A Pastoral and Theological Response to Losses in Pregnancy
by Janet S. Peterman
Ms. Peterman was the pastor of Saint Michael's Lutheran Church, Philadelphia in 1987.
This article appeared in The Christian Century, September 9-16, 1987 pp. 750-753. Copyright by The Christian Century Foundation; used by permission. Current articles and subscription information can be found at www.christiancentury.org. This article was prepared for Religion Online by John R. Bushell.
Many believe that an early miscarriage is not a real loss.
Last year on Pentecost I baptized an infant named Diana Lynn. No one but her mother came to watch. Diana was stillborn. Her mother, a visitor in our city, had waited hours for the hospital staff to find a pastor who would help her hand her child to God. Baptism was what she specifically demanded, what she had been taught to value as the unique means of salvation in Jesus Christ.
Presented with the same pastoral need again I would not hesitate to respond again with baptism. Yet baptism hardly fits the situation of a child who dies at birth, for it makes the act seem like a magical trick that opens God's arms. It leads us to believe that the arms of Christ on the cross are not already opened wide enough to receive this little one.
In the book Baptism: A Pastoral Perspective (Augsburg, 1975) Eugene Brand encourages teaching about baptism within the context of the gospel's call to repentance and faith. He notes that people are always led astray when the discussion of baptism focuses on whether an unbaptized infant can be saved.
"To think that for lack of Baptism a child would not be saved is to posit the responsibility for salvation with the church. More seriously , it evidences a defective view of God's love and mercy, and the freedom of his grace. It is one thing to hear the gospel truly and then refuse Baptism; it is quite another to die before one even knows of Baptism or the gospel." [pp. 42-31.
In a short treatise called "Comfort for Women Who Have Had a Miscarriage," Luther wrote that the church might acknowledge the agony of parents who lose a child during pregnancy or at birth. He wrote in order that parents, especially mothers, might be consoled, and to help them see that miscarriage is not a sign of God's wrath. Luther also addressed the question of the child's salvation if it died before baptism, noting that though we cannot presume God's salvation of the child without baptism, we can pray earnestly and trust in God's mercy.
Because the mother is a believing Christian it is to be hoped that her heartfelt cry and deep longing to bring her child to be baptized will be accepted by God as an effective prayer [for the salvation of the child].... Whatever [she] sincerely prays for, especially in the unexpressed yearning of [her] heart, becomes a great, unbearable cry in God's ears [Luther's Works, vol. 43 (Muhlenburg, 1960), pp. 247-81.
Baptism is inappropriate in the case of a stillbirth to the extent that it, denies God's ability to be merciful and takes the sacrament out of its biblical context of a call to repentance and faith.
On the other hand, baptism is appropriate in the case of a stillborn child inasmuch as the church has no commonly recognized rite for acknowledging a loss in pregnancy. Parents who suffer a loss in pregnancy need to experience what is affirmed in baptism: (1) the child's uniqueness before God; (2) the child's belonging to the community of faith; (3) the church's recognition that the death of the child is a real loss; and (4) the support of the Christian community for Christian parents, in this case parents who have experienced a significant loss. In the absence of something more appropriate, it is understandable that some faithful parents who experience a loss in pregnancy will request that the child be baptized.
0n Pentecost evening, the day when the gift of the Spirit was given to the church, Diana's mother sat in silence in her room. Nurses ran around the hospital nervously. "She won't give up the baby," the head nurse said to the person who called me. You could hear the panic in her voice. Meanwhile, Diana's mother sat, alone and in silence, for more than three hours.
Pregnancy and birth have always involved medical risk. In 1900 one mother died for every 100 deliveries, and ten babies of every 100 did not reach their first birthday. In just 85 years medicine has made marvelous progress in reducing the risks of pregnancy, birth and the first year of life. Still, not all pregnancies end well. Today it is estimated that between 15 and 30 per cent of pregnancies end in miscarriage, and one in 80 ends in the birth of a stillborn child. Many couples experience a loss in pregnancy. Yet these parents often report that almost no one understands their loss.
The medical response to these parents, especially to the mothers, can be quite insensitive. The mother of a stillborn child may be given a room with a mother who has just had a healthy baby. In the case of miscarriage, the mother may be told that she was never pregnant, even in the face of confirmed blood tests.
When obstetricians were asked in a survey why they did not discuss the risks of miscarriage with their patients, they usually answered something like, "Most pregnancies turn out well, so why should I interfere with my patients' happiness and cause them to worry about something that won't happen?" Even physicians have trouble dealing with the fact that pregnancy can end in death rather than life. (See Rochelle Friedman and Bonnie Gradstein, Surviving Pregnancy Loss [Little, Brown, 19821, p. 30.) To medical personnel, these deaths can represent failure, even personal failure. To family and friends, they are a painful reminder of the frailty of life and of childbearing. Others may turn away to hide their own vulnerability. In the face of these responses parents often feel abandoned.
The church's response has not been considerably better. Diana's mother wrote, "We were told that it was difficult for the director of nursing to find a pastor willing to come out to baptize Diana. We do not know if it was because on Sunday evening most pastors are involved with their own congregations or if it was because the death of an infant is so hard to face. "She understood the church's vulnerability.
I recently spent roughly six hours in a Lutheran seminary library looking for resources about losses in pregnancy. I looked in the card catalogue under "Death" and was encouraged to discover that in the past decade the circle of what is written about death has widened. There are now books on hospice care, euthanasia, abortion, suicide, bereavement, dealing with children about death, and moral and religious questions relating to death. But after hours of searching I found only one brief paragraph about stillbirth, and nothing about other losses in pregnancy. What is the searcher to assume? That this is not a death? Not a loss? That is a silence more oppressive than that hospital corridor on Pentecost night.
I checked other entries- "Stillbirth," "Miscarriage," Grief," "Pregnancy" -- and journals of pastoral care and worship materials. In each case there wlittle or nothing on the topic, and the little was difficult to uncover. One work that deals directly with stillbirth and miscarriage was cross-referenced under "Fetal Death" and "Perinatal Mortality. "Such sterile medical language is another kind of silence. In our culture and in the church, there is a great silence on this issue. For parents who have lost a pregnancy or had a stillbirth, the church is often an alienating place.
However, several good secular books have been written in the past decade to assist parents who have experienced a loss in pregnancy. If the church is to break the crisis of silence and speak a healing word, it needs information about losses in pregnancy and about the pastoral needs of families who suffer such losses.
Miscarriage is defined as the loss of a child prior to the 20th week of pregnancy; stillbirth is the death of a fetus after the 20th week. The largest percentage of miscarriages are caused by genetic accidents over which no one has control. Infection, hormones, metabolic and environmental factors also contribute. Stillbirths happen because of disease in the mother, genetic abnormalities in the child or difficulties in delivery. But sometimes the cause of death remains unknown.
Most people assume that the longer the pregnancy before the baby dies, the greater the loss. Consequently, many believe that an early miscarriage is not a real loss. There are differences in the grief reactions of parents according to their particular circumstances, including how far the pregnancy had developed; but a study by sociologists Larry G. Peppers and Ronald J. Knapp revealed that a loss in pregnancy, whenever it happens, is mourned as a loss in its own right. Peppers and Knapp studied 100 mothers and fathers who lost a child through miscarriage, at birth or in the first 28 days of life. Nancy Berezin summarizes their results:
"They found no difference in maternal reaction (e.g., sadness, insomnia, guilt feelings) between mothers who had suffered early fetal losses and mothers who had suffered either a stillbirth or a neonatal death. However, the researchers found that the nature and intensity of grief were strongly affected by the inappropriate reactions of friends, relatives and caregivers [After a Loss in Pregnancy: Help for Families Affected by a Miscarriage, a Stillbirth or the Loss of a Newborn (Simon & Schuster, 1982), p. 191.
What then, are the pastoral needs of those who have experienced death when they expected life? Just as there are many different hopes, dreams and expectations related to pregnancy, there are many different reactions to a loss in pregnancy. Yet some general themes can be touched upon that those in the church should be aware of.
First, the loss is experienced like any other death. Says obstetrician Jan Schneider:
"Spontaneous abortion [the medical name for miscarriage] has frequently been assumed to carry little emotional impact. Many miscarriages are known to be caused by chromosomal abnormalities incompatible with life and medicine has tended to consider miscarriage as a pregnancy that never was. Yet to the mother, it represents a baby who will never be [quoted in After a Loss in Pregnancy, p. I I].
Miscarriage is often a loss that is invisible to others, and parents may have to struggle for the right to grieve the loss of this baby and the loss of their future with this child.
Second, with a loss in pregnancy, the emotions of grief are sometimes 'complicated by fears about the mother's life or health. Often parents worry about whether they will have trouble with another pregnancy. Some fear that they will never be able to have a child. Also, mothers often feel guilt over the death, worrying about what they did or failed to do. Well-meaning. comments during pregnancy like "You're working too hard" or "Don't walk too much" can return to haunt a grieving woman. Implicitly, the woman is blamed. Pastor and congregation need to communicate the fact that losses in pregnancy are not sins to be forgiven but deaths to be mourned. Anger at God is not unheard-of among us. We can help others to express their emotions, we can listen, we can share another's grief.
Third, there is a need to be sensitive toward the grieving parents as a couple. For some couples the tragedy is their first serious life crisis, their first grief experience, or the first time they have felt isolated from each other. Losses in pregnancy can cause difficulties in the marriage.
The loss affects both parents, yet fathers and mothers do react differently. Bonding with the baby during pregnancy is slower for men than for women, and fathers often experience the loss as a disappointment of what they hoped would be, whereas mothers experience it as a death of what already was. Also, fathers are frequently overlooked when sympathy is extended; they tend to be powerless spectators of the crisis and the medical response.
Fourth, parents have a need to understand the options before them. For many years it was taught that the best thing a parent could do after a loss in pregnancy was to forget it. "Go home and get on with your life," they were told . This advice sometimes included the admonition to have another child as quickly as possible.
Anyone who has studied grief knows how devastating such avoidance is. Ignoring death, using sleeping pills (a common prescription for mothers of stillborns), or having another child does not make the loss disappear. Healing comes only in grieving, remembering and then moving on. We need memories.
Recent studies suggest that seeing or holding a stillborn child helps parents accept the reality of the death. Of course, no parent should be forced to do something that she or he doesn't want to do. Many parents, however, take comfort in how normal their child appears or how peaceful he or she appears in death. Imagining is often worse than seeing and knowing.
Pastors who are called into the hospital early after a death or loss can help parents understand the decisions before them. What should be done with the remains? What kind of pathology reports might be useful (e.g., chromosome studies)? Would it be helpful to see the remains? What kind of worship service would be appropriate and comforting? Will there be a burial? What other things might aid in remembering? Would naming this child be a good idea? If needed, pastors can also provide support for the parents' dealings with medical personnel.
Finally, medical personnel who have repeatedly witnessed infant deaths and miscarriages need pastoral care. Chaplains in hospitals might well consider establishing continuing education programs for their staff who work in obstetrics. Pastors of congregations which include health professionals might consider gathering them together occasionally to talk about the emotional costs of their work and the resources faith offers in situations of death and grief.
There are specific steps the church can take to become a more hospitable place for parents who have experienced death when they hoped for life. To begin with, it should clarify its teaching about baptism. We need to communicate clearly the commands of Christ regarding baptism (cf. Mark 16:16 and Matt. 28:19) without giving the impression that God saves only the baptized.
The church should also make references to the losses of miscarriage and stillbirth part of the natural discourse of the congregation. Public recognition of this kind of loss makes grieving more acceptable and possible. Premarital counseling is a natural time to mention the possibility of difficulties in pregnancy. Sermon illustrations can use miscarriage or stillbirth as an example of loss or grief. (Sermons might also highlight the positive biblical images of adoption-e.g., the royal psalms and the adoption imagery at Jesus' baptism.) Intercessions for the grieving might occasionally include mention of parents who have suffered a loss in pregnancy, even when one is not aware of such losses that particular week. Also, church libraries could easily include a book or two on the subject, such as Berezin's After Loss in Pregnancy, or Miscarriage, by Sherokee Ilse and Linda Hammer Burns (Lakeland Press, 1985). Both are short, good, and easy reading. While being careful to respect the parents' need for privacy, the community of faith can publicly recognize the loss in the same way that it makes mention of other deaths and offers consolation.
Finally, the church should provide a rite for use at the time of stillbirth or miscarriage. The rite should be published where it is seen and discussed. When parents and pastors know that an appropriate rite is available, it will seem a natural choice and a comfort in the time of loss.
What is it that the community of faith wants and needs to affirm at the time of a stillbirth or miscarriage? It needs to affirm that this experience is not what God intends life to be for us, and to proclaim that in Christ, God reaches out to the suffering with comfort and healing.
A public rite provides a public means for the family and faith community to mourn its loss and to acknowledge the uniqueness of this child or this pregnancy. The public rite encourages parents to accept their loss and God's consolation rather than avoid it. It helps them to commend their child or pregnancy back to God. The rite should be brief, including words of comfort, a biblical lesson and prayers; it could easily expand into a full memorial service, with or without Holy Communion. It should be remembered that parents may not want a public worship service in the sanctuary. Allowing the parents to choose what is helpful for them assists them as they grieve.
One word alone does not traverse a void of silence. The silence does not exist simply because we haven't known that so many suffered with losses in pregnancy. It exists because these early deaths are particularly hard for us to face. They remind us of the vulnerability of life. If we in the church can be more public in facing these deaths, then together we can find ways to surround with care those who have experienced such loss, and help them remember and, in Christ, be healed.
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