It’s hard to understand the real meaning of losing a baby unless you’ve been through it yourself. Francesca Vella met Richard Cassar and Doris Azzopardi, two dedicated people who are actively involved in the Stillborn and Neonatal Death Society (SANDS) Malta, within the Cana Movement. They explained the heartache that bereaved parents experience and the importance of adequate support during the grieving process.

“When you lose a baby, it feels like it’s the end of the world, and it’s almost impossible for a bereaved mother to ever have a peaceful pregnancy again,” explained Doris Azzopardi, a nurse at Mater Dei Hospital’s Delivery Suite.

Ms Azzopardi, along with Richard Cassar, a voluntary services officer at the hospital, leads support groups for parents whose babies were stillborn, or died during or soon after birth.

Mr Cassar said: “Although in essence, our values are Catholic, we cater for everyone. Seven sessions, including one with an obstetrician, are organised three times a year. Sessions are based on a model developed by spiritual counsellor Elisabeth Kübler-Ross.

Psychological research has shown that adequate support helps significantly during the grieving process. In essence the extent of the anger phase and the duration of the depressive phase are significantly reduced.

SANDS Malta helps parents psychologically, as well as medically, especially with regard to future pregnancies.

SANDS Malta dates back to November 1994, when a letter on the matter had been published in a local newspaper. The founding members of the society had met at a bereaved parent’s house.

Another meeting followed in 1995. The society was officially established in January 1996 by a group of bereaved parents and members of staff of the Department of Obstetrics and Gynaecology, with the assistance of the Cana Movement.

It now comprises a group of volunteers from various disciplines namely obstetrics, midwifery, nursing, social work, counselling and bereaved parents themselves. The organisation is affiliated to SANDS UK.

SANDS

· offers immediate support to bereaved parents;

· facilitates the process of bereavement through support groups;

· raises awareness among hospital staff and society at large with regard to the needs of bereaved parents;

· offers personal counselling if it is needed.

Mr Cassar and Ms Azzopardi explained that they address a number of issues with parents, particularly with regard to their sexual relationship, seasonal remembrance and also questions put by siblings.

Ms Azzopardi said: “If you already have children, you don’t only have to deal with your own grief, but you have to try answering their many questions”.

Both the mother and father go through a lot of inexplicable emotional pain, explains Ms Azzopardi. The mother often feels a lot of emptiness, anger, guilt, uselessness and failure, all added to the hormonal imbalance; fathers too go through a lot of emotional pain, and it sometimes can be worse than mothers’, said Ms Azzopardi.

A mother never expects her child to die before she does, let alone before it is even born, or just after birth.

“The worst thing is when friends, family and other people tell bereaved parents that time will heal all wounds, and that they should try forgetting about the heartache. If you try brushing aside traumas and hurts, they will haunt you,” she explains.

“Bereaved parents also need their space, they need to be close to each other and go through the whole grieving process.”

When parents lose a baby, family members should never offer, or take the initiative to clear the toys, cots, clothes and other things that the parents would have bought during the pregnancy.

“When you’re pregnant, you start preparing everything for your baby – you start decorating their room and you buy a number of things – a cot, nappy changer, clothes and so many other things. Things go wrong, and everything crumbles. Imagine going home from the hospital and finding an empty room because your mother say, would have cleared it completely.”

When a baby dies, members from SANDS who work at the hospital visit the bereaved parents and offer immediate support. This support could be of an emotional and informative nature.

The parents are asked if they would like to see and be with the child for as long as possible. Other children and family members like grandparents are also encouraged to visit and hold the child.

Photographs and other mementos like foot and handprints and locks of hair are taken. This is seen as helping the parents acknowledge the fact that they did have a baby whom they can miss and mourn.

After about six weeks the parents are offered the opportunity to attend support group sessions.

The sessions are semi-structured and are based on tasks that need to be worked through, admittedly, with a lot of grief and pain.

During the sessions bereaved parents discuss ways of accepting the reality of the loss, working through the pain of grief, adjusting to an environment in which the baby is missing, and carrying the memory of the baby while living a full life.

Topics that are reflected upon include the necessity to mourn, the bereaved parents and society, grief and grieving.

These deeply emotional topics are also interspersed with related reflections, poems, videos and songs by which the parents are helped to bring out the grief with the ultimate aim of helping them to gradually re-invest in life and in the future.

Every year, SANDS organises a communal burial for babies who would have died less than 24 weeks into the pregnancy. This year, the burial ceremony will take place on 27 November, at Addolorata Cemetery.

Babies who would have died during the year are kept in formalin, and before the ceremony, members of SANDS wash them and dress them up for the burial.

The Kübler-Ross model

Swiss-born psychiatrist Elisabeth Kübler-Ross first discussed what is now known as the Kübler-Ross model in her book On Death and Dying. This is the same model, which SANDS uses to provide support to bereaved parents.

The model consists of a grief cycle (shown in the graph), which indicates the roller-coaster ride of activity and passivity as the person wriggles and turns in their desperate efforts to avoid the change.

On hearing the bad news, people go through a number of phases explained in this table.