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(AP) – Of all the little moments of joy and contention that fill the Academy Award-winning film "Roma", the most heartbreaking film takes place in a hospital room in Mexico City, where a doctor coldly tells a young scared woman, "Your baby is born dead."
The haunting scene, which takes place in 1971, introduces graphically a subject still poorly understood and often avoided. Although world rates have since declined, stillbirths remain surprisingly common: nearly 3 million a year, most of them in developing countries.
The US rate, 6 out of 1,000, has not changed for a decade and the cause is unknown in at least a third of cases. Most US insurers do not cover autopsies and many parents do not want to, often leaving mysterious circumstances and potential risks.
"This is a field of research that is seriously under-researched," said Jennita Reefhuis of the US Centers for Disease Control and Prevention. "It's such a devastating event for a couple – it's something that deserves more attention."
SO NOW
The young Roma mother only has a few seconds to hold her child lifeless before a doctor tells her that he must take and "prepare" the body. From her hospital bed a few feet away, she silently observes the infant in a white shroud.
The coldness of this persistent scene is in part dramatic, but it also reflects the thinking of the time that stillbirths were almost to be discarded. Dr. Francisco Ruiloba, an obstetrician from Mexico City, said that many hospitals in Mexico and elsewhere have since adopted a more humanistic approach. According to Ruiloba, in her practice, mothers have all the time they need and the body is prepared "with respect and out of the room".
In 2009, the American College of Gynecologists and Obstetricians reaffirmed its guidelines stating that emotional support should be offered to parents of stillborn children, including references to counselors, support groups or therapists. Parents should have the chance to hold and name their babies, and say goodbye, advises the group.
Studies have shown that allowing parents to spend time with stillbirths can reduce the chances that mothers develop anxiety and depression later. Many US hospitals let parents spend hours or even days with them. Some hospitals take pictures of souvenirs, footprints and hand prints for families; some provide cooling beds to preserve the body while the family complains.
We emphasize "how important it is for the patient that we are comfortable with them, that we talk about it and that we rebadure them by telling them that it is a terrible thing, but that they they will come out of it, "said Dr. Alan Peaceman, director of Northwestern Medicine's maternal health department. fetal medicine service in Chicago.
Pediatric Nurse Lindsey Wimmer, whose son Garrett was stillborn in 2004, said parents "do not have the habit of seeing or naming their baby, but simply moving on and off. to have another one. .
"Their grief is waiting for them and they will never forget those babies," said Wimmer, executive director of the Star Legacy Foundation, a Minnesota-based group that promotes research and education on stillbirth.
Social media has given mourning parents a new outlet. Canadian Rebekah Shirey posted a poignant video for friends, showing what looks almost like a routine job and childbirth. Surrounded by family members and friends in an Ottawa hospital ward, with his partner Steve Martin by his side, Shirey grows, cries and cradles their stillborn son Elijah. It was July 29, 2017 and Shirey had learned a few days ago that Elijah's heart had stopped beating. The tests showed problems with his placenta.
"The more we are aware, the more our community makes things easier," she said.
SCIENCE AND ADVOCACY
US doctors define stillbirths as fetal deaths after 20 weeks of pregnancy; it is 28 weeks or later in many other countries. As in many countries, there is no US national registry, and although fetal deaths are reported in all states, documents often contain minimal information.
In the United States, about 1% of pregnancies end in stillbirths, nearly 24,000 per year. Obesity, diabetes, smoking and becoming pregnant after age 35 all increase the risk and this rate is twice as high in black women as in whites.
Placental problems contribute to about 1 out of 3 stillbirths in developed countries. As part of the US government's human placenta project, researchers are looking for better ways to detect placental problems, including imaging and blood tests.
Recent studies have provided new clues, suggesting that stillbirths could be related to reduced or excessive fetal movement, late-gestating women in late pregnancy, excessive temperatures, and air pollution. . One study even found that an unhappy "instinct" of pregnancy was more common in stillbirths than in other mothers.
Doctors advise women to pay attention to the movements of the fetus at the end of pregnancy and to know when a change may indicate fetal distress. Inducing labor is a possible option if pregnancy is sufficiently advanced and some studies have suggested that counting strokes could reduce stillbirth rates.
Several mothers of stillborn families in Iowa have launched a campaign urging women to "count the kicks" that has been adopted by the public health authorities of six states. In Iowa, where it was adopted in 2008, the stillbirth rate fell below 5 per 1,000. Although there is no evidence, Kimberly Piper, nurse and head of the department of state health, says the campaign may have contributed to the decline.
RECURRENT SCENARIOS
Approximately one in five births in the United States occurs towards the end of a normal pregnancy and without incident. The scenarios are strangely similar: a few days or weeks before the scheduled date, a woman suddenly becomes aware of any kick or lack of movement of the fetus. Most women want immediate cesarean delivery, but these are rarely done for stillbirths because of the risks. Instead, doctors give drugs to provoke the work and parents wait.
This is the nightmare endured in 2016 by Lindsey Schmitz of Chicago after a "clbadic" pregnancy. After 24 hours of hard work, the nurses gently placed Sawyer Schmitz on his mother's chest and moved away as the power of the moment sank.
"He was hot, he was handsome and smelled like a baby," Schmitz recalls. "He just seemed to be asleep."
Grandparents, aunts and uncles joined the parents in distress in the delivery room.
"They commented on her features, laughed on the chin," she said. "The nurses took pictures, a lot of pictures."
Schmitz says she is shocked by the things she did not think she could do in pain: "He cut off a lock of hair, read a book to it, we never dressed it. At that point, you do not know that's what you're going to want. "
She wanted to know the cause, but an autopsy and other tests gave no answer.
Now, Schmitz is volunteering as a resource for other women who have had stillbirths.
"When you're in this club, you realize it's much more widespread than anyone else talking about," she said.
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