Just when we thought death was no longer taboo, just when death had become as casual a topic of conversation as sex and real estate, comes a book to remind us that some deaths are still unspeakable. For all our supposed acceptance of death as a fact of life, we're still rendered mute in the face of a death we can never make sense of: the death of a newborn baby.
The awesomeness of this grotesque commingling of life's end with its beginning makes us say stupid things. "You'll soon have another baby," we coo, or "Nature only miscarries deformed fetuses," or, worse, "At least she died before you got a chance to know her." Most of us choose to say nothing at all, avoiding the topic in the self-serving belief that the parents prefer not to talk about it.
But when a fetus or infant dies -- be it through miscarriage, abortion for medical reasons, stillbirth, or neonatal disease -- the most useful therapy is talk. According to Susan Borg and Judith Lasker, co-authors of "When Pregnancy Fails," bereaved parents "need to be able to discuss their feelings, to express the anger, the guilt, the sense of failure. They need to be reassured that their feelings are legitimate, that they are going through a normal grieving process. They need to repeat conversations, to be constantly reassured, to have someone who will listen to the same details again and again."
Borg and Lasker know because they themselves are bereaved parents. Friends since girlhood, they each experienced in 1978 the shock of losing a newborn. And their response, after months of mourning and telling each other the same details again and again, was to write this compelling and intelligent book.
"When Pregnancy Fails" has no happy endings. All the threatened abortions described end in miscarriage; all the prenatal tests turn up deformities; all the labors and deliveries lead to the births of infants who, if not dead already, soon will die. And yet, the book is not morose. Borg and Lasker go beyond the painful stories of the dozens of families they met, to discussions of the social issues raised by infant death: the often bungling roles played by medical professionals, the clergy, the funeral industry, and the bereaved parents' own parents and friends; the possibility that malpractice or environmental pollution contributes to the nearly 1 million birth tragedies in America each year; and the ways in which these saddened, stunned families cope with their lives and make decisions about their futures.
The authors' message is that the dead baby, no matter what its gestational age, was a real presence to its parents, and its loss is a devastating loss. "The parents grieve for their baby just as they would grieve for a person who has lived." Even in an early miscarriage, which may occur long before the first signs of life are physically evident, the parents lose a child who occupied an important place in their imaginations and their hearts. "They grieve for the person whom they feel they already knew well and for the dream of what that person would become."
Faced with this very real -- and usually totally unexpected -- loss, the parents, unfamiliar with the details of death, often blindly accept advice to put the past quickly behind them. This means dispensing with holding funeral services, selecting a cemetery plot, giving the child a name ("Save the name for the next child," one unthinking nurse suggested), or even seeing or touching him. But this secretiveness doesn't make the mourning process any easier, say Borg and Lasker; it simply makes it more mysterious. "If they have no pictures, no gravestone, no treasured thoughts of a baby's individual characteristics, [the parents] may wonder why they're feeling so bad, what it is they are mourning for."
The authors suggest that parents of stillborn babies be allowed to hold them in the delivery room -- and, if they decline when the baby is first offered, that they be given a chance to change their minds. Memorial services for infants, say the authors, and even for miscarried fetuses, can help the parents and the community better understand their grief. So can naming the infant, and referring to him by name. And if the failed pregnancy was a first pregnancy, the parents must be encouraged to think of the next child as the family's second, not first, baby.
"When Pregnancy Fails" has very few rough spots -- the early chapters are a bit abrupt, and the chapter on malpractice is short on basic medical information -- but these are minor quibbles. Borg and Lasker have succeeded in turning their own unspeakable tragedies into a unique, well-written book. With its straightforward tone and comprehensive approach, it will offer solace and support to bereaved parents and guidelines for those who aid them: friends, parents, physicians, nurses, counselors, and ministers.
The book would perhaps do the most good for a group of readers it probably never will reach -- expectant parents. If they can bear to think about death at a time when their thoughts are filled with new life, maybe they would feel less helpless should their own baby die. Ignorance is not bliss if, in ignorance, the shocked parents miss the one look, touch, or gesture that might have helped give some shape to their boundless grief. "We were young, our kids were young -- who thinks about cemetery plots and undertakers?" one parent recalls. "We never thought for a minute that instead of a crib we'd need a casket."