A Vast and Sudden Sadness

Postmortem photography, though, has a long and treasured past. In the 19th century, when people died at home, families spent much of their savings on expensive silver daguerreotypes depicting their loved ones after they had passed away. Now I Lay Me Down to Sleep is a modern-day incarnation of this "memento mori" photographic genre (Latin for "remember your death"). Memories facilitate grieving, says Leon, which is critical to long-term healing. Holding a baby, talking to her and photographing her—all create memories that help parents cope with a devastating loss.

Parents who are hesitant about holding their babies often change their minds toward the end of a shoot, realizing that they'll have no other chance to embrace their child. And the sessions bestow a quiet time for mothers and fathers to treasure and honor their babies without any interruption from nurses or doctors. In years past, parents didn't expect all of their children to live. Today babies are dreamed about and dwelt on, and the deep attachment that develops between parents—especially mothers—and their unborn children starts earlier than ever before. At eight weeks, a baby's heartbeat can be seen on ultrasound; parents now find out gender and assign names months before their babies are born. All this has intensified the grief reactions many women feel after they suffer not just a stillbirth, but a miscarriage too, says Leon.

Studies show that mothers benefit from bonding with their stillborn babies. Joanne Cacciatore, a researcher at Arizona State University, studied 3,000 women and found that those who had the chance to see and hold their babies had fewer symptoms of depression and anxiety. This benefit may be temporarily reversed during a subsequent pregnancy. And nobody should be pressured to hold their babies. But more than 80 percent of women who did not regretted the lost opportunity. Cacciatore, whose fourth baby, Cheyenne, died in 1994, calls this a period of "ritualization," a time for parents to honor their child and to feel some semblance of control during an emotionally chaotic time. Holding a stillborn baby allows women to connect and then separate themselves from their babies after months united in the same body. And it gives parents the chance to create positive memories, rather than live with the unknown: What did she feel like? Whose nose did she have? Was she peaceful?

Doctors, nurses and social workers who encounter stillbirth have come to know this, and their thinking about how to care for patients has evolved enormously. Elisabeth Kübler-Ross's seminal 1969 book, "On Death and Dying," exposed the impact of loss and the long and intricate process of grieving. Parents of stillborn babies started talking about what it felt like to lose their children; physicians and psychologists began challenging the hush-hush approach. Michele Schwarzmann, director of maternal child health at Mercy Medical Center in Baltimore, can't forget the first stillbirth she witnessed in the 1970s. " 'Michele, you can't cry, you have to be strong'," she remembers her supervisor telling her. A decade later, Schwarzmann says she was finally allowed to express her sadness: "I sobbed for every baby I never got to cry over."

Stillbirth is in many ways a medical mystery. Despite its gravity, it has been largely overlooked. Even today, researchers don't know the true incidence of stillbirth nor do they fully understand why it happens. In some cases, doctors can identify a cause—a prenatal infection that travels from mother to baby, a genetic anomaly, a placental abruption, an umbilical-cord accident. But in at least half of all cases—more than 10,000 a year—they can't pinpoint the problem. "Over the last 50 years, we've put a lot of research and clinical energy into preventing sick babies from dying after birth and a lot of energy into premature babies," says Dr. Robert Silver, an Ob-Gyn at the University of Utah School of Medicine. "We haven't put the same energy into stillbirth."

All that became clear at a workshop held by the National Institute of Child Health and Human Development (NICHD) in 2001. "We realized that we needed to do a study that was larger than anything undertaken in this country," says Dr. Catherine Spong, chief of NICHD's Pregnancy & Perinatology Branch. With NICHD funding, Silver and other researchers began collecting data on more than 500 stillbirths at five sites around the country. Now they're analyzing the information. The hope is that the new information will help researchers sort out how to reduce a woman's risk for stillbirth, identify problems in advance so that couples can prepare for a loss and, ultimately, save lives.

No matter how good the science gets, however, some number of babies will continue to die and parents will continue to grapple with the shock. Not long after joining Now I Lay Me Down to Sleep in 2007, photographer Jennifer Clark got a call from a hospital near Salt Lake City. The parents, Melina and Tom Anderson (unrelated to Marirosa Anderson), had three other children—a son, Jack, then 6, and two daughters, Amy, 4, and Mae, 2—and they were excited about welcoming their fourth, another girl, named Ella. At 39 weeks, however, the baby's heartbeat started dropping precipitously and Melina had to have an emergency C-section under general anesthesia. Melina remembers waking up and hearing her doctor say, "I'm so sorry, she didn't make it." The umbilical cord, wrapped tightly four times around the baby's neck and once around her arm, had cut off her blood supply. Melina "made the kind of sound you never want to hear," says Tom. "Not really a scream, but almost. A moan." And then she started to cry.