According to the traditional Chinese customs, the dead are mourned through a public social ceremony. On the contrary, some Chinese believe that child death is a “bad death”, hence no public funeral or ritual is organized for stillborn babies, their death is not discussed because it is considered a shameful thing, as the god did not blessed the family [6, 7, 16, 17]. Parents who have never faced a stillborn baby before are totally lost on how to dispose of the remains, after the termination of the pregnancy due to lack of prior discussion and preparation. They have little knowledge or experience on how to deal with such events except, some cultural guidance passed on from their elders [18–20]. In this study, all the parents were not informed of what to prepare when they have to dispose the remain of their stillborn baby, until the mothers were hospitalized or the delivery was finished. Moreover, the parents noticed medical staff’s disrespectful behavior regarding the disposal of the remains of the stillborn babies and were deeply sadden after seeing that their babies left naked and placed in a paper box. It is important to understand that, to the parents, the stillborn was a baby and it used to be a life. Although, a dead adult would be mourned in a ceremony or funeral, there is no such ceremony organized for a stillborn baby.
The confirmation following the care for the remains in the hospital is the first as well as the last time for the parents to meet their stillborn babies . Thus, adequate display of care for the remains is in a way a chance for the parents to show their responsibility towards their babies. The results of the study showed that if the remains were kept naked or treated with disrespect, the parents felt guilty about it . In fact, the parents expected the medical staff to show respect to their babies, regardless of their death being either, before or after the delivery and they hoped that the nurses should treat the remains, as if the babies were still alive. The nurses are expected to gently clean the babies, cut the umbilical cord, dress the babies, and at least, wrap them with a towel. The parents would be most consoled when this type of care would be delivered [21–24]. This kind of care towards the baby as well as the parents will have a drastic and permanent influence on the family as a whole. For this reason, it is significantly important for medical professionals to provide appropriate care at the right time .
To properly take care of the stillborn remains, is an essential duty of medical heath care professionals. One of the basic tasks of the medical staff is to respect the culture and religious beliefs, valued by both individuals and their family members. In the Chinese community, the teachings of Confucius have guided and shaped the Chinese government and the way by which Chinese families have lived for over two thousand years. Worshipping ancestors became a very important part of Chinese life and it was believed that if respect was shown to elders and ancestors, they would receive their blessings. Many Chinese people have combined the teachings of gods and beliefs, from the three main religions of ancient China namely, Confucianism, Taoism, and Buddhism. Because of the wide variety of practices and beliefs, it is important to discuss individual’s needs after the death of the stillbirth body with the family [26, 27]. The Christian faith expresses itself through various denominations that have developed from differences in nationality, historical tradition, temperament, and belief.
The need to be spiritually prepared for death can be of great importance, often unspoken, to those who may no longer attend a formal worship in church. The chaplain’s ministry should also extend its services to provide care to patient’s relatives, particularly in times of obvious distress or sudden death, when the presence of the chaplain can bring comfort and support to the grieving family. It is very important in cases where unbaptized children are seriously ill or are near to death, that the parents are offered an opportunity to request Baptism for their child. The priest should always be contacted in such cases although, a layperson may also baptize with water in the name of the Trinity, in the absence of a priest. This applies to all Christians, but there are some free church members who do not sanction infant baptism, may wish their child to be named and blessed instead. It is felt that conducting a religious ceremony helps family members to avoid chaotic meeting, provides them calmness, helps them to quietly deal with their disappointment and peacefully heal from the trauma [27, 28]. It was observed in our study that within the first 8 hours after they departed, none of the parents touched the body of the dead baby. According to Buddhist doctrine, it is considered that a dead person should not be moved or touched, within the 8 hours following their death; otherwise, they would feel pain and fall into the abyss of evil. The livings share Buddhist classics with the dead person so that their soul and spirit are led home. If their bodies were touched, their spirit would get lost and fail to return home. Consequently, the soul would become a homeless one and would not be reincarnated . Due to their strong religious beliefs, most Taiwanese would follow the societal, religious and folk traditions. Therefore, because of parental love, all parents would send off their stillborn babies with whatever they can offer and would prefer to organize all of the beneficial ceremonies for the dead, to help relieve their grief .
The prevailing customs of the parents’ cultural environment also determines mourning proceedings. A recent study showed that for Japanese children, a funeral ceremony was organized whereas the stillborn babies were not entered in the family register. It was noticed that the mourning rituals were also determined by the relatives of the parents and according to their local customs. Another study conducted in Java showed that all those who participated in the rituals and ceremonies, including for stillborn children, allowed family members to manage the grief process so that they eventually reach a state of emotional detachment. Taiwanese folklore has many representations of stillbirth and in accordance with their cultural taboos, the parents were encouraged not to see, handle, name or baptize their stillborn child .
Because an infant death is considered unacceptable in society, parents bear the stigma and guilt associated with it and then shows indescribable “silence” rather than expressing their sadness [1, 2]. According to traditional Chinese custom, different ceremonies are held to facilitate the transition at various life stages – birth, adulthood, marriage, and death . The “stillborn” death of a baby in the perinatal period, however, is different from death occurring in other periods. According to Taiwanese culture and custom, children aged 12 or younger, who die is regarded as the early dead. Lot of taboos is associated with “early dead persons”, such as, no funerals would be conducted, no sacrifices would be offered and the elder family members should avoid touching the remains of the dead. It is strongly believed that those who violate these taboos would cause the reluctant departure of the soul of the dead and the soul would stay at home, bringing the family misfortune. Moreover, the dead would fail to be reincarnated and would become a homeless specter [30, 34]. In Taiwan, most people would follow the traditional religious customs and social taboos. Rituals like, worshipping the ancestors and having faith in spirits, are few customs which are accepted by the public [30, 33, 34]. Parents who choose not to look at their dead baby and touch their remains, helps them to handle their sorrow and guilt of losing the baby implicitly, with a reason which is acceptable to the public, as they followed the cultural taboos.
It is seen that in western countries, the strategies to alleviate sorrow include seeing, baptizing and naming the child in order to prevent pathological sorrow among parents [33, 34]. We found that the disposal of the remains of dead babies varies from culture to culture. According to the Taiwanese custom, the taboos have a totally different meaning and function for parents, as compared to western culture. The Taiwanese parents in this study, for instance, followed the taboo and chose not to see their dead babies. They did it out of consideration for the child, to allow its reincarnation and prevent their family members from being harmed. Therefore, medical professionals need to respect the customs and taboos of the parents and more importantly, they need to pay attention to individual’s faith and beliefs while practicing daily clinical care. Thus, clinical care should be combined with the culture and customs of families and discussion on the preparation for the care of the remains should be held with parents at an appropriate time and in an appropriate place, before such practices are implemented. Additionally, a private space should be offered to the parents where they can express their feelings, share their experience and have a quiet discussion. After relevant discussion is over, all of the decisions made by the parents should be respected and supported and individualized nursing care should be offered .