GUEST CORNER

A Burial Option for Babies Who Die Before Birth
Marilyn Gryte, R.N., M.S.

Marilyn Gryte is a counselor and grief educator with a background in maternal-child nursing and childbearing loss support. As a speaker and published writer in the field of grief education, Marilyn presents continuing education seminars nationally and teaches a graduate course in grief counseling for Oregon State University. She is a Licensed Professional Counselor on staff with The Counseling Center in Albany, Oregon and certified as a Grief Therapist by The Association for Death Education and Counseling. She has published two booklets, through Centering Corp.: No New Baby, for siblings expecting a brother or sister who is miscarried or stillborn, and Inner Healing After Abortion.

An Oregon cemetery now has a burial place for babies who die before birth. Expenses are minimal and the site may be used for stillborns, miscarriages and for symbolic burial. The site establishes a place for families to validate the significance of pregnancy loss; it provides a public place of mourning and remembering. It is designed as an alternative to hospital disposition and now offers families broader choices. This article will review how it is being used as a part of the healing griefwork after pregnancy loss and outline the steps taken to establish the burial site.

Supportive care for families experiencing miscarriage and stillbirth has increased nation-wide in the past decade. There was a time when hospital staff invited little involvement of the family and offered to "take care of everything." Now it is usual for families to see and hold their baby who has died, receive footprints, pictures and other keepsakes. The role of the medical team has changed from "protecting" the parents to one of offering participation, caring support and permission to grieve.

When families are encouraged to personalize their child who has died, the question about what to do with the baby’s body becomes important. For some families hospital disposition is an unacceptable option. A baby who dies a few hours after birth is usually buried in a child-size grave or cremated with a funeral or graveside service. There is, however, no standard social custom for a child who dies before birth. The earlier in the pregnancy the death occurs the more uncertainty families express about final disposition. Options commonly available for babies who die before birth include hospital disposition, opening an already existing family burial site, cremation or purchasing a child-size grave. For many families the gap between hospital disposition and purchasing a grave seems wide.

In 1989, at the request of some parents, we began to develop a burial place for babies who die before birth. One goal was to keep expenses to a minimum. A local funeral home has a long-standing policy of offering cremation for stillborn babies without charge to families. We asked the cemetery to keep burial expenses to $25 per family. Another goal was a burial place where little distinction would be made between actual or symbolic burial. Stillborn cremains, fetal tissue as well as symbolic items like booties, rose petals, photocopy of footprints or a written message are buried in uniform small containers. Some families participate by their presence without bringing anything for a burial. Families may record the brief life of their unborn child in a memorial book kept in the cemetery office. The purpose of the Burial Circle is to give permission to grieve and assist families in finding closure with a loss.

The Burial Service
The Burial Circle was dedicated October 1990 and the cemetery offers a community memorial service twice a year. The board chose an existing 50 foot circle of ground surrounding a large granite column. It stands in the middle of the cemetery as a landmark with a narrow road around it. They planted lawn, selected a small stone lamb for the base and engraved a stone plaque with a dedication.

We work with local clergy to offer a simple, participatory service. Some families contact us before the memorial service, others read about the service in the newspaper and arrive without calling. The grave opening is ready before the service. Families gather at the Burial Circle and they are invited to say who they are and the circumstances that bring them here. Those coming to bury are invited to hold their burial box during the service. Participants may speak, bring a poem to read, or make requests to be included in the service. When we are ready for burial each is invited to say good bye in their own way. Each then puts their box into the larger, sturdy burial container. We wrap the outer container in a flannel baby blanket and place it into the earth. Families may place a flower in the grave and take turns filling the grave with shovels of earth. Because it is brief and participatory children who attend with their families also find the service meaningful. The officiating clergy closes the service with a prayer or moment of silent meditation. Families are then invited to write in the memorial book and are given a certificate of memorial and a yellow rose to take home.

Establishing a Burial Site
The following steps are suggested for a community which may want to establish a similar burial place.

Explore the possibilities: In this community a local funeral director supported the idea and helped us identify which local cemetery to approach. Our selecting a non-profit cemetery may have increased the likelihood of it being community-service minded.

Contact the cemetery board personally: I contacted the chairperson for the board and was invited to speak at their next meeting. Speaking first-hand about a local need immediately gained their interest. Hearing that the support the hospital staff gives to families with pregnancy loss creates a new need for final disposition choices made sense to them. Some on the board had experienced a childbearing loss in their own families. The board voted to further explore this option.

Stay in touch and stay patient: New ideas sometimes take time to germinate and grow. In our case, the committee and board moved slowly as they were already involved in an expansion project. We called the board chairperson from time to time and offered to be available as a resource. The process from idea to dedication was eleven months.

Be specific with plans: Periodic burial reduces opening and closing costs. We needed to decide where the burial site would be, frequency of use, at how many weeks gestation cremation would be appropriate, selection of containers, grave markers and memorial book and to clarify who would be responsible for arranging the memorial services.

We decided to use uniform gold-foil cardboard boxes (3.5 x 2.75 inches) provided by the local crematorium as infant cremains containers. Tissue from miscarriage is held at the hospital pathology department and may be buried at parents’ request in the specimen container which fits into the cremation box. For fetal death at 20 weeks or later we require cremation. Before about 16 weeks gestation we are advised cremation would be total consumption. The groundskeeper was concerned about the ground settling if only cardboard was used and offered to cement-line the small grave. One of our goals was to complete the burial during the memorial service and the closing cement work would make this impossible. We worked together to find a suitable alternative. We chose an adult-size sturdy plastic cremation container as an outer burial container which will hold up to six infant cremation boxes.

The cemetery is willing to open a grave site twice a year in April and October and to place a bronze year marker at each site. The cemetery manager is responsible for fees and safe keeping of the memorial book. We at the hospital are responsible for contacting families, newspaper announcements and for arranging the memorial services.

Inform the medical community and the public: Realizing a community service is only as useful as its availability, we took steps to inform key people and the public through a brochure, letters and newspaper coverage.

• Brochure: We printed a brochure with the assistance of our graphic designer and PR department. "Planning. . . a tender good-bye" in a caring way describes the various final choices families can make after a baby dies. We chose to be clear and sensitive in our language. "Hospital disposition", for example, is described as "medical cremation without expense to families." The brochure is given along with other printed material to every woman who has a pregnancy loss at our hospital. We informed labor and delivery staff and the outpatient department who attend to miscarriages. The Women’s Center phone number is listed for further information.

• Letter: We wrote a cover letter, including a brochure and a flyer about the Burial Circle dedication, and sent it to neighboring hospitals, physicians’ offices, midwives, funeral homes, grief counselors, pastors and key community members.

• Newspaper: We contacted the local newspaper which ran a story about the planned dedication. The paper also prints a public service announcement before each memorial service.

Plan the memorial service: By inviting different clergy to officiate we increase awareness of the service in the community. The preferences of those participating influence whether we invite pastor, priest or rabbi. Realizing those attending may be non-religious reminds us to keep the focus on experiencing closure about a loss.

At one memorial service five families participated. Parents, young siblings and extended family gathered to bury the cremains of a recently stillborn daughter. A woman who miscarried at home a year before said she came "to express a more dignified good-bye" by her presence. One couple chose symbolic burial to make peace with an abortion a decade before. Another couple came to honor their child who was born 25 years ago and lived only two hours. The mother said because she was still ill in the hospital at the time of the original service she had "never said good-bye." A fifth woman came with two boxes for symbolic burial and said she wanted "to finally bring to closure" the mid-pregnancy loss of twin girls 32 years before. At a subsequent service one couple chose symbolic burial to make peace with infertility. They buried the first baby outfit they had saved for their someday baby and released a pink and a blue helium-filled balloon during the services saying, "We let go of this dream to make room in our hearts for new dreams."

Whether burial is actual or symbolic, the loss recent or long ago, the value of closure seems evident. An official burial place for babies who have died before birth gives unspoken permission for families to be creative and personal in whatever rituals of closure they may choose to mark a sad ending of a pregnancy.