Helping staff cope with perinatal loss

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    Perinatal loss - part 1 was about helping women who are experiencing or have experienced perinatal loss. This is part 2 - helping staff cope.

    One of the great things about my job is welcoming new life and watching miracles happen almost every day. Nearly every day I fall in love with at least one of the babies and/or new families in my care, and more often than not, it's all of them. However, this job is - as mentioned in the previous entry - like the proverbial little girl with the curl in the middle of her forehead. When it's it's good, it's very good; when it's not...well, we all know how the saying ends. It can be ugly and sad, and it can leave staff (doctors, nurses, and techs alike) feeling drained, heartbroken, and beaten up. What's the best way to help each other heal?

    My best answer: I don't know. My unit doesn't have a specific protocol for things like this.

    When we have a sad situation - a miscarriage, fetal demise, or unexpected bad outcome - we all band together and just lean on each other. The chaplain that's around has helped us on occasion too, but there are times there are things that need to be vented that only nurses (and sometimes, the doctors) will 'get'. Like, the times we say to each other after delivering the miscarriage that it's easier when the 18-weeker is born with no signs of life. That may sound crass, cold, or unfeeling to anyone who didn't deal with that situation. What it actually means to those of us who took turns holding that 18-weeker while she died is this: it tears our heart out to watch that baby girl fight like a mad dog to stay alive while we hold her and know that there is nothing we can do to reverse the process. We hope for the end to come sooner rather than later so that she no longer suffers. (Note: yes, it is ideal for parents to hold their babies in this situation, but sometimes parents can't or don't want to. So we make sure the baby gets what everyone deserves: someone to be there when they die.) People who don't do it on a regular basis might not understand the sentiment. When we vent to each other, we do understand.

    One of my best friends dealt with a sad situation a while back taking care of a patient who ruptured and started dilating at a previable gestation. The docs came in and talked with this patient and basically spelled out that there was not much that could be done at that point if the dilatation process kept up. This friend has dealt with multiple losses herself at various gestations and it was no big stretch for her to put herself in the patient's shoes. She kept her composure long enough to take good care of the patient at the bedside, but as soon as she got back to the nurse's station, she burst into tears. Those who were there saw her and rallied around her, giving her a much-needed shoulder on which to spill those tears. With us she didn't have to explain the situation to any chaplain or well-meaning supervisor. We already knew, and we knew her story too and why this was so difficult for her.

    (Please understand - I love having chaplains available 24/7. When patients desire a chaplain's services, I am most grateful to them for the spiritual support they provide. There is no substitute for that. Our unit chaplain meets with whomever wants prayer every week at a certain time, which I've heard is also a time of refreshment for those who've attended. So I don't mean this in any way to be a swipe at chaplains.)

    One L&D nurse with many more years of experience than I made it a point while doing a staff inservice a while back to not leave out the doctors. They are human too, and these things are really no easier for them than for us. I've debriefed informally with doctors as much as with nurses, and know doctors who've stayed well over their call shift to hold dying babies until they passed because parents couldn't. One attending came up from the OR sobbing after a very difficult, very bloody maternal loss. It's hard on all of us; a simple, "Hey, are you holding up okay, is there anything I can do for you?" can make a world of difference.

    I'll reiterate that I really don't have an answer for what the best thing to do in situations that leave us reeling. This is just what we do. It works for us.

    What about you?

    (Part 1 can be found here.)
    Last edit by ElvishDNP on Jan 18, '11
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  3. by   cav5
    This was well written. As a nurse and a mother of 4-one of whom died in the 20th week of gestation, I applaud what you were portraying. As a nurse I was glad that my only son didn't have to struggle to breathe, as a mother I felt alternating guilt and a sense of relief that God made that choice and I didn't have to wonder ever with what "if" they had tried this... very well done.

    I also have to say that it was the nurse who helped me and my family cope with such a grave loss. Without her intervention on that day I don't think myslef or my family would have felt any true closure and I still remember her 10 years later with such gratitude. For all the L&D nurses out there who have worked with families such as myself, thank you! We may never come back and say it but what you do remain with us for the rest of our lives and truly, truly makes all the difference in the world.
  4. by   ElvishDNP
    Rachel, I am so sorry for your loss and am glad that you had a nurse who helped you through what is a terribly difficult time. Thanks for your positive feedback.
  5. by   moma8gma1
    You know, I am not a nurse (was pre-nursing student until recently) but I feel compelled to tell you that I am SO impressed by and thankful for your compassion. You are definitely in the right profession, tears and all. You REALLY care -- it isn't an act. After reading about that monster abortion doctor back east who has killed near full-term babies and mothers (sepsis, ruptured uterus, perforated bowel, etc...) your post is like a soothing salve to my psyche and heart.
    But, anyway... just wanted to give you a big hug and thanks for that post. Thank you for loving those babies (and crying with their parents) in their last moments, as draining as it must be for you. They are lucky to have you as their nurse.
  6. by   kbm411
    As a Level 3 NICU nurse, I have experienced some very unfortunate losses. From the 23 weeker with a severe head bleeds to the full term with meconium aspiration syndrome, no loss is ever the same or easy. We all try our hardest to do everything we can for the parents and family (taking pictures, making memory boxes, letting them perform newborn care) but I can still see the need for support for one another. We have recently started a group in our unit that discusses all infant deaths in the unit. The meetings are started off with the attending reviewing each death and diagnosis and end with an informal discussion between the nurses who may have been involved with the infant/family. I have found that offering help to newer nurses caring for their first loss often helps them through the process. We all have our own way of dealing with a loss, and each of us try to go out of our way to make the family feel as supported as we can. However, by doing so, we often forget about ourselves. Our previous policy was to carry the body of the infant to the morgue with hospital security once the post-mortem care was done. When our hospital changed locations, the management offered a policy change for this process. Many of us felt that this was a way for us to grieve over the little angel that we had cared for for the past 12 hours, days, weeks, or sometimes even months. Now, we are given the choice to transfer the body ourselves or to call for hospital security. I always choose to carry the infant myself, it is my simple way of saying goodbye.