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Discuss the loss of a fetus or newborn with the patient and family, and use words such as “miscarriage” or “death” in place of the word “loss.”
There are many reasons, both predictable and unpredictable, for the loss of a pregnancy. Regardless of the cause, the family experiences varying degrees of grief that health care personnel must address. Pregnancy loss is often overlooked. Hearing friends or coworkers share their stories of a lost loved one, such as a parent, is common, but hearing those who have lost a pregnancy or newborn sharing stories in the same way is not. Because others may feel uncomfortable discussing the miscarriage, stillbirth, or death of a newborn, the family experiencing the loss may grieve with the grief alone or may feel isolated from society when experiencing such grief.undefined#ref1">1
In many cases, when a perinatal death occurs, the nurse is responsible for both the patient's clinical care and the patient's and her family's emotional support. Depending upon the setting, the nurse may also be responsible for caring for the dead fetus or newborn. The family should be offered the opportunity to hold the newborn for as long as desired. Some patients and families may initially decline to hold a stillborn; however, the nurse should always offer the opportunity. If the patient and family initially decline, the nurse should inform them that the baby will be kept in a private area of the nursery, and that they may change their mind at any time. If the patient and family desire, the newborn may be taken to the nursery intermittently and then brought back for periods of holding. For some, this process may be brief, but the nurse should be prepared for families who desire an extended period of time with their newborn.
As a member of the health care team who spends a significant length of time with the patient, the nurse should provide reassurance and comfort to the patient and her family during their time of grief (Box 1). This can be an emotional and exhausting experience for the nurse, but it is also a privilege and an opportunity to provide support during an extremely vulnerable period in the life of the patient and her family.1
The obstetric nurse should be well educated in the signs and symptoms of parental grief and in how to provide bereavement care to the family experiencing perinatal loss. Even in settings where social workers or chaplains are available, the nurse needs to feel comfortable dealing with the grief process. Many factors to consider when providing bereavement care include the circumstances surrounding the loss, the patient's age and cultural and religious beliefs, and the support system in place for the family. The nurse also need to ensure that the family has resources for grief support after the patient is discharged from the clinical setting.1
Rationale: Fetal and neonatal death reporting varies by state.
Rationale: All hospital employees should be aware of the pregnancy loss before interacting with the patient or family to avoid inappropriate comments or questions that may unnecessarily upset them.
Rationale: The patient and family should feel as if they are receiving the same attention as other patients who are delivering live newborns. In addition, the family may have many questions regarding how their baby will be handled following delivery.
Rationale: Some patients and families may initially decline to hold a stillborn; however, the nurse should always offer the opportunity.
If the family declines to hold the newborn, do not pressure them to do so. Offer the opportunity to each family member separately and allow him or her time to consider the choice.
Rationale: ID bracelets serve as mementos for the family.
Rationale: To assist the family's healing process, it is extremely important to clean and diaper the newborn as if he or she were born alive. The memory of the delivery is just as significant to them as it is to the family of a live newborn. The family should have the opportunity to remember their newborn as clean and swaddled.
Rationale: Before photographs are taken, the newborn should be dressed in clothing just as a live newborn would be. The patient and family should be given the opportunity to bathe the newborn if they desire. They may want to perform expected parenting activities, such as dressing the newborn and combing the hair.
Rationale: Most patients and families will want physical keepsakes. Initially, some patients may decline these; however, they should be obtained and offered to the patient before discharge. In some instances, patients will return weeks or months later and request photographs. Photographs of congenital anomalies should also be obtained.
Rationale: The patient and family should be offered the opportunity to hold the newborn as often and for as long as desired. They should also be offered private time together; the nurse should always tell them how long they will be left alone and offer to return promptly if requested, as feelings of anxiety and intense distress may be present during the early period of parental grief.
Rationale: Just as someone giving birth to a live newborn would, patients and families may want their family and friends to see their child. They should be encouraged to invite family and friends as they desire.
Rationale: Spiritual or religious beliefs may influence what rituals the family desires, and should be offered.
American College of Obstetricians and Gynecologists (ACOG). (2009, Reaffirmed 2016). ACOG practice bulletin no. 102: Management of stillbirth. Obstetrics & Gynecology, 113(3), 748-761. doi:10.1097/AOG.0b013e31819e9ee2
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