The day before Caroline and Ryan Caufield were due to have their first child, they learned their baby had no heartbeat. It was 2022, and because of COVID restrictions, it was the first time Ryan had been able to attend an ultrasound with Caroline.
The next day, the Caufields were directed to Highland Hospital’s bereavement suite, where OBGYN Heather Florescue (BA ’00, MD ’04, Res ’08) walked them through every step of the delivery and beyond.
Caroline remembers how Florescue introduced herself: “I’m Heather. I’m really sorry we have to meet this way, but you're stuck with me now for the rest of your life. I specialize in this, and I’m going to get you through it.”
Florescue, whose practice became part of URMC in December 2024, supported the Caufields throughout the birth of their daughter Kiera and also checked in the day after, on her day off. She continued to call every few days once the couple went home, and she was their provider throughout the pregnancy and birth of their second child, Keagan.
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The Caufields with their second child, Keagan, and Dr. Florescue.
Florescue’s support during Kiera’s birth included doing whatever it took to give the Caufields what they needed.
“Heather made sure our family met Kiera, despite COVID restrictions at the time. And that’s how she is in all of this. She’s a bulldog,” Caroline said, laughing. “She isn’t going to let anyone stand in the way of her patients’ best interest.”
She’s also gaining a national reputation for the work she’s doing. Some of her novel techniques to help families have spread to other hospitals in Rochester and throughout the country. She has teamed up with a national nonprofit and with other experts to establish a residency education program, filling an important gap that benefits doctors and patients alike.
It’s vital work because so much about the aftermath of stillbirth is counterintuitive. Many people assume that parents want to forget the loss as soon as possible and not be reminded even years later, but the opposite is often true.
Florescue learned mostly from experience—and from the moment someone pointed out that what she was doing was far from typical.
The Heather Way
In 2018, a longtime obstetrics patient said, “You need to teach the Heather way.” When Florescue asked what she meant, the patient explained that Florescue’s ability to connect with her patients and their families, and the empathetic support system she has developed, is not common.
Before that moment, Florescue never considered that her way of caring for loss patients was exceptional.
Florescue encourages her patients to call whenever they have a question or even an inkling that something might not be right during pregnancy, no matter the time of day. When a patient needs to sit in silence, she waits until they’re ready to talk, then lends a listening ear.
Caring for her patients, she quickly learned to encourage women to listen to their bodies rather than friends and family. Despite best intensions, loved ones often use their own experiences with pregnancy to affect their advice.
“Tragedy, unfortunately, can happen if worries are dismissed,” said Florescue. “If someone you love says, ‘I’m worried about my baby,’ tell them to call their doctor.”
After further investigating patient care for loss families, Florescue quickly saw a gap in medical education. She set out to teach the next generation of doctors as much as she could from her experiences.
Her research on stillbirth education led her to the Star Legacy Foundation, a nonprofit that offers support and resources to families who experience stillbirth, infant loss, and miscarriage.
Lindsey Wimmer founded Star Legacy after her son, Garrett, was born stillborn in 2004. She wanted to raise awareness and offer the kind of support that she had sought during her experience.
“Because of my medical background as a nurse practitioner, I was shocked that I knew so little about stillbirth and that the numbers were so significant,” said Wimmer. According to the CDC, roughly 1 in 175 babies are stillborn in the United States every year. “We decided to honor our son by supporting research. That grew into expanding into the education pieces as well.”
The education aspect of Star Legacy especially interested Florescue. She registered to attend a conference in 2019. It was the foundation’s largest annual event, yet Florescue realized she was one of only a few medical providers—and the only OBGYN—in attendance.
“That snowballed my desire to educate and teach how to take care of loss families,” said Florescue, who is now on the medical advisory board of Star Legacy.
Wimmer said, “We meet a lot of physicians who are kind and willing to listen, but Heather was willing to take it a step further. She recognized she had an opportunity to change how care is done in her own practice and in the greater community.”
Knowledge, not concern, was the missing piece. “Even though empathy is there, there’s a disconnect between the provider and the patient,” Florescue explained. “The thought is to give patients privacy and space … which is the exact opposite of what we should be doing. I set on a quest to tell people what they think is wrong is right.”
Teaching that Wrong is Right
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The bereavement rooom at Highland Hospital contains helpful items, including Florescue’s library cart.
Her quest led Florescue to first create a “tip book” with suggestions for residents and providers who care for pregnant patients. It begins with two simple suggestions:
“I am so sorry. Your baby has died.” Say this, sit with the patient, and just be.
Don’t discuss next steps unless asked. Then, just take things one step at a time.
The tip book continues with short and simple directions to help guide providers through conversations with their patients. Even for medical professionals, infant loss can feel taboo to talk about. But speaking about a lost child can help greatly with the healing process.
Parents want to know that someone else will remember their baby, which is why Florescue encourages loved ones to recognize birthdays, verbalize the child’s name, and even ask to see photos in order to give support. “It’s important to show the parents that they are not fully responsible for the legacy of their child,” she emphasized.
In addition to using these tips at Rochester-area hospitals and during a virtual session with a New York City hospital, Florescue has distributed her booklet to people all over the country.
She also worked alongside Wimmer and Star Legacy in starting a residency education program, which kicked off with a half-day simulation event in January 2024 at the School of Medicine & Dentistry. While building the programming, Florescue and Wimmer connected with high-risk OBGYN specialist Ponnila Marinescu (MD ’11, Flw ’21), who was doing her own work in perinatal loss at URMC.
Marinescu lost her baby, Mila, in February 2020. As she was making her way through this experience, Marinescu discovered the same gap in medical education that Florescue had noticed. She also saw a lack of support for loss families after parents leave the hospital. This discovery led Marinescu to create an outpatient perinatal loss program at Strong Memorial Hospital. The clinic offers follow-up care to families for up to a year after they experience their loss.
When Marinescu connected with Florescue, her mission for stillbirth care expanded to include medical education. “Most of my work before I met Heather was patient-related care,” said Marinescu. “But working with her has given wings to my internal goals of teaching this to residents.”
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Ponnila Marinescu (MD ’11, Flw ’21).
Together, Marinescu, Wimmer, and Florescue created the programming for the first OBGYN Residency Perinatal Loss Simulation, which was held in January 2024. It included a panel with former patients of Florescue who shared their personal stories of experiencing stillbirth. Residents also worked through simulations of patients experiencing loss, which is critical because people can react to the experience in different ways.
“I want there to be providers who understand and feel empowered to use the right language when they’re talking to their patients,” Marinescu said. “These families are enduring the worst experience of their lives. Whatever kindness we can share with them will make that experience more compassionate and meaningful.”
The program in January was just the first step of the trio’s plan. With funding and further research, they’re hoping to expand the reach of their educational programming to residencies across the country.
Another important part of their work is tending to the emotional needs of residents. Marinescu and Florescue have started offering safe-space meetings for residents in Rochester. Every other month, one of them opens their home to residents for an evening.
“It’s a space to be vulnerable, and it changes the residents’ perception of what their own biases and feelings are,” said Marinescu. ““It helps them realize that those feelings are real and need to be felt, grieved, and processed, but those feelings do not need to burden them in an unhealthy way.”
Those feelings can include guilt, sadness, frustration, and grief. To offer further support, Florescue will reach out directly to a resident if she knows a patient of theirs has experienced infant loss.
“It’s very lonely when you deliver a baby who has died,” Florescue said. In obstetrics, a provider may have to go from one room, comforting a family who has lost their child, to another, delivering a healthy baby with parents who are overjoyed. “We have to do that in a five-minute stretch, and we can’t let our emotions get the better of us.”
By providing residents with formal education and space to reflect, Florescue and Marinescu hope to help keep future providers working within patient care. “There’s a high rate of burnout for physicians regardless of the circumstance,” Marinescu explained. “But when you don’t give them the tools to approach these clinical cases in the most optimized way, the impact is even more significant.”
Hope can come from the work itself. Florescue points to research showing that doing something altruistic related to your job—like staying in parents’ lives indefinitely—actually decreases your chance of burnout. “It’s one reason I’m still here while some colleagues aren’t. Don’t get me wrong: I have burnout sometimes. But I’m going to keep doing this.”
The Power of Making Memories
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Caroline Caufield holds a Molly Bear, made by a nonprofit as a reminder of a stillborn child. Each bear weighs exactly the birth weight of the child. Caroline says it helps keep Kiera close to the family.
Through her extended care for patients, Florescue saw that loss families often find that the experience of making memories can help make a tragic day feel a little less so.
Before connecting with Florescue and Wimmer, Marinescu was unfamiliar with the idea of memory making, which involves creating experiences with your child before saying goodbye. This can range from reading them a book to singing a lullaby or taking photos and videos together.
It can seem logical for healthcare professionals to hurry up and go through the required steps, assuming that the sooner the family can move on, the better off they are. But the opposite is often true. “Taking the time to read your baby a story or do the handprints and footprints is so important,” Wimmer said. “Those moments are going to determine how the family views what has happened to them.”
According to Florescue, “You can never make too many memories. Some dads have questioned, ‘You want me to bathe her? You want me to dress her?’” But then they come around, and they’re holding the baby and watching football.”
Florescue started a library-cart program in hospitals to give parents the experience of reading to their child. The idea had come to her years before, when caring for a loss family. Designated library carts have now been implemented in every hospital in the Rochester region—13 in all—and in multiple hospitals across the country.
“It’s such a natural act to read to your child,” said Florescue. “You’re not only saying goodbye; you’re also saying hello.”
After reading to their baby, families can choose a book or two to bring home from the hospital. There’s a place for a dedication, where they can write their child’s name in a space labeled “This book belongs to ———”.
Using the library cart can help validate the experience of bringing a child into the world. It’s a form of recognition that they are parents.
“It’s always going to be tragic and awful, but it can also be beautiful,” said Wimmer. “A family may be able to say, ‘I didn’t get to raise my daughter, but I got to read her my favorite bedtime story or wrap her in my grandmother’s blanket.’”
For the Caufields, memory making was a big part of their daughter’s story. Florescue encouraged Caroline and Ryan to take photos and videos, read to Kiera, watch their favorite sport with her, and have family members hold her.
It helped guide them through the day. “In that situation, you don’t know what to do,” said Ryan. “The pictures and videos we have are our only memories. So having those to look back on is really nice.”
“We got to spend 24 precious hours with her, trying to make a lifetime of memories,” said Caroline. “It was the most beautiful, precious 24 hours and we are lucky to have gotten that with her.”
Feeling Florescue’s support and the serenity of the bereavement room added to making the day as positive as it could be.
“Everything they did in that room did help with the experience,” said Caroline. “I always tell my friends and family that even though it was a sad experience, my labor and delivery with Kiera was beautiful.”