I am an internationally qualified perinatal Birth & Bereavement Doula a seemingly complicated and/or unknown term that has people asking me over and over again: “So what is it you DO Nicci?” The simple answer is nothing, yet everything. Because in medical terms I do not ‘do’ much – although I have been the only one present in more births than I care to think about and pretty much did everything – from delivering the baby to cutting the umbilical cord and delivering the placenta! But as a rule of thumb I am not supposed to ‘do’. I am supposed to ‘be’. And that I try to do to the very best of my ability.
As a bereavement doula (I really don’t care for the term ‘death doula’) I provide support in situations of fatal perinatal outcomes and I comfort parents when a baby passes away. It is not a glamorous job. I clean vomit, blood, amniotic fluid and spilled apple juice. I make a client’s bed over and over again and fluff pillows and offer ice cubes, lip balm and hugs. I kick vending machines on behalf of a father who is desperately looking for a can of soda at 2 am in the morning and I beg gynecologists to give permission for more pain meds for a mom that is writhing in pain. I beg unit managers to allow a heartbroken father to ‘sleepover’ to be with his wife who is in labour (with their dead baby,) when it is against hospital policy and sleep is the very last thing I know he is going to do. I see raw pain and I hear the most agonizing, haunting cries you will ever hear in your life. And sometimes I hold a little body and that baby’s heart beats for the last time in my hands. It is not an easy calling, but I do it with great pride and love for my clients going through the unimaginable.
If I have to make a list of everything I do, it becomes quite an impressive list. But you see, I don’t like to do that. Make lists. Or write job descriptions or limit myself to a certain number of things I can/will/want to do. Because the reason I am a Bereavement Doula, the very reason I absorb so much of my clients’ pain and heartache, is very simple: I want to comfort as much as I can. I want to console broken parents and try to make the journey of the birth of their child bearable by being there, acting as a buffer between them and the cold medical world and cruel strangers who are so wrapped up in their own little worlds they do not think twice before inflicting pain on helpless, grieving parents. I wish I could say this does not happen often. I cannot…
Not one birth or miscarriage is the same. On that note, I really do not like the word ‘miscarriage’. Because nothing is ‘missed’ – whether you are 20 or 40 weeks pregnant, you go through the same labour pains – and everything is carried: Guilt, shame, grief, anger, fear… The Oxford dictionary offers two explanations for the word miscarriage: The spontaneous or unplanned expulsion of a fetus from the womb before it is able to survive independently; and unsuccessful outcome of something planned. I prefer the second definition. Because whether it is because of a baby dying in utero, a medical termination or a stillbirth, this encompasses pretty much what it is: An unsuccessful outcome for something that was very much planned, wanted and looked forward to. I don’t like the first definition because I don’t care for the word ‘fetus’. Let me explain why:
As ex-Director of a non-profit company called ‘the Voice of the Unborn Baby’ I fought for parents’ rights to choose whether they want to say goodbye to their child by having a funeral or cremation for them. Because of an archaic law on the South African law books, “fetuses” who are born before 26 weeks of gestation have to be treated as medical waste and are incinerated with needles, syringes, amputated limbs and other medical waste products. And the only way to get around this horrific law is for parents to make an affidavit to state that they need the ‘medical tissue’ or ‘placenta’ to bury for religious and/or cultural purposes. They also have to fill out a mountain of forms required by the hospitals to enable them to have the child removed from the hospital’s premises.
I have had to do too many of these affidavits and I cannot explain to you in words how much it aggrieves me to put my clients through this horrific conundrum of paperwork to enable them to give dignity and respect to their dead child. Yes, child. Because not once have I ever heard a parent speak about their ‘fetus’. No, they speak with much love and affection about their child, their baby, their angel – never ever, their fetus.
Being a Bereavement Doula in South Africa is not easy. Very few people know about this profession and time and time again I have to explain to a nurse or a doctor or a hospital manager what it is that I do. I obtained my International Accreditation as Birth & Bereavement Doula from Stillbirthday (SBD) University and I am hoping that this qualification will give people some peace of mind as to the level of professionalism and skill I have. But at the end of the day no one piece of paper can equip you to deal with raw, unadulterated pain and grief of a mother losing her child – of a dad losing his dream of being a father. No qualification can prepare you to hold a little body in your hands and feel life slipping away without you being able to do anything about it. No university can help you deal with your tears in the night after the fact, when you cry for a little life lost and for the pain of parents who will never ever forget. Nothing can prepare you fully for this job.
I wish you could be there. I wish you could see how I hold a mom’s hand whilst she is in the throes of childbirth. How I try to console an inconsolable father who does not have the know-how or strength to carry his own grief, let alone the mother of his child’s. I wish you could see how I comfort sobbing grandparents. How I clamp the cord, gently clean and wrap a precious little baby and take photos for families to keep as a reminder that their baby was born. Born still, but still born. The reason I wish you were there isn’t to hurt or harm you but I know if you could see what I do you would be beyond motivated to get the word out there that a job like mine exists! That parents do not have to face the daunting task of the birth of their stillborn or miscarried child alone. That they do have a voice. That someone cares!
It is my dream that my profession will be formally recognized and acknowledged in South Africa and that doulas’ services, like midwives, will be covered by all medical aids.
And because I have such a passion for this awesome career, I have developed South Africa’s very first Online Bereavement Training Program!! Click here to see more:
Except for different room numbers, the two doors looked identical. If you could have peeked inside, you wouldn’t have been able to tell the stories apart. Except for their age difference and the gestational age of their pregnancies, they were just two mommies-to-be waiting to give birth. And they did give birth, almost simultaneously. Yet contrary to what the naked eye could see, the stories behind those two doors are so far apart it’s mind boggling.
You see, the one gave birth to life and the other to death. Behind Labour Room 1 in an upmarket suburban private hospital, a young woman was unsuccessfully trying to take deep breaths to ease the pain that threatened to overcome her young body. She was very obviously experiencing severe discomfort with each contraction and as I held her hand I could almost feel her pain. Annah* looked at me and asked “Is this going to get worse?” I had to be honest because this is the one thing I promise my clients from the second we meet: Honesty.
I looked at her and told her that yes; unfortunately it was going to get worse. Her big brown eyes followed me as I walked around the bed and straightened her IV line. I saw earlier that her brown eyes had little specs of flashing green in them and I thought to myself that she was such a beautiful young woman. She asked again in a strong, clear voice, “How much worse Nicci?” I took her hand and assured her that it was going to be painful but it doesn’t last forever and she will forget the pain. Her mom Lisa* just looked away. I couldn’t tell Annah that the pain of the memories never leaves you. It would have been cruel and something she couldn’t prevent anyway. So I just squeezed her hand.
Annah was a young woman from a happy home with a great family and awesome siblings. At the end of the previous year, she just finished university and she was celebrating the New Year and the beginning of new things with her friends. Unfortunately, as it often happens, she drank too much alcohol. What happened is still a blur to her, but she fell pregnant right when she was supposed to start her new life. To her it was devastating news. But the news was not as devastating as the terrible news they got from Annah’s gynaecologist when she was around 20 weeks along. The pills Annah was taking for a chronic condition causes severe birth defects, deformities, paralysis and even brain damage. A medical termination had to be done as the doctor explained to Lisa that the viability of the pregnancy is virtually zero. According to the doctor it was a lot beter to terminate at 22 weeks than to lose a baby at 38 weeks. So a medical termination was booked.
I spoke to Lisa over the phone for the first time. “Lisa, it’s Nicci, I function as a bereavement doula and I was told that you want to make use of my services?” It is with relief in her voice that she confirmed that they needed my services. She also told me straight away that she suffered three miscarriages – all three between 20 and 24 weeks of gestation. Her first miscarriage was at 24 weeks, but they didn’t show her the baby or allowed her to hold the baby and she later learned that the baby was incinerated as medical waste – something that devastated her and still haunts her up to this day. I could hear the pain in her voice. I made it very clear that this will most definitely not happen if it is her daughter’s wish to see her child and to bury her child.
After I explained to her how the process worked, she asked me to please come immediately, they were about to break Annah’s water. I ran to get my camera and then I rushed to hospital. As fate would have it I couldn’t find parking anywhere and I ended up parking a block away from the hospital! At long last I reported at the nurse’s station and I was taken to the Labour Rooms. It was when I came around the corner that I saw the two identical doors…
Lisa is a beautiful woman in her early fifties and she looks much too young to be a grandmother. The first thing I noticed when I saw her was the utter sadness in her eyes. It was very obvious that not only was she in pain for her daughter’s sake but this medical termination scratched open old wounds. But after we talked a while I realized that although she was sad I could also see the shimmer of a tenacious woman with hope for the future. When I was first introduced to Annah she seemed a bit hostile but within five minutes we were chatting like we knew each other for ages. After a while she told me that she was pregnant with a little boy she was going to name *Zach. I was so relieved that we clicked. It is extremely difficult to assist someone who doesn’t want you there! In fact, it’s virtually impossible. It is also very important to always put your client’s needs before everyone else’s – in this case even her own mother’s.
Annah starting talking about Zach’s funeral – she said she wanted a particular casket and elaborated on exactly what she wants. The moment I saw that Lisa was about to say something (that I knew was going to be perceived as negative) I motioned to her to keep quiet. We both listened as Annah told us about Zach’s name, his casket and a few other details about saying goodbye to him. She seemed content that we were just nodding and agreeing with her but I could see that it was very difficult for Lisa not to say something…
Annah was complaining about her contractions again and I demonstrated to her how to breathe to make things a little bit easier for her. But I could see that the contractions were becoming very uncomfortable. I left the room to give Lisa and Annah a moment alone and as I was waiting in the corridor I couldn’t help to hear the familiar sound of a baby’s heartbeat in the womb over the ultrasound machine’s system from the other room. The nurse was telling the mom in Afrikaans ‘Dit is nou amper tyd’ (It is almost time now) and I could hear them laugh and make jokes about the impending birth of the woman’s baby. There was a lot of laughter indeed. The contrast to Annah’s situation was so stark it made me catch my breath for a second and I had to concentrate very hard to not let the sadness overcome me.
After a while Lisa came out and we went around the corner to have a quick private conversation regarding the situation but after five minutes she received a frantic phone call: Annah was in full-blown labour! I was astonished that this poor child went from 3cm dilation to full dilation within a matter of not even 20 minutes. We both ran to the room. We were there just in time. The doctor arrived as we got there and the next moment Annah’s agonizing screams could be heard echoing down the labour ward’s corridors. Between her pauses to take a gulp of air, I could hear a mini commotion next door as well. Unbelievably both women were giving birth at the same time. Oh the irony! The next moment Annah was screaming so loud my ears were ringing and with a soft popping sound little Zach was born. But contrary to the celebrations and exuberant exclamations next door of a healthy baby boy that had just been born, the tears were streaming down Annah’s face and Lisa was barely coping herself. If pain was a picture, I saw it in that delivery room.
The nurse delivered the placenta after the doctor cut the umbilical cord (and subsequently left straight away) and was gently busy cleaning Annah up. Lisa was standing with little Zach wrapped in a soft white towel blanket that was embroided with a pretty white silk bow that I gave to her shortly after the birth. I moved close to her trying to cover the baby up whilst the nurse was busy with Annah when I almost jolted in shock. The baby moved! This tiny little creature was still moving for some reason. I tried to stay calm but I was in so much shock I nearly fainted. Without thinking twice I closed the curtain with one quick pull and motioned to the nurse to come to us. Lisa was in an absolute state – she was crying and shaking, muttering under her breath “He’s moving Nicci, he is still moving. He is alive! Oh God help us!” The nurse rushed over and patiently explained to me and Lisa in a hushed voice that unfortunately this happens sometimes.
Apparently some babies moved for over an hour since they were born, struggling to take their first gulp of air that was sadly never going to happen – even at only 22 weeks of gestation! I was so traumatized and upset; I cannot even fathom how poor Lisa must have felt. Even the nurse was as white as a sheet! My heart went out to both of them. I couldn’t help but wonder if this was not the reason for the gynaecologist’s hasty exit? Did she realize that this baby was fighting to stay alive and couldn’t deal with the fact? Or was she just in the routine of popping in during a medical termination, do the delivery and pop out again? Whatever her reasons, it just didn’t seem right to me…
We decided to keep Zach with us behind the curtain until he stopped moving – we knew it would terribly upset Annah. If we were so distressed I can’t even imagine what Annah would do! But after a while Annah was demanding to hold her baby and we couldn’t postpone the moment any longer. Lisa took the baby boy to his young mommy and I quickly grabbed my camera to snap a few photos. I managed to hide it from them, but I was shaking so much I could hardly take a photo. That baby moving underneath my fingers is something I will never ever forget for as long as I live.
Lisa gently handed the little boy over to his mom and I could see a thousand thoughts running through Annah’s head as she took him from his grandma. “He’s beautiful. He’s so tiny. Look at his perfect little nose. He is so, so beautiful,” Annah softly murmured. I could feel the pesky lump in my throat returning to torture me again and I swallowed very hard to keep my composure. Not long after that, Lisa took the baby from her daughter – obviously fearing that he was going to move again. Unfortunately it seemed that her worst nightmare was going to come true…
Annah insisted to hold him again and almost snatched Zach from her mother’s arms. The next moment she became deathly pale. “Mom, I’m sure I felt the baby move?” Annah looked at Lisa with questions in her eyes and had a horrified expression on her face. I looked at Lisa and saw that she was speechless, and before she could say anything that could upset Annah and possibly haunt her for the rest of her life; I gently took the baby from her and explained that it was only his little muscles still contracting after death and not because he is ‘alive’. She seemed satisfied with my explanation and stroked her baby’s head with her forefinger, without saying anything. I sighed an inaudible sigh of relief. Thank God for small mercies!
I then told Annah that it was time for me to photography her little boy. I took a few photos of especially his tiny little hands and feet at the bottom of the hospital bed on a white towel. It was when I gently took his miniature, perfectly formed foot in mine that I felt a tremor from his leg again. It was so upsetting I felt like vomiting and I could feel the blood drain from my face. Lisa saw something was wrong and distracted Annah by giving her a sip of water. I knew I just had to keep my composure and without blinking an eye, I kept on pressing the shutter without even focusing on what I was doing. When I was finished taking photos (I deliberately took quite a while to do this, hoping the baby will finally stop moving, which he did,) I wrapped the baby and gave him to his grandma. Lisa took little Zach from me and gently rocked him. It was heartbreaking to watch…
The nurse motioned me outside and when I closed the door behind me she asked me when I was going to go to the police station to have the affidavit completed. We have to complete an affidavit, basically stating that we are taking a placenta out of hospital – you just fail to mention that the baby is part of the parcel! I told her that the commissioner of oaths was actually coming to the hospital herself – there was no need for anyone to go to a police station. She looked unsure of herself and then she asked me where the ‘casket’ was. I told her it was in my car but if she wanted to see it I will go and fetch it. She indicated that this was indeed what she wanted so I quickly ran to my car to get it. Our caskets are beautiful little woven baskets that look like a Moses basket and not like a casket at all, so luckily I didn’t upset anyone with it.
My interaction with the nurse just made me realize again that the healthcare professionals in this country were ‘flying blind’ so to speak when it came to these situations. How on earth can one expect a nurse to know the laws and to handle the situation if a specialist doesn’t even have a clue? It also made me think of how terrible it must be for these nurses to put a perfectly formed little body in a red plastic bag labelled as ‘medical waste’. What does that do to one’s psyche? How you do you cope as a human being with ‘throwing away’ another human being? It must be so absolutely devastating and difficult for nursing personnel to deal with the situation! I had an epiphany right there and then: We weren’t only fighting the good fight for parents and for unborn babies. We were also fighting for this nurse who has to live with her own conscience and memories after disposing of a body like it’s an amputated limb or used needles that one need to get rid of! Interestingly enough both the doctor and the hospital flatly refused to issue a death certificate…
When I got back Annah was sleeping and the nurse had taken the baby to the cooling facilities in the meantime. Lisa’s eyes were red from crying but she was calm and asked me a few questions which I patiently answered. Luckily Sonja Smith (a funeral director and also the commissioner of oaths) showed up and we finalized the paperwork and chatted a bit about Zach’s funeral. Annah has woken up in the meantime and knew exactly what she wanted for the funeral – I was impressed with how composed she was. I had to fill out a report for the hospital stating that I take full responsibility for the ‘remains’, I will dispose of it lawfully and the necessary paperwork (affidavit) had been done. Whilst I was doing this, Sonja went with the nurse to fetch little Zach. The nurse asked the grandmother to stay with me. Sonja was shocked to see where they kept little Zach: A small little ‘box fridge’ standing next to a cleaning mop and bucket used to clean the hospital floors! No dignity at all. It was obvious why the nurse didn’t want Lisa to accompany her to fetch the baby!
After finalizing the paperwork, we put little Zach in a carry cot and after saying goodbye to Lisa and Annah, we left. Neither one of them wanted to see the baby again, they both confirmed that they had said their goodbyes and that they didn’t want to see him again. In these situations we are absolutely led by what our clients want and we respect and carry out their wishes as far as humanly possible. Little Zach was snugly tucked into a comfy carrycot, covered with his embroided towel-blanket. He looked so peaceful at last.
When we got to Sonja’s car, she carefully placed the carrycot on her car’s seat and fastened the seatbelt. Just before she closed the door I asked her to give me a moment to say goodbye. I gently touched Zach’s little forehead and whispered goodbye. This is always the toughest part of my job: Saying goodbye to a tiny little human being. I was thinking that those two rooms were going to haunt me for a long time – and I so wished that both rooms had the same outcome: A beautiful, lively little newborn baby boy. But we don’t always get what we wish for and that is precisely why I do what I do. Because the outcome can be so sad, someone needs to comfort the people going through this excruciating pain. Someone needs to answer questions, hold hands and utter soothing words to aching souls. Someone has to hide the fact that a medically terminated fetus was fighting to live from an already traumatized young mother. Someone just needs to be there…
I am honoured to say that that day, I was that someone.
*Not their real names
(Please note that the above is a true event that happened to me, Nicci Coertze, personally. Except for Annah and her mom, it is not someone else’s story to tell.)