Bright red blood trickles down the obstetrician’s yellow sleeve as she rotates her wrist back and forth in the woman’s pelvis. A sharp cry fills the labor and delivery room. The obstetrician squints, then withdraws her bloody gloved hand from between the pregnant woman’s bent white legs, wipes it on her gown, and looks up at me with concern in her eyes.

“Are you the neonatologist?” she says.

“Yes, I just got your page,” I reply as I step around the privacy curtain and into the room.

“She’s 21 weeks and 5 days today. The dates are good.” Her brow furrows. “I think she’s abrupted.”

I nod and grimace. The word “abrupted” triggers an image in my mind of a recent stillborn baby, lying dead on the resuscitation table; the shrill cries of his mother still echo in my head.

“There’s been no fetal movement. None for two hours,” the obstetrician says and shakes her head.

My stomach knots. Not another stillbirth.

I’ve lost count of how many babies I’ve seen who were delivered dead—small premature babies, big full-term babies, twin brothers and sisters, some already with names, some a suspenseful surprise, and all with hopeful parents. The reactions of the parents haunt me—mothers and fathers blindsided by a tsunami of grief, their dreams and hopes destroyed in an instant, leaving a wake of raw emptiness without explanation or solution. In these situations, there are no celebratory birth cheers, no filming and photographs, no tears of joy with the first cry—there is no first cry, no first breath…only cruel silence and cold, helpless fear. Then a massive, soul crushing wave of pain marked by weeping and wailing. Today, I know the tsunami is coming.

I look over at the mother in labor, Mykhaila, who is trembling under a blanket. I turn to her and introduce myself. “I’m the baby doctor,” I say with a gentle smile.

“Hi,” Mykhaila says in a quiet, raspy voice as she seems to sigh in relief. She brushes aside her disheveled ginger-colored hair, revealing freckled cheeks and bloodshot powder blue eyes.

Her tall, thin husband, Marko, steps toward me. “Thank you so much for coming to save our boy,” he says in a thick Ukrainian accent as he shakes my outstretched hand. His cobalt blue eyes appear to soften behind his black wire rimmed glasses and he flashes a brief smile.

I pause as the words “to save our boy” fall like a boulder on my chest. I grab a stool, slide it to Mykhaila’s bedside, and sit down.

“I can’t lose my baby,” Mykhaila says as she wipes pearls of sweat from her forehead. “I’ll do anything for him.”

Marko strokes Mykhaila’s hair and looks at me. “We know babies born at 22 weeks can live. Our baby is so close. You must give him a chance. We are counting on you.”

I let out a slow breath and glance down for a moment. In medicine, we use statistics to help guide us, but with the single human in front of you, the one you want to help, it is often “all or none.” You’re born alive or you’re born dead. In these cases, percentages and p values are literally no longer significant.

“I can’t imagine what you are going through,” I say, looking at Marko and Mykhaila. “This is your baby boy. I know you want him to live more than anything.”

“His name is Fedir,” Mykhaila sobs.

“It means, ‘Gift of God’,” Marko says, wiping his eyes.

“That’s a special name,” I say with a faint smile. I look down at my clasped hands and wait in silence for a few seconds. I then look up and make eye contact, first with Mykhaila and then Marko.

“This is really scary and must feel totally out of your control.” I pause. “I need to be very honest with you,” I say in a slow, calm voice as Mykhaila and Marko stare at me. “In the best circumstances, survival at 21 weeks and 5 days, which is how far along Fedir is today…is close to zero.” I lean toward them. “And, what worries me the most, Fedir has not moved in hours.”

“How can you not try to save him? Doesn’t he deserve to live?” Marko exclaims and raises his hands in the air.

I bite my tongue. Despite anything I can do, I know that today Mykhaila and Marko will lose their son. I think of my beautiful little boy who will greet me at the door with a giant smile and beaming brown eyes when I get home. What if I lost him? An image of him lying dead in my arms flashes in my mind. I gulp, clench my jaw, and put my right hand on my chin. For a few seconds, I reflect on my next words.

“Yes, he deserves to live. I am here to help. I am not leaving,” I say. Marko nods and squeezes Mykhaila’s hand.

“Here comes the baby!” the obstetrician announces.

Mykhaila lets out a loud scream as a pair of tiny bruised legs is pulled from her vagina. A moment later, the obstetrician holds tiny Fedir, cupped in her bloody gloved hands. The white fluorescent ceiling lights shimmer on his gelatinous skin, which is covered with burgundy blotches where his fragile blood vessels have burst and bled. Ripples glisten along his chest, marking his toothpick-like ribs. The obstetrician sets his fragile body on a white delivery blanket. He is still and lifeless.

When Marko sees his newborn son, he drops to his knees, buries his face in his hands, and begins to cry.

I take a deep breath. In the face of death, my role is to be present and reverent. I kneel by the bedside and with a slow, gentle motion, scoop Fedir into the palm of my gloved hand. He weighs about as much a can of Coke. His coffee bean-sized eyelids are still fused. His nostrils are 2 little dots, about the size of mustard seeds, and his thin lips look sealed. I run my gloved finger along his smooth head, covered in scant wisps of matted brown hair.

I listen for any breath or heart sounds to determine if he is still alive. The round head of my stethoscope covers most of his narrow chest. I can feel the intense stares of his parents as they wait for me to look up and speak. The slight movement of my hand creates a periodic, soft rubbing sound, which makes me question a faint heartbeat, but with further focus, I confirm that all is silent. Fedir is dead. As I close my eyes to concentrate and think of what to say, I hear Mykhaila’s muffled sobs.

Finally, I look up at Mykhaila, who stares at me with wide blue eyes mixed with hope and fear.

“Fedir is dead,” I say and pause. “He died in the womb. I am so sorry.”

Mykhaila lets out a loud wail as Marko buries his head into her shoulder.

I gently wrap Fedir in a white blanket. As I peer at his tiny face, I think, I couldn’t save you, but I can honor you. I lift his bundled body and place him in Mykhaila’s arms.

“Here is your son,” I say. “Mykhaila, you can touch him.”

Mykhaila hesitates, then reaches out and lifts Fedir’s tiny right hand with the tip of her index finger. His whole hand rests on her finger. She brings him close to her and kisses Fedir’s forehead as her tears bathe his face. Marko reaches out and holds Fedir’s hand between his fingers.

I place my hand on Mykhaila’s shoulder and say, “None of this is your fault.”

Tears pour down her cheeks as she nods and starts weeping. Marko leans into her and hugs her, then kisses Mykhaila’s forehead.

The next morning, before my rounds, I check on Mykhaila and Marko. When I enter their room, I am surprised to see Marko cradling Fedir, who is swaddled in a blanket.

“Thank you for trying,” Marko says.

How can he thank me when he is holding his dead son?

I look over at Mykhaila who is sitting up in bed. Her eyes are red and puffy. “He will always be with us,” she says with a brief smile.

Nobody likes to talk about dead babies. Worldwide, babies who died in the womb are too often a silent matter—millions of unnamed babies with untold stories; most without death certificates or funerals. Instead of a beautiful child to raise, parents are left with an endless ache of emptiness, a lifelong journey of grief tormented by “what-ifs?” As a neonatologist, I also struggle with this silence. At random moments—watching my kids play at the park, driving home from a call night, on an evening walk—I too, wonder “what if?” So I am sharing Fedir’s story to represent all the untold silent stories I keep inside. Stillborn babies are still born and still matter.