Catalina Pizarro, a music teacher, was told that it could happen at any moment. They were referring to the death of her daughter Clara, who was still growing inside her. An ultrasound had detected, at week 11, a cystic hygroma and generalized hydrops. Clara died at week 20, on December 5, 2018, but her parents had begun losing her much earlier, from the day that diagnosis changed the wait for a birth into the wait for a death. A civil court in Santiago ruled, in the first instance, that the doctor treating her must pay her $100,275,000 for obstructing her access to termination of the pregnancy due to fetal nonviability, which she says she requested on three occasions. The doctor appealed and maintains that he acted in accordance with the law and good clinical practice. Catalina has gone back to playing bass in a tropical music band and still keeps Clara's ashes, which she would like to scatter in the sea when the trial ends. While the courts decide, the case allows us to talk about something that is rarely named: the pain of remaining pregnant when it is already known that the child will be lost. A woman leaves an ultrasound with the same body she entered with, but with a life she no longer recognizes. The belly keeps growing and her child's heart may keep beating. Everything seems to continue, except the future. How does one begin to lose someone who is still living inside us?
Socially, grief usually begins when someone dies. There is a wake, relatives arrive, and people embrace without knowing what to say. For losses that begin before death, we have almost no rituals. A woman may still appear to be a pregnant woman to others while, inside, she has already begun to say goodbye, and that leaves her very alone. As soon as a belly starts to show, the questions appear: when is it due, will it be a boy or a girl, what will it be named. They are affectionate questions, but they hurt. Some women stop going to gatherings, hide a pregnancy they once wanted to show off, or answer evasively, and end up protecting others from their sorrow just when they need to be held up. For weeks, a woman may return to the clinic only to check whether her child's heart is still beating. It usually happens in the same waiting room where other pregnant women chat about names and show off their ultrasounds, and she has to sit among them knowing that her own child will not be born alive. The place that was supposed to care for her reminds her, every time, of what she will not have. A mother can love her child and, at the same time, wish for an unbearable wait to end. She may want to hear that heart one more time and feel anguish at the idea of hearing it again. Sometimes she talks to it and then forces herself not to grow attached, because she knows it will not last. Then comes the guilt. When she holds on, she fears what is to come, and when she tries to protect herself, she feels she is abandoning someone she still loves. In the clinic of trauma, two blows are spoken of. One is the event itself: the diagnosis, the wait, the death. The other comes afterward, in the response of others — an unfortunate comment or the silence of those who prefer not to ask. Often it is this second blow that turns suffering into trauma, and that is why what happens around a woman while she waits matters so much. A threat that drags on keeps the body on alert, disrupts sleep, and forces one to relive over and over what is feared. Some people continue living that wait years later. When death arrives, one must meet a child and say goodbye to them in a single encounter. Some mothers want to hold them, give them a name, keep a photograph. Others need to say goodbye in another way, and no one should impose one on them. Love is not measured by the weeks someone managed to live. With that child, the future the family had already imagined is also lost. Upon returning home, many discover that the world keeps functioning. Children go to school, people work, the bills keep arriving, and getting out of bed can be impossible. Within a single family, each person mourns the loss in their own way, and those differences weigh too. The three-grounds law provides for an accompaniment program that, in the event of a fetal death, includes measures such as a memory box or a room to say goodbye. Since 2021, the Dominga Law has required support and respect in the face of gestational and perinatal grief. That it is written down does not ensure it reaches those who need it. How we accompany a woman who knows her child may die remains pending. Delivering the diagnosis is only one part. One must also understand what that news means to her, respect what she decides, and give her a place where she can say what she feels.
_María Jesús is a clinical psychologist, specialist in bonds, rupture, and grief (https://psmjsandoval.cl/).
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