ABOUT THIS STORY
Reporter Joan Garrett spent four months reporting and researching how families and hospitals manage a stillborn birth. The information included in this project was taken from more than a hundred hours of interviews with families, doctors, bereavement experts, photographers, nurses and hospice workers.
BY THE NUMBERS
• Statewide, Tennessee had 457 fetal deaths in 2010, at a ratio of 5.8 per 1,000 live births.
• In Hamilton County in 2010, there were 27 fetal deaths, at a ratio of 6.6 per 1,000 live births.
Source: Tennessee Department of Health
GAVIN CHARLES CASTLEBERRY
Weight: 3.3 ounces
The tears come when Gretchen Castleberry isn't prepared. One morning it was during her workout class. She was thinking about her friend's child's first birthday party. Her third son, Gavin Charles, was supposed to have his birthday a few weeks from now, but he died, just 18 weeks old in his mother's womb.
After the birth, Gretchen didn't work for a year. She got a tattoo of Gavin's tiny feet on her foot.
At night, while her two living boys and her husband, Chris, are asleep, she sneaks upstairs to hold onto the blanket they wrapped Gavin in at the hospital, still stained by a spot of his blood.
On this day, she left the gym in the middle of her workout and drove to the place where Gavin is buried. She smeared a patch of dirt from the gave into her journal, tried to wipe away her runny nose and wrote: "My heart is continuing to live without you ... I still miss you."
They waited five years to have a baby. Then the time was right. Adam Mew had just finished college and was hired to pastor a Church of God in Graysville, Tenn. At 18 weeks they planned to unveil the baby's gender to their family. After the ultrasound, the doctor would conceal it in an envelope and that envelope would be given to a friend who would call a bakery in Dillon, S.C., where their families lived. Adam and Carrie Mew would drive there to be with them.
The next day, they would cut into the cake. Pink for a girl. Blue for a boy. They would all celebrate. Carrie was finally showing, and no one in the family had seen her pregnant.
But when the doctor looked for a gender he couldn't find a heartbeat.
In the car, their bags were packed for the eight-hour trip. They went anyway.
Seven days later, July 7, they delivered a stillborn baby boy.
SAMMIE JACK GUTIERREZ-WALLER
Weight: 10 pounds, 11 ounces
While her boyfriend, Zach Waller, was in class at the University of Tennessee at Chattanooga, Kat Gutierrez waited in a computer room nearby. She squeezed a stuffed monkey in her arms, like she does every day, a surrogate for their baby who died in June just days before his due date.
She was 37, 10 years older than Zach, and they wanted to have a baby together before it was too late. Now they don't know if they will be able to start again and have a family. They take antidepressants. They still haven't gone into Sammy's room, full of unused baby shower gifts. Zach dropped half his classes at UTC.
Not long after the baby was buried, Kat started having panic attacks when Zach was away. The counselor calls it separation anxiety. So she waits for him to come out of class.
The baby was gone overnight, and she wonders when something else will be taken.
Afterward, when the baby was underground and the nursery door was shut, their thoughts swung back to the quiet moments of anticipation.
The winter morning in 2009 when Tracy Jones woke her husband, Heath, at 6:30 a.m. to tell him the pregnancy test was positive. They would be parents.
"I love you," he told her.
Months later, when they snuck into a consignment sale before it was open to the public to get a good deal on a cherry wood crib and started slinging bright yellow paint on the nursery walls as soon as they got home.
All the days he pressed his hand on his wife's swollen belly and spoke to the child.
"Baby Girl," he said, "there are a lot of people out here waiting on you."
She was due to arrive in the heat of the summer, on Independence Day. So in April the Joneses left their home in Rossville to lie on a South Carolina beach. It would be their last trip together alone, they thought. They called it their baby-moon.
Heath used a hand-held video camera to capture the sun and waves to show his daughter when she got older. He panned to a little girl making a sand castle.
"One day, you are going to be like that little girl right there," he said, shifting to Tracy smiling, her belly bare. "This is your first trip, but it won't be your last."
When Tracy sprawled across the hotel bed, her shirt rustled because of busy little kicks in her tummy.
They imagined how fast and strong their girl would be, how they would run after her in their living room or through the front yard, tired but happy.
But toward the end of June, Baby Girl slowed down, and a sense of fear and fragility that always existed in the background of the baby showers and planning came rising to the surface.
Tracy called her mother, sister and friends, but everyone reassured her. The pregnancy had been routine. The baby was simply running out of space, in waiting.
The doctor, too, told her that everything was all right. He looked for a heartbeat and found one.
Then, on June 25, 38 weeks into the pregnancy, contractions started. Heath told his boss at the life insurance company that Baby Girl was coming.
In the office, the doctor said Tracy was dilated 1 centimeter.
"Do you think we can have the baby on Sunday?" the doctor said. A nurse rubbed a fetal heart rate monitor over and over Tracy's stomach.
Yes, the couple agreed. They were ready.
The nurse interrupted.
"Doctor, I can't seem to find the heartbeat," the nurse said. "Can you help me?"
Babies aren't supposed to die. They are supposed to crawl and drag their bottoms across the floor with wet diapers and cry in the middle of the night. They are supposed to take halting first steps and graduate to Pull-Ups.
But babies do die, even before they leave the womb, at 16 weeks and 25 weeks and 38 weeks. Nationally, one in five die before it is 20 weeks old. Last year, 457 died after 20 weeks in the womb in Tennessee, 27 from Hamilton County. Many went suddenly, without warning.
Mothers and fathers don't talk much about these babies. They are not sure how to.
Parents call them babies, but science calls them fetuses until they take a breath outside the womb.
Friends and co-workers can't swallow the cruelty of a dead child, so they don't ask.
In the months and years afterward, parents are left to wonder how to get over a child they imagined sending to college and marrying off but never met. How do they pack away the images, the dreams?
They would never forget the purple on the walls in the ultrasound room. The tech's face, shocked and frozen. The black cavity on the screen where the heart once pulsed with promise.
The words from the doctor: "I'm sorry, but she didn't make it."
Tracy's mind raced. Could they jump-start her little heart, she asked? What would happen to the crib, the diapers and the milk in her breasts? What had she done wrong?
Heath and Tracy walked out the back door of the clinic, avoiding the expectant mothers in the lobby. Inside their car, the couple stared silently through the windows.
In the back, Baby Girl's car seat was empty.
Three years before, they had met and married in the church Tracy grew up in. Heath was only 23 when they started a friendship, and she was six years older, a teacher, athletic and serious. He had a passion for playing the drums and worked at his father's construction company.
After Sunday services and church league softball games, they would linger together, talking about how he could be a better teacher in his Bible study class.
She thought his gray hair, which had come far too early, made him look distinguished. He loved her brown eyes.
Then one day she told him she thought he could be the one. He kissed her a month later and proposed eight months after that. They waited to be with one another until the wedding night.
A family was always part of their plans.
"She didn't make it," Heath told his mother over the phone, crying.
"Are you sure?" she said, panicked. "Did you tell them to hook the machine back up?"
"Yes," he said. "We are sure."
By 3:31 a.m. the next morning at Parkridge East hospital the nurses were barking for Tracy to engage her muscles and move the baby down. A vaginal delivery was safest for the mother, the nurses said. Caesarean sections are used for high-risk babies, and Baby Girl was already gone.
It was hard to feel her body. She had taken a sleeping pill and been given an epidural because the doctor didn't want her to compound her heartache with physical pain.
"Push!" the nurse said.
Tracy silently strained. Heath was quiet, too.
"Push!" the nurse yelled again.
Nearly 15 family members waited in a room nearby. They told the couple they had enough faith for a miracle.
Heath tried to pray intensely, like Jesus in the garden before his crucifixion.
"If you can, take this cup from me," he prayed.
"Push!" the nurse exhorted again.
Heath watched for the head to emerge and listened for the sound of a baby's squall.
They only got a death certificate because Baby Girl wasn't considered an official life. Not until later that year did the state Legislature decide to start giving birth certificates for stillborns.
Tracy sat up to see her when Baby Girl slid into the doctor's hands, but everyone told her to look away. When they are alive, babies squeeze their arms close to their sides, curl their toes and fingers. Baby Girl was limp.
But Tracy wanted to see her, to know if she really was a girl. So the doctor put his hand on Baby Girl's back to support her, to make her look less lifeless.
"She was a girl," she said.
Hospice workers gave the couple a card to keep in a heart-shaped, hand-painted box. It said the girl was 5 pounds and 13 ounces, 20 inches long.
In a quiet room away from the parents, nurses tried not to tear the transparent and red skin when they cleaned the baby. They dressed her in a pink dress and a small, lace bonnet that had been donated for days like this.
While holding Baby Girl, Tracy was afraid to touch the body. Baby Girl's face was bruised and her lips and nose were bleeding. Tracy looked under her bonnet - black hair.
They wondered if dwelling over Baby Girl was morose. Maybe it was better not to know that she and her baby had the same underbite, that their eyes were both set far apart.
But the doctor told them they needed to touch her. The few moments would be precious in years down the road.
Hospice workers pressed her toes into a mold of clay and sent a photographer to take black-and-white pictures of Tracy and Heath looking at her, holding her.
They named her Leila Abigail and stayed beside her for 12 hours. Tracy's arms were sweaty and achy when the nurses carried Baby Girl to the morgue.
At Lakewood Memory Gardens three days later, they buried her in a white casket shorter than 2 feet. Heath's father and Tracy's brother carried her. Tracy's aunt bought the couple two plots so they can be buried nearby when their own time comes.
It was 96 degrees, and Tracy bawled as the group of 100 people sang: "When peace, like a river, attendeth my way. When sorrows like sea billows roll. Whatever my lot. Thou has taught me to say. It is well, it is well, with my soul."
In the weeks after, Heath cried himself sick. His immune system collapsed, and he battled infections for three days in bed.
Baby Girl's due date came and went.
When Heath finally went back to work, no one there mentioned Baby Girl. Co-workers shied away from him. They didn't ask the color of her hair, what it felt like to hold her just once.
Babies were born to other couples at church. Babies cried in the grocery store. Tracy couldn't look at them.
In the fall, when Tracy returned to her classroom, the second-graders ran up to her for the news of the birth.
"How is your baby doing?" they asked. She pulled them aside.
"My baby didn't make it," she said, tearfully.
Heath and Tracy went to bereavement counseling together, and she told him she wanted to talk more about the death. Somehow, she needed to relive it, read about it, cover herself in it, so she couldn't forget.
Heath wanted to put it away, he said.
When Tracy's body had healed and her period came again, she started longing to fill the empty nursery, its walls still covered in yellow paint. She journaled about how afraid she was to lose a baby like that again.
"I do want to have your siblings, but I would rather spend eternity with you and Jesus," she wrote to Baby Girl.
Heath spent a lot of time inside his own head when he drove around on his job. Doctors told the couple that the sudden death probably was caused by a blood clotting disease they spotted in tests afterward.
"I can't do that again," Heath said to God in the car. "I don't have the strength to lose another."
He said he felt something speak in reply.
If they did try, the counselor told them they would never be able to replace Baby Girl. There would be new joys, new fears, but the old sadness would remain.
And in October, when they found out they were pregnant again, it did feel bittersweet. They went to Baby Girl's grave to tell her she was going to have a brother.
Around Christmas, when they found out Tracy had blood clots in her uterus, they went twice a week to sit by the stone, hoping some presence of Baby Girl would guide them through another pregnancy.
One night they read her the story of Jesus' birth.
"This is why we celebrate the season," Heath told her. "You probably know the story better than we do."
Tracy couldn't speak.
They lit a candle on Christmas Day to remember her. In family pictures, they held a doll that looked like an angel and imagined she was there with them.
A year after Baby Girl's death, the summer came again and so did the fear. A very pregnant Tracy went to doctor appointments twice a week, always monitoring movements, measuring the blood flow to Tracy's umbilical cord.
At night, she laid on her back and worried.
"Heath, he's not moving," she would say to her husband. "He needs to move right now. He's got to do something."
Baby Girl had died at 38 weeks. So they weren't going to wait that long this time. On the 16th of June, 36 weeks in, they planned to be at the hospital to induce the labor.
But their son had turned himself upside down in the womb and punched his way out. Her water broke at the hospital registration desk.
Heath, covered head to toe in scrubs for the Caesarean section, watched as they cut into his wife. He was quiet again, nervous, praying, listening for his boy to scream.
His feet came first.
So the doctor pulled.
Michael Levi's voice erupted from his tiny lungs, filling the room.
"You can look up," Heath told Tracy once the baby was in his arms.
Tears dripped off his face.
"That's your son," he said.
When they got home, Tracy framed the few photos she had of Baby Girl and hung them on the wall near her brother's crib.
At St. Thaddaeus' Episcopal Church, the night of the memorial a few months later, children were everywhere. They cried and writhed over their daddies' shoulders, ran down the aisles, climbed over pews and rolled on the floor until someone told them to get in their seat and sit up straight.
Tracy and Heath came with Michael Levi.
A candle with a blue bow tied around it flamed in the center of the sanctuary. Harp music and little sobs echoed off the rafters. The group of parents gathered here every year to talk about their dead babies, to remind themselves that they weren't the only ones walking around half hearted.
There were songs for the lost babies and poems. On a table people laid out scrapbooks of their births, uncelebrated. In images, broken-faced parents hold babies as small as the palm of their hand.
In the front of the sanctuary, people came forward to light their candles and say their babies' names aloud.
Heath held Michael Levi and leaned in to speak the name. Tracy stood beside him. Her face was red from crying.
"Leila Abigail," Heath said.
Fifteen months had gone by since they buried her, and their family didn't seem whole. Baby Girl's birthday will come and go, come and go, and she will never grow up. Tracy loved Michael Levi, his big cheeks, chubby wrists and long dirty blond hair, but she was afraid to love him. She wondered if the new bond with her boy meant she would love Baby Girl less, that she would forget.
After the last name was read and the candles blown out, the group walked outside. Tracy and Heath held pink balloons and stood in a circle with the other families.
A woman told them that if they let their balloon float away, they were saying hello to their babies.
Heath and Tracy let go.
"Do they come back, Daddy?" a girl whispered to her father nearby, watching them.
Heath and Tracy's eyes followed them, too.
Against the night sky they danced like fireflies, rising toward the heavens.