managed to do so very quickly and, just 7 weeks after that awful day, I was pregnant again.
I have no idea why I chose Mount Usher on that day, but it has become a very important place to us. We had no remains returned to us after my surgery. There is no grave, no other place to associate physically with our baby. The following year, we went to Mount Usher on the anniversary of the miscarriage, to honour our lost one. It was joyous to be there with our 6 week old, having wondered the year before if we would ever have children. Each year, we go to the gardens in April, to celebrate the short life of our first baby. It’s become a very special way in which to remember, mark time, and take stock. Going there is simultaneously returning to a moment in time, where I can meet my baby by remembering that sadness, and celebrating how far we’ve traveled each year as a family.
Since the miscarriage, I have carried two healthy babies to term. Both pregnancies were emotionally challenging in the early weeks, for different reasons but physically easy, and wonderful once we got to the 20 week mark. I’ve had beautiful births, thanks to the GentleBirth programme. There is so much to be grateful for. But this year I could have been at Mount Usher again with a full term bump, or a slightly smaller one. I lost a baby last year who would have been with us within the next few weeks, and another a short while later who would have arrived this summer. They were very early losses, with no physical trauma and I was thankful that the pregnancies hadn’t struggled on, only to fail at a later stage. There being two consecutive losses was worrying – and Google didn’t help matters as it told me fertility drops off a cliff at 39 and only 1 in 4 of my eggs are likely to be of much use. The last few months have been difficult at times – being in the ‘baby business’ , I am in contact with pregnant women constantly although, strangely enough, bumps that I meet professionally don’t induce any jealousy. I have naturally enough felt pangs at seeing what sometimes seems like everyone I know becoming pregnant over the past few months. But it’s been entirely bearable – not the running-my-guts-through-a-mincer feeling that was so overwhelming after my first loss.
The day we spent in Mount Usher this year was our most memorable yet. My 5 year old, who has been extremely challenging lately, was an angel for the day. The sun came out as we arrived and, as the weather had been unpromising, it seemed we had the place to ourselves. We had a fabulous picnic, followed by a gorgeous meander that magically took us to spots we’d never been before. And the highlight…I got to see the sheer excitement on my first rainbow baby’s face as we told her, in our special place, that we will be welcoming another into our family this autumn. In time for Hallowe’en. We all agreed – this was the best day ever. Until next year…
In Japan, there is a way to honor and acknowledge the loss experienced through miscarriage and babies born still. "Mizuko Kuyo" literally means, "water" and "baby," and it represents the spirit of a child who died inutero, “beings who float in a watery world awaiting birth.”
Statues represent children that never were. The statue is called a "Jizo." Initially the family writes the baby's name on the Jizo, as well as the date of the loss. They may also include a personal message to the baby. If there are ultrasound pictures, one might be left with the Jizo. The ceremony is performed by a Buddhist Monk, who essentially reads a scripture-like prayer for the baby. Families may come and add caps or bibs of red, pinwheels or other small toys and food offerings.
Mizuko Kuyo has no direct English translation. I would go even further to say, English-language cultures (and many other cultures) have no direct translation in ceremony, emotional comfort and release, and familial acknowledgement of this loss.
As a doula, I have seen women and families experience miscarriage and babies born still. While every mother feels her experience differently, she often does feel it deeply. Sometimes these are family mournings, when the baby is closer to birth or gestational maturity. With the majority of miscarriages occurring before 12 weeks of pregnancy, more often this loss is a private ordeal. Many mothers or couples haven't shared the news of their pregnancy yet; the support which might be extended by their community is missing, and the mother, especially, floats through the loss feeling alone with her secret pain.
I don't know why our culture is so bad at this type of loss (we aren't good with loss in general). The point of Mizuko Kuyo is to recognize the passing of a "baby before birth." One Buddhist Monk notes, it doesn't have to be an official religious ceremony, and anyone can have their own Mizuko Kuyo -- even years after their loss. One woman, searching for a way to peace after her miscarriage, asked her husband to participate in Mizuko Kuyo with her. She shares:
"I gathered a few things. The pregnancy test – it symbolized the happiness my husband and I shared when we learned of our pregnancy. A family picture. I also wrote a note that simply said,
This post has been inspired by a dear friend dealing with her own loss tonight. I am sorry. Love and light to all who have experienced this pain.
♥ four young boys and a boy dog (offspring)