Answer: Longer than you think
By Tay Shi An
September 11, 2006
SHE was stunned to hear the news. Housewife Rahimah was into her eighth month of pregnancy when she was told that her much-awaited baby had suddenly died inside her womb.
Torn with grief, she then asked if the hospital could surgically remove the dead foetus. But the 25-year-old housewife said a nurse told her bluntly: 'We don't do operations for dead babies.'
The hospital later apologised for the nurse's remarks.
Madam Rahimah was informed that the operation would be done only the following day.
As her condition was stable, there was no urgency.
Madam Rahimah and her husband turned down the offer to be warded immediately, as they had to make arrangements for their other children, said the hospital.
But Madam Rahimah claimed she was not told whether it was safe to wait.
The young Singaporean mother spent the next four hours worrying about what a dead foetus inside her body would do to her.
Back at their two-room rental flat in the east, the couple called their parents to tell them the bad news.
Madam Rahimah's husband is an Indian national and Singapore PR.
Madam Rahimah said: 'They told us we were stupid and that I should have taken out the baby immediately. They said it was not safe.'
That scared the couple further.
Her husband subsequently accompanied her back to the hospital late that night and she was warded at KK Women's and Children's Hospital (KKH), she said.
HOW LONG IS SAFE?
So how safe is it to delay the removal of a dead foetus from the mother's womb?
Doctors say it's generally safe for a stillborn to be left inside the mother for more than two weeks.
A baby that dies after the 28th week of pregnancy is referred to as stillborn.
Dr Tan Kok Hian, a senior consultant at KKH, said that a dead foetus will not decompose in the womb as it is in a sterile environment. Therefore, there is little chance of the mother getting infected.
Stillbirths occur in about one out of every 200 to 300 pregnancies.
As in Madam Rahimah's case, about 40 per cent of stillbirths at KKH cannot be explained, said Dr Tan.
The other 60 per cent of stillbirths are usually caused by birth defects, placental problems, infections, chronic health conditions in the pregnant woman or umbilical cord accidents.
It occurs among all age groups, but those aged 30 and above face higher risk of stillbirth.
Good control of hypertension and diabetes in the mother, earlier delivery and early and regular antenatal care help to reduce the risk of stillbirth.
'Unfortunately, a significant proportion cannot be prevented as the cause is unknown or the occurence is sudden and unexpected,' said Dr Tan.
Last Monday was supposed to be a special day for Madam Rahimah and her husband.
It was the day they had picked to have their baby daughter delivered by caesarean section.
But instead of cradling a bundle of joy in their arms, they ended up mourning their dead baby.
It all seemed to happen so quickly after Madam Rahimah realised that her usually-active baby had suddenly stopped moving in her womb.
She was due to give birth this month.
Worried, she went to KKH later that night. There, a doctor did a scan and told her he could not find the baby's heartbeat.
The baby, who had seemed perfectly healthy throughout the eight-month pregnancy, had died.
Madam Rahimah and her 38-year-old husband, a foodstall assistant, were devastated. They have two other children aged 3 and 4.
She recalled: 'When we watched the National Day fireworks from outside our home the night before, I could still feel her kicking.'
At the hospital, a nurse told the mother that they could try to induce labour so she could give birth to the dead baby naturally.
Mothers of stillborns can choose to deliver their babies via natural labour (which usually happens within two weeks), induced labour (which may take one or two days) or caesarean sections.
Madam Rahimah asked if she could undergo a C-section instead.
That's when the nurse told her that the hospital do not do operations for dead babies.
But after the nurse learnt that her first two children had been conceived through C-sections - which meant her womb has a higher risk of rupturing if she goes through labour - she was scheduled for the operation the next day.
Madam Rahimah said she saw her dead baby just once - after she had just regained consciousness after her operation.
She said: 'A nurse brought the baby to me. I was crying, and she put the baby on my chest.
'I could see only her face - she was wrapped up in a green blanket. I couldn't move. I had a drip (in my left arm), so I used my right hand to touch her cheek.'
Her husband took pictures of the baby with his handphone. He then took her in his arms, unwrapped the blanket and examined her.
Madam Rahimah was afraid to look.
She was relieved when her husband said the baby looked normal.
'He said she had good hands, good legs, and all her body parts looked fine. She was perfect. Only her stomach was a bit bloated, and there were red patches on her body,' she noted.
'Just by looking at her, you can't tell something is wrong with her.'
The red splotches on her dead baby's skin were formed because of a lack of blood flow and oxygen which caused the tissue to degenerate, said Dr Tan of KKH.
Madam Rahimah said she and her husband did not claim Shafiah's body.
Before the operation, they were asked if they wanted to do so.
Distraught and confused then, the couple said they decided not to claim the body as they had no idea how to make funeral arrangements for a baby.
Madam Rahimah said: 'The hospital said we could leave the body to them, that they would make arrangements for a Muslim burial to be done for us. So we said okay.'
But now, Madam Rahimah regrets the decision.
'I feel guilty every day, as if I didn't respect her,' she said.
Madam Rahimah said she has seen a counsellor at a family service centre to help cope with her loss. The centre also got a volunteer to fetch her children home from the childcare centre for two weeks.
She said her husband has since come to terms with the loss.
'He doesn't want me to cry, so we don't talk about it.'
But their two young children keep asking about their baby sister.
She said: 'She's an angel to us now, a little well-wisher. We were just not fated to have her as our baby.'
COPING WITH LOSS
Dr Beh Suan Tiong, a gynaecologist in private practice at Thomson Medical Centre, said the emotional and psychological impact on the mother 'is likely to be greater if she is asked to continue carrying the dead foetus'.
But there are some who need time to accept the death and are not ready to let go until they get a second or third opinion, said KKH senior medical social worker Majella Irudayam.
After losing a baby, parents usually feel a strong sense of sadness, anger or bitterness.
Dr Tan said: 'Many parents also feel guilt. They often wonder if they did something to cause their baby's death, which is usually not true.'
At KKH, nurses and doctors are trained to provide support for bereaved family members, Ms Majella said.
KKH also encourages grieving parents to create memories of their baby by taking photos, or making footprints, handprints or saving lock of hair.
Dr Tan advises these parents to take care of their health. He suggested that they talk or write journals and read books and articles for information, guidance and support.
A support network like family, friends, a religious community or a support group would also help.
Said Dr Tan: 'You will never forget your baby, but you will heal. It does not happen overnight, but it will happen.'
Madam Rahimah said she and her husband had earlier named their unborn child Shafiah Shahrin.
Now, all Madam Rahimah has to remind her of her baby girl is a pale blue scrapbook, printed with the words 'Memories' and 'Our Special Baby'.
Inside are two photographs of her stillborn baby, which the hospital gave her.
She also keeps her ultrasound scans and doctor's appointment card.