We were finally summoned into the examination room, and the midwife began the routine in her usual somewhat perfunctory manner. She had started her career with the Peace Corps in South American and often gave us the impression that she considered prenatal check-ups little more than a formality in this country for couples from our economic bracket. Her attitude changed suddenly during this visit. No heartbeat was audible on her "dop-tone" listening device. She applied more goo to Elanah's belly, pressed harder with the dop-tone. She put the instrument aside and tried another one, then a third. Finally, she excused herself and went to arrange an emergency ultrasound at the hospital next door. Elanah and I were left sitting numbly in the examination room. I didn't need to see the results of the ultrasound. Any doubts I may have had, any shred of hope I may have been clinging to, had evaporated after the midwife's first try with the first dop-tone. The unthinkable had happened. Although the full impact had yet to sink in, I knew our baby was dead.

Elanah: The midwife tried to distract us with small talk and anecdotes while we sat for an unbearable amount of time in the waiting room of the Radiology Department. As the sonogram began, neither the technician nor the doctor spoke to us or even dared to look us in the eye. They both rushed out of the room as soon as the session ended. I was beginning to feel toxic, especially when the technician, not daring to touch me again, tossed a towel in my general direction as she made her hasty exit, mumbling that I could wipe off the conductive gel myself.

Rather than facing us directly, the radiologist reported through the midwife. Even at this point, her words were somewhat equivocal: "The doctor feels there's no movement." It was up to us to fill in the blanks: "You mean the baby's dead?" After a mandatory detour to the hospital billing office, we were referred to the Birth Center's backup obstetrician. We met with her later that afternoon, and she agreed to supervise my labor and delivery. She advised us that I would probably go into labor spontaneously within a few days, as was usually the case with stillbirth at term. If I didn't, she recommended induction. Finally, seven hours after our "routine" prenatal visit had been scheduled to begin, we arrived at home and tried to absorb the news.

Labor of Love
Elanah: The skies were crying for us the following Tuesday morning as I was escorted in silence down a long corridor to the Birthing Room. I felt like a prisoner en route to my execution - denied food or water, hooked up against my will to a web of wires. I resisted a momentary urge to run the other way and submitted passively. The curtains were drawn against the gray, bleak day and a sign outside the room announced an IUFD (intrauterine fetal demise). The musical tapes and other items we had packed as labor aids lay unused in our suitcase.

Speeded by the use of a contraction inducing hormone, the labor lasted only 7 hours and was physically intense. There were some unpleasant emotional moments, too, most of them triggered by the obstetrician's periodic interruptions. Her obvious discomfort with this special birth prevented her from ever considering our own physical and psychological needs. Having previously agreed to "whatever we wanted," she now disregarded many of our wishes, leaving me feeling angry and betrayed. She undermined my confidence by rushing labor along with judgmental remarks like "Let's turn up the Pitocin; we don't want to be here all day," or "You want to get this over with, don't you?!" And then she made me start pushing before I was fully dilated, saying "We're not going to wait any longer."

Fortunately, the intrinsic momentum of the birth process soon brought me to a state of deep inner concentration, where I was beyond the reach of superficial annoyances. With the support of the nurses, they were very sensitive and treated us with dignity, and with Michael and my parents at my side, I was able to complete my labor without using any pain medication. In this way I managed to salvage at least part of my original vision of a natural, active birth. Remaining lucid and connected enabled me to create meaningful memories which sustain me to this day. In particular, I recall how the nurses and my parents formed a semicircle around me during the final contractions, each one taking a turn massaging my back, wiping my face, feeding me ice chips. Michael held my hands as I called to our baby; the deep blue of his eyes soothed me and held my concentration while we breathed in unison.

With the final push that delivered our daughter, I felt a serge of joy and accomplishment. My sense of pride and love increased when I got to hold her. I undressed her and examined every inch of her, counting her fingers and toes. She was everything we had hoped for. Despite Michael's ambivalence and my parents' initial disapproval, I was determined to give her a name. Abandoning our earlier choices, we decided on the Hebrew name Malka, meaning "angel" or "princess". Saying goodbye turned out not to be the agonizing ordeal I'd anticipated. As I watched Malka's father and grandparents say their own farewells, I began to appreciate how birth truly is a remarkable transformation.

Michael: I, too, was surprised by the beauty that remained in our experience of Malka's birth. Somehow the power and magic in her moment of emergence were able to transcend the tragic circumstances surrounding the event. I was full of admiration for the way Elanah had handled herself and tremendously relieved that she had suffered no serious complications.

Malka's appearance was perfectly normal aside from some patches on her belly and arms where the skin had begun to tear. If I had not known otherwise, I would have thought she was sleeping peacefully. Somehow, though, I couldn't bring myself to hold her - her limp body seemed so fragile, like a bag of jello that might start to come apart if handled too roughly. So I touched my lips to the middle of her forehead and kissed her gently. "Goodbye, baby. Beautiful girl-baby, goodbye."

As check-out time approached the next morning, we were unceremoniously shooed out of our postpartum room. At the same time, we were being hounded for a decision regarding funeral plans. Not having realized that the baby's remains would be released by the hospital, we had made none. We had requested an autopsy, but were told that the baby could not be sent down to the morgue until we provided the name of an undertaker. I sneaked into a vacant room and began going through the yellow pages dialing funeral homes. Cremation? The voice at the other end of the line told me it would be too expensive, but couldn't give a precise figure. Burial? Another disembodied voice suggested that we ask for an unmarked "potter's grave" at the local cemetery.

After consulting with Elanah's parents, we contacted their family burial society on Long Island. It was a long way from our home in New Hampshire, but I found it comforting to think that Malka would have her great-grandfather and other relatives to keep her company. Even from this quarter, however, we met resistance. Yes, we were entitled to use the family plot, but, according to the funeral home in New York, the cost of flying the baby's body to Long Island would be "prohibitive." Finally, Elanah took the situation in hand. "Hello, this is the mother of the baby. Just tell me right now, are you willing to help us or not? Don't tell me the cost is prohibitive! Give me a number and let me decide if it's prohibitive." We kept the hospital staff at bay until the funeral home could call back with a quote that seemed quite reasonable under the circumstances. They also gave us the name of a local mortuary which had agreed to transport the baby to the airport. Finally we were allowed to leave the hospital and go home.

Looking Back
Michael: For a long time, I had a sense of incompleteness in the wake of our hasty funeral arrangements. Even now, there is a part of me that wonders if Malka's body is really there. It doesn't matter that there is a clear evidence of a baby-sized hole being dug and refilled. It doesn't matter what the cemetery's records say. I don't know she's there. The lack of an official memorial service isn't what bother me. I just wish I had been there with her. At any rate, I did end up achieving a closure of sorts 3 years after Malka's death by commissioning a permanent headstone to mark her grave.

As time goes by, I also find myself regretting the decision not to bring our own camera to the birth to get at least one decent photo of the baby. The nurses did their best with a decrepit Polaroid, but the pictures they took were out of focus to begin with, and after 6 ½ years, they have faded beyond recognition.

I have had better success preserving images of my emotional experiences via poetry. Writing for me was not only a powerful cathartic, but also a way of setting up communication between my intellectual self and my emotional self. As for establishing memorials for Malka, I have found other ways to do that as well. Whenever I give money to a good cause it is in her name. When I spend time helping other bereaved parents through HAND, it is time spent with her. Somehow these memorials seem more fitting and truer to her spirit than that thin slab of rock with those letters and numbers scratched in it.

Elanah: I left the hospital saddened but optimistic, convinced the worst was behind me. The first few days were consumed with concrete tasks such as finalizing burial details, waiting for my milk to dry up, notifying friends, etc. All too soon these were over leaving me with empty days and no focus. I wasn't prepared for the intensity of grief that followed, or for its duration.

Losing my baby also meant losing my pregnancy and I mourned both losses equally. A piece of me was still deeply connected to being pregnant, haunted by the presence of a "phantom" womb or "phantom" pregnancy. I often found myself searching for Malka among all the dark-haired infant girls I encountered in public, not quite trusting that she was actually dead.

For many months, I needed to tell and re-tell the details of her birth, desperate to prolong at least the biological aspects of motherhood. I was so grateful to the friends who let me join in conversations about their own birthing experiences and who accepted as natural the pride with which I shared mine. It was hard enough being around their babies without my child, but it would have been excruciating to have to pretend that I had never gone through pregnancy or birth.

Like Michael, I found writing wonderfully healing. I carried my journal and poems wherever I went. They became my baby, my substitute outlet for all the love and creative energy I had inside. They also charted the journey of my grief and revealed the progress that was otherwise too gradual to recognize.

By Michael Dilts and Elanah Kutik [Michael and Elanah's first child, Malka, was stillborn at 37 weeks. Subsequent autopsy revealed no obvious cause of death. Malka now has 2 living sisters, Rebekkah and Arianne.]