Coping with Neonatal Death or Loss of a Premature Baby

A couple in a baby room
Coping with the loss of a premature baby.. Design Pics/Ron Nickel / Getty Images

Anyone who goes through the unspeakable tragedy of losing an infant likely comes through the experience as a different person. In the media, you see a lot of stories about sudden infant death syndrome (SIDS), but much less about the more common types of infant losses that can take place in the first month of the baby's life.

Because these losses often occur because of factors associated with the mom's pregnancy, such as premature birth, some people consider neonatal death a form of pregnancy loss.

What Neonatal Death Means:

Neonatal death is the loss of a baby less than 28 days old. SIDS and other losses of older infants (classified as post-neonatal death) are not within the scope of this article, which will focus on loss of infants shortly after birth or after complications arising from prematurity.

Neonatal Death from Prematurity:

The most frequent cause of neonatal infant loss is premature birth. Although medical science has advanced considerably in the past decade, doctors generally cannot save babies born before 23 or 24 weeks of pregnancy. Although babies can be born alive at earlier stages of pregnancy, sadly the medical community has yet to find a way to save these babies.

Infants born late in the second trimester can require months of intensive medical care to have a chance at survival. Babies born at 24 to 25 weeks have about a 50% survival rate, and these babies may go on to have resulting physical or learning disabilities.

Other Causes of Neonatal Infant Loss:

Congenital birth defects, or chromosomal problems, are the second most common cause of loss at birth. Some of these conditions are "incompatible with life," meaning the baby can't survive more than a few days or (in rare cases) a few years without severe disabilities.

Examples include trisomy 18, trisomy 13, or anencephaly (a severe form of spina bifida).

In other cases, pregnancy complications like intrauterine growth restriction or hydrops fetalis could lead to a baby having serious medical problems at birth. Infections could also cause infant loss, as could being deprived of oxygen before or during delivery.

What to Ask About Hospital Procedures:

Parents must decide whether to hold the baby after death or keep mementos, such as footprints or a lock of hair. Holding the baby can help or hinder the grieving process for different people, and preferences vary. The safest bet is to keep the mementos -- you don't have to look at them if you don't want to, but if you do want to, you will be glad to have them.

Doctors may wish to do an autopsy after neonatal death. This can be helpful for closure or for planning future pregnancies. Still, some parents may not be able to handle the idea, in which case the doctor can sometimes obtain this information in other ways.

Coping with Neonatal Infant Loss:

As most groups point out, coping with any type of pregnancy loss is not a single event but a process that can be lifelong. Parents dealing with neonatal loss may have to process an extra roller coaster of emotions associated with giving birth to a live baby and potentially seeing that baby struggle for survival in a NICU for weeks or months.

Parents may have also faced having to decide not to pursue intensive medical intervention after a birth in which doctors gave the baby a poor prognosis for survival. If you were in this situation, it's normal to be struggling with guilt and "what ifs" about what happened in the hospital. In addition, moms may face added emotions about having to deal with the physical aspects of giving birth -- recovering from delivery, producing breast milk, and fluctuating hormone levels -- which may intensify the grief of missing the baby.

Regardless of your situation, remember that you are dealing with a major traumatic event in your life. Do not push yourself too hard or expect to be able to get over it quickly (and do not listen to anyone who says that you should "just move on" before you're ready). Think about finding a support group, either online or in-person, to talk about and process your feelings about losing your baby.

If you want to try again for another pregnancy, talk with your doctor about when it is safe to try to conceive again. You may not feel ready to try again for a long time, if ever, and that's OK too. If you do wish to try, however, the right time will probably vary by situation and your own feelings of readiness. Your doctor may want you to have extra prenatal visits and monitoring in your next pregnancy, so be sure to work with your doctor to develop a plan.

Sources

March of Dimes, "Neonatal Death." Quick Reference and Fact Sheets Mar 2006. Accessed 31 Jan 2008.

March of Dimes, "Preterm Birth." Quick Reference and Fact Sheets Feb 2007. Accessed 31 Jan 2008.

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