Miscarriages usually happen early in a pregnancy — eight out of ten happen in the first three months. Some miscarriages can be so early in the pregnancy that the woman does not even realise she is pregnant – she may assume she had an unusually heavy period flow that month.

Linda van Laer is a counsellor with Alliance Counselling who specialises in bereavement help for women and families. She says, “Stillbirth occurs in the later stages of pregnancy, a stage usually deemed to be the “safe zone’ – so it can be more physically and emotionally intense compared to a miscarriage”.

Professor Tan Kok Hian, Head of the Perinatal Audit and Epidemiology Unit, Division of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), stresses that “stillbirth and miscarriage are separately defined, not because one or the other is an easier or more difficult loss to deal with, but because they differ in many ways”, such as when it occurs and how it happens.

Stillbirth can be caused by a number of reasons, including issues with the placenta or umbilical cord, high blood pressure, infections, and more. A stillbirth can happen to pregnant women of any age, background, or race, and they can be unpredictable – around 25 per cent of cases go unexplained.

Professor Tan explains,  “The risk is a bit higher for couples who have already had one stillbirth”. However, he adds reassuringly that most women can go on to have a healthy pregnancy after a stillbirth. “With increased knowledge and better treatment of maternal conditions, the number of stillbirths has decreased”.

“It’s a rollercoaster of emotions,” says Ang Lee Beng, Master Medical Social Worker and Chairperson of the KKH Bereavement Support Committee. She says mothers go through emotions such as panic and fear. They may even feel disbelief and confusion, “especially when their pregnancy has been smooth-sailing”. 

“Some mothers may even blame themselves for not being attentive to their symptoms or their body.”

Counsellor Linda Van Laer sees similar reactions. ”Guilt and self-blame is a common reaction during the grief process.” According to her, some women even feel their body is “broken”, and doubt it will be able to carry a baby – especially if they have had to give birth to their deceased baby.

Yes, unfortunately, with a stillbirth, a mother is encouraged to go through with labour and give birth naturally. It’s because a Caesarean is a major operation with risks of its own.

Felicia Tan, the founder of Angel Hearts, has lost a child herself, so she understands what it is like. “Some women feel the family or husband are not as understanding or supportive as they need.  Or she may say the husband did not carry the baby himself, so he cannot understand.” 

However, she notes that the situation can be hard to navigate for both parties. “It is an unknown territory [so] it is hard for the husband to know what is going to happen next.”

Even if they are heartbroken, men can find it hard to ask for support.

“In most cultures, there is more acceptance for women to show their grief openly. Men are conditioned to grieve differently,” explains van Laer. “Men often worry that sharing their grief with their partner will only add to her sadness.”

Not only that, but they may have “felt helpless” as they stood by while their partner gives birth to their deceased baby”

Ang agrees that men tend to keep their feelings to themselves, even if they are anguished by the loss. They feel like they have to “protect their wives” and “keep their feelings to themselves and not burden their wives” with them.

Grief always has a way of affecting relationships, whether we want it to or not. While bereaved parents may both be experiencing grief at the same time, it doesn’t necessarily mean they are mourning together.

“Each partner will move through the grief process at their own pace, in their own way. Often, partners do not experience the same feelings at the same time,” says Van Laer. It’s natural, but that doesn’t make it easy. This can cause friction because one party may feel like the other is less affected by the loss and that they aren’t on the same page.

Thinking back to her own experiences of losing a child, Tan admits, “I didn’t know how to communicate with my husband during that time. I thought, ‘How am I supposed to communicate to you, and explain what I need when I don’t even know how I feel?’”

Yet, she says the important thing is to keep trying to communicate with each other, regardless of what is happening.

When it comes to grief, the experts agree it’s a unique experience for everybody. ”There are no rules for how to grieve, or how long it will take,” says Van Laer. “There is no set pattern to it. Some parents find comfort in telling others about what has happened. But other bereaved parents may prefer to grieve privately instead of being expressive and public about their emotions”. 

For Felicia Tan, nobody grieves the same way. “Your individual grief is unique. You can’t compare your grief to someone else’s and say ‘Wow you’re more jialat, I am less jialat’… you can’t compare it in that sense. The process you go through may be similar, but what exactly happens could be different.”

Research done shows that many bereaved parents feel they are blamed for the deaths of their babies and do not have the right to grieve because they are silenced when they want to speak about them. This makes the topic of suffering from a stillbirth a taboo. Research also finds that bereaved parents can be cut off by friends, or are sometimes accused of aborting their baby when it isn’t true. Often they are encouraged to forget about the baby and try for another.

But why does this line of thinking still exist in the 21st century?

Van Laer puts it simply, “There is still considerable stigma and discomfort surrounding the topic of stillbirth. It’s partly because people don’t know how to talk to bereaved parents about their loss. So it’s left unrecognised.”

“It can make bereaved parents feel even more isolated or rejected  – it’s like their loss is a non-event that is not recognised.“

Ang agrees. She notes that bereaved parents can feel very alone in their grief. For example, while they may see themselves as parents , others may not see it that way. So special days such as the child’s birthday may pass unmarked by the rest of the family. As Lee Beng says, “Opportunities to share memories and thoughts of their baby during special anniversaries are also reduced over time”. 

Tan understands why families may find it difficult to talk about such a tragic event. But she feels change is in the wind. She says that it’s now more common for older family members to come to counselling sessions. Sometimes they want to understand more about the thought process of the bereaved. Other times they want to discuss ways they can help. 

“Senior citizens want to know (about stillbirth). Since they couldn’t get the answer out from the bereaved, or it’s too painful to ask them, they want to know from us.”

While it may seem like a lonely battle, there is help and support available in Singapore for bereaved parents.

Ang says that after the stillborn child is delivered, “the medical and nursing team will arrange a single room so that the couple can spend time together bonding with their baby by holding their baby, taking photos or even arranging for their own parents to join them.”

Not only that, but at KKH, “The ward staff will facilitate the process of capturing the handprints and footprints of their babies. Parents are also offered informational brochures on grief and loss, and a ‘memory box’ to contain these memories of their child.” This gives parents the opportunity to create some memories with their baby and have something physical to remember them by.

Van Laer says that in her sessions at Alliance Counselling, her most important job is to “provide a safe and compassionate space where a mother can freely share her experience, her thoughts, and her feelings”.

For those looking for other forms of support, Angel Hearts has two therapy programmes: Sewing 101 and the Grief Recovery Method. 

During the Sewing therapy, clients deconstruct wedding dresses, a symbol of love and happiness, into funeral clothing for babies. Parents can show the child that despite the sad ending, they are loved.

Sewing 101 also gives bereaved mothers the chance to confront their grief and work through their emotions through the act of sewing, which Felicia Tan calls “therapeutic”. 

The Grief Recovery Method, on the other hand, is a “course for you to learn to understand that whatever you’re going through is normal, and is part of the process,” says Tan. It can be conducted individually, or in a group.

The days and months following the birth of a stillborn baby or the very early death of a baby can be physically and mentally exhausting.

Master Medical Social Worker Ang is a believer in self-care;  “It is important for grieving parents to take extra effort to get plenty of rest, eat well and exercise regularly. A short holiday or even just a change of environment can also help parents work through their emotions.”

Van Laer adds, “Some bereaved mothers feel surprised or guilty if they have moments when they feel normal, or even happy. But sometimes you do crave a distraction from your intense feelings, or you want to focus on other areas of your life. 

“Grief does not have to be 24/7. These moments of joy can help to sustain you, so you can cope better, long term.”

Angel Hearts specialises in grief counselling for bereaved parents and offers hands-on programmes and counselling sessions, which can be one-on-one or group sessions. “The group sessions help you to see the trains of thought in other people, so you know you are not alone”, is how Felicia Tan explains it.

Stillbirth Facts In Singapore

• A stillbirth is a baby born dead after 28 completed weeks of pregnancy (before this time, it’s known as a miscarriage).
• There are 80 – 120 stillbirths in Singapore every year. 
• Stillbirths can be caused by placenta complications, problems before and during labour, birth defects, and problems with the mother’s health, such as high blood pressure or infections.
• Not all stillbirths can be prevented, but the risk can be reduced by not smoking, avoiding drugs and alcohol during pregnancy, and attending antenatal appointments so medical staff can monitor the baby’s growth and wellbeing.
• For support after miscarriage, stillbirth or losing a baby in Singapore, you can contact Alliance Counselling, The Bereavement Support Committee, and Angel Hearts.

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