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Hello & Goodbye

C. Rosenberg

Pregnancy loss is painful, confusing, and isolating. Even without a halachically prescribed period of mourning, parents can learn to grieve for the loss of a life that never was

Wednesday, February 01, 2017

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REAL TIME “Most often, the emotional and psychological difficulties that couples face after pregnancy loss are far more significant than the physical challenges,” says Dr. Victor A. Rosenberg, MD, Attending Physician at North Shore University Hospital, Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine. “Most women will recover physically within a few weeks, but the psychological difficulties persist.” The emotional healing from pregnancy loss can take months and years. Support during that time can make all the difference.

S taring at the static, unmoving figure on a sonogram screen, Malkie Klaristenfeld was practiced enough to figure out that this marked her third stillbirth and 14th pregnancy loss.

It had been 15 years since she’d birthed her first stillborn, an unbearable loss, and experience of yearning, hope, and grief. It was 15 years since she’d realized that the prevailing belief — move on and forget the loss — was at best ineffectual, and at worst, a betrayal of her experience and the life she had carried.

“I couldn’t just move on,” she says. “I couldn’t make myself forget that wrenching nightmare of leaving the hospital, fully cognizant of the growing distance between my child in the hospital morgue and myself. Nor could I fill the aching emptiness of arms bereft of a live bundle of joy. I knew I’d either have to bury myself along with that baby, or do something. There was no forgetting.”

Prevailing medical belief about stillbirths was two-pronged: swift and clinical. The baby had to be removed at the earliest opportunity to prevent maternal infection. As soon as the baby was delivered, the baby was whisked away to the morgue, and the bereaved parents were left with the task of making burial arrangements. And then came the task of “moving on,” forgetting about their loss. For many years, the pervading belief had been that if you don’t see the baby, you don’t connect to it, and can forget about it easily. Malkie knew this wasn’t so; despite mothering a crew of healthy children, she carried the searing agony of loss with her every single day.

Stillbirth was taboo: conversations conducted in whispers, the gender of the baby rarely discussed. Closure, believed both doctors and well-meaning laypeople, would come in the form of a new pregnancy.

But Malkie soon learned that openly confronting a loss can lay the groundwork for healing. She read of how having the opportunity to say hello before bidding the baby goodbye can be an important step on the path to closure. Holding the baby, taking some quiet moments to talk and daven with the baby before giving it over to the chevra kaddisha for burial helps concretize the loss and allows parents to grieve.

“Together with askanim who felt passionately about this, I reached out to rabbanim in the States and in Eretz Yisrael, as well as some medical professionals, and explained the psychological and emotional aspects of the loss — a parent will never forget their child. The pain is too great to simply be discarded.” She advocated for the therapeutic importance of saying “hello” and “goodbye” to their baby, who had been such an important focus of their lives for weeks or months.

The rabbanim researched this approach, questioning Malkie extensively on the emotional repercussions of what had been done until now, and on how her proposed changes would aid parents. Having received rabbinic support, Malkie trained as a perinatal bereavement coordinator at Resolve Through Sharing (RTS), a national, not-for-profit organization that provides training for compassion in bereavement care.

In her training as a perinatal bereavement coordinator, Malkie learned that the ‘“hello and goodbye” approach had already worked wonders in helping bereaved parents receive the closure they needed to the tragedy of losing a child before it knew life.

While developing her approach, Malkie clarified the fundamental differences between a Torah and secular approach to this heartrending goodbye. “We know that everything happens for a purpose; that those neshamos have fulfilled their tafkid and are now returning to Shamayim — the very best place possible — in the very same state of purity and innocence they’ve descended to Earth. Although we cannot always find meaning in the misery, there’s comfort in knowing that there’s a purpose to the pain,” she says.

As well, parents find comfort in the idea that these pure souls can be entrusted with their parents’ tefillos, hopes, and dreams for the future. They are going directly to the Kisei Hakavod and can intercede on their parents’ behalf.

Getting to Know You

The only opportunity parents have for this type of closure is within a few hours of birth. True, this is at the height of physical and emotional trauma, but as one who hasn’t always had the opportunity for that closure, Malkie knows that it’s vital. Together with Zahava Farbman, LMSW, associate director of Project Chai Crisis Intervention, Trauma, and Bereavement Services; Dvora Entin, LCSW of JFCS Ma’oz, Philadelphia; and other trained doulas and social workers, Malkie now acts as an emotional and educational doula, preparing the couple for what lies ahead in a practical, physical, and emotional sense. This alleviates a lot of anxiety that comes with the unknown. Her organization, Knafayim, provides both emotional and practical support through pregnancy loss, as well as other women’s issues related to loss.

“I help the parents see what their choices are, and the psychological effect their actions will have in the future,” Malkie says. “Yet, I encourage them to speak to their rav before making a decision so that they’re completely comfortable with it.”

For years, parents birthing a stillborn child were told to have nothing to do with the baby. Today, those parents are discovering the comfort that can be found in confronting the loss, and learning to say hello before saying goodbye

Naomi and her husband aver that the hello-goodbye they gave their baby was deeply meaningful. After four miscarriages, Naomi’s new, steadily progressing pregnancy seemed promising. Relief proved to be short-lived, however. A 20-week sonogram revealed that the fetus had AMC (arthrogryposis multiplex congenita) a rare congenital condition involving severe physical deformities, and it was confirmed to have medical complications as well.

“It was Gehinnom. The unknown. The paralyzing fear of what the future held. Then there were the typical — and not typical — challenges of pregnancy. A pregnancy I knew wouldn’t result in a healthy child. Absolute Gehinnom.” Complicating matters were the people who knew about Naomi’s earlier miscarriages and kept wishing her well.

Naomi’s baby lived for under an hour. But Naomi and her husband named the baby — a name she still uses today when speaking with her husband in private about the baby. She and her husband held, spoke to, sang to, and took photos of their child. Two years later, Noami speaks with gratitude of the opportunity she was given to say hello — and goodbye.

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