Twenty years ago, a couple came to our town to celebrate the 12-week milestone of their pregnancy. After two previous miscarriages, they dared to be hopeful, even excited. But during their third day of fishing, swimming, and sunbathing, the woman detected a subtle, pinkish vaginal discharge-the signal of the beginning of the end twice before. Within hours, the bleeding and cramping increased.
When they arrived at the ED of our small hospital, she was bleeding profusely; clearly, a miscarriage had begun. Her hemoglobin level had dropped 2 g/dL. A pelvic exam showed that the fetus was still in the cervical os, and a dilation and curettage was ordered. After surgery, the woman was transported to the same day surgery department for a brief recovery period. The staff there called the birthing center, asking whether we could help this patient with her grief. I'd worked with many miscarrying women and agreed to help out.
When I entered the room I found the woman resting on her side, facing the wall, holding her husband's hand. He sat slumped beside her, his eyes red rimmed. I touched her shoulder and introduced myself as an obstetrics nurse. She lay still, unresponsive. I told them that my work with parents who'd experienced a baby's death had taught me much about the anger and heartache that can come with a miscarriage. I asked them if they'd like to speak about it.
She turned to me. Could she put into words what she was feeling? I asked. She talked about the previous miscarriages. Now her body had "let her down" once again. She said, "I feel like I wasn't really pregnant. There wasn't really a baby there. This is just a bad joke." Her husband said nothing. I told her that the "what ifs" and "if onlys" might be unresolved for a while. We spoke about grieving and the supportive people they had in their lives. As I left, I told her I would return before she was discharged.
I then went to the laboratory and asked the pathology technician if I could see the remnants of the dilation and curettage. I explained that I was hoping to make footprints of the fetus. Such a request was new to her, but she helped me pick through and inspect-using a gloved hand and a small tissue forceps-the blood clots, pieces of tissue, and fetal parts. My hands quivered as I worked. This was even harder than I had anticipated.
When I finally saw the two tiny feet, barely a third of an inch long, I picked them up, gingerly, one by one, and wiped them dry. I wanted to make sure that the ink from the ink pad would adhere to the soles and leave a clear imprint on the plain white index card.
As I reentered their room, I felt uneasy. I wasn't sure how this discovery would be accepted; I knew only that I wouldn't discuss the surgical "products of conception." I explained that I'd wanted to retrieve a memory for them and presented the index card to the woman, who was propped up in bed.
She took the card in both hands, gazing at the tiny footprints, and drew them to her chest. She sobbed quietly. "There really was a baby in there," she said. "I really am a mother. This is my baby." Her husband began to cry.
As I was about to leave, I asked their permission to make a copy of the footprints to include in presentations. I told them that everyone at my lectures would hear about their tiny baby. They agreed. I made a photocopy, gave them the original, and never saw them again.
James Baldwin wrote, "Not everything that is faced can be changed, but nothing can be changed until it is faced." Since then I've presented many lectures on pregnancy loss, each introduced with an overhead image of the two little feet. After the lectures, audience members often display a surprising range of unresolved grief. I've been an obstetrics nurse for 32 years, but this couple stays with me. I took a chance with them, and I know it could have ended differently. Even so, I would do it again.