Pregnancy Loss At Any Trimester

February 15, 2020 Jelina Sonnenberg

Death is never an easy subject to discuss. Society most of the time just tries to use it as a headline for shock value and views.

But when it comes to pregnancy loss though, society has a good way of trying to brush it under the rug. It makes people uncomfortable. It’s not something that is just talked about at dinner (albeit I wish it would be).

I wish it would be discussed more openly between people. Before some type of tragedy happens. Before someone loses a pregnancy or an infant. Before people feel utterly broken and alone, only to find out they aren’t. Where once that tragic information is told to them, or when the bleeding begins, they know immediately who to turn to, because they’re NOT ALONE. That they have people from the get go who will help them navigate this journey of loss.

Ugh I just want to scream it from the mountain tops. YOU ARE NOT ALONE. Going through this may be difficult. You or a friend may be reading through it through tears. Please reach out to me, honestly. I will help in whatever way I can.

And please take EVERYTHING you can. Take all the photos, of everything. I promise you, in 5 years, you WILL want everything you can get from the day you meet your baby. These will be the only tangible memories you have.

🌿 Early Pregnancy: Medically Assisted Birth (D&C or D&E)

Birth in a hospital: you may be placed under general anesthesia, or sedation, and after the birth, you will stay in recovery for a few hours, when you will be discharged.

Birth at an office : the doctor may administer local anesthesia, and your discharge will be in less than an hour (like a pelvic exam).

What to Bring
1. Camera
2. Someone to support you (to wait in waiting room, and to drive you home)
3. Scented eye mask to wear during the birth (not your favorite smell though, it may be triggering later on during your healing process. The flip side though, that if it’s your favorite scent and you smell it later, it may bring back happy memories of the day you met your baby).
4. Music (use headphones)
5. Wear your favorite scented lotion or perfume
6. Any ultrasound pictures you may have, favorite scriptures, inspirational quotes or affirmations, that you can read in the waiting room

Welcoming Your Baby
During this stage of pregnancy, you may likely be discouraged from seeing your baby. Your baby may not be delivered completely intact physically. If you ask your doctor during the time of the birth, you may be allowed to have your baby’s physical form returned to you after their analysis/autopsy of the baby is complete. If you are permitted to have your baby returned to you, a representative of the hospital will likely call you within two weeks of the birth for you to come and receive your baby. He or she will likely be placed in a small container. Please know that your baby’s physical form is not going to be intact, and this may be extremely upsetting for you to see (please consider not opening the container but finding solace in knowing you have your baby with you and are able to bury/cremate your baby).

Other options you have if you choose not to take your baby home:
1. Hold a funeral/celebration of spirit/burial for your baby
3. Plant a tree in honor of your baby
4. Donate to a charity in your baby’s name

Have at Home:
1. Maxi pads for lochia
2. Warm comforting foods for your body during this healing time.

🌿 First Trimester At-Home Birth (4-10 weeks gestation)

Things to have: support person, phone (to call 911 in case of heavy bleeding), maxi pads, camera, and plenty of water/food to keep your energy up, several large old towels, latex gloves for scooping from toilet if needed

However, the earlier in the pregnancy you are, it will be very unlikely that you will be able to identify or retrieve your very tiny baby (flushing is very likely inevitable). If you are able to retrieve your baby, please see the After Birth section of the 10-20 week gestation birth plan below.

🌿 late First/early second Trimester At-Home Birth (10-20 weeks gestation)

Things to do:
1. Set up colander or cheese cloth in or across toilet to catch anything before it goes into the toilet, if you don’t have either of those a net will work as well to be able to scoop things out of the toilet.
2. Set up old towels around the birth space to catch blood.

After the Birth:
1. Large sheet of tinfoil/wax paper - to be used as a place to hold/view baby
2. Saline (contact solution) can be put in a clear shot glass/cup/vase (this helps restore your baby’s fullness and can magnify his or her shape so you can see him or her more clearly)
3. Tweezers/toothpicks - to help move any pieces of placenta/sac

Things to Expect
1. Sometimes bleeding will begin, and then completely stop (for hours or even days) before resuming.
2. Bleeding should not fill a heavy maxi pad sooner than one hour at any time during the labor.
3. The placenta is between the size of a pear to a grapefruit, and will probably be expelled in grape sized pieces and is expelled every time the bathroom is used. Very rarely does it birth in one piece, however it is possible.
4. Very small, fleshy, flaky pieces of discharge are probably pieces of the uterine lining.
5. It is easier to retrieve everything that is being expelled, to look through and identify your baby, if you hold the small fish net or colander underneath your vagina in the toilet bowl, than it is to allow everything to first be caught in the toilet and attempt to retrieve it after (because everything may be slippery)
6. Labor will likely peak right before the birth of your baby, at which time, for the first hour postpartum, bleeding may increase, but you should not fill a heavy maxi pad sooner than a half hour, during the first hour (after the first hour, bleeding should begin to taper off).
7. When your baby is born, place him or her on the foil tray you have set up on your bathroom counter. Using the tweezers and foil creates a place you can gently pull back some of the additional sac fragments to simply look upon the physical form of your baby. Because physical changes happen rapidly, placing your baby into the clear jar of saline water can help draw out the fullness of his form again and continue to preserve him. You’ll need to change this water at least every 4 hours if you choose to keep him in here longer.
8. Name your baby
9. Take photographs
10. When you are ready, place your baby in the small Tupperware container and then in the special box.

🌿 late First/early second Trimester hospital Birth (10-20 weeks gestation)

What to Pack1. Camera
2. Music playlist/speaker
3. Snacks
4. Cell phone/laptop
5. Massage tools (rice packs, rolling pin, paint roller, oil, etc)
6. Change of clothes for labor partner and birthing person
7. Lip balm/Chapstick
8. Toileries bag (contact case, hair ties, shampoo, toothbrush, deodorant, etc.)
9. Robe
***additional special items: two teddy bears or blankets (one to leave with your baby, and one to take home), mold for baby’s hands or feet

Birth Plan Example:

General:
- Natural Unmedicated Birth
- Quiet Room and Dim Lights
- Aromatherapy Scents
- No medication unless I am aware and provide consent
- No students/trainees - Prefer my waters to break on its own

Labor:
- I would like a Heplock on the outside of my forearm
- IV fluids if I become dehydrated, but would prefer to eat and drink as needed. I need the energy.
- Prefer to maintain all mobility (walking, changing positions, birthing ball, shower, squat bar), emotional dystocia is likely – deep lunging, deep roaring, deep moaning all can help labor progress
- Please limit vaginal exams, and only upon my consent.

Pushing:
- Non-coached 2nd stage when I feel the urge to push
- I would like to try various positions (side lying, hands and knees, squat bar, etc.)

Delivery of Placenta:
- Please do not pull on the cord (no traction)

Baby Care:
- Immediate skin to skin
- I would like my partner (if applicable) to cut the cord.
- Prefer to bath baby on our own

*Mentally prepare for going home. The first few days at home can be very difficult.
*If your baby has hair, ask for scissors to cut a lock off.
*Utilize all of the special plans you have, including saving mementos, holding your baby, capturing baby’s smell with a blanket you will take home with you, dressing your baby, naming your baby, taking photographs, and including a pastor and friends and family.

🌿 second/third trimester hospital Birth (20-40+ weeks gestation)

Vaginal Birth:

What to Pack
1. Camera
2. Music playlist/speaker
3. Snacks
4. Cell phone/laptop
5. Massage tools (rice packs, rolling pin, paint roller, oil, etc)
6. Change of clothes for labor partner and birthing person
7. Lip balm/Chapstick
8. Toileries bag (contact case, hair ties, shampoo, toothbrush, deodorant, etc.)
9. Robe
***additional special items: two teddy bears or blankets (one to leave with your baby, and one to take home), mold for baby’s hands or feet

Birth Plan Example:

Delivery of Placenta:
- Please do not pull on the cord (no traction)

Baby Care:
- Immediate skin to skin
- I would like my partner (if applicable) to cut the cord.
- Prefer to bath baby on our own

Cesarean Birth:

Have at Home:
1. Maxi pads (for lochia)
2. Nursing pads and a a hospital grade pump and storage bags/bottles for milk donation OR cabbage, sage tea, and decongestant for expedited weaning
3. Antacids
4. Dannon Activia yogurt or your favorite probiotics(for healthy digestion)
5. Journal (to remember when to take medications on time as well as journaling and getting your thoughts/emotions/feelings down on paper)
6. Warm comforting foods for your body during this healing time.

What to Pack:
1. Camera
2. Change of clothes for everyone
3. Lip balm/Chapstick
4. Toileries bag (contact case, hair ties, shampoo, toothbrush, deodorant, etc.)
5. Robe

The Broad Process for a Scheduled Cesarean:
- You wil change into a hospital gown upon admittance.
- Blood pressure cuff and heart rate monitor are placed.
- The nurse may shave your bikini line however you can do this before you arrive.
- Your IV is set up
- Once an OR is open, you will typically walk to the room (partner will be taken to a waiting area for them to change before being taken back to the OR).
- Pressure boots are placed on your legs (they reduce the risk of blood clots).
- The anesthesiologist will place an epidural/spinal and will walk you through the procedure if you’ve never had one before.
- Once you are lying down a urinary catheter is set up once you are numb.
- A paper sheet “screen” will be put up to block your view of the surgery, and your hands may be tied down to prevent you from spontaneously touching the open area.
- You can ask for the screen to be dropped as baby is born if you like.
*You can ask your anesthesiologist about an analgesic that may allow you to be more alert after the baby is born (Duramorph).
**May seem like you can’t breathe but if you can talk, you’re breathing.

The Broad Process for an Unplanned Cesarean (a decision was made for a cesarean after labor had begun):
- The nurse may shave your bikini line if needed.
- Your IV is set up if not already set up
- Once an OR is open, you will the wheeled in the hospital bed to the OR (partner will be taken to a waiting area for them to change before being taken back to the OR).
- Pressure boots are placed on your legs (they reduce the risk of blood clots).
- The anesthesiologist will place an epidural/spinal and will walk you through the procedure if one has not been placed already.
- Once you are lying down a urinary catheter is set up once you are numb (if not already placed).
- A paper sheet “screen” will be put up to block your view of the surgery, and your hands may be tied down to prevent you from spontaneously touching the open area.
- You can ask for the screen to be dropped as baby is born if you like.
*You can ask your anesthesiologist about an analgesic that may allow you to be more alert after the baby is born (Duramorph).**May seem like you can’t breathe but if you can talk, you’re breathing.

Birth Plan Example:

Family Centered Cesarean Plan

I would like my partner AND doula to be with me at all times. (I understand we may be separated while anesthesia is administered but would prefer a member of my birth team there for that as well.)
I wish to have an epidural/spinal for anesthesia.
Please no IV narcotics, anti-anxiety, or sedative meds-I want to be as alert as possible to meet my baby. I will ask for something if I feel anxious.
Please do not give anything via IV at all without informing me first
Please limit O.R. conversations to matters related to our baby’s birth-Please limit small talk.
I would like to have my arms free/not strapped down to the table, to be able to hold my baby.
I wish to have the screen lowered/clear screen if available during my baby’s birth.
Please bring my Partner to warmer to receive baby and trim cord.
Please perform double layer suturing to enhance my chance of VBAC in the future.

Resources

StillBirthday - You can find bereavement doulas, more in depth birth plans, and a plethora of other information pertaining to the birth of your baby.
Forever Footprints - Offers keepsakes for you to cherish your baby long after the physical form is gone.
Planning an Infant Funeral
Weighted Teddy Bears - Molly Bears and Comfort Cub
Professional Bereavement Photography - Now I Lay Me Down to Sleep