Journal of Marital and Family Therapy

1991, Vol. 17, No. 3, 215-232

LEARNING ABOUT GRIEF FROM NORMAL FAMILIES:

SIDS, STILLBIRTH, AND MISCARRIAGE*
John DeFrain
University of Nebraska-Lincoln

Family therapists can learn a great deal that would be of utility to them in their
clinical work from normal families grieving ouer the death of an infant. When
a baby dies, families begin a long and difficultjourney, a search for security and
meaning in a world that for them has gone insane. The researcher discusses 10
probing, extremely difficult questions family members commonly pose in the
aftermathof an infant death and offersguidelines that could be helpful to family
therapists hoping to be of service to families in the process of healing andgrowing
through this tragedy.

When a baby dies, each individual in the family begins a unique journey that will
change the course of her or his life in a host of profound ways. The life of the group, the
family, will also be changed-in most families, dramatically changed-by the death of
a baby. Most families survive the loss, though an apparently small percentage of spouses
divorce as a result. In the final analysis, most family members will come to believe that
a great deal of good can emerge from the ruins of such a tragedy. Most family members
conclude in the long run that individuals and families “recover”from such a catastrophe
or “resolve” the ensuing crisis; but many of these same people also believe that life will
never be the same. Life, for many, takes on a deeper meaning. The bittersweet reality
of life is indelibly printed on the soul: Life is beautiful, many bereaved family members
conclude. Life is fragile. We inherit the earth for a few precious moments and then are
gone.
This article focuses on 10 compelling questions family members commonly pose
following the death of a n infant and concludes with suggestions which might be of some
use to family therapists working with bereaved families. It is hoped that some of the
quantitative research findings and testimony from family members presented in this
article will shed light on these questions and be useful to family therapists in their
efforts to help families find a modicum of peace and meaning in the aftermath of a
tragedy.
The 10 questions family members commonly ask come from nine distinct investiga-
tions, dating back to 1975, into the nature of a family’s grief following a sudden,
unexplainable infant death (Sudden Infant Death Syndrome), a stillbirth, or a miscar-
riage. Nearly 850 people in every state of the U.S. have been involved in this research
(239 SIDS mothers and fathers; 80 SIDS grandmothers and grandfathers; 73 SIDS

*The reported research was supported by the University of Nebraska Institute of Agriculture
and Natural Resources, Agricultural Research Division. The author gratefully recognizes his
colleagues in this ongoing research:Linda Ernst, Jacque Taylor, Leona Martens,Jan Stork, Warren
Stork, Deanna Jakub, and Elaine Millspaugh. The author has three children, all of whom are
living.
John DeFrain, PhD, is Professor of Family Science, Department of Human Development and
the Family, University of Nebraska-Lincoln,Lincoln, NE 68583-0809.

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surviving siblings; 350 mothers and fathers who have experienced a stillbirth; and 101
mothers, fathers, and surviving siblings who have experienced a miscarriage).

THE RESEARCH BASE FOR THESE QUESTIONS

The research methods and procedures employed over the past 15 years are ade-
quately explained in a series of other articles and books (DeFrain & Ernst, 1978;
DeFrain, Taylor, & Ernst, 1982;DeFrain, Martens, Stork, & Stork, 1986,1990; DeFrain,
Ernst, Jakub, & Taylor, in press). The purpose of this article is not to report a particular
study’sresults but rather to synthesize the major questions and themes uncovered across
nine distinct studies and show how these insights can be useful to bereaved families
and professionals.

THE QUESTIONS
Qualitative analysis of our data from nearly 850 bereaved family members indicates
there are 10 very common questions asked by people whose lives are directly affected
by the death of a baby. Mothers and fathers ask these questions. Surviving siblings
need to have some kind of answer to these questions, and so do grandfathers and
grandmothers. Other relatives need to know, and so do friends, neighbors, and all the
other members of the community who learn of the tragedy. All need to find answers to
these questions so that together they may build a healthy, loving community of caring
souls.
None of the questions, however, are easy to answer. Many, perhaps, will never
really be answered; but all are questions that the bereaved and their loved ones and
friends seem compelled to keep asking themselves and each other, and the simple act
of questioning and searching for answers is an essential part of the healing process.
Why Did This Happen? “Babies just don’t die,” the bereaved person thinks. “Children
just don’t die. There must be some reason for this. There must be some explanation.”
Almost everyone the researchers interviewed or read testimony from over the years has
felt some guilt. They blame themselves in some way for the death, even though in the
vast majority of cases they cannot rationally be held accountable.
Even though it seems outrageous, the fact remains that many babies do die each
year in this country. Approximately 1.1%of infants in the U S . die in the first year after
birth; and about 1%of the babies born each year in the U S . are stillborn, according to
the National Center for Health Statistics (1985). An estimated 10 to 14%of all known
pregnancies end in miscarriage (Buehler, 1983; Day & Hooks, 1987). Some estimates
are significantly higher.
Many of these losses defy rational explanation. For example, it is estimated that
perhaps eight to ten thousand of the infants who die each year in the US.die suddenly,
and for no apparent, explainable reason. Typically, a mother or father or babysitter will
put an apparently healthy baby in the crib and come back minutes or hours later to find
the infant dead. An autopsy reveals no known cause. This occurrence, labeled Sudden
Infant Death Syndrome (SIDS), shatters a family; and though family members may be
desperate for an explanation, no explanation is possible a t the time of autopsy (DeFrain,
Taylor, & Ernst, 1982; Culbertson, Krous, & Bendell, 1988; Harper & Hoffman, 1988).
The search for the answer to the question of why this happened often begins with
the physician. The distraught family members feel that the doctor can answer this
question; but this is not necessarily the case. Many times the physician can give a
medical reason for the death. For example, in the instance of a stillbirth, the physician
can often say that anoxia (lack of oxygen) was a “cause” of the baby’s death: the placenta
sometimes becomes compressed during delivery through the birth canal, cutting off the

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oxygen supply; the cord may also wrap around the baby’s neck, cutting off oxygen (Borg
& Lasker, 1981).
In many cases, however, physicians are at a loss for words concerning the cause or
causes of the death. Kirk notes that “It i s . . . important not to attach too much hope to
the autopsy as a means of explaining everything’’(1984, p. 50).According to Kirk, recent
studies indicate that in nearly half of the stillbirths medical investigators could not
determine a cause (1984).
There are a wide variety of causes of miscarriage, including fetal abnormality,
a hormone imbalance in the mother, structural defects of the uterus, infection, and
abnormalities in the immune system. Falls seldom result in miscarriage. In the great
majority of cases, the fetus is found by pathologists to be abnormal. Genetic defects,
drug and alcohol use, and exposure to toxins such as heavy metals, chemicals, and
radioactivity, increase the risk of miscarriage. “In its way, the high incidence of abnor-
malities in miscarried fetuses provides some reassurance that a pregnancy reaching the
sixth month will most likely result in a healthy child” (Baxi & Fox, 1988, p. 245). In
our recent study of miscarriage, the parents reported that 70% of the doctors told them
they did not know why the miscarriage occurred, even though 49% of the miscarried
babies were scientifically examined by a pathologist. A family’s faith in physicians may
be undermined when this occurs, but the medical profession cannot be expected to know
all the answers.
People who lose babies often go on a long, involved quest to find the answers, and
they are often dissatisfied with the results. The search is complicated by medical jargon;
also, some medical personnel are for many reasons uncomfortable talking about the
death. Finally, a medical reason for the death is not really what most bereaved people
are seeking.
This notion needs further explanation: if a parent’s baby dies, and the physician,
whom the parent respects and often loves, tells the parent that the baby died of pneumo-
nia, the parent is satisfied with the answer in one sense. The parent now knows the
“cause” of the baby’s death; but the parent still does not know why the baby died. A
perfectly rational parent’s response could go like this: “Yes, I know it was pneumonia.
You explained that . . . but why did my baby die?”
The parent is pleading for an answer the doctor simply does not have. “The world
can kill a baby, you say?’ the parent reasons. “If that is true, the world is capable of
any atrocity. I can’t imagine why I want to keep on living in a world like that.” The
search for a n answer to the question “why’)thus takes on a new, broader scope.
Why Did This Happen, God? Many bereaved family members offer prayers to God in
the aftermath of a baby’s death. Below is a prayer one mother wrote not long after her
first son was stillborn:
Oh Lord, for months we looked forward to hearing that first cry. . .There’snothing more
beautiful than a baby’s first cry as he comes into the world. I found that out when I had
our first son.
But my arms are empty now. There is no baby to hold. My body says yes, yes, I should
be a new mother. There is milk in my breast and my body is flabby from where he was
in me.
Nine months we planned on this baby. For years we planned on this baby, and it just
hurts so much not to be able to have him with us.
Oh Lord, our hearts are so filled with grief. We miss him so much.
Many people pray to God for answers to their questions. Many people blame God.
The death of a baby can begin a spiritual journey for a young person who has not spent
much time thinking about the nature of God and life. The death is often the catalyst for

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a search for workable religious beliefs. A young mother or father who has adopted by
default a simplistic “Sunday School” type of faith in “a kindly old gentleman with a
beard who watches out for me” can be devastated by the death of the baby. God will
never be the same.
The investigators have talked with many, many people who have hated God for
“killing my baby.” One minister, who had been preaching his faith in God to a faithful
congregation for years, was deeply distressed to find that faith alone does not protect us
from harm. When his son died in his arms, he began a longjourney to find a new theology
which better fit the life that he was experiencing, a life in which fathers sometimes have
the misfortune to see the death of their young.
“Why?” this minister asked himself and other people and God. He concluded after
a number of years, as many other parents conclude, that we simply do not know the
answer and we never will.
It seems logical to some parents that if the world can kill babies, then God is not
in his heaven and all is not right with the world. “The world is a series of random, freak
occurrences with little meaning,” one father told us. Other parents, however, insist on
keeping the faith.
Some are almost bargaining with the God they believe in. The bargain goes like
this: “I really want to hate you, God, for taking my baby away, but I won’t. I’ll believe
in you, God. I’ll believe. More than ever.” Promises can include being more honest and
kind and going to church or synagogue more often. The unspoken and fervent plea that
goes with the bargain runs like this: “Oh, please, God, I will be good; but don’t take
another baby away from me. I simply can’t stand any more.”
Many people come to the conclusion that a personal God had nothing to do with the
baby’s death. These people may or not believe in God, but if they do believe in God, it
is not an anthropomorphic God. These people eventually find that babies sometimes do
just die for no apparent reason, or for no reason that really makes any sense to humans,
They also conclude that if God exists, God is not “a divine Santa Claus,” in the sardonic
words of one mother, but a broader concept:
-God is love.
-God is life.
-God is the earth, the universe.
-God is the goodness in each one of us.
How Can I Help Someone Who Is Grieving? Grandparents ask this question, and so do
other relatives, friends, and professionals involved in the crisis. Parents ask this ques-
tion, too: how can they help their spouse, their children, and the many people they
encounter after the death who have no idea what to say or do. Surviving siblings also
ask how they can help the family heal.
One of the most moving examples came from a mother who had experienced a
stillbirth:
The nicest thing that happened to me was on the first day I returned from the hospital.
A neighbor lady from the next block (in her seventies) came into my bedroom, marched
stiffly to my bed, gathered me into her arms without one word, and her tears fell over
my head and down my face, a s she stroked my hair. After awhile she dried her tears and
mine, marched stiffly out of my room, and down the street.
She died two weeks later in her sleep. What a tremendous loss to our world. I learned
that she had lost two children in their infancy.

The family members told us of the innumerable ways people help each other when
the world goes mad and a baby dies:

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Listening, This perhaps comes up more often than any other recommendation from
bereaved parents, siblings, grandparents, and other involved persons. People who simply
listen and are there are invaluable.
Sending cards and letters, and calling on the phone, and caring for living children,
and bringing food, and doing housework, and helping with the chores, a n d . . . The list
of specifics is endless and quite simple. People help by doing the things that help
everyday life go on, for it must.
Sharing our own losses. Bereaved persons tell us time and again that others who
have experienced tragedy in their lives are especially welcomed and especially comfort-
ing. There seems to be a n invisible bond.
Remembering the baby. Parents have a desperate need to remember the lost baby,
forever. To deny them the right to remember is to deny their humanness.
I really appreciated it when people asked us how we were doing. It was a way of saying
they hadn’t forgotten. Also, I was really touched when people would call Ben by his name.
It was a way of acknowledging him as a real person.
People should not forget the baby that died, even though we now have another baby.
Hauing courage. “They make me feel like a leper,” many people affected by a baby’s
death have told the investigators. As a society we tend to be a death-denying clan, a
group wishing not to be reminded of life’s ever-present catastrophes. Those who lose a
baby understand society’s foolishness perhaps as well as anyone. To be of help to those
who have lost a baby, one must have tremendous courage, the courage to face the pain
of the grief-stricken, and the courage to face one’s own pain, the pain human beings feel
because of our inability to come honestly to grips with the reality of life.
A m Z Losing My Mind? Many of the bereaved wonder on occasion if they are “going
crazy”:
In the beginning I lost all sense of being. The second day after the funeral, I went out
and tried to dig up her grave. I thought I could see her in her walker or hear her cry. I
stayed up all of the day and night checking the other kids. I’d leave them several times
a week and go to the cemetery and sit by her grave all afternoon.
At the time I was four months pregnant. After my little boy was born, my husband and
I took turns with four-hour shifts, watching the baby for several weeks. Then I would
dress him in her clothes, until one day I put her shoes on him and I had to get my oldest
child to take them off.
Their world has been turned upside-down. What they thought was a good world, or
a t least a reasonably good world, has killed a baby. “Either the world is crazy, or I am
going crazy,” one reasons. Going a bit crazy, however, can be a relatively reasonable
response. Why shouldn’t a person be fearful? Why shouldn’t one cry? Why shouldn’t one
be filled with rage?
In a study of the psychological effects of a stillbirth on surviving family members,
the investigators asked 304 parents about irrational or “crazy” thoughts they had in
relation to the death (DeFrain, Martens, Stork, & Stork, 1986).The signs of stress and
strain are quite common (see Table 1). These “crazy” thoughts will go away with time,
but they can be utterly terrifying.
As the reader can see in Table 1, the majority of parents felt they had irrational
thoughts. These thoughts include the belief that the baby is still alive, leading some
mothers and fathers to want to rush to the cemetery and dig the baby up before it
suffocates in the grave. Other parents have said that they thought the nurses mixed up
the babies in the hospital nursery, putting the wrong nametag on their baby: “It was
somebody else’s baby that was dead, I thought. Not mine!” One parent concluded that

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Table 1
Irrational Thoughts, Moving, Divorce, Violence, Substance Abuse, Sleep, and
Suicide after a Stillbirth
Number of Parents = 304
Percentage of Parents Answering “Yes”
Questions Mothers Fathers
“Did you have any irrational thoughts related
to the stillbirth?” 65% 51%
“Did you move from your home and/or
community to escape the pain of the stillbirth?” 24% 18%
“Did you ever seriously consider divorce as a
result of the stillbirth?” 9% 7%
“Did you divorce as a result of the stillbirth?’’ 1.5% 3%
“Did alcohol or other substance use begin or
increase because of the stillbirth?” 13% 7%
“Did you ever want just to go to sleep and
wake up after the pain was gone?’ 62% 50%
“Did you ever seriously consider suicide
because of the stillbirth?” 28% 17%

the doctor was running a black market child-stealing ring. The doctor, she believed for
a short time, had sold her baby for $25,000 and told her it died at birth.
The surreal nature of a baby’s death makes impulsive and angry behavior common
in families. Many parents move away from their homes and their hometowns and
extended families and friends to try to escape the pain. They sometimes leave no
forwarding address. Some consider divorce, and a small percentage of marriages do end
(DeFrain & Ernst, 1978; Rando, 1986).
A sizable percentage of parents consider suicide. As Table 1 indicates, in our study
more than one in four mothers (28%) who experienced a stillbirth considered suicide.
Nearly one in five fathers (17%)considered suicide (DeFrain, Martens, Stork, & Stork,
1990). One mother nearly overdosed on drugs after her third child was stillborn. This
woman, a skilled professional, felt terribly burdened by guilt because of the death: “I
kept thinking of that third lost lamb. Not of the two that were healthy and happy. I
kept wanting to be with my third lamb.” She continued:
I came real close [to suicide]. If it hadn’t been for a really close friend, I probably would
have. I had taken a lot of pills and had been drinking all day. My kids were with my
mom and my husband was gone. I hadn’t answered the phone all day. For some reason
when she called, I answered. I don’t know why. . .
She said, “What are you doing?’ I said, “Well, I’m just sitting here drinking.” She said,
“Are you all right?” I said, “No.” She said, “Where are your kids?” and I said, “Gone.”
She said, “I’ll be right there!” I don’t remember anything else except her banging on my
front door saying, “Let me in!’’I let her in, and I was really frightened. I wrote a suicide
note.
[In the note] I said that I was really sorry . . . That I felt all along that it was my fault
that she died . . . and that I was very sorry. I can remember sitting in the rocking chair
in her room with her picture.. . Thinking that I was going to be with her. That’s how
out of it I was. I kept thinking that if I just died she wouldn’t have to be alone any more.
In a recent survey we asked 127 SIDS parents, “Have you ever thought of suicide
because of the death?” Forty-two percent responded that they had considered taking

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their own life because of the baby’s death; 6% responded that they had actually tried to
kill themselves because of the death (DeFrain, Ernst, Jakub, & Taylor, in press). One
father tried to gas himself in his car inside the garage because he had not wanted the
baby in the first place; mothers reported trying to overdose on drugs and trying to crash
their car into a bridge.
In a study recently completed on the effects of Sudden Infant Death Syndrome
(SIDS)on 80 grandmothers and grandfathers, the team found that three grandmothers
(4% of the total group) had thought about taking their own lives after a grandbaby’s
death. As one grandmother explained: “I’m a mother. I’m supposed to take care of my
children; and here I’m a nurse, too, and my daughter’s baby dies and I can’t do a thing.
It makes you just want to give up. It is unbearable.”
Preliminary data from an ongoing study of miscarriage ( N = 101) indicates that
10% of the parents in the study (all mothers) considered suicide because of guilt and
grief over the miscarriage.
Sampling procedures for the studies of SIDS, stillbirth, and miscarriage were simi-
lar. Why, then, do we find that SIDS parents are more likely to csnsider suicide than
parents who have experienced a stillbirth? In the same vein, why are stillbirth parents
more likely to consider suicide than those who have experienced a miscarriage? We
cannot answer these questions with any certainty, but one likely hypothesis is that
there may be a n association between the strength of the bands parents form with infants
and the length of time the parents have had with the infants before the loss. If there is
a statistical correlation between strength of bonding and time passed, we believe that
the correlation is probably rather modest because another factor also enters into the
equation: the personal definition the individual has of the event. To most who experience
it, a miscarriage is the death of a baby; but to some the miscarriage is only the interrup-
tion of the development of an embryo or fetus. One woman explained her situation this
way: “I bounced back from the miscarriage really quick. I had three preschool boys at
the time and I was going crazy with them. A fourth child would have killed me.” A
miscarriage for her was a relief. To other people, such as those who have been trying to
have children for several years, a miscarriage is a quite different event. In the case of
a stillbirth or a SIDS death, parents generally experience less ambivalence: the loss is
clearly the loss of a baby.
Do Men and Women Grieve Differently? Fathers and grandfathers clearly share the
pain from a baby’s death:
Following Jennifer’s death, I saw my father cry for the first time in my life. Her death
shook this pillar of strength to an emotional state I don’t believe he ever knew before.
My father felt badly about this emotional state and the afternoon before Jennifer’s funeral
as we stood in our front yard, he apologized for not being stronger. He was truthful when
he said, as he sobbed, how he expected and wanted himself to be the strength and
resolving force to guide us through this tragedy, but he just couldn’t. He had never
experienced such a helpless feeling and it was hard for him to accept that feeling.
. . . When is it my turn to cry? I’m not sure society or my upbringing will allow me a time
to really cry, unafraid of the reaction and repercussion that might follow. I must be
strong, I must support my wife because I am a man. I must be the cornerstone of our
family because society says so, my family says so, and until I can reverse my learned
nature, I say so.
It is commonly believed that men and women in our society are different in terms
of exhibiting emotions. This belief has some truth in it in regard to the bereaved families
we have studied. In our most recent study of 127 SIDS parents, 85%said their personal
approach to grieving was different from that of their spouses. Groups of both fathers
and mothers have consistently told us that fathers are likely to be less emotional, less

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able to talk about the death, less able to cry. It is quite clear, however, that many couples
do an excellent job helping each other cope with the crisis. Perhaps the best relatively
objective measure of couples’ success in this regard is the low incidence of divorce
reported related directly to the death. (For example, 1.5%of stillbirth mothers and 3%
of stillbirth fathers said they divorced as a result of the death. And only 4% of SIDS
parents in our most recent survey indicated they divorced as a result of the death.)
Fathers are in a double bind. Society has put fathers in a stereotypical role of
caretaker and source of strength for the mother. They have to provide for the needs of
their wives, who are not only emotionally wounded after the death of a baby, but often
still recovering physically from the rigors of childbirth. The father has little choice in
this matter. In many instances he is the breadwinner in the family and must keep going
to work when he would much rather retreat to the solitude of home. It is this dual role
which makes a father’s grief difficult. He has to find a way, somehow, both to grieve in
a healthy manner and to keep going in life at the same time.
This situation is similar for many mothers, of course, especially for mothers who
have surviving siblings a t home that demand care and attention and/or have job respon-
sibilities outside the home. Mothers often must keep going for the sake of the surviving
children; often they must also satisfy their employers’demands a t work; and, somehow,
they must find strength to attend to the needs of their bereaved husbands.
Spouses who realize one another’s dilemma are spouses who appear to cope best
with the crisis: she gives him time to grieve, and when he is feeling a bit better, he gives
her time to grieve. Those who have fallen into stereotypic societal roles, in which the
husband plays only the role of caretaker and the wife plays only the role of aggrieved,
are often doing each other a disservice and express bitterness because of the bind in
which they find themselves (Rando, 1986).
What Will Happen to the Surviving Children? The death of a baby affects many people.
Mothers and fathers are often overwhelmed by grief, so that the surviving children may
become “the lost souls of the family in crisis,” as Grollman has said (1979). Parents
often do not understand why the baby died and do not have the strength to try to explain
the mystery to the living brothers and sisters. As a result, the surviving siblings struggle
alone in the darkness.
Parents too need all the aid and comfort they can get, and their living children can
be of great help. What can be more comforting to a parent than to curl cp on the couch
with your loving children wrapped around you in a warm embrace? Many parents have
reported the great comfort they have received from their children, even a very young
child.
Qualitative analysis of testimony from parents and surviving children indicate
three common ways adults answer a child‘s question of why the baby died
1. If the adult does not feel s h e knows the answers to the questions surrounding
the mystery of the death (medical and/or theological), the adult is honest and
acknowledges this fact, for example, “I’m sorry, but I really don’t know why.’’
2. If the adult does not know the answers, the adult can tell a tiny, seemingly
comforting lie, similar to the stories we tell children about Santa Claus and the
Tooth Fairy.
3. If the adult is convinced s/he knows the answers, the adult can tell the child
what slhe believes to be true.
In the researcher’s view, approaches 1 and 3 are reasonable, but 2 would not be
recommended. The children first and foremost need comfort, and they will get comfort
from a parent who can honestly give it. If a parent believes in an anthropomorphic God
and heaven, explaining these beliefs to one’s child will be relatively easy and should

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comfort the child. If a parent is not sure what happens after death, concocting stories
that simply do not hold any logical water will only confuse a child. The child will
eventually learn, a t least by adolescence, that the parent does not know the answers to
many questions but is afraid to talk honestly.
Positive and negative behaviors often tend to increase after a death in the family:
some children become more loving and concerned and cuddly, more attentive to parents’
and siblings’ needs; other children are more fearful, more angry, more withdrawn. Most
of the problem behaviors seem to “go away with time,” as one parent reported. Other
problems are more severe and may need professional help from family therapists:
When our daughter sees other babies, she will tell the mother our baby died. She is very
demanding and naughty, almost all the time. She has been potty trained for almost two
years, and now she has a hard time making it to the bathroom. She hangs on me and will
hardly let me out of her sight. One day she said to me that she got mad a t the baby and
made him cry, and that’s why he died. I explained to her that it wasn’t her fault. The
next day I placed her in a preschool, and they have helped her much more than we ever
could, since we are so close to the tragedy [a child of three and a half].
She [the baby who died] was very special to him [a young adult, age 201. When she died,
he began having severe problems in school and a t home. These diminished somewhat
after a year but reoccurred with his subsequent brother’s birth. He ran away from home
in the middle of the night because he was afraid he would cause the new baby to die by
staying in the house. Only now, two years later and with the help of a family therapist,
are conditions beginning to improve.

Our son who is mentally retarded was more withdrawn than usual after the funeral. He
was also more aggressive. He was not able to express himself in words, so he took it out
physically. About six weeks after the funeral he came home from the preschool with rope
burns. He had managed to hang himself in a venetian blind rope. It really scared us as
we were not sure . . . still n o t . . . .

Should We Have Another Child? Yes. And no. It is clear from the testimony of the
mothers and fathers in our research that having a subsequent child is a good thing for
the majority. They need so desperately to invest their love and energy in the life of a
baby, and the coming of this subsequent infant is a joyous occasion; but the experience
of going through another pregnancy after one has already lost a baby is also a terrifying
experience. Will it happen again? Furthermore, if parents do succeed in having a
subsequent baby, they often are anxious for months and months after the birth, continu-
ally going to the bedroom door to check for breathing: “It’s as if my heart stops for what
seems like hours until I hear him breathing and can believe that he‘s okay. Okay, at
least, for now.”
Multiple miscarriages are a genuine possibility for many parents. In our current
study of 101 family members who had experienced a miscarriage, mothers averaged 1.9
miscarriages. One mother reported that she had experienced 15 miscarriages: “One
child out of 16 pregnancies survived. I survived, also, but my marriage didn’t.’’ A tiny
fraction of a percent of parents in the US.experience more than one stillbirth or death
of an infant after birth. Lightning can strike the same family twice: “And even though
the physician may tell you the chances for it happening twice are very small in your
particular case,” one father said, “you still are worried stiff.”
Having other living children fills parents’ hours with important tasks that simply
have to be done; but rushing to have a “new” baby can cause tremendous guilt for
parents. They report that they have felt they are desecrating the memory of the baby
who died by thinking so soon of having another baby. “My mother told me not to be so
totally upset because I could always have another baby; but babies aren’t like pets. You

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just don’t rush out to the pet store and buy a new one when one gets run over in the
street, do you?”
Parents who have a subsequent baby need not think of this baby as a replacement
for the baby who died. Rather, the subsequent baby can enter the world in honor of the
memory of the baby who passed. As one grandmother said, “She has Jason’s eyes. Jason
lives on in Ellie.”

How Long Will the Pain Last? A long, long time. Parents who have been bereaved for
many years are often quick to respond that “You will remember the baby who died as
long as you live.” To try and forget is probably impossible, and perhaps an ill-conceived
idea. In our research we have found people who 30,40,50, and 60 years later describe
the experience of losing their babies to us, and the descriptions are told so vividly that
when the individual tells the story it sounds almost as though the death occurred just
yesterday.
A colleague, Barbara Chesser, reports the phone call she received when she was
working on a study of accidental killers, those who had accidently killed another person.
“The woman called me from Alabama. She was very upset. Crying and talking rapidly
and somewhat incoherently. She had called me in Nebraska, a professor she did not
know, to volunteer for my study because she had accidently killed her baby.”
Chesser continued: “I talked with her for almost an hour. The woman really had
not killed her baby. The baby had died for no apparent, explainable reason. By definition,
SIDS. I explained this to her over and over and over. Finally she was calmed and
thanked me for my kindness. She said that when the baby died, her family would not
let her talk about it, so she had borne this tremendous burden of guilt all by herself.
“As an afterthought I asked her exactly when the baby died,” Chesser said. “The
way she described the death and her mental state indicated to me it had not been long
ago a t all. The woman replied: ‘December 10, 1947.’ I was astounded. That’s 40 years
ago!”
Bereaved parents often have hundreds of flashbacks. The mind‘s eye records details
of the horrible event and plays them back over and over again. The flashbacks come
often during the first few months and taper off as time passes, but the tape is stored in
the memory. Perhaps forever.
People do survive the death of a baby, however, and go on living. For the first few
months they live as if they were “on automatic pilot.” They go through the motions of
life, not really involved. They walk as if they are in a dream, or a living nightmare.
Time does heal the wounds, to an extent; and whether we like it or not, life demands
that we get involved. We have to go to work to help feed our spouse and our surviving
children. Many parents successfully “program” their grief. They return to their normal
patterns of daily living rather quickly but make sure there is a time each day when
they can think about their lost baby and cry in private. They have learned this technique
out of necessity, for they have concluded that the boss at work generally does not want
a person around long if s h e cannot carry her or his share of the load. (We continue to
receive occasional reports from bereaved parents who were “let go” because they did not
function well a t work after the death.)
In the various studies we have always asked the parents how long it takes to regain
“the level of personal happiness” they held before the death of the baby. This is done in
a rather simple fashion, but the results are useful to study. The parents construct a
graph which shows how happy they felt they were before and after the death. No attempt
is made to define happiness for the parents; each parent defines happiness in her or his
own unique way.
Hill (1949, 1958) noted that families respond to crisis in a manner resembling the
path of a “roller-coaster”: a steep decline in functioning followed by a long period of

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recovery. His graphic depiction of the path of a family’sjourney through a crisis served
as the catalyst for the development of Figures 1 and 2. (Figures 1 and 2 synthesize data
from studies of SIDS and stillbirth.)
The “average” mother and father were relatively happy before the baby died, as the
reader can see by looking at both figures. But when a baby dies, parents are plunged
into despair. Most parents begin the long journey out of the abyss and do regain the
level of personal happiness they had before the baby’s death. This process, however,
takes a long time: on the average about three years.
It is interesting to compare Figure 1 (the graph of the mother’s recovery time) with
Figure 2 (the graph of the fathers’ recovery time). They are, for all practical purposes,
identical. Mothers recover somewhat more slowly (especially after one year there is a
modest discrepancy in mean scores), but the differences between the mothers and
fathers, practically speaking, are not dramatic.
Preliminary data from our recent study of miscarriage indicate that mothers and
fathers recover somewhat sooner than parents who have experienced SIDS or stillbirth
(9 to 15 months is common).
Figure 1
Mothers’ Average Level of Personal Happiness Before and After the Death
of a Baby (N= 328)
“Wewould like to try to get some idea of how the baby’s death affected you personally.
Circle the appropriate number to describe your feelings for each time period.”

very happy (5) -

Nine months before
Individual
\ (4.43) Three years after
(3.91)
somewhat happy (4) -
Individual
average (3) -
individual
somewhat unhappy (2) -
1ndividual
very unhappy (1)-
The death
(1.11)

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Figure 2.
Fathers' Average Level of Personal Happiness Before and After the Death
of a Baby ( N = 88)
"We would like to try to get some idea of how the baby's death affected you personally.
Circle the appropriate number to describe your feelings for each time period."

Individual
very happy Three years after
Nine months before (4.18)
Individual
somewhat happy

Individual
average

Individual
somewhat unhappy

Individual
very unhappy (1
The death
(1.04)

Should Z Reach Out For Help? One of the most important keys to recovery is how
skillful one is in reaching out for help. A small percentage of parents join a support
group if they have the opportunity. Most good-sized cities seem to have support groups
for grieving parents now, and many parents will drive a long way to attend meetings
in another town. The researcher's belief is that these groups can be incredibly powerful
in helping people heal. Support groups which have leadership from both bereaved
parents and professional family therapists are especially effective in our estimation. A
few comments from parents on the power of the support group are useful illustrations
of these points:
We were thrilled [by the support groupl. At last we had found somewhere where we could
take off our brave faces and grieve. Everyone there had been there and could tell us that
we weren't going crazy and that we would survive. They hurt with us and for us and the
love and concern felt like a warm blanket wrapped around us. We have a terrific social
worker in the group who helps us keep the communication going-he is a wonderful
person whom we have all grown to love.

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It was comforting because you could sit and talk about your feelings to parents who felt
the same way. There were tears and laughter.
Very helpful. It felt like a release of tension. I could say things about what I was feeling
and ask questions without fear. Nobody was uncomfortable or acted like I was crazy.
Nobody was ashamed to cry. We occasionally cry and laugh at the same time!
I needed it. I felt they were the only ones that understood.
There are many bereaved parents who find it difficult to attend support group
meetings. Many choose to grieve alone. Other parents, we are convinced, simply are
afraid of what they witness at support group meetings. A group of parents still mourning
over their lost baby 5, 10, 15 and more years later can spark fear and anger in many
newcomers:
A meeting six weeks after Sandy’s death was horrible at the time. There was no profes-
sional leadership and we all sat around a table and told what had happened to us. Some
of these people had deaths occurring more than five years ago and all I could think of
was that I didn’t want to be like them (depressed,etc.) in five years.
They discussed autopsies and I came away furious. I just never went back.
The people leading it were grieving over their abortion and it made me mad!! Abortion
is murder and those people made me physically sick to my stomach.
We disliked it. The people in the group almost as a whole were bitter, angry, and having
marital problems. We were bereaved most recently but felt we had better ways of dealing
with it. They discouraged us with their lack of hope.
A handful of related, common emotional threads runs through most of the responses
from those who are dissatisfied with support-group meetings: fear, anger, and feelings
of hopelessness. Though these emotions are genuine, many times they are grounded in
a fundamental misunderstanding of the dynamics of grief. Many of the newly bereaved
parents perhaps are not yet able to distinguish between simply coping on a day-to-day
basis with a baby’s death and long-term resolution of complex issues and feelings. Most
bereaved people are able to “get back to normal life” relatively quickly after a n infant
death. They care for the surviving children; they go to work, go to school, and so forth;
but many bereaved family members describe this as simply “going through the motions.”
Resolution of the complex issues and feelings surrounding the death, on the other hand,
takes a number of years for most parents. Newcomers may not understand that support-
group veterans have successfully “gone on” in their lives but still find it helpful several
years later to have a forum where they can remember their babies. Newcomers some-
times think support-group veterans are simply “crazy” and do not want to have anything
to do with them because the veterans might make the newcomers “crazy” in turn. The
thought that one may be in terrible pain over the loss of a baby many years from now
is most threatening to the newly bereaved.
Even though we are convinced of the importance of community-based support
groups, we have found in all of the various studies that the family was rated as the
support group most often turned to in this crisis: spouses first, followed by other family
members and friends. Many people have expressed fear about reaching outside the
family to others in their pain, and this fear has kept them from joining a support group.
These people fear that others will castigate them for some mistake they have made or
look down upon them i n some way. In support group discussions, however, people tend
to find out soon that they are among friends: the group members have all felt guilt, fear,
hysteria, anger, jealousy, depression . . . the full range of emotions. This knowledge that
“we are all in the same boat” is very comforting to members and gives them the strength
to carry on:

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I never will be able to take Bryan or Dougie to the park or zoo, but I can take them to
my support group and be able to talk about them very openly without someone saying,
“When are you going to get over this?’’
What Have I Learned From All This? People who have lost a child have experienced
the terrible bitterness that life can bring. They also learn some wonderful lessons which
enrich their lives for a long time to come:
What did I learn from all this? I learned that I have a great deal of love to give.
[I learned that] Life is precious.
I learned that I have a strong backbone. Though arthritic.
I’ve found that spending time with my husband is more important than doing trivial
things that don’t really matter. Life isn’t always fair, but it should be lived to the fullest
instead of wasted away.
Suffering brings a depth of compassion and understanding that is unavailable to one who
has not suffered.
People are important-not things. There are many things in life to enjoy and to be
thankful for: a sunshiny day, white fluffy clouds in a blue sky, the singing of birds, the
laughter of my children at play, their thoughts and expressions a s they grow, my hus-
band’s love, a warm house on a cold winter day, the support of friends, the love of God.
I learned that I enjoy being alive.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Family therapists, and the many other professionals who come in contact with those
whose lives have been changed by the death of an infant, may find the following thoughts
helpful:
1. When a baby dies-whether the experience be labeled a miscarriage, a still-
birth, or infant death-the people affected by the death want to know why.
They want to know the medical “causes” for the death if these are possible
to ascertain. And perhaps more importantly, they often want to find some
theological explanation for the death. Since no one, really can explain the death
adequately in theological terms for another person, we believe it is best for
professionals to listen carefully to the person and help him or her construct a
personal answer that brings some measure of comfort. This personal theology
may seem illogical to the professional but may be perfectly functional for the
bereaved person.
2. Feelings of guilt among bereaved parents and other family members and friends
are common and often very irrational. These individuals generally need to
retell their account of the story many times and in great detail, and they can
gain comfort and release by the listener’s gentle understanding that, given the
circumstances, the individual probably did all that he or she could for the baby.
3. Professionals generally will communicate better with the bereaved by listening
and asking questions rather than making statements. Individuals react to the
death of an infant in a wide variety of ways; it is extremely difficult to judge
which grief reaction is dysfunctional and unwise to label a person. Also, almost
anything one says in counseling severely distraught people can be interpreted
by the grieving person in a negative way, so one must exercise a great deal of
caution.
4. Many bereaved people will wonder if they are “going crazy,” and acute grief
reactions often look bizarre to the professional. The majority of bereaved par-

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ents, for example, will say they have experienced irrational thoughts; further-
more, thoughts of suicide are very common, and a small percentage of parents
will actually try to kill themselves. For this reason alone active intervention
by professionals and family members is essential: the death of an infant is
literally a life-threatening crisis for the surviving family members, and profes-
sionals, relatives, and friends need to monitor family members’ behaviors after
the death very carefully. Also, grieving parents are likely to want to move away
from their home and home town in an effort to escape the pain. Some are likely
to begin or increase their intake of alcohol and other drugs “because of the
death.” Finally, small percentages of parents will consider divorce or actually
will divorce “as a result of the death.” The death is obviously a serious crisis
for families. Virtually all parents we have contacted label the crisis “severe,”
usually the most difficult they have faced in their lives. For these reasons,
professionals would be wise to join together with the members of support groups
for bereaved people and devise active, efficient, and swift intervention strate-
gies. This is a life or death situation for many people, and their dilemma simply
cannot be ignored.
5. Professionals may have to make a special effort to “uncover” the grief of the
father or the grandfather. Males in the family are likely to suffer as much from
the death as females. In fact, we have found no evidence to the contrary in this
regard.
6. Similarly, professionals will have to make a special effort to remember that
surviving siblings grieve over the baby too and are often lost from view in the
crisis.
7. Grandparents can be highly distraught during this crisis; some grandmothers
have reported considering suicide because of the grandbaby’s death. A family
systems approach seems most appropriate to us for the majority of families.
The death of a baby is clearly not an individual’s loss: it is a loss felt deeply
by all members of the family. Though individual treatment is on occasion
warranted, we believe that in most cases it would be wise to encourage group
solutions to many of the dilemmas the death imposes. It is often useful to
include grandmothers and grandfathers in therapy sessions because parents
and surviving siblings need to understand the depth of the despair grandparents
can feel because of the death. Also, supportive grandparents can be extremely
helpful to mothers, fathers, and surviving grandchildren in the day-to-day
challenges caused by the death, providing emotional and financial support and
child care on occasion. Family therapy can help strengthen these bonds.
8. The birth of a subsequent child and/or caring for surviving children in the
family does perhaps as much as anything to help heal the wounds bereaved
parents carry; but subsequent pregnancies can be terrifying times for families,
and support from many sources is essential. It is unwise to advise parents t o
have another baby. They must make that decision themselves.
9. The “average” bereaved mother and the “average” father “recover” from the
death of a baby (SIDS or stillbirth) in approximately three years or more.
Preliminary data from mothers and fathers who have experienced a miscarriage
indicate “average recovery time” to be approximately 9 to 15months. It is clear,
however, that people are never the same after a miscarriage, stillbirth, or infant
death. The bereaved need, somehow, to learn that they can “heal” and that life
will go on. They need to learn that life will get better, even though there will
always be that tender spot, that bittersweet memory of “the little baby that
didn’t grow.”

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10. A few very cautious comparisons among miscarriage, stillbirth, and infant
death would be useful at this point. First, it is important to keep clearly in
mind at all times that emotional pain, in the final analysis, cannot be weighed
or measured. As social and behavioral scientists we make faint-hearted
attempts with our Likert-type scales and Reuben Hill’s roller-coaster profiles
(Hill, 1949, 19581, and these attempts are on occasion somewhat interesting
and instructive. In any truly scientific sense, however, the author is convinced
that emotional pain defies objective measurement. This is useful to remember
as we casually philosophize around the dinner table, making possibly invidious
comparisons between the pain an individual experiences when a spouse dies
and the pain an individual experiences in a divorce; or the pain a mother
experiences when a baby dies and a father’s pain; or the pain of one who
experiences a miscarriage and the pain of stillbirth or SIDS. These comparisons
are almost universally interesting to human beings, and the author has been
guilty of crawling out on several of these limbs before. Great hurt can be
inflicted, however, when these comparisons are made after an infant death. In
this regard, the bereaved sometimes are as insensitive as those who have not
lost a baby. For example, we have heard many comments like this over the
years:
Well, she told me she understood my pain, but she really didn’t understand! I
had experienced sudden infant death, and she had only experienced a stillbirth.
The longer you have the baby, the worse the pain. Obviously.

Such reasoning would also dictate the belief that a stillbirth is somehow “worse”
than a miscarriage and that a second-trimester miscarriage is somehow “worse”
than a first-trimester miscarriage; and we have heard these beliefs expressed
on many occasions.
Carried to a seemingly logical conclusion, if a 95-year-old woman’s 75-
year-old son dies, she should be suffering the most of all because she has built
bonds with that son for 75 years; but we have not heard anyone make that case
yet.
The truth of the matter is no doubt much more elusive. Perhaps the 95-
year-old woman is suffering the most. Perhaps she is not; but since emotional
pain cannot be weighed or measured, one cannot say for certain. It is best not
get into an Olympic competition in the realm of pain and misery.
These often invidious comparisons lead people to want to develop support
groups made up only of those who “truly understand.” On many occasions
we have talked with people who felt ill-at-ease a t a particular support-group
meeting because they got the feeling that a miscarriage did not seem to be a
great enough tragedy for group membership. On other occasions, people have
complained that since they had experienced the death of an infant, they had
nothing in common with parents whose adult child had been killed in an auto
wreck or committed suicide. One can understand how a bereaved person might
come to such a conclusion, but in the long run the individual is unwittingly
cutting herself or himself off from countless people who could be wonderful
supporters.
Those who have experienced a miscarriage do tell us that, on the average,
they feel they “recover” somewhat sooner than those who have experienced a
stillbirth or SIDS. Perhaps the definition of the event is a key here. SIDS and
stillbirth are clearly deaths; no one will dispute that. But in the case of a
miscarriage, especially miscarriages which occur in the early months of fetal
development, there is a good deal of controversy and confusion over how to

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define the event. If one defines the miscarriage as the death of a baby, no matter
how small, one is likely to grieve longer than if one defines the event as simply
the loss of a fetus. By way of comparison, we also know that thoughts of suicide
are relatively more common among those who have experienced stillbirth and
SIDS than among those who have experienced a miscarriage. These general
research-based findings have only modest utility for the family therapist work-
ing with individual families, however, because there is such remarkable diver-
sity of responses among bereaved parents: a particular father grieving over his
wife’s miscarriage may be much more likely to kill himself than a particular
mother who has experienced SIDS. Many other factors have to be considered
in assessing the seriousness of a particular situation: the cause of death, if it
has been ascertained; the levels of guilt of each family member, and whether
anyone fears punishment from God and other people; past experiences with
loss; other stressors and crises the individuals or the family as a whole are
currently experiencing; the strength of the marriage, the strength of parent-
child relationships, and the level of support from grandparents; alcohol and
other drug intake; and so forth. In sum, further research will probably outline
several more differences among groups of people who have experienced miscar-
riages, stillbirths, and SIDS. Family therapists working with individual fami-
lies are best advised, however, to consider all families experiencing any of these
losses a t risk until careful analysis of the individual situation has been made.
11. Finally, with good support from family members, friends, and professionals,
people do heal. Family therapists can play an important role by becoming
involved with lay support groups. The family therapist often will feel ill-at-
ease and inadequate in the face of such enormous pain. If the family therapist
has not experienced an infant death in her or his own life, feelings of self-
consciousness and of being somewhat of an “impostor”can persist. The therapist
will be likely to challenge herself or himself with the same questions everyone
else asks when confronted by the death of a baby: “How can I possibly help
someone whose baby has died?” “What can Z possibly say that would make any
sense to this family?” “Why did this baby die, anyway” “Why didn’t they prepare
me for this in graduate school?” But lay members of the support group who
have personally experienced the death of a baby also harbor great insecurities
because they often feel they have not had the educational background and
clinical training necessary to deal with such a crisis. Lay members are thus
often quite pleased to welcome professionals into the support group. By helping
each other, the lay support group members and the family therapists can
develop a very powerful network for bereaved families-a literal circle of power
and love. Thus, the group members help each other to heal and to grow in
life. Bereaved people who find themselves outside such a circle can carry a
tremendous burden of guilt and pain literally for the rest of their lives.
It is quite clear that the families who have lost a baby have learned a great deal
about life and its challenges, and they have a great deal to teach all of us. When one
becomes involved with bereaved families as a professional, one is likely to experience
over time a wide variety of feelings: feelings of being totally absorbed, shattered,
challenged, frustrated, terrified, saddened, angered, awed beyond comprehension,
enriched, and blessed. Blessed, indeed, by the beauty and power of life.

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