When you lose your pregnancy or your just-born child, no matter how it happens: a miscarriage, stillborn baby, death of a young toddler, the loss and grieve are devastating and hard to handle. Moreover, even if the termination of the pregnancy is by choice, the experience could be just as painful and difficult. This kind of loss may influence the way we view ourselves, both physically and emotionally. In the WTB book, there is a chapter which offers explanations, consequences and personal stories and experiences of other women, and also ways to handle and ease those feelings.
Even when it’s by choice, pregnancy is a process of many contradicting emotions: happiness and excitement alongside fear, confusion and uncertainty. During the time of the pregnancy, most of us are sure, or at least want to be sure, the everything is going to work just fine, and in the end of those nine months we will give birth to a healthy baby, but sadly that’s not always the reality. For these reasons, we are going to talk and share our knowledge about everything from the physical reasons of childbearing loss, the medical procedure of losing a pregnancy and emotional aspects that come along with the loss, and also burial, grieving process and religious aspects of a stillborn or a child who passed during the first years of his or her life.
Fetus – a live creature at the beginning of it’s development. The fetus’s life circle start at the moment of conception and ends at the moment of birth, when it becomes a baby.
Beta – a hormone manufactured by the placenta fourteen days after conceiving. The existence of this hormone in a woman’s blood indicates pregnancy. Beta hormone levels double every two or three days during the early stages of the pregnancy, and therefor the may use to determine pregnancy length, even though it’s not always accurate.
Keeping track of the beta hormone levels is a tool used to knowing whether the pregnancy is in order. In case of pregnancy termination, doctors will perform Beta levels test, to see if it dropped to ten points or less. Less than ten points indicates the no placenta was left in the womb.
Different Types of Miscarriages
Natural (Spontaneous) Miscarriage – lack of proper development of the fetus and or the gestational sac during the first trimester, until the 14th week. This type of miscarriage is the most common complication that causes childbearing loss. About 15% of first pregnancies end in a spontaneous miscarriage. 2% of women who go through this type of pregnancy loss will experience it again in future pregnancies.
Threatened Miscarriage – a situation in which the fetus’s heartbeat was detected at the beginning, but bleeding start to appear 5-9 weeks into the pregnancy. Those bleedings are the indicator of the possibility that fetus will cease to develop.
Pregnancy Loss Cases –
Chemical Pregnancy – there are cases in which Beta hormone tests indicates pregnancy, but a later ultrasound shows no signs of gestational sac. That’s what’s called chemical pregnancy, which usually caused by chromosomal problems, womb deficiency, infections and low hormone levels. Those pregnancies cease to exist before they are firmly established. In some cases, we may never even know we were pregnant, since the process is faster than our menstrual cycle.
Blighted Ovum, Gestational sac without a fetus – much like the previous scenario, in this case, blood tests indicates the existence of a pregnancy, only the ultrasound shows an empty gestational sac. If the ultrasound is taking place in the earlier stages, around five or six weeks, there is a chance that the test was taken too soon, and that there is a baby. But if the ultrasound was done during the 7-8 week and later, than it’s an undeveloped pregnancy.
Pregnancy loss may be the result of various situations:
Ectopic Pregnancy – happens when the the fertilized egg starts to develop outside the uterus, usually in the Fallopian tube. One out of five pregnancies is an ectopic pregnancy. This pregnancy might put the pregnant women in grave danger and requires immediate termination. Some of it’s symptoms are irregular Beta levels – when they are suspiciously high or when they aren’t going up, and strong pain around the tube area.
Molar Pregnancy – when there is no fetus, only accelerate development of the placenta, which then turns into a tumor. Molar pregnancies are common in older women, the older you are when you get pregnant, the more chances you have to experience it.
In order to treat the tumor, a substance that melts the tumor is injected into the pregnant woman’s body. After this, it’s recommended not to try and get pregnant again for 6-12 months.
Multiples Pregnancy – in recent times we are witnessing a growth in the amount of women who experience Multiples Pregnancy. One of the main reasons for than is the increasing numbers of women going through fertility treatments like assisted conception and fertility medication.
Pregnancy Termination – initiated pregnancy termination or in another word, abortion, are carried out in cases when the fetus has no pulse or when it suffers from an illness or deficiency. In Israel, abortions can be executed until the 17th week in most clinics and medical centers, but there are some hospitals that will perform it until as late as the 23d week.
The Anticipated Procedure – In order to get to do an abortion, you will have to get the approval of an experts committee. The committee will determine whether or not you can have an abortion, and if the decision is positive, the hospital will than determine when and how the procedure will accure. When the pregnancy is in the more advanced stages, the committee will include high ranked experts.
What are the choices that we have?
Natural Pregnancy Loss – our first option is simply to hold tight and let nature take it’s toll, or in other words – to let our pregnancy to end by it’s own. Natural pregnancy loss could take place at the early stages, and this option requires a close and precise medical supervision. Sadly, our body doesn’t always recognize the defect in the pregnancy or doesn’t react as fast as we want it to. By choosing this path, we need to know we are risking in an emergency and the need of a fast and critical medical intervention.
Using medication – this procedure could take place until the 7th week of the pregnancy. In some hospitals it occurs in women departments but in most of them it will take place without the need to stay over night. The procedure has two stages, with one pill taken at each stage. The first stage is to take the first pill, and afterwards spending a couple of hours under supervision at a hospital. Than you go home and come back 48 hours later for the second pill and a six hours supervision. If there are complications, you will be hospitalized for a longer time. If everything is normal, you will go home and come back two days later for an examination and a follow-up.
Curettage – a surgical procedure in which the medical team cleans the inside of the womb. During the curettage, tissues are taken out of the uterus by a spoon-like instrument. The process takes between 20 to 30 minutes, and is done under full anesthetization. In order to prevent future problems and infections, the patient will be taking antibiotics.
To help the procedure, a seaweed called Laminaria is inserted into the cervix area a day before the surgery. The seaweed’s job is to adsorb liquids and help the cervix to be wilder, so that the chances of internal damage are minimized.
After the abortion, you might experience bleedings that could last up to two weeks, continuously or alternately. Regular period should start showing 4-8 weeks afterwards.
Women with negative RH must be injected with a substance called Anti D within 72 hours from the abortion, to protect them from dangerous antibodies from the fetus’s blood.
The Loss of a Newborn
Premature Birth – sometimes, even though the pregnancy seem to be in order, contractions will begin prematurely, unstoppable and without any medical reason. When this happens during the early stages of the pregnancy, the newborn passes while the mother is giving birth or a very short time afterwards. If the pregnancy is more developed, around the 23rd or 24th week, there is a chance the baby can be saved, and it will be receiving treatment at the hospital’s Neonatal Intensive Care unit (NICU). In Israel, premature birth in the early stages of pregnancy takes place in four out of a thousand pregnancies. In most cases, we can only find out the cause in the postmortem examinations.
Stillbirth – when a child is born deceased. Called stillbirth because there is no baby crying at the end, the traditional indicator for a live, breathing baby. There’s a few reasons for a pregnancy to end with stillbirth – gestational diabetes, high blood pressure, an accident involving the umbilical cord, undetected coagulability and other defects and illnesses. However, the reason for at least half of all stillbirths remain unknown. Most hospitals are prepared to handle these very sensitive, difficult situations. If the death of the fetus is known beforehand, and still there’s a need to go through a regular birth, we recommend to request the assistance of a doula who specializes in stillbirths. It may help to ease and comfort the woman giving birth.
Sudden Infant Death Syndrome (Crib Death) – one of the greatest (and saddest) medical mysteries. Crib Death refers to when a child under 12 months dies in his sleep, with no warning signs or explanations, even after a comprehensive examination of the scene and baby. In recent years, few risk factors have started to come up – low weight at birth time, multiples pregnancy, lacking of proper medical surveillance during the pregnancy, mother who is 20 years old and under, exposure to cigarettes smoke and sleeping on the belly. In order to try and minimize the risk, it is advised to put your baby to sleep on it’s side, preferably on a hard mattress. Also, you need to avoid overheating the room and smoking indoors.
Burial and Grieving Costumes of Fetuses and Newborns in Judaism
According to Judaism, a baby born before it’s time belongs to a different category – it did not fully developed into a whole human being, and is stuck between being a fetus and being a real baby. Therefor, a child who passes within 30 days of his birth, is not considered as a baby, and grieving customs do not apply to him. There is no obligation to say Kadish, to arrange a funeral or to make a Kria (קריעה – the customary ripping of clothes).
Name Giving and Circumcision – if the deceased is a baby boy less than eight years old, Hevra Kadisha usually circumcise him before burial. Regarding the name – it is customary to name the baby as fast as possible, to help and allow grieving, and so it’ll be remembered by name. Naming before the burial is custom with both girls and boys.
Your Mommy and Daddy wish to speak about you.
Thirteen weeks you spent inside your mother’s womb, you loved meat, tomatoes and orange juice.
You were growing in your own fetus’s time, while your mommy and daddy were planning a room for you, with colourful curtains and ducklings on the walls.
You were warm inside, you were safe and sound.
You were happy. The ultrasound showed your fast heartbeat, as if you were excited to be seen by your Mommy and Daddy, and you already had a small nose and fast moving arms.
You were good inside, and it was good for us knowing you are there, we waited for you with patience.
We want to believe that you were tucked in until the last second, and even when your heart stopped, you didn’t want to come out (truthfully, we also wanted you to stay, just a little bit longer).
Eventually you came out. You came out quietly, like somebody who had given up.
You were only a few centimeters long, fetus size.
You Mother held you in her hands while we took you from the hospital room to the nurse’s station. We knew we were saying good bye.
We are happy that you left us and this world while loving hands are hugging you.
Good bye Jonathan.
Mommy and Daddy love you to the moon and back.