It’s been six months. I still can’t stop thinking about the baby in the bathtub. Talking to Lara about what I saw in the post-mortem room helped, but there is still something about it that will not diminish. I keep emailing her; I read everything she sends me about maternal deaths, stillbirths and pregnancy loss. Internet algorithms start assuming this has happened to me – I am, after all, a woman in her mid-thirties – advertising me books on parental grief, leading me to charities and support groups. But it’s still not the answer I’m looking for. I’m not grieving – I don’t know what I’m doing. Am I traumatised? Probably, but not exactly. It seems bigger than my own internal reaction. I need to speak to someone who understands what I saw – for whom there was no aftermath of personal loss and support groups, just an aftermath of whatever this is.
I remember Ron Troyer, the retired funeral director from Wisconsin, telling me, over a year ago in the cafe, about helping parents dress their dead children. It was another story in a long career of interesting stories when I heard it, but now it kept playing in my mind – how the parents always called the autopsy incision a scar, how he sat with them while they held their cold babies. He had stressed to me the importance of seeing and being with that baby, whether it had lived for months or arrived stillborn, and I had nodded because I had dressed a dead person and agreed that it was an important thing to do. But now it felt like babies were in another category altogether, and that there was another kind of death worker that I had, until this point, not even considered: a midwife.
The role of a midwife, before it became a regulated profession that required medical training, was more of a neighbourly one, as it was across most cultures: they were self-appointed carers during pregnancy and birth. They were also there, before the commercialisation of the funeral industry, to lay out the dead. The bookends of life were considered to be the realm of women. But despite their changed role, there are times when the beginning and the end are the same moment, when babies die before they breathe. Midwives exist at the centre of human power and fragility – they remain life and death workers, both.
I emailed Sands, a stillbirth and neonatal death charity in the UK that I had found in one of my late-night internet searches, and asked them if they would put me in touch with a midwife. I explained what I was doing – that I was writing a book about people who work with death, and that I thought midwives were an overlooked part of that community. They replied within hours, introducing me to a woman whose job I didn’t know existed: a bereavement midwife, someone who delivers only the dead or soon-to-be-dead.
Why would a person train for a job so joyful – at least from the outside – only to specialise in its bleakest moments? Did she once feel what I did?
In the Heartlands Hospital in Birmingham I get lost on the way to the bereavement ward. Entering the building through the maternity door, I ask a woman on reception for directions. ‘Oh love,’ she says. ‘Bless you.’ She gently directs me, soothing like a lullaby, a hand on my back, away from the women resting outdated magazines on the swell of their bellies. I’ve never had a baby, I’m just someone who came in the wrong door, but you can probably make a good guess about what the issue is with a woman who’s hurried in asking for the head bereavement midwife.
When I find her, Clare Beesley wears a blue nurse’s outfit with ‘MIDWIFE’ embroidered on it, black tights and black polished shoes on her small feet. With her blonde hair slicked into a neat beehive, her huge kind eyes and her soft Birmingham accent asking if I’d like a cup of tea, she is almost a cartoon of a caring nurse. I’m anxious and late, but I’m instantly calmed by her presence. I feel like I could tell her anything, like I might accidentally call her Mum. I’ve known her for twenty seconds.
The ward around us is shades of beige and purple; they’ve done the best with what the NHS buildings have to offer, and have painted it and filled it with furniture in the most calming colours they could find, though I can imagine this shade of lavender being forever tied in your mind to death. They call it the Eden Ward, and there are autumnal flowers on the doors for each of the three rooms they have here. Clare walks softly into the second one and I follow. She tells me the third is filled with a family, but I never see them or hear them.
It’s quiet here on the ward. There’s no panic or bustle – it’s different from any hospital experience I’ve had before and every vision of a labour ward I’ve seen on screen. Clare tells me that they’re lucky; in other hospitals women carrying dead babies have to enter the ward through the regular maternity wing, with all the screaming life and hope that comes with new birth. Here, they can come through a side entrance, swerving the mothers whose pregnancies went as planned. Here, when babies are born, there is a silence that is piercing.
We sit on purple chairs on one side of a large bed: a double, with all of the plug sockets and access to oxygen that would come with a regular hospital bed. In the corner, a sink. A clock, a window. There’s a coffee table in front of us with a bag of travel-sized toiletries on it, some folded socks, a tube of Polo mints. A typed note says they come courtesy of Sands (the same charity who put us in touch) and that they’re for bereaved parents. It’s these simple considerations that can count for a lot in strange and awful times. There’s a bowl of wrapped cookies and cakes. This feels somewhere between a wellness clinic and a hospital room, as if a hospital room is wearing the wellness clinic’s clothes. All of the technical equipment is here – this is a medical environment, after all, and giving birth is physically the same for the mother whether the baby lives or not – but they’re trying to ease the blow of why you’re in this room: to deliver your dead or almost-dead baby, however small it may be.
Why would anyone be here by choice?
As a young midwife Clare was – like many young midwives – unfamiliar with death and unsure of how to deal with it. She still had her grandparents. Nobody in her life had died, other than a pet. When she would see a note on the board in the delivery suite about a family who had lost their baby, she would dread being sent to their side. ‘I was so frightened because I knew I couldn’t help them,’ she says. ‘It was really overwhelming to someone who had recently qualified.’ (Even now, two decades later, only 12 per cent of neonatal units have mandatory bereavement training.)
About a year into Clare’s time as a midwife, a woman went into labour with a baby so young they knew he would not live. He had only been gestating for twenty weeks, which baby growth charts liken to the size of a banana – bigger than a kumquat, smaller than an aubergine. The family were prepared and came with the full knowledge of what was about to happen: that there would be no resuscitation, that twenty weeks was too young for a baby to survive – that notable cases of survival place the foetus’s age at a minimum of almost twenty-two weeks. The mother went through her labour knowing there would be no living baby at the end of it, and though he was too young for any medical intervention to save him, when he was born he was breathing.
‘Seeing her baby moving and gasping was so distressing for her,’ says Clare. ‘I just remember, and I won’t ever forget it – she was screaming my name. Clare, you must do something. Please help me. Can’t we do something?’ The baby only lived for a few minutes.
When her shift ended, Clare got into her car, shut the door and sobbed. ‘I can still feel the emotion I felt at that time. To see someone’s raw grief and know that you can’t do anything to make that right for them. As somebody who came into a job that everyone perceives as a job of happiness, not the extremes of such devastation and sadness…’ She trails off. Now, in the silent ward, she looks like it just happened. Her huge eyes glisten. ‘But it’s part of your job as a midwife,’ she says, visibly steeling herself. ‘It’s our responsibility.’ According to Tommy’s – the largest charity carrying out research into pregnancy loss and premature birth in the UK – it is estimated that one in every four pregnancies ends in loss during pregnancy or birth. One in every 250 pregnancies ends in stillbirth; eight babies are stillborn across the UK every day.
A few years later, another midwife set up a bereavement team and asked Clare if she’d like to be part of it. She went along to the training sessions and the more she learned about the situation, the more she realised there was something she could do. She could not breathe life into the baby, but she could look after the families. She couldn’t take the situation away, but she could shape it in a way that was less bad. ‘I never thought I would lead the service doing this,’ she says. ‘I came into midwifery to do a happy job, and I’ve ended up being a bereavement midwife for most of my career. But when you see the difference you can make to parents and their time with their baby, and how that can affect their lives forever, it’s such an important part of midwifery. You can’t control life events – life isn’t in our control – but you can control how you look after a family when they are dealing with the most devastating moment in their lives.’
Clare has been dealing with that moment in strangers’ lives for the last fifteen years. Women come here to deliver non-viable foetuses that can fit in the palm of your hand. They come here to deliver full-term babies whose hearts have stopped beating or are not going to survive for very long outside the womb. She sees the concealed pregnancies, the longed-for and doomed pregnancies, the last-ditch attempts fathered by the terminally ill. She sees the relief in women who didn’t want a baby in the first place, and she sees parents tear themselves and each other apart over whether or not to carry on despite the severe genetic defect that would only postpone a premature death. She sees mothers and babies die at the same time. She gets in her car at the end of every shift, doesn’t turn on the radio, plays no music, and spends the forty-five-minute drive home to her own four children silently decompressing.
Clare shows me the cupboard of knitted hats and baby clothes – mostly white, different sizes, from handmade tiny ones to full-term. The knitted caps serve a cosmetic purpose here rather than one of warmth, much like they did in the mortuary with Lara: as a baby passes through the birth canal the planes of its skull overlap so it can fit, but if there is excess fluid in the baby’s body – as a result of its death – the planes of the skull can dig into the brain, deforming the head. Clare says she puts a little cap over it and no one can tell the difference. Next to the bonnets are brass-hinged wooden jewellery boxes, or so I think, until she stands on her tip toes to reach one, opens it and it’s empty but for a white lace doily. ‘These are the coffins for the very little ones,’ she says, holding it up so I can see inside.
I had no idea that a bereavement ward existed, let alone coffins for babies as big as my car keys. In my mind I can see the cardboard boxes of all sizes on the trolley in the mortuary at St Thomas’ with Lara, many boxes far smaller than the A4 print-out that was balanced on top of each of them for the pathologist. Clare says that there are women who come here who lose their baby at five weeks and react with more devastation to the loss than a woman who loses hers at full term. She says there’s no standard emotional weight tied to weeks in the womb. If it’s a baby you wanted, it’s the loss of potential – an entire other life lived, yours and the baby’s, a parallel universe where this didn’t happen and other things did, a life that you bought things for, planned things for: clothes, shoes, a pram. It’s nothing to do with the size of your baby at all.
‘We’ve all got our own stories behind what happens. You can’t say someone who’s had a miscarriage at ten weeks is not as important as somebody that’s had a stillbirth at term, or a baby that’s lived for two days,’ she says, placing the wooden box back in the cupboard alongside the others. ‘There’s so much that’s misunderstood about pregnancy loss. The perception that you can just try again makes that little life seem not as important.’ I think about the twelve-week rule, how pregnant women are not supposed to say they are pregnant, for fear of jinxing it, for fear of having to say they are no longer pregnant – how that loss is experienced in isolation, expected to be endured in isolation, how for many there is no symbolism, no coffin, and how fewer than half of the women who experience a miscarriage ever find out why it happened. You were an ecosystem, a world with at least one inhabitant, and then you weren’t.
We’re in the Quiet Room now. This is where family wait for news, as they hover around the tea- and coffee-making facilities. It’s where biscuits sit untouched on plates while a baby arrives silently in the next room. In the corner is a plastic tree from which paper butterflies hang, labelled with the names of the babies delivered here, with notes from their parents and the scrawled attempts at communication from young siblings.
She opens another cupboard and shows me the stock of memory boxes. They are white, pink, blue. Inside is a blank book for photographs, with space for hand- and footprints. Families are offered a piece of silver jewellery made out of these prints. There is also a box for grandparents, perhaps to mark the moment they became one. Clare says they’re working on a pack that they can give to siblings to help them understand what’s just happened, to give the baby a place that makes sense in their lives.
Memory boxes are there to record the baby for those who want something they can keep, but they are also there as a safety net for those who aren’t sure: families who are too distraught, too afraid to look at their baby because of what they imagine they might see, what image might be indelible in their mind for the rest of time. The midwives can take their baby, photograph it, take prints from their hands and feet, and place these records in a box that can be left unopened, hidden at the back of a closet until one day, years from now, parents might be ready to look. A picture to prove it happened. A footprint to show the baby was tangible. You were someone’s mother.
In a 2013 New Yorker piece, Ariel Levy talks about the miscarriage she had at five months on the bathroom floor in a hotel in Mongolia. She held her baby and watched him breathe – a living human, who existed only briefly. She phoned for an ambulance and they told her the baby would not live. ‘Before I put down my phone, I took a picture of my son,’ she writes. ‘I worried that if I didn’t I would never believe he had existed … In the clinic, there were very bright lights and more needles and IVs and I let go of the baby and that was the last I ever saw him.’ She looked at the photo constantly, and then daily, and it was months before she got it down to once a week. She tried to show the picture to other people, holding her phone up and proving that he was here. Proving to herself, and others, that the baby existed was essential for her to go on living.
Human impulses are the same across centuries – the Victorians needed these photos too, they just took longer to capture. The need in Levy to record was also within the parents standing beside their baby’s coffin, waiting for the photographer to signal that it was over.
Memory boxes and photos like Levy’s can also be, despite their benign position, a focus of a family’s rift. Cracks in relationships can expand to full breaks under such stress – on this ward, people are at their most vulnerable and their most angry – and sometimes there is a push–pull tension where this blank box sits at the middle of the fight. Everybody grieves in their own way, but family members can judge each other on how they do it, can worry if someone is doing it correctly, can step in and try to take charge if they believe they are doing it wrong. The problem with the memory boxes hinges on the fact that people, sometimes, cannot agree on how much time to spend with a dead body, whether it’s right to record it, whether they should see the body at all – the crux is the idea that grief can be diminished if you try to forget, or if you literally bury it, just like Spain’s Pact of Forgetting. But historical black holes make unsatisfactory graves to bury anything. How do you move on to grieving if, without the finality of seeing, you’re still trapped in disbelief?
Ron Troyer had also told me, when he spoke about helping parents dress their dead children, that it was not uncommon in the past for the father to arrange a swift burial or cremation while the mother was in hospital recovering from the birth – he would make the body disappear so she wouldn’t have to see it, and therefore would not become further upset by its presence. It enraged me to hear it: if that happened to me, I would feel like my baby had been stolen from me twice, the second time by someone I could blame. I wondered how many marriages survived it, and if so, for how long. Where did these women put that unspeakable grief and how many were drowned by it?
Clare says this attitude is still not uncommon – in an effort to do good, some people unwittingly do damage. She has, as always, empathy with both sides. ‘Your natural instinct is to protect them, isn’t it? They don’t want to see somebody they love in the pain that they’re in, and they think by taking what’s happened away, it takes the pain away. But it doesn’t.’
In some of Clare’s cases, I struggle to imagine the reasoning behind the things these people do. She recalls one family where the very dominant father was adamant he did not want a memory box, but the meek mother, in a quiet word to the midwives, revealed she very much did. The midwives secretly made her one, recording the body of her baby in photograph and footprint, and smuggled it into her bag as she was leaving the hospital. Three months later, she phoned the ward in tears: he had found the box and destroyed it.
‘It may be him not being able to cope with seeing that,’ says Clare. ‘It may be him finding it upsetting that his wife’s upset by seeing that. But we don’t store photos, because we’re not legally allowed to. We didn’t have anything that we could give her back. That was gone forever.’
I ask her if this reticence to engage with the body of the baby is present at the scene of its birth. Do people always want to see their baby? Or do some place a block between them, mentally regard it as some biological malfunction to be removed and forgotten? I can hear Poppy the funeral director saying, ‘The first dead body you see should not be someone you love.’ I imagine the events of seeing a dead body for the first time and having your baby die twinned in the one moment and I feel sick. I wonder how much the fear of the unknown, a desperate act of self-preservation, robs parents of their one chance to meet their baby.
‘In the majority of cases most people do want to see the baby,’ she says. ‘Initially, not always, but when the baby’s born, they do. It’s about preparation. Seeing a baby that’s born at twenty weeks is very different to a baby that’s born at term. They’re quite shiny. They do look different, in terms of their skin colour, their transparency. And I think everyone googles after a doctor’s appointment, don’t they? They can’t help themselves.’
Babies die for many reasons, and some of those reasons are visible: here they deliver babies with severe abnormalities, from major spina bifida, where the spinal cord is not enclosed within the skin, to anencephaly, a defect of the brain and skull, where the top of the head just isn’t there. Then there are the babies whose hearts have stopped beating but the induction has been slow (because the mother’s body hasn’t responded to the medication, or for some other reason) and the baby has stayed where it is for days, maybe weeks. Within or without the womb, dead bodies change: the colours turn, the skin peels. Clare says the skin can look like a blister, bright red underneath. ‘That’s upsetting for families because their instant reaction is, Is that painful?’ The parents aren’t sure if it happened while the baby was still living. ‘It isn’t painful. It’s just where the fluid isn’t circulating around the body any more, so it seeps under the skin. It makes the skin very fragile.’
To all of my questions about the reactions of parents, Clare keeps saying that everyone is different, that there is no one correct way of reacting to your dead baby, and there is no one way that people do. We are squeamish, as a society, about dead bodies; we’re conditioned to be apart from them. We construct them in our imaginations, stacking them up to all the heights of horror our minds are capable of. To have one come out of you, and then to hold it, is another experience entirely. Clare tries to work out the best approach for each family. If a family is very unsure, she will offer the baby in stages and ease them into it gradually. She will take the baby away, spend time with him, then come back and tell them how he looks. She may suggest looking at photographs first. She might wrap their baby in a blanket completely, or have their tiny feet poke out the end for them to hold. Most families, treated gently and with as much time as they need, end up changing their minds.
‘I think people are almost relieved, in a way, that it isn’t what they built in their mind. It’s almost like, Oh my gosh, she looks like a baby. Of course she does. She’s your baby. The one thing that I’ve become a lot more confident in is that you just have to be kind – always kind – but honest,’ she says, ‘and very sensitive in what you say and how you say it. If parents aren’t shocked by what they see, it’s because you’ve done your job. You’ve prepared them. It’s a hard thing for a parent to say, “Actually, I am frightened about seeing my baby.” It’s about normalising some of their feelings in these circumstances. None of it feels normal, and to the outside world, none of it is normal.’
The benefit of the bereavement ward is that nobody is hiding death from you, so you know the full breadth of what you’re allowed to do – which is, essentially, anything you feel you need to. It isn’t like this everywhere: in a study by the University of Michigan, published in 2016, they found that of the 377 women spoken to whose babies were stillborn or died soon after birth, seventeen were told by doctors and nurses that they could not see their baby at all, and thirty-four were refused when they asked to hold them. The study was to investigate the level of PTSD and depression in bereaved mothers, but they were unable to draw conclusions on whether or not holding your baby had an effect on the four-fold likelihood of depression, or the seven-fold higher odds of PTSD, since so many reported they did not get the chance. But they did find that what Clare said was true: that it didn’t matter if your baby was born dead, or if they lived for a few days. The mental and emotional wake of baby loss has nothing to do with the baby’s age.
On the bereavement ward, seeing is grieving. Mothers who have been focusing purely on getting through the physical side of the process will know that should they want to hold their baby, they can. If she knows her baby won’t be resuscitated, she can hold her baby to her heart as the smaller heartbeat fades. Whatever they want to do, Clare will be there with them to assist and facilitate.
‘You’ll never know those options if you haven’t had somebody discuss it all with you,’ says Clare. ‘How would you even imagine seeing your dead baby, let alone thinking, Do I want hand and footprints or do I want photos or do I want to hold my baby while my baby dies? How do you even think about all these things? The hardest thing for families is looking back and having regrets. In years to come, thinking, I had a chance to hold my baby and I didn’t.’
The summer before I arrived late at the bereavement ward, the news was full of pictures of a whale: an orca still carrying her dead calf with her, ten days after its death, pushing it with her head as she swam through waters off British Columbia. After seventeen months of gestation, she had been somebody’s mother for thirty minutes. Finally, the whale let go, and that made the news too. She had tired herself out in the cold sea, pushing the weight of her grief.
We look to whales as avatars of human emotion. We can’t help it; they are so unknown, mysterious and vast that we can project anything we like onto them as if they are the side of a building, an emotional Rorschach test. The orca made the news because she wouldn’t let her dead baby go: we were collectively heartbroken for her, though it was weird, some thought, that she pushed this corpse with her through the ocean when she could swim off and forget. There she was, rising from the deep, dragging something from our subconscious and showing it to us on the news, telling us that pretending it didn’t happen is not the same as grieving. While nobody can measure or predict anyone’s grief when a person of any age dies – people mean things to us that are ours to feel uniquely – baby loss is its own realm. You’re losing someone you thought you had, who no one is going to meet, so your loss is unshareable except to the few who were there. Whale or human, some cannot let the body go because it’s all they have.
The mortuary here on the Eden Ward is theirs alone: no babies lie wrapped on trays below adults, there is no designated refrigerator in a vast wall of refrigerators in the basement of a hospital. Here they have just the one, in a room painted sky blue, with a mural of small flowers in pink and lavender. Far from the stark fluorescence of other hospital mortuaries, it is one you can sit and spend time in. Some parents return every day until the funeral to read the baby stories. Some phone the ward in the middle of the night, unable to sleep, and ask that someone check on their baby. Others take their baby home in a small cot fitted with a cooling unit, and try to cram a lifetime into the two weeks they have before the funeral, before the ground or the crematorium takes their tiny body away – they have picnics with the basket beside them, the baby’s older siblings playing nearby. Some push their babies in crisp new prams to the garden behind this building. It too has a tree – a real one, this time – decorated in the fluttering names of the many babies who passed through here.
Baby death is something we don’t know how to talk about: miscarriages go unspoken, news of a stillbirth is often met with stunned silence. Nobody wants to say the wrong thing, so nobody says anything. New parents, without their babies, become part of a club they never signed up for, invisibly exiled in the crowd. Lives never go back to the way they were. Which is why, in a senior role that could easily become an administrative one, Clare insists on remaining clinical. She wants to be someone who was there in the room, she wants to be one of the few who met this baby, someone the families can come back to years later if they are emotionally lost, or if they are pregnant again and want to speak to someone who understands the fragility of their body and mind, someone who understands their very real fear of things going wrong again. Clare has seen the fear and she has felt it: in her own fourth and final pregnancy, something was wrong – her baby had stopped growing, and she knew the reality of everything that might be coming. Her husband – who she describes as not an emotional man at all – had seen her dread, her quiet worry, and cried when the baby arrived safely, after an emergency C-section. She admits she is wildly overprotective as a mother, and fears death only because her children would be without her. She has seen it happen time and time again on the ward.
As I leave, somewhat dazed, Clare points me in the direction of the small garden. I walk around the pebble path and look back at the plain brick building from this self-conscious oasis, carved out of the middle of a cement hospital block, tended by volunteers. I read the names on the plastic butterflies as they catch the light. I wonder what the baby in the bathtub was called, whether it would help, if I knew it, to write his name here. ‘Do something,’ the woman had pleaded with Clare, holding her tiny, gasping baby, all those years ago. ‘Do something.’ I think about Clare sobbing in her car, and I think about the baby in the bath, how I stood and watched him sink, how I could not make him live and I could not make it better, and I remember how I wanted – more desperately than I have ever wanted anything – to do something. The pinwheels in the flowerbeds spin in the breeze. If you look up you can see the windows of the rooms where the babies arrive into Clare’s waiting arms.