Story #84 - Kim, Montclair VA (USA) - Stillbirth, Perinatal Mood Disorders, Breastfeeding Struggles, Pregnancy After Loss & Mental Health Care
I met with Kim and her family the day after Valentine’s Day. Her house was filled with banners that said “Love” and the sun was pouring in from every window.
Kim was not only generous with her words regarding her three postpartum periods, but also with her life. She allowed me to perform true documentary photography by simply being around me (and my camera,) on one chilly Saturday afternoon of February.
For her wisdom, her hospitality (and for so much more,) I will be forever grateful she was put on my path.
Life with my firstborn, Aaron, was easy. His delivery went smoothly, and he was such a cute baby.
He's twelve now. At the time, his dad and I had agreed that we were only going to have one child because he already had four daughters of his own, all from previous relationships. When I found out that I was going to have a boy, I was a bit terrified. There was no boy in our family anywhere, and I didn't know what I was supposed to do with a little boy!
But when he came, all the fears went away. He popped right out and didn't make me struggle for it! I was overwhelmed with how perfect he was. To feel the realness of this human you've created when it's your first child can be so powerful. I remember thinking, "It not fair that my baby is so cute." I thought about all these other sad women who didn't have a baby as cute as mine, and I couldn't stop crying!
I gave birth in a rustic military hospital. It was on base, at Belvoir, and new moms had to share rooms and group-bathrooms that were located down the hall. The care was amazing, but the accommodations… not so much.
As soon as we left the hospital, the number one thing that I wanted was a Big Mac. I have this famous photograph in which we're in the car on our way home, and I'm holding a Big Mac next to the baby's head; the whole box is bigger than him!
Aaron was a joy of a baby, but it was hard. I was tired, and I had all these expectations about what it meant to have a newborn and be a mother. I failed miserably at breastfeeding. I had read all the books, took all the classes, learned the basic functions that our body is supposed to perform… and I still felt like I was failing. You think that because your body is "supposed" to have babies, it's also supposed to know how to care for them. So anytime that doesn't go according to plan, it seems like the part that's supposed to make you a woman and a mother is broken.
Breastfeeding, to me, was that part. It was the only painful thing about my postpartum period. It was difficult to come to terms with my baby not latching and losing so much weight he was dehydrated. We eventually went with formula, and that added another layer to the sentiment of giving up and failing at motherhood. The pressure is intense.
Ultimately, I know we gave it a good shot. I say "we" because my ex-husband and I were both working hard to make it happen: Aaron's dad would reach over my shoulder to hold him so I could use the shield. He would then use the breastmilk that I had pumped to feed him with a syringe because Aaron wouldn't take a bottle. Goodness gracious, the hours spent crying! Until finally I said, "It's over. He'll be okay. I'll be okay. Babies grow up fine on formula."
And he did.
Other than my struggles with breastfeeding, life with him was so good. He was born in March, and I had enough maternity-leave from being a teacher to stay out of school until September. I healed quickly, and I was able to stay home with him for a good six months. When I went back to school in the fall, I was sad to send him to daycare, but I was also excited to be my old self again. He went to a home daycare close by. And man, that was good!
I was so in love with that little dude. He was such an easy baby. All the things I had read about what could have gone wrong… none happened. I loved him, he loved me, and he was all over me all the time.
The older he got, the more I started feeling this pull for him to have a sibling. He already had four older sisters, but even though they were close, they were much older than him. I have a younger sister, and she's such an important part of my life. I feared he was going to miss out on having a close sibling.
His dad was not interested in having another child at first, but we eventually agreed to try again. Months went by. Nothing. We ended up having a few courses of IUI done, and then I got pregnant with Mara. At first, I was really scared when I learned I was having a girl—it was the opposite of what had happened with Aaron: how will I know what to do with a girl!?
Getting pregnant definitely took longer than I'd hoped. I had this idea that my kids would be three years apart, no more no less, like me and my sister. Aaron was two and a half when we first started trying, and he was four when I finally got pregnant.
About halfway through my pregnancy, we brought him to the doctor to get his physical and get him ready for kindergarten. Quickly, the doctor noticed that his shoulders weren't aligned. He got x-rays done, and it was determined that he had scoliosis.
It was an incredibly scary time. Aaron's scoliosis was found to be congenital. Two of his vertebras didn't form all the way during his fetal development, but you couldn't see it when he was standing up, only when he bent over—that's why I never noticed it. Of course, I felt guilty for not seeing it before.
We had to keep an eye on it to make sure it was not going to keep curving. But after a few months, his condition was considered pretty serious, and we were advised to remove those two vertebras and then use rods to straighten the rest of his back. Obviously, the younger, the better for that kind of thing—but also, the younger, the more terrifying it is for him to have surgery. The doctors gave us a choice between "let's wait, see, and hope nothing comes out of it," or "let's wait and, one day, there might be so much pressure on his spinal cord that he will wake up paralyzed." We decided that the surgery was worth the risk.
I was at the beginning of the pregnancy when Aaron had his surgery. We hadn't told him yet about the new baby and chose to wait after the operation because it would have been a lot for him to process. By the time he went in, I was four and a half months pregnant. I was starting to show and would spend a lot of time in the hospital with him. It was hard. Scary and hard.
I felt very anxious. I was afraid of his surgery, but I was also afraid my stress would impact Mara.
But Aaron recovered quickly. Once we were back home again and he was walking on his own, we told him about his baby sister. He was so excited. SO excited. My pregnancy with Mara was easy. I mean, I was big, I was uncomfortable and nervous, but at that point, the only difficult part had been the IUI.
I'm trying to remember how I felt with her, and I believe I had a typical level of worry.
It's difficult to think about the times "before" because when you go through any kind of loss, there is a moment when everything changes and nothing is the same from that point forward. For that reason, it's hard for me to look back on my pregnancy with Mara and remember how it was before our world fell apart, on the day she was born.
The thing I do remember is happiness. So much happiness. Her due date was on Christmas Eve. We took our Christmas card pictures, and I was humongous! Our whole Christmas was planned around having a baby.
Mara came a few days early. I went into labor with her on the 17th. That day, we went to see Santa at the mall with Aaron and had a very Christmassy day planned. I've written a lot about that day, and it always comes out the very same way: we were doing fun Christmas things, and I started to feel uncomfortable, like "It might be the day!"
My family was already gathered at my parents' house to celebrate. We had elected to stay home "just in case," so we called them that evening to let them know that we were going in to have a baby. Everyone was so excited!
I was definitely contracting, but it was still kind of slow. Then suddenly there was a bit of bleeding. I got scared, but I tried to remain calm because I know those things can happen during labor. It's easy for me to freak out, so I called the hospital, and they told me to come in.
By the time we got there and checked into a room to get my vitals, they couldn't find her heartbeat.
She had been moving all evening.
I had felt her.
It all happened in a matter of one or two hours.
It seemed like we were in a movie. We could tell something was wrong based on the nurse's face, but she was not allowed to say something. I kept saying, "What's happening? What's happening?" I was incredibly scared.
The doctor on call that night—Dr. Asato, who became so important to our family—came in. She was the first person who said, "We can't find a heartbeat." She added that they would do an emergency C-section to see if they could save her.
At that point, I became hysterical. It was the middle of the night, and we didn't have anywhere for Aaron to be. He was in the corner of the little child waiting area while I was being told that his sister didn't have a heartbeat. I was also bleeding heavily, and it was becoming more dangerous than I fully understood at the time.
I remember I didn't get to see Aaron before they wheeled me into the OR. Everything happened quickly, and I was overwhelmed by so many different sensory stimuli. These sounds and lights became at the core of my trauma later on. My ex-husband was there, but I remember that I was afraid that something was going to happen to me and that I wouldn't have had the chance to see Aaron or say goodbye to him.
They moved me onto a table. All I was doing was crying and screaming, "Please help me, please make sure she's okay!"
Because it was time-sensitive, they didn't wait for the anesthesia to start working before cutting me open. It was only a few seconds, but I felt everything.
And then, it went dark.
I woke up groggy. My husband was there in the room, and there was a doctor. As soon as I started to wake up, the doctor left. I knew she must have died, or else somebody would have reassured me.
I later found out that her dad had gotten to spend half an hour holding her while I was still asleep. I didn't get that much time. It's not like today, where you can spend 24 hours and they put your baby on a cooling blanket.
The moments I spent with her are blurry. I knew that her appearance would change over time, and I wanted to hold her for as long as I felt comfortable with how she looked.
While I was still waking up from the anesthesia, they bathed and dressed her. She had her little hat and a blanket, just like every other baby. And she got to be with her dad.
It just felt unreal. You think, "How can that be possible?"
She was so small. I mean, she was not tiny compared to preemies, but a little less than six and a half pounds. Aaron was on the higher side of seven, so she felt… fragile. She looked unharmed, like a sleeping baby. We took pictures with her and photos of her. And then, when the coloring on her cheeks and her lips began to change, I let her go.
After we handed her back, people started asking about arrangements. That, too, happened really quickly. You don't know what to say because you don't think about those things before going to the hospital to have a baby.
But everybody at Belvoir was really kind. The care was incredible. You know, after Mara died, I connected with many communities of bereaved parents. So many people have additional traumas because of callousness or insensitivity in the hospital. We didn't have any of it. And I'm very grateful for that.
Dr. Asato came, later on, to check on me and explained what had happened: I had a placental abruption, and that's what caused my bleeding. They couldn't tell if that's what had made my contractions start or the other way around. I also had marginal cord insertion on my placenta. Basically, the cord wasn't in the middle of the placenta where all the vessels were, but on the side. Many babies are born perfectly healthy despite this condition, but it amounts to an undernourished baby. That's why she was so small and why, after the abruption, she didn't have enough nutrients and oxygen to sustain her. Her cord was also very curly, which made it difficult for the blood to circulate.
Ultimately, Mara passed due to an unfortunate combination of things.
We are lucky because we received that information when we were still in the hospital. So many parents are left with unanswered questions when their babies die.
I became numb. Every sound was far away, and the lights and colors were off.
People were asking me questions that I couldn't possibly answer: what's going to happen with your baby's body? Who's going to tell our son that her sister had died? Everything seems to happen the same way than when you have a live baby, but you are left with empty arms and an empty car seat on your way home.
You walk out of the hospital apathetic. Your body knows it had a baby. Your brain does too. But you feel empty. There's a lot of stories about that moment of empty handedness after a loss.
Christmas came and I didn't know how to do it. The feelings are still very clear in my memory. I was laser-focused on Aaron. He's what allowed me to go through basic motions of daily life: food, laundry, and turning on music.
He stayed out of school for a while too.
And he was devastated.
We tried to explain the best we could, but it didn't make any sense to him. I mean, it doesn't make any sense to an adult, so let alone to a four-and-a-half-year-old. It brings up big grownup questions, like the universe and our place in it. So we also had to go through researching how we were going to talk to him about this.
Christmas changed forever for me after Mara died. It's still a really hard time of year. It doesn't get any less hard, but you get used to how the "hard" feels.
I like to think that it doesn't ever hurt less.
It just hurts less often.
Interlude
While I take pictures and listen to Kim, Ayla, who's 7, comes into the room.
As Kim explains her pain of recovering Mara's ashes after she was cremated, Ayla asks, "What does cremated mean?"
Kim responds, "Cremation means that your sister's body became tiny pieces that went into the sky on a windy day. We picked the perfect spot to carry her right up to the clouds."
Her daughter says, "Yes! It's in the pictures there, above the couch! That's so cool!"
She then takes Mara's hair out of the box.
"They feel just like your hair, right?" Kim says.
Ayla doesn’t speak. She finds the outfit Mara was supposed to wear on her way home from the hospital. Under it, a little piece of paper with her footprint.
"Is this her foot?" Ayla asks.
"Yep! That's hers! Her tiny footprint," Kim says. "And this is the clothes she was going to wear at Christmas."
On the shirt is written “Mommy's favorite gift.”
"Man, I love this outfit," Kim says. She pauses.
Ayla finds a stocking with "Baby Sister" on it. It was made by her Nana. She then pulls a newborn hat and looks at her mom in disbelief.
"Yeah, babies are tiny," Kim says. "Your sister was so, so amazingly tiny."
I took my full 12 weeks off maternity leave, and then I had to figure out what I was going to do about work. Was I going to stay home, even though I didn't have a baby to care for, or go back to teaching? Having such a public job, it felt like an impossible task. My students had gone through this pregnancy with me, and I didn't know if I'd be able to face them with such personal trauma. Plus, I was having bonus time with Aaron at home, which felt lovely, but I still was stumbling through everything.
For a while, I thought I might never go back. Teaching takes so much of you. You are giving from every emotional well that you have as a person and I felt like I maybe didn't have it in me anymore. That also added to my sense of loss, because I actually decided I was going to be a teacher when I was in eight grades. It's the thing that I've always dreamed of doing, and it's the only career I've ever had. I love it. To sense that I wasn't capable of doing it anymore was really frightening.
But ultimately, I decided to return.
Part of that decision was influenced by the outreach from our school community. Our friends, our teachers, and our students sent a great deal of love and support, in so many different ways. That entire box is full of student notes. It helped me feel hope, and it helped me remind myself that I had a purpose.
Still, when I went back, it was brutal. I returned on February 13th, and Mara had died on December 18th. It was horrific. But that day, I also learned—and this is something I'm still learning all the time—how many people have had some type of pregnancy or baby losses.
I've learned how much suffering is left untold.
I've always talked about hard things in my life, so when I went back to school, many people I had known for years came out of the woodwork and told me things like, "I've had four miscarriages, and I've never talked about it." Students came forward and shared that their moms lost a baby. One of them wrote to me that she herself had had a stillborn baby when she was a junior. Not only these people were trying to provide reassurance, but they were also seeking it.
That has come to be Mara's role in the world: the connections with other people who need comfort, understanding, and kindness. Sometimes, speaking up empowers people to express themselves. But sometimes, that's not even what people need: they are just looking for the comfort or affinity of belonging in a club nobody wants to be in. It has become her legacy. Now, both of my living children can speak freely about having a sister they lost.
The same has happened with my extended family. When my parents were growing up, those things weren't talked about. Private matters were taught to be kept quiet. Mara's passing has forced our family to be willing to acknowledge the pain and hurt and deal with them.
I vividly remember that I kept hoping a baby would magically appear on my doorstep. There're so many babies out there abandoned by their parents. Why can't there just be a baby for me? I immediately yearned to fill the empty space. It became this completely irrational hope that there would somehow be a baby showing up because I didn't see any other way that I was ever going to be okay or have another child.
But I did. Her dad and I decided that we were going to try again because I didn't want it to end that way.
Sometimes I think that getting pregnant again after Mara died was the ultimate act of bravery.
"Acts of bravery" paved my life. Aaron's surgery was one. Then Mara died, and it felt like going back to work would be the bravest thing. And then, trying for another child became one. It's crazy to think that somebody would willingly put themselves at risk just to have a baby. But we did.
We were super high risk at that point. We went through a small amount of counseling to know if we were okay, but that was the extent of it. It had been so hard to get pregnant with Mara that we didn't want to waste more time and did IUI. It worked after only one round. We couldn't believe it. By the end of April, so four months after Mara died, I was pregnant with Ayla.
I spent the whole nine months terrified. But the entire time, I also felt like I was such a badass. I was doing my reading, researching, getting information, journaling, caring for myself. I truly felt like "I got this. I went through something terrible that left me broken and absolutely terrified… but I got this."
Ayla came early. By then, I was monitored twice a week. We were still a month out, but she had dips in her heart rate during my appointment. Dr. Asato was my doctor for her too. She kept me overnight to see if it was a pattern, and I was like, "ABSOLUTELY. I am not leaving here with anything remotely out of the ordinary happening." Ayla kept having these dips throughout the night, so they decided that we would deliver her in the morning. So we sent Aaron to school, and then my ex-husband and I proceeded to the OR! It wasn't an emergency by any means, but it was urgent. I was awake the whole time. She came out screaming right away, and it felt so good. She breastfed like a champ, making me cry only for like… two weeks! Then I got double mastitis, and we decided to stop. I couldn't get well, so we had to put an end to it.
Ayla was amazing. Alive. Perfect.
But life itself was neither amazing or perfect.
I developed postpartum depression. In retrospect, I didn't recognize it as such. I thought that, because my baby had died, having another child would make things right. But it didn't. Now I know that bereaved parents are at a higher risk of mental health issues. After Ayla was born, nothing got immediately better like I had planned for it to. Not only that, but I felt sadder because I couldn't reconcile the idea that she was only here because Mara died, which is an impossible thing to think about.
I felt sad being happy. I felt guilty being happy.
The hardest part was fear. I developed unmanageable fear that something would happen to Ayla. Carrying her up and down the stairs, I would begin to panic and have to stop and sit down. I compulsively checked on her to see if she was breathing. And then I became scared that something was going to happen to Aaron, too. Within the first two months, it spiraled out of control. I couldn't understand why I didn't feel better.
Finally, Aaron called me out for my change of behaviors. I was angry. I was yelling. I cried all the time. I was so obviously unhappy, and it was really starting to cause Aaron stress. He began saying things like, "I feel you're always mad at me."
I knew then that I wasn't managing this well on my own. I needed help.
I was so scared, but I went to counseling for the first time. It should have been part of the process all along, but I just didn't feel that I needed to. I thought I had it under control.
I shifted my research to this—that's how I deal with anxiety by researching data. I was diagnosed with postpartum depression and situational depression. I saw a counselor who, unfortunately, ended up being so, so harmful.
Ayla would come with me to these appointments. The first time she ever laughed was there. But one day, this counselor told me that I should try to focus on how my grief was not necessary because my baby was sitting with Jesus.
I was stunned.
Yes, I had this baby, and I had wished for her harder than I ever wished for anything in my life. Yes, I knew she was a miracle. But that reality couldn't attach itself to the pain. They both were incredibly different feelings, so to tell me that it's not necessary to feel them because there's Jesus… I just couldn't believe it.
You expect regular people to say insensitive things like these, but not in a counselor's office where you're supposed to be safe. It was really harmful.
Not to mention I had never expressed anything remotely close to spiritual or religious beliefs.
I tried to move past her comment and went in three more times. On the third time, she told me that I should decide on a specific time of the day to allow myself to think about Mara, then the rest of the time, I would have to intentionally set these thoughts aside. She was basically telling me that my grief was only good for 20 minutes a day. More than that, it was an obstacle to my daily activities.
I never went back.
Afterward, I found scholarly journals and connected with loss communities. I was doing better with them than in counseling. I also started using Prozac and my primary care doctor—whom I love love love—helped me find the right dosage. I had so many preconceptions about using medication for mental health concerns. There's a lot of stigmas attached to it. But trying to implement behavioral technics on an unstable emotional base isn't working. Prozac helped me feel more even so that the behavioral technics would work. It made a huge difference. I started to be able to regulate my paralyzing fears. I was less impatient. I talked openly to Aaron about how I was struggling and what I was doing to improve.
I know being upfront with him will help him see the world in a more empathic way. I know these experiences helped me have a much better understanding of the pain that an individual may be experiencing. My family had to become emotionally literate by having to go through it too. This situation is part of our history now.
As for Ayla, she does talk about her sister quite a bit. The other day we looked at pictures of Mara for the first time. She said she was pretty. Ayla and Mara looked exactly the same as babies! And then she drew me a picture: it's me in a princess gown and I have a crown on. She made three gemstones across the top: one for her, one for Aaron, and one Mara. The tip is purple because it was the color of the vivid sunlight the morning after she passed, and we use purple to celebrate her. It's also on top of the crown because Mara isn't with us anymore, but above us, in the sky.
On December 17th, my whole family and colleagues wear purple. The root of this initiative is to not let pain erase what little we have of her. Instead of trying to make it go away or ignore it, we talk about her and what happened to her. Like this, people see that you can live alongside your loss.
We say her name and share her story day after day. She is the reason why we can have hard conversations.
That’s what Mara has given us. That’s why she truly is my one favorite gift.