Please Take the Abortive Material

Edyta W. from a medium-sized city experienced many losses in her short life. Starting with the parents: her mum died, her dad left her, life in an orphanage surely wasn’t a bed of roses. She has more bad memories than good ones. But none of them can match the loss of a child.

She lost the pregnancy in the first trimester. Edyta was 28 years old. The worst news was that part of the foetus was miscarried and part was left inside. “No one is mentally ready for something like that, and I had nobody to help me. Only surgery, no support. Pregnant women waiting for delivery next to me, and a mother who had given birth on the other side of the wall.”

Edyta’s story illustrates what was reported at the beginning of February in the report “Care for patients in cases of miscarriages and stillbirths” by the Supreme Audit Office, which analysed the work of 37 hospitals in seven provinces. Conclusions? In 29 facilities, the standards of perinatal care were not respected and women in trauma were not provided with adequate support.

When I ask Edyta if any of the staff made her feel that they understand her pain, she replies without hesitation that not at all. “I felt like I was ‘neither the first, nor the last one’.”

***

Thousands of patients may be affected. In Poland, 40,000 women a year suffer from pregnancy loss.

“I have been in this situation twice”, Katarzyna Ś. from Łódź starts her story. “Once when I was 34, I had a miscarriage after 7.5 weeks. The doctor asked if this pregnancy was wanted. Second time four years ago, week 22. I was hospitalised with spotting. It turned out that I was fully dilated, the amniotic sac was already coming out, and it was probably over. I started giving birth, I didn’t get anaesthesia. The nurse shouted that I should stop screaming in pain and be quiet because other people were asleep. I was flooded with amniotic fluid, I was terribly cold. When I asked them to change my shirt, they yelled at me that they couldn’t do it then. They were discussing a nice delivery which someone had at the maternity unit. They didn’t talk to me.”

Paulina (name changed): “My biggest love, my daughter, passed away two years ago. I was 39 years old, I felt great when I was pregnant, I could do anything. My little girl was developing beautifully, prenatal tests without any reservations. Until in the sixth month I had contractions and my stomach turned as hard as a rock. In hospital, during an ultrasound, the doctor did not comment on anything, and at the end stated that I was carrying a dead girl. Only when the doctor woke me up after the procedure, asking what about the burial did I realise what had happened.”

There was heavy bleeding during the miscarriage and when Paulina began to curl up with pain, she let the nurses know. One came, complained that Paulina wasn’t giving birth yet, and left. Nobody showed her kindness, warmth, interest. She felt like an object.

***

Katarzyna was placed in a room with a pregnant girl. After the miscarriage, the nurses lower their eyes when they see her. When she enters the ultrasound room, the doctor asks, “Why are you so sad?”. Another one grabs her breasts in the corridor, “Good! Lactation begins”. It’s only when she says she can’t take it any more that she is transferred to a single room.

“Hospitals are short of staff. And work in the emergency mode burns out quickly. It is impossible to pay attention to what a woman experiences when you are in a rush and have five more points on your ‘to do’ list”, comments Joanna Pietrusiewicz from the Rodzić po Ludzku (Childbirth with Dignity) Foundation. “There is withdrawal, hiding behind the mask of procedures, it is difficult to bring up human reflexes. Focus on tasks can be seen by women as indifference and a technocratic approach. I do not believe that people who choose to work in hospitals are heartless. It’s the system that causes dehumanisation. People are tired, exhausted. How long can one work in the forest fire mode?”

The results of the audit did not surprise Pietrusiewicz. They only confirmed what women have been writing to the foundation about for a long time. “I do not want to justify doctors and midwives’ actions or release them from responsibility, but I know that they are overworked. The record holder worked 80 hours non-stop! For a woman who is going through a pregnancy loss, mindfulness is key, but you must have time to act in this way.”

***

Katarzyna Łodygowska, a lawyer known online as Matka Prawnik, has been helping women who have experienced loss for years, although today less often than before, when the phone rang almost every day.

“There are fewer women in need because there are foundations helping them, but it does not mean that the situation has improved”, she says. “The regulations are such that it is the medical facilities that are responsible for informing the would-be mother what to do next, and their staff have their hands full.” But another problem is that hospitals sometimes mislead their patients.

“I thought that nothing would surprise me any more”, says Łodygowska. “But last week I was called by a woman who was told by the hospital that pursuant to the verdict of the Constitutional Tribunal she was obliged to take the abortive material. The girl heard that she had to bury it and call a funeral home, and that’s not true! She didn’t have to do this. She was forced to a funeral, although she did not want it.”

Sometimes would-be parents receive abortive material in lignin or an envelope. “On the one hand, we have to protect life from conception, on the other – it is often treated in hospitals as medical waste and utilised, and parents are completely surprised by what they receive. Some need to bury the abortive material, others do not, but the process must be carried out in accordance with the procedures and with respect for their will not to aggravate the trauma”, says the lawyer.

Two days after the miscarriage, Katarzyna still did not know what to do. She was still in shock. The doctor yelled at her. “He insisted that I should decide whether I want burial or not because he was fed up with such matters.”

***

Not every woman has a bad experience. Sandra had everything ready with her husband. A corner in the room, a crib and folded clothes were waiting for Emilia to come into the world. It is January 12, 2020, 34th week of pregnancy, the Great Orchestra of Christmas Charity is having its Grand Finale. Sandra is used to the fact that the little one has hiccups, but she hasn’t gotten it for a while and she hasn’t been moving. Sandra has a bad feeling so she goes to hospital. There she hears the three worst words in her life: “No baby’s heartbeat.”

The doctor from the New Hospital in Świecie says that the heart has stopped beating. She starts crying. Her husband is waiting in the car, unaware of anything. Sandra calls him hysterically. She does not understand exactly what the doctor says, she hears only that the missed abortion occurred two weeks ago. She is given medication to calm her down, and pills to induce labour in the morning. It starts after eight, she feels pain. Only after a drip does it become less unbearable.

“The doctor explained to me that this unfortunately happens. He said what I can do and what I am entitled to”, she says. “He offered the help of a psychologist, but I was not ready. I was lucky to be alone in the room. The staff turned a blind eye to the fact that my husband was with me outside the visiting hours and was collaborative. I have no objections to the care I received. I didn’t feel like ‘just another case’.”

Zuza M.: “I was furious. I went amok, I wanted to escape from the hospital. I didn’t believe my baby was dead.”

She has lost three pregnancies since January 2018. Out of helplessness and despair, she stopped thinking about having a child. When in May 2019 she saw two lines on the test, and then saw the baby on the ultrasound monitor, she was happy. It was supposed to be the long-awaited daughter. In week 21, the baby stopped moving. “She came into the world with no signs of life. She left quietly. I had two hours to say goodbye and then they took her from me. I hugged her, she was so beautiful, so tiny. She looked as if she was asleep.”

In the hospital room in Bydgoszcz, Zuza was alone, away from children and pregnant women. Medical care? Helpful, understood her pain.

***

“The point is not to process the loss with a woman”, emphasises Katarzyna Łodygowska, “but to respect her will”. The situation when the patient buries her child, although she does not need it, cannot be reversed. The only thing she could do is claim her rights in civil law proceedings, which is rare. Polish women do not decide to do it because it is mentally too much and often difficult to prove.

Katarzyna: “I learned about my rights from Matka Prawnik. She’s the only person who explained anything to me. At hospital, I was not told what to do, whether I had to organise a funeral, whether I could go on sick leave.”

She couldn’t see her child. She wasn’t given any choice. She thought about reporting it for a long time but was unable to. The despair was too great to dwell upon it. She feels sorry that women are treated this way in the 21st century. There is so much talk about saving life, and when push comes to shove, it’s not even a foetus. Just tissues.

Anna N. got pregnant just when she moved with her husband to Poznań. He knocked her up. They had been married for two years, pregnancy was not a problem for her, but her husband said he was not ready. His reaction knocked her off her feet. They stopped talking. She would go to doctors’ appointments alone. She thought that at the worst case scenario the child would be hers.

It happened in the ninth week. She came home from work, started making dinner. Suddenly she got wet. It was blood. A little bleeding at first, then a haemorrhage. She waited for three hours in the emergency room. This is where everything happened, where she delivered a foetus. And where she had curettage. “I won’t forget it for the rest of my life”, she says. Because the next day she was discharged home without antibiotics. She was surprised because as a midwife she knew that an antibiotic would be recommended.

A day later, she was supposed to go to work, but she couldn’t even do her hair by herself. Chills, a fever of 39.5 degrees. She went to the doctor. She had a referral to hospital, but was not admitted. The doctor sent her to the hospital out-patient clinic. There were eight patients there, she was about to pass out. She waited four hours. She got a referral, was admitted to hospital again, had another curettage. When she recovered, she heard newborn babies crying behind the wall. She had to listen to them for three nights. A psychologist at the hospital said she could have another child. After leaving, she found help on her own. She was attending therapy for a year. “I didn’t try to press charges against the hospital because I knew it wouldn’t get me anywhere.”

***

Edyta still imagines what her daughter would look like today. She decided herself that it was a girl. It was a difficult moment – to give the name and gender necessary to issue the death certificate. Together with her husband, they chose Łucja Laura.

She was given no information on what to do after the loss, and the manner in which she was handed over the necessary documents was rather curt. “So official, I felt terrible. And these words: ‘It will work next time. You’re still young’”, she remembers. They got their daughter in a container. As she saw it, she knew she was too traumatised for the funeral.

“Sometimes doctors tell patients early in pregnancy that it is best if they clear up on their own. They are right”, explains Matka Prawnik, “but they forget to add, ‘Please catch what you lose in the toilet, without it you will not know the sex of the child.’ Knowing the gender is key to exercising your rights as parents, e.g. to apply for shortened maternity leave.”

You have to pay about PLN 300-400 to determine gender. Some can afford such an expense, others not. The state discriminates against these people on the basis of their financial status. A woman gets a pill, a urine pot, and is left to her own devices.

***

After what happened, 35-year-old Dorota Knap needed a talk the most. Her son was born in September last year. Almost week 21. The examination results were all good. She thought she was going to have a premature baby. Contractions and dilation appeared in the clinic at night. After 17 hours, she gave birth naturally. The child did not survive.

Her German is not perfect, but good enough to talk freely. Thanks to this, in a hospital in one of the cities of Bavaria, she was able to freely tell a psychologist about her loss and contact her after leaving the hospital. In Germany, psychological support is provided for as long as it is needed by the woman and her partner. Patients who have miscarried or had a stillborn child can also join support groups or group therapy with other families that experienced the same situation.

Gerald’s photo still stands among other family photos. She always says that she has three children, although she saw the third one only for a moment after giving birth. Hospitals offer their patients a photographer who comes to a commemorative photo session. Parents can use this service for free. It is also common for friends to prepare memory boxes for the baby and mother.

“Women in Poland should know that it could look like this. That you can talk about what you have gone through, if you want to, that you can shout, cry, that you can get proper care”, says Dorota. “After the loss, we are often obliged to return to work and to life quickly. And yet without support, we will not be able to live as before.”

In many cases, this later affects the family, other children, and the relationship with the partner.

***

Anna could not pull herself together after what she went through in the emergency room. It was in 2014, she was 27, and after two years nothing moved forward. Her husband lived his life, she felt completely alone. They divorced. “If it were a little better in hospital, maybe the pain would be less poignant?”, she wonders. Today she works as a nurse. After being traumatised by crying babies, she could no longer be a midwife.

The report of the Supreme Audit Office indicates that women after a miscarriage can be classified as at risk of developing post-traumatic stress disorder. It describes the effects of miscarriage as follows: “It causes a shock through its suddenness, unpredictability and lack of control. It results in increased tension, a feeling of discomfort and the breakdown of coping mechanisms. It has a huge impact on the mental functioning of a woman and her family”.

Unfortunately, as Katarzyna says, sometimes family and loved ones also fail. They don’t know how to behave, so they distance themselves. “I wanted someone to come and clean the house, cook dinner, take me for a walk so badly. My husband was there, but he was constantly at work. After three weeks, the family thought I was over it and it only hit me after two months. I had an attack of neurosis, depression. Even though I was in a more convenient situation of having one child at home so I had someone to return to. After that, I did not try to get pregnant. Had it not been for these experiences, I know it would have been different. But I didn’t want to go through this any more. I am still undergoing psychiatric treatment, it is deep inside me.”

***

Edyta heard from doctors that it is normal that women miscarry. She remembers many tearful nights. She was devastated by low self-esteem, loneliness, questions: “what kind of woman am I?”

When she saw mothers with prams, her heart broke with pain. She bears this loss to this day. This cannot be forgotten. “I want you to write that such traumas will be understood only by a woman who has experienced them herself. I know that the doctor will not bring my child back, but it is largely up to them in what condition I leave hospital.”

Sandra admits that she has not managed to get back on her feet until today. Five months have passed. Only now did she dare to go to therapy.

Zuza blamed herself for a long time. She asked herself how she could allow it, since she had promised her daughter that as long as she was with her, she would be safe. But she didn’t want to give up. On May 26, 2020, on Mother’s Day, she took a test. She was pregnant again.

“In the 20th week I found out that I have a son under my heart. He was moving a lot, his heart rate was beautiful and the results were excellent. In week 38, my miracle came into the world. I know I went through this hell to finally touch heaven.”

Week 22. Full dilation, the amniotic sac was already coming out. I didn’t get anaesthesia. The nurse shouted that I should stop screaming because other people were asleep. They were discussing a nice delivery which someone had at the maternity unit.

Author: Paula Szewczyk

The text was published in „Wolna Sobota” on 20 March 2021