Choices Before Termination
Knowing what to expect from your procedure;
and making memories to last a lifetime
By Nancy W.
Did you know that the Chinese characters which make up the word for "crisis" include two symbols, one for danger, and one for opportunity? I
know that this is a time frought with much anguish for you. But I would like to help you also see it from the perspective of opportunity.
I want to give you some ideas to think about as you go through your procedure. I recognize, by this point, you are nearly numb; at least I was.
And you may feel that you are beyond making any more decisions. But there are some things you may want to consider. The information provided here
may help you to feel that you have some control in how the process goes, which will later help your grief process along.
Choices before termination: Time-limited or not?
The choices vary somewhat according to which procedure you are having, so keep that in mind. Also, some of the choices are very time-limited,
in other words, you have a limited window of opportunity in which to do some of the things. I will try and differentiate which things are time
limited, so you can focus on these things first and make the necessary decisions.
I don't want to completely overwhelm you, but I know from both personal and professional experience that most people would want to know what
choices they might have, and not all facilities are set up to educate you on the process and give you the choices. For some of these choices, once
the window of opportunity is over, it is gone forever. Many parents go through this process with no idea of what they might have done, and later
feel remorse for the missed opportunities.
The importance of making memories
Let me digress and talk about making memories for a moment. You may not realize it right now, but making some loving memories of your otherwise
difficult day can be the beginning of the healing process; the beginnings of healthy grief "work" which we all need to do in order to put our loss
in some perspective over time. It is in no way wrong to want to make some memories. For instance, as long as there have been cameras, folks have
been capturing the image of their stillborn infants for posterity. There is nothing new about that idea. Think of what you do as a way of honoring
your little baby's brief presence in your lives.
No matter which procedure, if you have a religious faith, you may want to consider having a blessing or in-utero "baptism" of your baby prior to
beginning the procedure. This is one of those time-sensitive choices. You may or may not be prepared to name your baby. Naming is not time-dependent,
and each person has their own unique feelings about naming, so take your time. But contact your pastor, or inquire if a chaplain is available if
this is important to you.
What to bring for your procedure
You may want to consider packing the following: calming music, comfy pajamas and warm socks, your favorite pillow, maybe a special stuffed animal
to hug and snacks to sustain your husband or partner. Consider any special items you might want: some folks have brought teeny preemie clothes or a
baby receiving blanket along to use and then have as keepsakes. Bringing along an inkpad for foot and handprints if the baby is big enough, and a
card to print them on, is something I wish I had done. Prints are priceless and are time sensitive. Don't forget your camera: You may decide against
using it, but at least you will have the option open.
Choices by trimester: First trimester
I don't know how far along you are, so I will consider three possible scenarios. First is a first trimester termination. This is usually
accomplished with a dilation and cutterage (D&C). You may or may not be awake for the procedure. Your opportunity to "see" your baby is on the
ultrasound pictures. If there are to be any further tests to confirm the diagnosis, you may want to make sure and ask for a copy of the video, and
any still photos. Bringing a blank video is sometimes helpful in this process. If you feel strongly about having the baby's remains, insist that
they cremate the remains. Talk to a funeral director; they can usually be very helpful in answering your questions and helping with options. Make
sure and do this ahead, as well as discussing your wishes with the clinic in advance. Many clinics are not used to doing this for a first trimester
D&C, so you may have to help the process along if you feel strongly about it.
After the first trimester, the procedure may be either to labor and delivery (L&D) or dilation and evacuation/extraction of the fetus (D&E). I
will give you some ideas about each.
If you labor and deliver, they will start by dilating the cervix. Usually, in the US, this procedure involves seaweed sticks, called laminaria.
These are inserted all at once or over time as the cervix dilates. Laminaria cause cramping which can be fairly painful as the cervix changes. In
some other countries, other medications are used to soften the cervix. This process of softening the cervix is often doen the day before as an
outpatient, to give it time to work. Most babies are so young that they do not survive the process, but be aware that some babies do survive the
labor and delivery. For this reason, more and more hospitals are either offering or insisting on administering an injection that causes fetal
demise before inducing labor.
Pitocin (or an equivalent pseudo-hormone) is then given to bring on uterine contractions, to further open the cervix and push the baby down and
out. Your labor may be pretty uncomfortable. Ask your physician if you can be medicated or anesthetized. Sometimes you can and sometimes you can't,
depending on your circumstances. Some women find that overuse of pain medication, such as the Demoral pump, slows their labor.
During your labor is a good time for soothing music. If you are not anesthetized, be sure to get up and go to the bathroom frequently, as a full
bladder slows the labor by blocking the descent of the baby into the birth canal. Just so you know, sometimes tiny babies are delivered into the
toilet. You may want to ask for a bedside commode, for that reason.
The length of the labor can be quite variable, from a few hours to a day or more. As you get nearer to the transition, when you are ready to push
the baby out, you can often tell because you become much more restless and don't want anyone to touch you. You may feel as if you need to have a
bowel movement once the baby has entered the vagina. When the baby is born, they will need to check to see if the entire placenta is delivered. If it
is not, they will want to do a D&C to make sure they can get the entire placenta out. Retained placentas can become infected or cause continued
Memories and keepsakes
If you labor and deliver your baby, then you can have some very precious time with your baby after the birth. If the baby is born alive, you can
hold and comfort your baby until he or she dies. Otherwise, you can hold your baby as long as you would like. This is the time to get photos, and
foot and handprints, all time-sensitive choices. You may want to dress your baby, or wrap him or her in a blanket which you can later keep. You may
want to have a blessing then. Take your time, above all! There is no rush. Do not be rushed into a D&C unless it is absolutely necessary. If you are
anesthetized for that procedure, you may be too sleepy to spend that precious time with your baby. And do not be rushed out of the clinic or hospital
until you are ready to say good-bye to your little one.
Make this time memorable and special. Say what you long to say to your little one. I have had parents sing to their baby for hours, literally,
rocking their little one for this one first and last time. There is no right or wrong; follow your heart. If you are in a hospital, they have a big
camera which they use to photograph all newborns. The hospital may takes pictures of your baby for free (the companies do not charge when there is
a stillbirth). You do not have to see them, if you don't want, however most parents want to down the road. Some hospitals will keep photos, blankets,
etc. for a certain period of time, if you are not ready to take your baby's things. Or take your own pictures. They are priceless, believe me. The
hospital may issue a birth and death certificate if the baby is born alive. Or there may be a baptismal certificate. Save all your papers until you
are ready to sort them out; don't throw anything away just yet. You never know what you might later want to have saved. Get copies of ultrasounds.
Our kids wanted to see Katie and they wanted their little sister to have this one little stuffed dog; we bought three in the hospital gift shop,
so all our kids could have one. It did not turn out that our kids (then ages seven and nine) could see Katie, though I have helped many siblings
over the years to see and hold their baby brother or sister. Done carefully, with a trained professional, these can be very meaningful encounters
for siblings. Our children were able to participate in her funeral however, which helped them a lot.
If you have a D&E, you will not be awake for the procedure, so your choice of memories to make isn't as long. Plus, your baby's remains may not
be intact after the procedure, so you may not get to hold and spend time with your baby. But there are still options: a blessing beforehand,
sometimes a carefully posed picture shot by staff, sometimes that is not possible. Sometimes footprints or handprints are possible, especially if
you bring the stuff for it. And you can bring a special blanket or stuffed animal, just because. Ask the staff ahead of time and tell them you are
making some memories.
Third trimester terminations are usually an L&D procedure as described above. If you are facing a third trimester procedure, you may be bearing
the added burden of traveling to another state to have the procedure done. In most cases, the procedure spans a four-day period with labor and
delivery on the third day and a final check-up on day four. The few doctors who perform third trimester procedures in this country are more
familiar with the heartbreak that making this decision entails and usually offer many of the options discussed above, such as baptism, photos and
holding your baby.
You need to consider what you would like to have done with the baby's remains. Most funeral homes handle a tiny baby's remains for free if
simple cremation is chosen. You may have to pay extra for a special urn or box for ashes, and you will have to pay for a casket, if one is used.
You will have to pay for funeral services, and for burial and a headstone, and possibly the burial plot. Some cemeteries have a special area for
babies. Ask your care provider how they coordinate with the funeral home,and who does what, when. Also know, that you can have the baby's ashes
returned to you (usually for free), and that you can keep them as long as you lieke, or you can choose to either have them interred at a later
date, or scatter them in an appropriate place. Also clarify if you or your doctor want an autopsy prior to the funeral home coming for your baby's
Choices that are not time-sensitive
From this point forward, your choices are no longer time-sensitive. You can plan a memorial service and decide about your baby's final resting
place at your own pace. If you ask on the listserv or in the discussion forum, you will see that folks have done all sorts of things to commemorate
their little ones. Over time, you can decide what you want to do with the things you have saved.
You can make a scrapbook, a Web page, or put your special things in a memory chest. You may want to decide to honor your baby with a special
donation to a charity, or you may want to plant a tree, or plant a garden, or you may want to release balloons in a special ceremony.
We had Katie cremated and her ashes placed in a beautiful little wooden box, with a plaque on it engraved with her name and the date. We took
her ashes back east to Cape Cod, where we buried her in a family cemetery along with eleven generations of my family. We all wrote letters to her
and buried the originals with her. Her name is on the family headstone. For five years after we buried her, we sent a tiny Christmas tree back east
every winter for her grave ... and each summer my folks plant flowers on her grave. We get back when we can; our other babies' remains are
scattered in the Rocky Mountains near where we lived at that time. We own an airplane, and we get back from time to time and fly over our special
place. We also donated to the hospital foundation, and she has a beautiful plaque in the hospital's lobby on their "Tree of Life." I love to go there
and trace her name with my finger ... just to know she existed!
Some people have an obituary done. Others do not tell anyone. What you say, and to whom is intensely personal. If you tell your story, feel free
to tell only part of it to people you aren't comfortable with knowing about your decision. I often say simply that Katie was stillborn, since she
was. Also because, in our culture, stillbirth garners more respect than miscarriage, so people recognize your loss as significant. If you say
miscarried, most people will just pass your experience off as nothing (isn't that sad?) I live in an intensely conservative right-wing anti-abortion
county. I do not tell many people what we actually did; I do not feel the need for the kind of response we would get.
Make a plan
I just want to reiterate how important it is to make a plan. Some parents even write it out and bring it with them and share it with the staff.
As someone who has been on both sides of this fence, I can tell you that it will help the staff be more sensitive to your needs. And it will give
you some control in a situation where you often feel out of control.
You will get great support on the AHC listserv and Discussion Board.
There are hundreds of moms and usually a few dads who are either actively participating or lurking there, ready to help if they can. Your privacy
will be respected. Being able to express your thoughts and feelings, to "get them out" is very healing. In some of the major metropolitan areas we
try to have get-togethers a couple of times a year.
I have written another article for this site called Grief After A Heartbreaking
Choice, which can give you information about the process of grief after termination.
I know this has been long, but I know that you will be better off if you are well prepared beforehand. Forgive me if it seems there is "too much
information" here. I bring these things up because I have helped scores of couples through this process and know what usually matters. The hardest
thing is to run into parents, after the fact, and hear their laments for things they wish they known about ahead of time while there was still a
chance to do them.
For those of you who have not found this letter beforehand, or who may have not been given all of these choices: reading this article may cause
you to have some regrets. Please know that you did the very best you could, given the unique situation you were in. Also, even armed with options,
we are often unable to make choices because of the state of shock we are in at the time. Please be gentle with yourself, and remember: It is
never too late to find a special way to honor your precious child!
Much of the healing process revolves around working through the see-saw of second-guessing. Arming yourself with information empowers you to make
choices on your path to healing.
Last of all, I want to offer you hope. You will survive this great and ultimate gift of selfless love for your precious child. If you pay some
attention to your grief work, you will someday find meaning and purpose in your baby's brief life.
There are many websites available that will help you make memories of your little one. We would be glad to post a link to reliable sources for
memorial photography, memorial markers, memorial jewelry, etc. Please check here for Memorial ideas: