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Stillbirth and neonatal death

Although still very taboo, stillbirth and neonatal death (defined as the death of a baby within four weeks of birth) are more common than most people realise. 

According to 2011 statistics, in Belgium, around:

      • 1 in 230 babies is stillborn (1) (2) (3)
      • 1 in 400 babies die within the first four weeks (4)

Parents who lose their baby often feel very isolated, as friends and family may not know how to support them, and they may have trouble finding the information they need, especially if they don't speak French or Dutch.

If you:

 


Definition of stillbirth in Belgium

Although under Belgian legislation the loss of a baby in utero after 22 weeks or with a birth weight of more than 500g is considered a stillbirth (5), a stillborn baby can only be officially registered – and therefore officially named with the Belgian authorities – if he/she is born after at least 180 days of pregnancy (i.e. almost 26 weeks).

For babies born just before this cut-off, hospitals are known to offer to adjust the dates of the pregnancy to allow families the maximum of rights in terms of naming, declaration, and other rights such as maternity/paternity leave.

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Giving birth to your stillborn baby

Being told that your baby has died in the uterus usually comes as a huge shock, and you may have trouble believing the news. In the following hours and days you may have a lot of decisions to make, e.g. about whether to be induced immediately or wait for a day or two.

Hospital staff should be able to give you all the information and support you need to make those decisions, and you may also have support from a psychologist.

Many mums are scared of giving birth to their baby. Unless there is a reason for a caesarean birth, you will most likely give birth naturally. Hospital staff will be particularly sensitive to your needs, e.g. in terms of pain relief and who you want to be present.

This page from BabyCentre gives some information about what to expect. 

 

Saying goodbye

The decision of whether or not to see, hold, or photograph your baby is a very personal one, and hospital staff should respect your choice. Even if you decide not to, staff may offer to take photos of your baby, which may then be included in your medical file should you wish to look at them in the future. They may also offer to make foot and/or handprints of your baby.

The website of the UK stillbirth and neonatal death charity Sands provides some useful practical information and suggestions about saying goodbye to your baby and ways to remember your baby.

Remember though that this is a UK website, so advice about registration and funeral formalities will not apply in Belgium. For Belgian specific-information, the website Hospichild provides a good overview of procedures and admin (though in machine-translated English), some of which are included below.

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Looking for answers

For some parents whose baby is stillborn, there is a definite cause, while for many others, there are simply no answers – in many stillbirths, the baby appears to be completely healthy. If your doctor is not sure why your baby died, there are various tests that may provide some answers. There is no obligation to agree to any of these tests, but results may help avoid problems in future pregnancies.

In Belgium, thorough testing is offered, and may include:

      • analysis of the placenta, membranes and umbilical cord;
      • maternal blood tests to check for certain conditions;
      • tests for infection.

The website of the UK stillbirth and neonatal death charity Sands includes information on possible causes of stillbirth and neonatal death as well as on ongoing research and efforts to prevent such deaths.

You will also be offered a post mortem examination of your baby, which may be able to provide significant information about why he/she died. A post mortem would only be carried out with your full consent, and after your care provider has explained the kind of tests that you can request to be carried out.

The UK stillbirth charity Sands has compiled a useful document aimed at helping parents make the decision of whether or not to request a post mortem

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Registering the stillbirth/death

The staff looking after you will be able to tell you what you need to do, and in many cases, will offer to liaise with the commune on your behalf.

If your baby: :

was stillborn before 180 days of pregnancy                 

Your baby's stillbirth cannot be registered.

Some parents ask for a ‘declaration of a late miscarriage’ (‘déclaration de fausse couche tardive’), which is needed if you wish to have a funeral for your baby. See below for more information on funeral arrangements.

For babies born just before this cut-off, hospitals are known to offer to adjust the dates of the pregnancy to allow families the maximum of rights in terms of naming, declaration, and other administrative aspects.    

was stillborn after at least 180 days of pregnancy  

Your baby's stillbirth must be registered.

Your doctor or midwife completes an official declaration of the stillbirth (‘déclaration d’enfant sans vie’ / ‘akte van een doodgeboren kind’), in which you can indicate the first name(s) of the baby – a family name can unfortunately not be given (6).

At the present time, the father of a stillborn baby who is not married to the baby’s mother, or who had not yet signed a declaration of paternity ('acte de reconaissance' / 'erkenningakte'), cannot declare paternity after the birth.

was born but died shortly after birth (irrespective of how long the pregnancy lasted)                                   

Your baby's birth and death need to be registered.

This is also the case if your baby died before the birth could be registered.

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Funeral arrangements

The staff looking after you will be able to tell you what you need to do, and may be able to help you start making arrangements, such as contacting a funeral home/undertakers. 

If your baby:

was stillborn before 180 days of pregnancy                                                                                                                                                                                               

If you wish, you can request that your baby be either buried in a special section of your commune’s cemetery or be cremated and the ashes scattered in a special section of your commune’s cemetery – all communes should have a small area of their cemetery reserved for the burial of babies who were stillborn before 180 days of pregnancy, and for the scattering of ashes.

To be able to do this, your doctor or midwife needs to complete a ‘declaration of late miscarriage’ (‘déclaration de fausse couche tardive’) - they can the make the request to the commune for the cremation/burial on your behalf.

Neither the parents’ nor the baby’s name will appear at the cemetery.

was stillborn after at least 180 days of pregnancy 

or 

was born but died shortly after birth (irrespective of how long the pregnancy lasted)                  

Your baby must be buried or cremated - burial or scattering of your baby's ashes can be in the cemetery of your choice.

Cremation/burial cannot take place less than 24 hours after the stillbirth/death.

 

Funeral costs

While Belgian mutuelles will contribute to funeral costs for a baby who was born but died shortly after birth, this is not the case for babies who are stillborn – this is because a stillborn baby has never officially been registered as a ‘dependent’ of either parent. This unfortunate loophole means that parents whose baby is stillborn may be faced with fees of around €1000 for even a simple funeral/cremation.

Some employers have been known to contribute to funeral costs. Your HR department will be able to advise you.

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Worth knowing

If your baby was stillborn after 180 days of pregnancy or born but died shortly after birth - irrespective of how long the pregnancy lasted – and you are part of the Belgian social security system, you are still entitled to:

      • paid maternity leave and paternity leave (if the father’s name appears on the declaration of stillbirth/death certificate) - for this, you will still have to liaise with your mutuelle(s), and provide a copy of the declaration of the stillbirth / death certificate. Note that if you wish to return to work before the end of your maternity leave, you may require a doctor’s certificate.

      • the birth allowance ('prime de naissance' / 'kraamgeld') from the Belgian state - this is typically paid as of the 7th month of pregnancy, but even if you did not claim it at this time, you are still entitled to it provided the pregnancy lasted at least 180 days. You have 5 years from the date of the stillbirth/birth to claim the birth allowance.

        Whether or not you applied for this allowance during the pregnancy, you will still have to provide your family allowance agency with a copy of the declaration of stillbirth / death certificate.

      • tax deductions for your baby for the tax year in which he/she was stillborn/died - your baby is still considered as fiscally dependent for that tax year, which will entitle you to some tax deductions.

It is also worth knowing that bills for medical care related to the loss of your baby, e.g. consultations, blood tests and ultrasounds, can continue to come for quite a while after the stillbirth/death, which may feel like insensitive reminders as you are trying to come to terms with your loss.

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Physical aspects for mum

Milk                                                                                                                                                                              

If your baby was stillborn in the third trimester or dies soon after birth, your milk may still come in, which may be very emotionally difficult.

Your doctor can prescribe medication to help prevent your milk coming in and/or a lactation consultant can help you manage and decrease milk production.

This article may also be of some use: http://www.glowinthewoods.com/how-to-stop-lactation/

Physical recovery after the birth                                 

You may still benefit from some postnatal physiotherapy to help re-strengthen your pelvic floor muscles, which would have weakened during pregnancy, and which may have weakened further during a vaginal birth.

In addition to the nine sessions of perinatal physiotherapy you are entitled to per pregnancy, each calendar year you can also have a total of 18 sessions for a specific reason (i.e. two additional prescriptions of nine sessions each) and so, any extra sessions you need can be taken under the umbrella of 'pelvic floor re-education'.

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Where to find support

An independent midwife is a good point of contact for holistic support after losing a baby. This is also covered by the mutuelle. 

Community Help Services offer a helpline (+32 (0)2 648 40 14) as well as English-speaking psychologists, psychotherapists, bereavement counselors.

The Brussels Childbirth Trust (BCT) has an ‘Experiences Register’ – this allows BCT members to be put in touch with other members who have experienced stillbirth, and who can offer support and advice.

 

Waterloo-based mum Joanne Fraser has set up a support group, Pregnancy and Infant Loss Support Belgium, for the loss of a pregnancy, stillbirth, infant death, conceiving or expecting after a loss. "It is a terrible thing to have to go through the loss of a baby in a foreign country away from family and friends. Even worse is not having anyone to speak to about it." Joanne has been involved in grief support for a while now and - having not really found a group here in Belgium - decided to start one. The group currently has a closed Facebook group, which gives an opportunity to meet and support each other. Email This email address is being protected from spambots. You need JavaScript enabled to view it. for further information or to be added to the Facebook group.

 

In Brussels, the women’s clinic at Edith Cavell hospital offers private counselling and a support group – Paroles de Deuil – for families who have lost a baby due to stillbirth or in the first few weeks. This may only be available in French.

For English-language information and support, you may find two UK charities helpful:

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Suggested reading

The UK stillbirth and neonatal death charity Sands offers a free pdf bereavement pack, with a range of materials, about topics such as choices you might be offered, remembering your baby, special information for dads, as well as advice for how friends, family and employers can help and support bereaved parents.

The charity Tommy's also provides the document 'When a baby dies - Information for parents, family and friends'

Personal accounts such as:

http://www.theguardian.com/lifeandstyle/2012/jan/22/losing-iris-stillborn-sarah-hughes

http://www.independent.co.uk/life-style/health-and-families/features/the-stillborn-baby-ill-never-know-8519873.html

Books:

When A Baby Dies: The Experience of Late Miscarriage, Stillbirth and Neonatal Death by Alix Henley (2001) pub. Routledge ISBN-13: 978-0415252768

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References

(1) Brussels: Données périnatales en Région bruxelloise – Année 2011 - in French
(2) Flanders: Perinatale activiteiten in Vlaanderen 2011 - in Dutch
(3) Wallonia: Données périnatales en Wallonie – Année 2011 - in French
(4)2010 European Perinatal Health Report
(5) 17 JUIN 1999 - Arrêté royal prescrivant l'établissement d'une statistique annuelle des causes de décès / 17 JUNI 1999 - Koninklijk besluit waarbij het opmaken van een jaarlijkse statistiek van de overlijdensoorzaken wordt voorgeschreven
http://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=1999061735&table_name=loi (in French)

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