Stillbirth and siblings: Children need to learn how to grieve

One of the most heart-breaking moments for parents in the aftermath of a stillbirth diagnosis is when they remember, with great pain and angst, the siblings at home and become acutely aware of the daunting task before them, “How to tell the children?”

In a general sense, parents have two very important life skills to teach their children. The first is how to love, and the second is how to grieve. In ideal circumstances our collective wish is that children could be protected from grief, but that is very much a head-in-the-sand approach.

From the moment we are born we experience loss. Loss of our first home, being separated from our main caregiver as a baby or toddler. Being dropped off, reluctantly, to the creche, childminder or Montessori. Our goldfish dies, our pet dog finds a new home, our best friend moves school – all of these early childhood losses become practice points for the bigger events that may come later. Teaching children from an early age how to be with difficult emotions is a life skill that can be as important as reading and writing, as it will support them in the rest of their relationship-filled life.

In the past, involving children in the death of a baby was rarely something considered. Children were “taken care of”, “minded” and “shipped off” to a relative or family friend, usually without explanation, knowledge or age-appropriate advice on what was happening within the family. In the past, young children often experienced the pain of felt emotions, without knowing why the little baby they had been promised didn’t come home. Why their mother disappeared from them, for days on end, and came back to them altered, absent and crying. Children did not always know or understand, and in the absence of explanations, drew their own conclusions – misinterpreting perhaps that they had done something wrong to cause the upset.

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Articulate the words

Children feel grief, though most are not old enough to be able to articulate in words what might be going on in their inner world. Drawings, paintings and artwork give clues, as does observing for changed behaviour in the aftermath of loss.

Fear often fuels parents’minds when care providers begin the conversation around the inclusion of children when a baby has died. It is like walking a tightrope – difficult to maintain balance. On the one hand, care providers must not force an agenda of “knowing what’s best”, as parental choice is paramount. On the other hand, bereavement care practices have advanced, and those working in this area know first-hand the advantages of including and involving the siblings. Sometimes it may not be appropriate for children to see their little sibling, in which case mementos and storybooks help. But for the majority of others, inviting parents into a trusting relationship, engaging with those experienced to listen, hear and hold their individual concerns, can result in unexpected rewards.

For one, children are more resilient than we give them credit for. And in general, children will respond to grief according to how the parents respond. As adults we are aware of the finality of death; small children are not. It is very much a creative and imaginary process for them, so storytelling helps.

Tensions and concerns

So within the maternity hospital, as the sibling’s arrival is much awaited, tensions and concerns reach peak level. Often grandparents, aunts or uncles stand on egg shells, conscious and afraid to say or do anything that might cause upset. Once the children arrive they tend to wreak havoc and, to their credit, they manage to shake everybody up. Some parade confidently through the door; others remain shy and demure until warmly embraced by their mother, whose absence has been felt. In age appropriate, well-rehearsed and culturally sensitive language, the children are told the sad news. Parents tend to answer the many, repeated “why” questions as simply and honestly as possible: “We don’t know why – the doctors don’t know why”, followed quickly by reassurances that “it was no one’s fault”.

It is natural for children to cry openly, to go into “protest” mode, with parents comforting and giving them language to express their feelings; “It’s okay to be sad, Mum and Dad are sad, disappointed or angry too.”

It is important they are not pushed to do or say anything

Inviting children to develop a sense of attachment to their baby brother or sister is important. Some parents invite their children to engage with ideas of how best they might remember their brother/sister, wondering where at home they might put the child’s photo, special blanket or teddy. Parents sometimes propose that when the stars light up the sky on certain nights, that they will all have to search for the brightest star, as an indication of their baby sibling’s ongoing connection from another world.

Curious

Children are curious and can easily be led into telling if they would like to meet their baby brother or sister. Preparation is important; talking to them about the baby’s appearance and allowing them come towards the baby in quiet moments, in the absence of onlookers, usually helps. It is important they are not pushed to do or say anything.

When they do meet their sibling, they tend to say it  just as it is: “Why are his lips blue, Mammy?”, “Why is he cold?” or, the hardest question of all, “Why can’t we just keep him?” Explanations by parents in simple, clear language usually resolves their innate curiosity about appearances, and keeping answers simple, honest and plausible is what children need in that moment.

Normality

Before too long they are fighting over who can hold the baby next and some sense of normality around a situation that is anything but normal emerges. Proud photos are taken, sibling teddies awarded, thanks to the support of the voluntary sector, and memory-making takes on a whole new life of its own. Additional ink imprints fly around the room in competitive comparison with one another. Soon thereafter, demands for the treats promised emerge. And before long, they’re heading off again with a loved one, for yet another sleepover, older siblings hanging around that bit longer for greater reassurance.

In the aftermath, tears of relief fill parents’ tired eyes, and they are reassured, at least momentarily, that – in time – they will all be okay. And maybe, just maybe, the best bereavement specialists they are likely to encounter are perhaps their own children, who will be up early every morning needing more hugs than usual, as well as breakfast.

Childbirth and death: the statistics

- 2.3 million stillbirths occur worldwide each year
- 1916: the perinatal mortality rate was 81 per 1,000
- 2016: the perinatal mortality rate was 3.7 per 1,000
- 2016: 65,904 babies were born in Ireland
- 488 were perinatal deaths,
- 294 were stillborn (15 per cent unexplained)
- 166 died within the first week of life
- 28 died within the first month of life
- Almost half of all childhood deaths in Ireland occur in the first year of life.

Bríd Shine is midwife specialist in perinatal palliative care and bereavement at the Coombe Women & Infants University Hospital.

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