Hannah Dahlen understands the heartache of losing a baby at birth.

The renowned privately practising midwife and mum lost two of her own babies, shortly after giving birth.

“I lost my two little boys a year apart - full term babies who were born and came out in very poor condition, and later on we had to switch their ventilators off,” she says.

“It was only with the second one that we discovered there was a rare genetic abnormality that wasn’t picked up with the first.”

Those devastating experiences prompted the now Professor of Midwifery at Western Sydney University and spokesperson for the Australian College of Midwives (ACM) to travel Australia and New Zealand conducting workshops on grief and loss. Her midwife Shea Caplice also released a short training film, Hannah’s Story, of their experiences to shine the spotlight on perinatal loss.

The birth of a baby is supposed to be one of the happiest times in people’s lives but Australia’s Mothers and Babies report shows in 2013 there were a total of 2998 perinatal deaths - 10 perinatal deaths for every 1000 births, with 2191 fetal deaths and 807 neonatal deaths.

Professor Dahlen says midwives are often at the forefront of providing vital care for mothers and fathers through the traumatic experiences of miscarriage, stillbirth and perinatal death.

“While I lost two babies and it was tragic and there has been no experience in my entire life that has been worse, I can honestly say I was given wonderful care and I have talked to plenty of mothers who haven’t had that,” she says.

“I think the psychological damage that can be done at this time is immense and we are very good at perhaps doing the paperwork and doing all of the pathology and those things but where we do fall down a lot is in that ability to simply be with women and their families during this terrible time.

“I think nothing can make the loss less but the care you receive can help you come through it the other side a much more intact person, a person who is wise as opposed to a person who is shattered and damaged for life.”

Professor Dahlen, a midwife with more than 25 years’ experience, says while it’s common for undergraduate programs to include bereavement training, it’s important student midwives are not shielded from bereavement experiences while on placement.

“Often student midwives are excluded when a baby dies, people want to protect them and they say - ‘they can deal with that later, let’s not get them involved now’,” she says.

“Well, you know what happens when later comes and they’re expected to know what they’re doing and they haven’t got that experience.

“The theoretical part at university we do teach but also equally critical - nobody can teach you how to be with women in a more profound way than actually being with women.

“It’s really critical that students are exposed to perinatal loss and are well supported by experienced midwives, so that they come out of the experience not traumatised but able to provide sensitive care in the future.”

Professor Dahlen says midwives can tap into feelings from their own experiences of loss and grief to empathise with, care and provide support for grieving families, regardless of whether the parents are experiencing a miscarriage, stillbirth or perinatal death - which are all vastly different experiences of loss.

“We can’t really walk in another person’s shoes but we have to walk that journey with them and we have to be able to understand that it is whatever that person says it is,” she says.

“We can’t go back into their past experiences, we can’t understand all of the characteristics they bring to that experience that defines that so uniquely for them.”

It’s crucial midwives keep communicating with parents and providing reassurance, information and support instead of resorting to silence amid fears of not knowing what to say to families.

“There’s this terrible feeling when a baby dies that we feel responsible, we feel guilty, there’s all these fears about litigation and so sometimes what people do is they all hunker down and don’t talk to the mother, which is the worst possible thing you can do,” Professor Dahlen says.

“We need to understand that the best way to be with a woman is to be able to just be there, have the ability to touch and cry with a woman, and that this isn’t being unprofessional, this is something women highly value.

“When a midwife sheds a tear with a mother she honours that child with her tears and the ability to say ‘I’m just so sorry’, the holding of a hand, the rubbing of a back - all of those things are absolutely critical.”

There are many small but vital ways midwives can provide care, compassion and support for grieving parents, from respecting their cultural, religious and individual beliefs around death to creating memories of their baby.

Amid the sorrow and suffering, Professor Dahlen says midwives can make a fundamental impact on the experience of families grieving through stillbirth and perinatal loss.

“I will never forget a woman who came in with her daughter, and her daughter had a baby, and the woman rang me the next day and she’d had a baby in this hospital about 25 years ago,” she recalls.

“She said - ‘I never ever found out what she was or anything about her. Is there any way that there’d be a record now?’

“For 25 years, she hadn’t even talked about this experience - the baby was just whisked away. In those days that’s what we did - we thought if they didn’t see the baby, then they wouldn’t grieve but of course that’s ridiculous.

“I went back through the records for 25 years and I found her baby’s records and it was a little girl. I found the names of the people who were there and the weight and everything, and I made her out a memory book and posted it to her.

“She rang me back and said - ‘that’s just healed a quarter of a century’s grief to know those details’.

“So while a woman may not want it now, it’s really critical that we have something later on that we can give them.”


How midwives can assist bereaved parents:

1. Say - I’m so very sorry. These are the most important words a midwife can say, Professor Dahlen concedes. “Just saying - ‘I’m so very sorry, I can’t begin to imagine what you’re going through but I want you to know I’m here’ and giving them time.”
2. Don’t try to make it better. You can’t make it better but you can be there for the journey. “Make sure they have good supports, there are fantastic support networks out there and lots of perinatal loss groups that are brilliant, where women who have gone through similar experiences can support each other with professional help,” Professor Dahlen says. “It’s really important for midwives to make sure all those structures and supports are put in place.” Sands is an Australian miscarriage, stillbirth and neonatal death charity that helps bereaved parents.
3. Don’t forget the dads. We often focus on mums and forget the dads, Professor Dahlen says. “Fathers go through their own way of grieving. When a baby is first lost, they’re very much trying to support the mother and often their needs are not as well identified and addressed. If the dad later on crumbles because he’s not had that support, then the whole family crumbles.” Not-for-profit organisation Pillars of Strength can help.
4. Don’t rush parents. It’s important parents have the ability to see their baby afterwards, and can see the baby for several days. “We have now increasingly got things like cold cots available which means that women can take their babies home as well, if they want to do that, and the cot will keep their baby cool. It’s really important that we don’t put any deadlines on women. I would hope there’s nobody that pressures any mother or father to give up their baby before they’re ready to say to goodbye.”
5. Respect cultural, religious and individual beliefs. “It’s really important that we find out what’s important for the parents,” Professor Dahlen says. “For example, for many Muslim parents burying the child before sundown is really critical and for some New Zealand parents the placenta is a very important thing that is kept and buried.”
6. Create memories. Creating memories or mementoes, such as taking footprints and locks of hair, can improve maternal mental health outcomes.