"It's hard to talk about this to anyone. My family is also suffering so honestly, I don't want them to feel bad about how bad I'm feeling. My friends have their own problems and don't need to hear about mine. Besides, many of them have a new baby which isn't a place I want to be right now."

"I don't know what happened," she continued. "No one has given us an explanation that makes any sense. All I know is ... that ... I don't know... it's not supposed to happen like this. One minute I was pregnant with a big healthy boy and the next minute they tell me he's dead. When they put him in my arms, he didn't look dead. He looked perfect."

She cradled her arms and gazed into the emptiness. In a flash, I could see her baby there, in her mind and in mine, plump and perfect as she had described him. Unexpectedly, I was overcome with a feeling that brought me way too close to home and for an instant I was transported back to the birth of my son, sixteen years earlier. 

My pregnancy was also uneventful. I loved being pregnant and the bigger I got, the better I felt.  When my due date came and went, no one was particularly concerned other than anxious relatives who called for hourly updates. After three weeks post due date (hard to believe this was so long ago it was before docs were doing routine ultrasounds), and a failing placenta, a C-section was the only way my baby was going to come out. We packed, we prepped and we let the doctors do their thing given that nature's course had stalled. 

Though memories of the moments after delivery are vague as my aging brain rummages through the past twenty four years, I remember the hurried response and the flurry of scrub-clad, nameless figures around me. Baby was whisked away to an undisclosed, oh-my-god-what's-wrong-with-my-baby location as my belly was meticulously stitched closed. After what seemed like forever due to either my altered, medicated state or my panic, I'm not sure which - my baby boy was brought to me, swaddled neatly and capped with the sweet striped infant hat that today, is packed away in a box of things with which I simply cannot part. He was perfect, apart from his misshapen head that resulted from being overcooked and pelvis-squeezed for too long. I would later learn that the critical moments just before he was perfect were in fact, life-threatening. When they wiggled his big head out of my tiny incision they saw he wasn't breathing. His Apgar score was 2 at one-minute. (This score, measuring skin color, heart rate, reflex, muscle tone and respiration is determined at one and five minutes after birth. Scores below 3 are generally regarded as critically low and above 7 are generally normal.) To this day I don't know which specific criteria he fell short on, but I do know that when the test was repeated at five minutes, his score was 8. All was well. 

But for an instant, he wasn't breathing. He had aspirated on meconium, a risk of post mature babies and thanks to split-second intervention, had an endotracheal tube down his little throat to suction his mouth and airway. Before I knew what was happening, he had been intubated, observed closely, cleaned off and literally within minutes, returned to my swollen chest yearning for the warmth of my newborn baby. He was, as Lyn had just described her baby boy, perfect.

In addition to aspiration, another risk of post maturity is intrauterine fetal demise or stillbirth. 

The ache I felt in my chest as Lyn recounted the events of that heartrending evening at the hospital was too deep and too personal to ignore. I took in a full slow breath as Lyn pulled out a picture of her son. "Can I show you a picture of Mathew?"

"Of course," I said, digging deep for the most soothing and tender voice possible.

The moment of silence while she looked for her one enduring keepsake of his precious self seemed eternal. The room felt still and empty. Then, the emptiness started to throb as if in sync with my rushing heart beat. What would I see? How would he look? Could I separate this from my own experience? Would I be able to stop thinking of my son? Would I be able to hide what I was feeling? Could I remain neutral in my response? 

Rob leaned over to grab a peek at the photo before she handed it to me. I leaned toward her, accepting the picture as a delicate gift she was sharing, as if she were handing me a sacred piece of herself. I looked at Mathew. He was just as she had described him, big and gorgeous. His eyes were closed. He looked peaceful as if he were sleeping. I remember being bothered by my quiet thought that she was right, he didn't look dead. The dull pain in my heart grew sharper as images of my own son's birth flooded into my vision. I could almost feel my objectivity vanishing.

"I'm so sorry," I looked at Rob and Lyn, "it's so awful, sweet Mathew, he's so beautiful." Another moment, in therapy as in life, when the right words are nowhere to be found. Her eyes filled with tears, "I miss him so much." Her sobs became heavy with unimaginable grief. My instincts led me to sit quietly after saying, "I know you do." 

When the pain is that great and that palpable two things are for sure: 1) she needs to express it and 2) she needs to know you can tolerate it. The space we create between the client and our selves during such time of incredible emotion is as important as our desire and ability to comfort her  Bear in mind that a loved one who responds to her weeping might hold her and console her in the hopes of helping her control the pain to some extent and perhaps cry less. Loved ones unite against the unbearable pain hoping to lessen it, even if only slightly. If you stop crying you won't be in so much pain, they might think. 

Our job, on the other hand, is to let her know that no matter how bad she feels, how hard she cries and how much it hurts, it's okay. The message is that she has permission to express the inexpressible and that it will not unnerve us nor will we try to inhibit the process. To the contrary, although we too want to be consoling in our response, the difference is that we want her to stay in that painful space for a bit longer than she might like, so she can say the things she needs to say and feel the things she needs to feel in order to get some relief and make room for healing.

It's well known that one has to be extremely cautious about any physical contact in a therapeutic context. Sometimes, any physical contact can be misinterpreted as I'm here for you but I'd feel better if you stop crying and that's the last message we want her to get. Moreover, it can violate an important boundary, one of personal space. We need to be careful of our own emotional response and why we think reaching out to her would be the best thing to do at that moment. Timing is crucial. At another moment, such as when she's leaving the session, I do believe a gentle touch is not only an appropriate gesture of comfort it can also provide closure on a difficult session that tells her all is okay, she is safe here. 

I confess that the feeling I struggled with while listening to Lyn and Rob explore their sadness was one of guilt. I thought about our similar tales of pregnancy and post term deliveries and still, any way I looked at it, my baby lived and their baby died. Any time a strong emotional response invades the therapeutic setting we have the ingredients of countertransference material that can be 1) useful to the session, 2) harmful to the session or 3) incompatible with the work we are doing. In this case, it had honestly never occurred to me that my son had been so close to death, until I sat along side their anguish. (cont'd)