The Family Tree: a place where no one has to face perinatal bereavement alone

When a pregnancy ends, regardless of the stage, parents are confronted with a reality that is often difficult to name: perinatal bereavement. 

At the Fetal Medicine Clinic of the Obstetrics and Gynaecology Department at Erasmus Hospital (H.U.B.), healthcare professionals regularly support couples facing a pregnancy that is not progressing, a medical termination of pregnancy or the loss of their baby. Different situations, unique stories, but the same question that keeps coming up. 

“Are we the only ones going through this?” This question stayed with the healthcare professionals for several years. It also gave rise to the Family Tree, a place of remembrance open to all families experiencing perinatal bereavement, whether or not they are receiving care at H.U.B., conceived by the teams to enable bereaved families to give a place to what they have been through and, perhaps, to feel a little less alone. 

“We know there are many of them, but we do not see them” 

For Dr Caroline De Coninck, a gynaecologist at the Fetal Medicine Clinic, the idea for the project arose from situations encountered in day-to-day care. She particularly recalls a couple who were expecting their first child after undergoing medically assisted reproduction. It was a much-anticipated pregnancy, following a long wait. Then, during the second trimester, a brain abnormality was detected in the baby. Regular support began, every week, to explain, listen, answer questions and help the parents through an extremely difficult decision. 

“ We see couples who are completely overwhelmed by the sadness and enormity of what they are experiencing. And they often wonder whether they are the only ones.”, explains Dr De Coninck. 

Yet healthcare professionals know that they are far from being alone. Perinatal bereavement nevertheless remains a subject that is rarely discussed. After losing a baby, parents may feel that they are left alone with their pain. Those around them do not always know what to say. Some no longer dare to raise the subject, for fear of reopening the wound or simply because they do not know how to find the right words. 

“ It is such a taboo subject that people may isolate themselves. We no longer dare to talk to them about what happened. And they themselves may find it difficult to talk about it. ”, explains Dr De Coninck. This was precisely the isolation that the team wanted to help break. 

A tree to connect stories 

The idea of a tree quickly took hold. Its roots, its connection to the earth, its branches reaching towards the sky: everyone can find their own symbolism in it, without it being associated with a religion or a particular way of experiencing bereavement. 

The project developed over almost two years. Gynaecologists, midwives, psychologists, social workers, fetal medicine professionals and delivery-room teams worked together to consider what this place could be. A real tree? A sculpture? What material? Where should it be installed? How could it be made welcoming to families over the long term? The final choice was a metal sculpture, installed in a peaceful, green setting near the hospital. 

But behind this apparent simplicity, the project required many stages: finding administrative contacts and a sculptor, meetings with the field teams, choosing the sculpture (design and size), administrative procedures with authorisation from the Green Spaces Department and obtaining a planning permit from the Region and, finally, an agreement between H.U.B., the owner of the Tree, and the Green Spaces Department, responsible for Vogelenzang public park, to ensure the site’s maintenance, safety and long-term preservation. 

The Brussels-Capital Region’s Green Spaces teams quickly embraced the project. The chosen location, away from the bustle of the hospital, proved to be an ideal setting for quiet reflection. 

“ We really wanted this place to last. To still be there, even years from now, whatever difficulties might arise”, emphasises Dr De Coninck. 

At the same time, another discussion was continuing with the teams: that of the ribbons that would allow families to leave a trace on the tree. Because time has a particular place in bereavement. The ribbon deteriorates over time. This change can also become symbolic: the ribbon changes over time, just as bereavement evolves: its form changes, but the story it represents remains. 

There is no such thing as a “small bereavement” 

A pregnancy may end in the first trimester. An abnormality may be discovered several months later. A medical termination of pregnancy may be decided upon. A baby may be lost around the time of birth. The circumstances differ. Pain, however, cannot be measured by the number of weeks of pregnancy. 

“ When you are expecting a baby, have invested in the pregnancy and everything comes to an end, it is still a bereavement. A non-viable pregnancy in the first trimester is also a bereavement”, Dr De Coninck reminds us. 

For healthcare professionals, this recognition is essential. Because after the loss, the journey does not necessarily end when returning home. Sometimes people must continue living with questions, memories, an absence and a space that has suddenly become empty. The team also observes how much bereavement can lead to social isolation. Family and friends do not always know how to talk about it. Some parents may then feel that their baby is also disappearing from other people’s language.  

The Family Tree aims to offer a space to which people can simply return. Without an appointment. Without having to explain how they feel. To come and place a ribbon. To sit for a few moments. To think of their baby. To pay their respects.  

A place for all families, whatever their story 

The tree does not seek to bring families together around one single way of experiencing bereavement. Quite the opposite. Each ribbon will tell a different story. The parents’ age is irrelevant. Nor does the stage of pregnancy matter. Family backgrounds, beliefs, culture and ways of expressing emotions may be very different.  

Some people will need to talk. Others will not. Some parents will find comfort in a support group. For others, this approach will feel too intimate. Language barriers, personality, beliefs or fear of being judged may also make certain forms of support difficult. The tree offers another possibility: a simple gesture that is accessible to everyone, at any time. 

“ You can simply come and place your ribbon and see that other families have experienced something similar, even though every story is different”, adds Dr De Coninck. 

This aspect is particularly important for fathers and co-parents. Within a couple, each person may experience bereavement differently. Some show their emotions more openly at first, while others express them later. 

“ The timing of bereavement may differ, even within a couple”, explains Dr De Coninck. 

Caring today, while also thinking about what comes afterwards 

For obstetrics and gynaecology teams, supporting someone through perinatal bereavement requires particular care. The difficulty also lies in the stark contrast between what the pregnancy initially represented and what it suddenly becomes. An event that was meant to be joyful can, within a few hours, become one of the most painful moments in a couple’s life. 

“It is a very complicated situation to manage. And every member of the team genuinely wants to support these families well”, says Dr De Coninck. 

No single professional can meet all the needs of a bereaved family alone. Gynaecologists, midwives, psychologists, adult psychiatrists and child and adolescent psychiatrists, and social workers: each contributes their expertise at different points in the journey. 

And support must continue beyond the acute phase. 

“ We need to think about what comes afterwards. Not only about what happens in hospital”, emphasises Dr De Coninck. 

Working with specialised organisations helps maintain contact with families and offer them other resources once they leave hospital. This continuity is essential: bereavement does not end when medical care comes to an end. 

Making room for bereavement, so that it can be spoken about 

The Family Tree is therefore much more than a sculpture installed in a park. It arose from situations encountered by healthcare professionals in their daily work. From conversations with families. From the desire to acknowledge a reality that is still too often left unspoken.  

“ I hope this tree will stand for a long time and help people talk about perinatal bereavement. I hope families will feel less alone and that this subject will become less taboo”, concludes Dr De Coninck.