The silent birth: A feminist perspective

We grieve all that cannot be spoken, that for which there is no name (Griffin, 1978). The social work profession embraces the idea that social action is necessary as a part of the field's responsibility to society. This includes political and social action that seeks to improve the lives of others, particularly the underrepresented and the vulnerable populations (Reamer, 1998). The feminist perspective, a theoretical paradigm often used to examine women's issues and one embraced by many social workers, "rests on the concept of the personal is political" (Collins, 1986, p. 215). There is, perhaps, no more deeply personal and profound experience for many women than losing a baby to stillbirth (Cacciatore & Bushfield, 2008). Stillbirth, or sudden intrauterine death, occurs 10 times more frequently than Sudden Infant Death Syndrome, yet it has failed to be acknowledged as a public health problem ("Racial/Ethnic Trends," 2004). This translates to about one in 110 pregnancies that will end in stillbirth. Despite improvements in prenatal care and advanced medical testing, stillbirth rates over the past 10 years have declined only slightly in the United States (Ananth, Liu, Kinzler, & Kramer, 2005; Goldenberg, Kirby, & Culhave, 2004; Silver, 2007). Many sudden intrauterine deaths occur at or near full-term to otherwise apparently healthy infants. Upon postmortem examination, one-fourth to one-half of stillborn infants die as a result of causes that are indiscernible (Froen et al., 2001). Mothers, and often fathers, are left searching for answers, for any explanation to the questions surrounding the child's death, often left in the turmoil of irrational self-blame (DeFrain, 1986). Although etiological aspects of stillbirth are cloaked in obscurities, the psychosocial dimensions of grief responses to stillbirth, as well as child death in general, are often even more elusive (Froen et al., 2001; Goldenberg et al., 2004). The birthing process is often a traumatic physiological event (Silver, 2007; Slade, 2006; Soet, Brack, & DiIorio, 2003; Smith Armstrong, 2002; Hendrick, Altshuler, & Suri, 1998). Researchers in England discovered that "20% of mothers who have a stillbirth experience prolonged depression," and at least one in five suffer from posttraumatic stress disorder (Walling, 2002). Approximately 20 percent to 30 percent of women who have experienced stillbirth exhibit "appreciable psychiatric long term morbidity" (Radestad, Steineck, Nordin, & Sjogren, 1996). As a result, it is not unusual to observe significant stressors in families after such a tragedy. These disruptions can result in prolonged dysfunction leading to an erosion of familial relationships and, sometimes, even severances. The emotional effects of giving birth and death simultaneously are often misunderstood (Fletcher, 2002; Malacrida, 1997; Michon, Balkou, Hivon, & Cyr, 2003) and rarely examined beyond the cursory rhetoric of perinatal death (Cacciatore, 2007). Women who give birth to a dead baby may feel disenfranchised from social groups in which babies and children are integral, while their mourning experience is generally decried by society in general (personal communication with R. E. Kubler, Scottsdale, Arizona, 2004; DeFrain, 1986; Fahey-McCarthy, 2003; Fletcher 2002; Saddler, 1987; Worth, 1997). Fathers, too, are often faced with tumult after stillbirth. Both bereaved mothers and fathers demonstrated significantly higher levels of depression from a control group, those effects being longer lasting in mothers up to 30 months after the death (Boyle, Vance, Najman, & Thearle, 1996; Vance & Najman, 1995). "Fathers are in a difficult position after a stillbirth for a number of reasons: They are expected to take care of the wife emotionally; they are expected to continue to work and pay the bills; and they need to grieve for their lost baby themselves" (DeFrain, Martens, Stork, & Stork, 1990, p. …