Choices Urged For Parents Mourning A Baby's Death

GAINESVILLE, Fla.---Expecting the joy of birth, but experiencing the sorrow of death: That is the heartbreaking tragedy for parents of stillborn babies.

As parents begin to grieve, some will want to see and hold their baby; others will be more at peace never seeing their child. Some will want a private funeral and seek detailed information about the cause of death; others will choose hospital cremation and not want to hear any more about why it happened.

"The important thing is for parents to decide, not physicians and nurses," said University of Florida obstetrician Dr. Kenneth Kellner. "We have reviewed more than 800 cases in which babies died in the womb or within 24 hours after birth. We learned there is no way to predict whowill select which methods of grieving."

Kellner's research was published earlier this year in the Journal ofPsychosomatic Obstetrics and Gynecology.

While it might sound like common sense to give parents options, only in the past 20 years have American hospitals routinely offered the opportunity to see stillborn babies. Still, there are pockets ofresistance among hospital staff who are uncomfortable with the issue. In other places, parental choice is taken away by staff who insist they see their child.

"Making choices gives people a feeling of control over their lives," said Kellner, a professor in UF's College of Medicine. "Furthermore, there is little information to suggest that any one choice is a healthier way to grieve."

In Kellner's study, 80 percent of the mothers saw their babies and 55 percent held them. Among fathers, 72 percent saw their baby and 39 percent held them. Most of the babies--75 percent--were named and private memorial services were held for 30 percent. The data were collected at Shandshospital at UF from Jan. 1, 1979, through March 1, 1991.

Most pregnancies conclude with the delivery of a healthy baby, but eachyear tens of thousands of families in the United States experience a fetal death after the 20th week of gestation. In 1992, the most recent year for which information is available, there were 30,284 such deaths, according to the National Center for Health Statistics.

"This has been a difficult issue for physicians and nurses, in part because of the training we used to receive," Kellner said. "What I was taught as a resident was that this is something that should be swept under the table, that people didn't want to talk about it, so the quicker momgot pregnant again and the quicker she forgot about it the better."

When a colleague showed him a book about mother-infant bonding more than 20 years ago, Kellner began to believe it was time to ask parents what they wanted.

"When I first started telling mothers that they could see and hold their baby, many of my colleagues said the idea was morbid and sick," Kellner said. "So I would ask them: 'If her mom died, shouldn't she have the right to spend some time alone with her to say goodbye?' And they would try totell me, 'That's different.'

"But it's not different. What's important is what the baby means to her, not what the baby means to us. She has lost her future with an infant she has idealized."

Kellner frequently receives calls, especially from nurses, who complain that physicians won't show parents the babies. As he has done for years, Kellner visits such hospitals, emphasizing that parents must be given control.

In other places, the pendulum has swung in the opposite direction.

"Some people have lots of fears and are rushed into seeing their child," said Cathi Lammert, executive director of the National SHARE Office, a Missouri-based support organization with local chapters throughout the country for families who have experienced stillbirth or early infant death. "I've had parents call me and say they felt their rights wereviolated. One woman didn't want to know the sex of her baby, but the counselor came in and said, 'I have pictures of your son.' "

Kellner and several other UF researchers tried to determine whether the age, race, marital status, educational level and religion of the mother influenced grieving choices. But none of those factors was related.

"We're constantly surprised by how people react," Kellner said. "We know we shouldn't presume anything, but sometimes with an adolescent mom, we'll think: 'She seems pretty immature. She's not going to name the baby and we're never going to see her again.'

"And yet, she wants a funeral, wants to name this baby, hold this baby, and lo and behold, she comes back for her postpartum visit and comes back again later for the autopsy report."

Kellner and his colleagues at UF have now helped more than 1,200 families through the pain of stillbirth and early infant death.

"You can't bring the babies back to life, but