We're a nation geared to happy endings. Work leads to security. Love leads to happiness. And healthy pregnancies lead to healthy babies.
But what happens when things don't work out that way?
What happens when a perfect pregnancy goes haywire, when a baby's heart inexplicably stops and instead of a cradle at the end of the ride home, there is only a casket?
And what happens after the shock wears off and the isolation and self-doubt set in?
Last November, the worst happened to Shari Davis and her husband, Michael Dubin. The couple arrived at Cedars-Sinai Medical Center as Davis was well into labor with their second son, Daniel. Davis donned a gown, then climbed onto an exam table as a nurse attempted to gauge the baby's heart rate.
"She thought she was finding a heartbeat, but it was mine," Davis said.
"There was a resident who said, 'Let's just get the ultrasound hooked up.' When they did that, it was quite clear that the heart wasn't beating and the baby wasn't moving. No one would say anything. Finally, I said, 'Are you telling me my baby is dead?' And after a very long pause, someone said, 'Yes.' Michael held my hand very tightly and just cried with me."
About 45 minutes later, Daniel was born, silent and perfect.
As she held her baby, Davis said, "I just kept screaming, 'My baby is perfect! He's perfect!' I just couldn't grasp that a baby could be perfect and still die."
Less than three months later, Wendy Kilbourne Read, 30, went into labor with her second child, a daughter. In a routine exam with her obstetrician to determine how far she had dilated, the doctor was smiling and laughing as he looked for the baby's heartbeat.
Suddenly, his smile evaporated.
"What's the matter?" Read asked. "You're scaring me."
"Get dressed," he told her urgently. "We're going to the hospital."
Later that day, as she and her husband, James, wept, Willa was delivered by Cesarean section at Cedars-Sinai.
"It is the most unbelievably painful thing to hold your dead baby and see this perfect child," Read said. "Our daughter looked so beautiful, so peaceful."
When a baby dies, families are consumed by shock, grief and, very often, an overwhelming sense of loneliness.
"I wanted so desperately to talk to someone who was a good mother, a careful person," Read said. "Someone who had gone through what I did."
Nancy Flax, a hospital social worker, put Read and Davis in touch after Read's milk came in and she remembered that Davis had found a folk remedy.
"I told Wendy I put raw green cabbage leaves in my bra," Davis said. "It was soothing and my milk went away in a day. Also, it was comic relief."
Finding someone who shared her deepest wound, Read said, was invaluable: "I feel that Shari saved my life."
Davis and Read--and their husbands--have also found solace in the company of others who have lost babies at birth. They attend monthly meetings of a hospital-based support group facilitated by Flax and Sharron LeBo, a Cedars-Sinai delivery nurse who lost a baby in 1975 and was so angry at the insensitivity displayed by her doctors and nurses that she resolved to find ways to ease the trauma for her own patients.
"As we have worked through our grief," Davis said, "one thing that affects us is that none of us had any idea that our child could die, that stillbirth is a possibility in today's age of medical technology."
"It is not as incredibly uncommon as everybody thinks it is," LeBo said. "It is one of those tragedies in life people don't dwell on and talk about."
"Stillbirth is a tragically common occurrence," said Dr. Richard Pauli, director of a program at the University of Wisconsin in Madison that has developed a protocol for hospitals to follow in the event of stillbirth.
Stillbirth is defined as the death of a fetus any time after 20 weeks of gestation. Before 20 weeks, the loss is considered a miscarriage. In this country, about 1%, or one of every 100 to 115 deliveries past 20 weeks, ends in stillbirth. The incidence of stillbirth in fetuses who reach full term is significantly less than 1%.
Catherine Reiser, associate director of the Wisconsin program, said her group has been able to identify a cause of death in about 40% of the 1,200 stillborn babies it has studied. Dr. Cynthia Curry, a medical geneticist at Valley Children's Hospital in Fresno, said she has been able to discover a cause of death in about 70% of the 500 babies she has studied.
Causes of death are complicated and varied. They can include genetic defects, congenital anomalies, bacterial infections and placental abnormalities, but there is no simple catchall to describe the phenomenon.
"There are multiple causes of death in stillborn infants," Reiser said, "but not one that you can point to as the most frequent or common."
How seemingly perfect babies die is still something of a mystery.
"There is more we don't know than we know," she said.
According to Pauli, the umbilical cord is often inappropriately blamed for the death.
"Pressed to find some explanation for a baby's death, medical personnel often are tempted to attribute death to the most obvious feature at hand--a twisted, knotted, short, long or constricted umbilical cord," he wrote in a recent newsletter. "Only about one in every 40 stillbirths arises because of cord (problems)."
The deaths of Daniel Dubin and Willa Read, their mothers said, were attributed to probable umbilical cord problems.
Despite that, both women went through a period of blaming themselves.
"I couldn't believe there wasn't something I hadn't done to cause it," Davis said. "I was one of those people who didn't let pregnancy stand in my way. And after my baby died, I thought, how could I be so cavalier?
"At one point, Wendy said, 'I must have been able to do something to get that cord off Willa's neck. If only I had stood on my head, maybe I could have prevented this.'
"And I laughed, because I had stood on my head when I was playing with my son, Noah. And I thought that's what caused it."
To listen to mothers and fathers who have lost babies at or before birth is to confront an implacable kind of grief. They grieve for the end of their dreams and futures. They grieve for what might have been.
Their stories can make your heart hurt, but they tell them hopefully--that doctors and nurses become better at handling tragedy in the delivery room, that the rest of us understand it can happen to the most vigilant parents, and that such losses are not felt less keenly because the child has not yet lived.
"We did all the right things," said Judy Leib, who lost her daughter in January.
"The perception is, it's done when you leave the hospital," said her husband, Daniel. "But the reality is, it's the loss of a child, and no one understands that." They regret not being encouraged to hold and name their baby.
"You feel like a freak," said Barbara O'Donnell, who was seven months pregnant with Brendan when his heart inexplicably stopped. "You're not the only one out there."
"It's like you're cruising on the freeway and a truck slams into your from out of nowhere," said Mitch Pindus, whose wife, Polina, underwent a harrowing delivery in January before losing their daughter, Rochelle, 12 hours after birth. "They don't tell you about this in LaMaze."
Indeed, they all wished that someone--their doctors, their childbirth instructors--had told them that perfect pregnancies don't always produce perfect babies.
It might not have altered their fates.
But they might not have felt so alone.