Note: This article contains sensitive, potentially triggering content.
When I speak to medical interpreters about the complexities of interpreting for infant and pregnancy loss, it’s in tribute to the little girl who made me a mother.
“Your baby doesn’t have a heartbeat.” The words no parent wants to hear. And the words no interpreter wants to relay.
Six years into my career as a health care interpreter, I had already interpreted for miscarriages, induced abortions, and adoptions. But when I lost my baby, it changed my life forever.
It was April 2012, and I was 27 weeks and two days pregnant with my first child. My husband Adam and I found out we were having a girl and already knew her name would be Maya. At my previous obstetrician visit at 24 weeks everything looked great. The doctor even said that “the baby was happy in there.”
Just as I turned 27 weeks, I wasn’t sure if I could feel her moving. Counting fetal movements doesn’t start until 28 weeks, and I still wasn’t sure how to distinguish between baby movements and other sensations common in the first and second trimester. To complicate things further, I had an anterior placenta, which the doctor said would make it harder for me to feel the baby move.
I tried to push the thought that something was wrong out of my head. It was a Friday and we had plans over the weekend to see The Phantom of the Opera with my parents. I wanted Maya to feel the joy I felt when witnessing an enthralling musical performance.
On Sunday night, I told Adam we should go to the hospital for peace of mind. I still believed I was overreacting, but I knew I would be anxious if I didn’t get examined.
When we got to the hospital, I changed into a gown and went to the bathroom. I remember thinking the baby was lying low. The nurse took my history and we waited for the resident to come.
The resident entered the room with the portable ultrasound and did an exam. I remember her rubbing the transducer slowly back and forth over my abdomen many times. Finally, she looked at us and said the dreaded words, “your baby doesn’t have a heartbeat. I’m so sorry.”
I froze. To this day, I can’t remember what the resident looked like. I’m sure there were some other questions asked and answered, but I don’t remember them. Even now when I think about that moment, I can feel myself frozen in time, unbelieving. Thinking, how could this be happening? The doctor had just told me a few weeks earlier that my baby was “happy.” How could my baby be dead?
Suddenly, Adam and I were faced with decisions we never imagined we would have to make. The doctors asked us if we wanted to go home and wait for labor to start spontaneously or initiate an induction. I couldn’t comprehend that I was going to have to give birth to my dead child. I thought there must be an easier way. Couldn’t they do a procedure? Why would I have to suffer through labor and go home with empty arms?
The physicians explained that it was the healthiest option for me and the most likely to prevent complications in future pregnancies. I reluctantly opted to start the induction process. It was surreal. I had gone to the hospital for reassurance and now I was staying to deliver my stillborn daughter.
Adam and I called our parents to tell them what had happened. It was heartbreaking to be the bearer of such news. Maya was the first grandchild for both families and now she was gone. All the baby clothes hanging in her closet would never be worn. Baby showers would be canceled and we would be planning a funeral, not decorating her room.
The labor and delivery process were a blur. I remember Adam on the phone and our parents coming and going. We were visited by a chaplain and our pastor who prayed with us. All the while, I kept pushing the button on my patient-controlled analgesia pump to try to make everything go away. Regardless of the number of times I pressed that button, I couldn’t make it go away.
As I reflect on the experience now, the people I remember most from labor and delivery were the nurses. I came to learn later on that there is a subspecialty group of labor and delivery nurses called bereavement nurses. If Adam needed to step out, they came and sat with me. They listened to me as I talked about the despair and helplessness I felt. They validated my loss as a real loss.
One of the nurses was named Angel. I can still see her sitting next to my bed and holding my hand as I tried to process what was happening. I told her that “we had been planning to name our baby Maya, but I wasn’t sure anymore.” She looked at me knowingly and said, “I think you are sure. Maya is a beautiful name.” I sobbed. This was a crucial breakthrough for Adam and I. Naming our daughter allowed us to grieve her properly. We were able to grieve all the hopes and dreams we had for her that would never come to fruition. We grieved the little things too. My husband had been practicing how to put hair up in a ponytail. Now, there would be no little girl’s hair to brush. The expectant joy we had felt with the promise of a daughter had turned into a black pit of despair and grief, which we were both navigating differently.
The nurses made a memory box for us with Maya’s name on it. The hospital called a photographer who came to take pictures after she was born. One of the photos was my husband’s wedding band around Maya’s tiny foot, an image I still have as my screensaver today. They even made molds of her hands and feet, which are carefully displayed in a curio cabinet in our home. While other parents would get to take their babies home and create a lifetime of memories, we would take a box home that would be one of a few tangible possessions to remember her short life.
Navigating Loss as an Interpreter
When I speak to medical interpreters about the complexities of interpreting for infant and pregnancy loss, it’s in tribute to the little girl who made me a mother. The one who touched my life so deeply that I would forever be changed. When meeting with a psychologist during my recovery, she once told me that in her decades of experience she found that “the deeper the love, the harder the loss.” Suffice it to say I experienced clinical depression after Maya left us.
With the support of my husband, friends, family, and my own will to have another child, I slowly started climbing out of the dark hole that enveloped me. I reached out and found other women, like me, who could understand the loss of a baby and the unfulfilled promise of a life together. Eventually, four of us revived a support group for people suffering from infant and pregnancy loss. I found comfort in our unfortunate bond. All of us eventually went on to have more children and support each other through our subsequent pregnancies. We understand each other in a way only members of this undesirable club can.
Losing Maya is the worst thing I’ve ever experienced. I can only imagine how difficult it would have been if I didn’t speak English, have a solid financial situation, or a dependable support system. When I train interpreters on how to navigate interpreting for these kinds of losses, I emphasize that if they’re doing their job right, they’re making a significant difference in people’s lives.
According to Drexel University’s online module, Psychological and Medical Aspects of Pregnancy Loss1, “two out of five patients [who have had a loss] will not only experience intense grief, but also a complicated bereavement with depression, anxiety, or PTSD [post-traumatic stress disorder] symptoms.” This type of complicated bereavement can manifest through feelings of “guilt, worthlessness, suicidal thoughts, or [the inability] to care for others.”
Furthermore, the module explains in detail the reasons why miscarriage is just as likely to affect patients as having a stillborn child or experiencing the death of a baby or older child. Miscarriage is considered an “ambiguous loss…[one that is] not defined in social or legal contexts as the death of a human being.” Parents are often confused and don’t know how to feel or who to talk to about their loss. Especially for first trimester miscarriages, family and friends are often unaware the individual was pregnant.
The encouraging news is that health care providers are trained to have conversations with patients about miscarriages, pregnancy, and infant losses. Drexel University highlights this saying, “psychopathologies decrease if a woman is counseled appropriately.” This is why it’s fundamental for interpreters to practice the principle of communicative autonomy2 in these encounters. In other words, get “each party in [the] encounter to be responsible for and in control of [their] own communication.”3 Health care providers receive training on what to say or not to say, but interpreters and the general public do not. Intercultural communication is complex, especially when dealing with infant and pregnancy losses. In life and death situations, it’s tempting for interpreters to want to help by offering words of comfort to the patient or family; however, by doing this they risk saying the wrong thing, even if they mean well.
I can still feel the sting of well-intentioned comments from family and friends after Maya died. “At least you didn’t lose a child.” “Your loss isn’t as bad as other losses.” “Everything happens for a reason.” “When are you going to start having kids?”
If you’re interpreting for a patient who appears to be having a normal pregnancy, don’t assume she has never had a loss. I had three “normal” pregnancies after Maya, but there was never a day I felt confident that everything was going to turn out alright. I was always aware that a loss was possible, even if it was statistically improbable. Make a point not to add or omit anything from the conversation with the obstetrician. They know the patient’s history, but you may not. Physicians are not infallible, but they do have the advantage of being able to prepare properly for these encounters.
Expect the Unexpected
If you’re called to interpret for an obstetrics patient, my advice is to expect the unexpected. Pregnancy losses are not uncommon. According to the American College of Obstetricians and Gynecologists, the number of early pregnancies that end in a loss is roughly 10% and “[a]pproximately 80% of all pregnancy losses occur in the first trimester.”4 If you’re going to interpret for an obstetrics patient, prepare yourself that a loss is a possibility, even if you have worked with the patient before and there were no complications.
Many limited-English-proficient patients in the U.S. have limited access to health care. The conversations you interpret between a patient experiencing a loss and their health care provider could be some of the few opportunities that patient has to receive proper counseling. Remember, by being a professional interpreter and limiting yourself to your interpreting role, you’re making a difference in these patients’ lives.
The bassinet where we laid Maya after she was born.
General Advice for Interpreting for Obstetrics Patients
- Geller, Pamela, Mark Woodland, and Christof Daetwyler. Psychological and Medical Aspects of Pregnancy Loss (Drexel University College of Medicine online module).
- Meder, Danielle. “Interpreting Best Practices to Support Communicative Autonomy” (Cross-Cultural Communications).
- Garcia-Beyaert, Sofía. “Communicative Autonomy and the Role of the Community Interpreter.” In Marjory Bancroft (Ed.), The Community Interpreter®: An International Textbook (Culture & Language Press, 2015), 363.
- Early Pregnancy Loss (American College of Obstetricians and Gynecologists).
Marisa Rueda Will, CHI has been a medical interpreter at a major U.S. medical center for over 15 years. She became a certified health care interpreter (Spanish) in 2012, and a licensed interpreter trainer through Cross-Cultural Communications in 2017. In 2020, she became a simulation center instructor. She is a member of the National Council on Interpreting in Health Care Webinars Work Group. She specializes in education through storytelling and has published articles on the blog of ATA’s Interpreters Division. Her company, Tica Interpreter Training and Translations, focuses on training and educating novice and advanced medical interpreters, based on real-life patient experiences. email@example.com