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The Church’s Response to Miscarriage & Stillbirth Needs More Work
by Michael Baum, Andrew & Patricia Kishler
The day after Memorial Day 2009, our family attended a very small funeral at St. Tikhon’s Monastery in the hills of northeastern Pennsylvania. The cemetery setting was lovely, the mourners few. The hand-dug grave was small and the coffin smaller still: a wooden box about six inches long, hand-crafted by a grandfather of the deceased.
We were burying our expected child, brother, and grandchild, who had lived only two months in his mother’s womb. Our hearts wept as the officiating priests read the Orthodox funeral service for infants, including a line that compared our departed child to “a ship that passes and leaves no wake behind.”
Like many such tragedies, the death of little Constantine made us starkly conscious of something we were largely oblivious of before, and it inspired considerable research and inquiry. We know now that death before birth is very common—so common that we can hardly believe how little attention it receives. Statistics on the frequency of miscarriage vary with source and definition, but the best estimates are in excess of 30 percent of all pregnancies.
Some authorities say that it is normal for couples to lose at least one unborn child, and only if it happens repetitively is medical intervention indicated. Yet society at large ignores the pre-born dead, and even our churches are often ill-prepared to deal with them and their bereaved parents, whether liturgically, pastorally, or theologically.
Hiding from Death
That society ignores or dismisses pre-born death is perhaps unsurprising. A nation in which more than a million pre-born infants are deliberately killed every year can hardly be expected to pay much attention to a few million more such deaths that occur naturally. Ignoring pre-born death is consistent with the way secular society routinely removes both birth and death from view—and miscarriage is both at the same time. Sterile language like “product of conception” obscures the reality of more accurate but emotional terms like “baby.” Even the word “miscarriage” can be deceptively clinical, connoting some failed abstract process rather than a real human death.
The majority of those in the medical profession seem to regard pre-born death purely as a condition to be treated, rather than as the loss of a family member. Our bereaved mother, Patricia, received excellent and sympathetic care from her local providers, but little understanding that there was a baby involved. When she brought to their office the tiny amniotic sac and its contents, which she had retrieved after the miscarriage, in case they needed to do any tests, the doctor—a Romanian and presumably born into the Orthodox Church—asked: “What are you going to do with it?” Patricia’s response, “Bury it,” met with a blank stare of incomprehension. Resolution of the immediate medical situation seemed to spell an end to the entire incident, in the view of this medical group.
A much more helpful response came from her Chicago-based family-practice physician, also Orthodox and a great advocate of home childbirth. He gave her much helpful advice over the phone, including: “You have given birth. Rest a lot for the next two weeks. And name the baby.”
Naming the child did help Andrew and Patricia immeasurably in getting through the crisis, and is actually one of this doctor’s recommendations for all pregnant mothers early in their pregnancy, to begin their relationship with the baby as a human being. Indeed, many sources on pregnancy loss, both Christian and secular, recommend naming the child as, at the very least, a way of humanizing the loss and making remembrance easier.
If we cannot expect the world to know what to do with miscarriage or stillbirth, we should be able to expect better from the Christian Church. The nature of Christianity is to tackle, not turn from, unpleasant realities. Sin. Suffering. Death. A God who became flesh, suffered, and died to overcome sin and death. Traditional Christianity—and, indeed, traditional Judaism—does not sugarcoat or explain away unpleasantness. Instead, the Church provides means for Christians to live with and through the hard times, deriving strength from God and learning to “treat all that comes . . . with peace of soul, and with firm conviction that thy will governs all,” in the words of the “Prayer for the Coming Day” by St. Philaret of Moscow (d. 1867).
A Higher Response
From a pastoral and community perspective, the Church should provide means of coping to all those bereaved by the too-common occurrence of pre-born death. First, of course, comes the mother, whose feelings of distress are often complicated by ambivalence. On the one hand, she may not feel “justified” in grieving for a child who society insists was not really a child. On the other, she may blame herself or search her conscience for errors of commission or omission that might have caused the miscarriage.
Patricia found herself comparing her feelings to the reactions of friends who had lost children, and feeling guilty for grieving too little—till she mentioned this “insufficient guilt” to Andrew and he pointed out that, even as she spoke, she was shedding tears. “Grief [in these situations] is not all-or-nothing,” the Orthodox scholar Christopher Humphrey has observed. Mothers going through these difficult passages need the ministration of the Church in all its depth and breadth.
The other aspect of response to pre-born death is, of course, ministry for the departed. Our research turned up little in the way of formal liturgical provision for these deaths in most Christian traditions. Yet providing formal rites for the pre-born dead is justified by arguments both of definition and of utility.
The traditional Christian faith has always asserted that pre-born infants are human souls from conception. That is the underpinning of our categorical opposition to abortion. By definition, then, the pre-born deserve the rites of the Church like any other departed human soul.
The argument from utility has the same basis: If we so believe, then we should so demonstrate to the world, by treating these tiny departed as we do all others who die. Not to do so makes us vulnerable to charges of hypocrisy—which, indeed, some supporters of abortion have leveled against Christians on this very basis.
Admittedly, considering the pre-born as deserving the full rites of the Church raises some theological questions. But the questions do not go away if we ignore the issue, even as the world tries to ignore the pre-born dead themselves. Pastoral and liturgical response to pre-born death potentially could take many forms:
• During a threatened pregnancy, praying for the mother and for the endangered infant as we would for an ailing “born” person. (One of our Orthodox pastors says the “prayer for difficult pregnancies” over all expecting mothers in his congregation, even if they are not in difficulties at the moment, and he also gives a special pregnancy blessing for them each time they receive the Eucharist.)
• After the miscarriage or stillbirth, immediate care of and prayers for the mother’s physical and spiritual well-being, and for her potentially mixed feelings of grief and guilt.
• Ministering to the dead infant, commensurate with the attention given in that particular Christian tradition to other departed souls: anointing, prayers for the dead, funeral, and so forth.
• Ongoing ministry to both mother and child: care for the mother during healing, reception as she returns to church afterwards, future commemoration of the dead.
Overall, according to our researches, no church currently provides a fullness of response to pre-born death that parallels its treatment of death as a whole. Some traditions, however, come closer than others.
Knowing how Christian doctrines and practices have splintered during a millennium of schisms, we started by searching for some baseline in traditional Jewish beliefs. Judaism has splintered, over the centuries, perhaps as severely as Christianity, though in different ways.
Nevertheless, there are some common threads in Jewish practice. The Tanakh (“Old Testament”), while not dealing with the issue directly, makes clear in several places the value of the life in the womb. “The Lord called me from the womb, from the body of my mother he named my name” (Is. 49:1). “Before I formed you in the womb I knew you, and before you were born I consecrated you” (Jer. 1:5). Exodus 21:22 specifies penalties for a man who injures a pregnant woman and causes miscarriage, even accidentally; some interpreters believe that the death of the pre-born child requires the death of the one responsible.
Sadly, the rabbinic tradition does not seem to have taken these (admittedly indirect) indications of the humanity of the unborn child very far. Judaism does not specify prayers for dead infants. One rabbi, asked about this, simply explained, “This kind of death is not supposed to happen.” But a less sympathetic explanation is that in traditional Jewish thought, at least as expressed by contemporary writers, the unborn baby is regarded as only a “potential” human being.
Also, the customary rituals for dealing with the dead are not specified until the child has survived at least 30 days after birth. Some authorities do call for burial of a fetus past 40 days of gestation, with suggestions that more complete rituals be added the further along the miscarried pregnancy was. But it appears that these provisions, many of which may have developed in recent times, are aimed more at soothing the grief of the parents than at ministering to the departed.
Now, it should be borne in mind that death, in traditional Judaism, is the end of life. Though belief in some form of resurrection formed a thread of Jewish thought long before the coming of Jesus, the focus was and is on this life, not the next.
For Christians, however, death is the door into eternal life. So the status of the soul even of one who has not seen the physical light of day is much more important, as are our ministrations to that soul. Perhaps for that reason, the Christian Church took deep interest in the unborn very early on. Tertullian, in the second century, referred to prenatal injury as “a loss suffered by what is already a human being.” Other early Christian advocates for the unborn include Jerome, John Chrysostom, Basil the Great, the authors of the Didache, and many others. In taking this stance, the Church split with pagan and classical thought, and began to differentiate herself from Judaism as well.
Another factor that probably influenced Jewish (and some Christian) practice toward miscarriage is one we tend to forget: the high incidence of infant mortality throughout most of history. To put it bluntly, dead babies were just a routine fact of life when many of these old customs were spelled out. Even in the first half of the twentieth century, fetal mortality (over 20 weeks gestation) in the United States was at least three times higher than it is today. The relative lack of formal observances for the pre-born dead may have been a sort of coping mechanism to deal with unrelenting sorrows, or even a concession to the impracticability of dealing with so many funerals.
This does not mean that churches today cannot and should not do better, now that our medical technology allows us to identify early-stage pregnancies more readily and to appreciate embryos and fetuses more fully as developing human beings.
Christian Practice Today
Rites for pre-born death exist in some Christian churches, but they are scattered, inconsistent, and largely dependent on the preferences of individual clergy or parents. One funeral manual from the Presbyterian tradition, for instance, states: “ If [the parents] consider the stillborn child as having been a person who died, then a funeral service for a child is in order. . . . In the case of a miscarriage, a healing service for the bereaved is appropriate” (emphasis added) (from A Funeral Manual, Perry H. Biddle, Jr., 1994).
Various Evangelical writers have campaigned for a more systematic practice of services for miscarriages, but what currently exists is largely books and websites of advice, spiritual counsel, suggestions for prayers for healing—all positive and potentially helpful, but nothing formal, prescribed, or expected.
The current edition of the American Book of Common Prayer (BCP) has no provision for miscarriage, nor does the 1928 edition (or even the classic 1662 English BCP). The 1929 BCP of Scotland has one brief optional prayer within the rite for “the churching of women” to be said “in the case of trouble or bereavement,” but it’s not clear if it can apply to a miscarriage as well as to the death of any child shortly after birth.
Contemporary Roman Catholic practice provides a blessing that parents “may seek.” It consists of prayers for comfort and healing, a reading from Lamentations (3:17–18,21–24), and the Lord’s Prayer. Not a sacrament, the service can be led by clergy or laity. There is no provision for rites beyond that, and no mandated rituals.
The Orthodox tradition provides liturgical resources, though, as with other traditions, there are gaps, and the actual application of those resources depends on who is applying them.
We will base the balance of this essay on Orthodox resources and recent thoughts on the issue, with the expectation that the challenges, and our thoughts about how to address those challenges, could apply, mutatis mutandis, equally to other traditions.
Orthodox prayers and services for what seem like all possible situations are provided in The Great Book of Needs, which spans four volumes of about 400 pages each in the English version. The Book of Needs attempts to provide the assistance of the church in every aspect of our lives. For the occasion of a miscarriage, the book supplies “Prayer for a woman when she has miscarried/aborted an infant,” and also a “churching” prayer for the mother on returning to church after recovery.
The first prayer was read for Patricia a few days after her miscarriage. Overall it was a great comfort, though a few phrases ring rather harshly on modern ears:
. . . According to Thy great mercy do Thou Thyself have mercy upon this Thy handmaid, who today lieth in sins, having fallen into manslaughter, casting out, willingly or unintentionally, that which was conceived within her; and forgive her transgressions, voluntary or involuntary. Preserve her from every snare of the devil, cleanse her defilement, and heal her pangs. Grant health and goodly strength to her body and soul . . . by Thy great mercy restore her in her humbled body, and raise her up from the bed whereon she lieth. . . .
This prayer has been criticized as insensitive for the passages that lump together abortion and natural miscarriage. This stress on guilt may reflect the church’s historical abhorrence of abortion and an “abundance of caution” should that be the cause of the miscarriage. In any event, according to Fr. John Breck, work is underway on a partial rewrite “to preserve the acknowledged link between human fallenness and physical illness, while avoiding the implication that the mother herself is morally responsible for the death and ‘abortion’ of her child.”
Yet our experience argues that preserving “the acknowledged link” will be important to this rewrite, and that even granting the insensitivity of some phrases, the prayer does touch on the sense of responsibility the mother often feels, whether justified or unjustified. One of the professors at St. Tikhon’s Seminary said that in his pastoral experience, feelings of guilt and inner questions of possible responsibility often haunt mothers of pre-born dead children, and this prayer addresses these concerns.
And the prayer does not shrink from the gravity of the situation. We were always very aware that a real life had been lost, regardless of whether anyone was “at fault.” The Book of Needs recommends pastoral counseling on the question of abortion versus natural miscarriage, while the prayer simply acknowledges the tragedy of a baby who died before birth, and seeks forgiveness if there is anything to be forgiven.
The other provision in The Book of Needs is an alternative “churching” prayer to be said over the woman on her return to church shortly after the miscarriage. This is a reduced version of the standard churching prayer said over every mother and baby when they first appear at church post-partum. The version used after miscarriage omits, of course, the language welcoming a new baby. But it does formally acknowledge that a birth occurred, that a life was involved, and that the mother’s life in the church is resuming, with all the support that entails.
It is in the other aspect of ministering to pre-born death—services for the infant himself—where there is more room for improvement, or at least for clarification. There are no prescribed Orthodox services for a miscarried child: no funeral, no commemoration, no anniversary observances. This is because the unborn child is not baptized. Indeed, there is a school of thought that the pre-born dead cannot partake in the fullness of God’s kingdom for his departed, and therefore should not even be buried in the same part of the cemetery with the faithful.
Thankfully, this custom—which has been condemned as “nothing less than barbaric” by Fr. Alexander Rentel, a professor of Orthodox canon law—is not universal and was not applied in our case. The funeral service for infants was read, with some modifications, over little Constantine. The monastic community at St Tikhon’s stepped in out of loving concern and conviction regarding the sacredness of all human life, and made room for Constantine among all the other Orthodox awaiting the resurrection in that place. The only distinguishing aspect of the pre-borns’ grave markers at St. Tikhon’s is that they bear only one date. Other monasteries exercise similar care over the pre-born dead.
Some progress is being made toward addressing the perplexities of theology and custom that have inhibited pre-born funerals for the Orthodox. In March 2001, the Holy Synod of the Church of Greece set guidelines for burials of unbaptized babies, classifying children of Orthodox Christian families as “candidate members” of the church: “After the establishment of infant baptism, the unbaptized children of Christian parents occupy the place of catechumens.” And catechumens may receive a Christian burial in the Orthodox tradition.
This decision by the Greek synod may be a welcome step toward ending the situation in which, in the words of Fr. Peter Jon Gillquist, “children who die in the womb are among the only human beings . . . denied any place in the liturgical life of the church.” We look forward to the day when such precedents will spread across Orthodoxy and Christianity as a whole, and extend to the pre-born dead the full range of services for the dead.
Clarity & Witness
We do not suggest that the Church impose an inflexible regimen of ritual on all parents grieving a pre-born death. Some bereaved parents are reticent, particularly about miscarriage, especially considering the personal and societal ambivalence mentioned earlier. But the Church needs to offer clear direction to both clergy and laity as to what rituals are normal, basic, and available to assist her members through these difficult times.
With more extensive guidance, the parents of the pre-born dead might find great comfort in sharing their grief with the community, and the community would have opportunities to share sympathy and prayer.
And in so doing, we could begin to make a more public assertion of the truth that we all hold privately: that these tiny dead were and are human beings, created in God’s image. That these deaths, like all others, have been conquered by the completed work of Jesus Christ. And that these small saints, too, will be raised with all the saints in glory on the last day by the One who said: “Before I formed you in the womb I knew you.”