care of patients with a loss

I have been an RN 12 + yrs (OB fro 10), I experienced a fetal demise at 16 weeks and and I can't believe what a new perspective I have. I cannot even begin to remember all of the pts I have cared for over the years who have experienced loss, but I hope that I did the best I could for them. None of us are perfect, and I think we could all learn something from a patients perspective.

Things not to say to pt: 1.)At least it wasn't your first. ( this wisdom was bestowed upon me by a stupid/young resident). I quickly told him that I had lost my "first" to an early m/c. And just because it was my 4th child DOES NOT make it easier.

2.) "At least it happened now" (as opposed to later or having a sick baby). I totally get that, but it does not need to be said. The pt/SO know this on some level. This does not ease anyones pain.

3.) "At least you have kids at home" Once again, I get that . Yes, I am very lucky/blessed but this also was my child. Until you experience this, it is hard to see "it" as someones baby. But the parents very often view this as a very real part of the family already and it is a loss of that dream.

4.) "God has a reason" I guess you have to know the pt pretty well before this is a safe thing to say, but trust me I am religious and I HATED hearing this. After you lose the baby you hear EVERY SINGLE STORY on the news about every abuse in the world and it makes you think..these people get to have healthy babies? Where is God in all of that?

The words that meant the most to me were "I am so sorry for your loss". Other things that helped were "I can't imagine what you are going through but I am thinking of you", "I will keep you in my prayers" Someone even asked if it was OK to pray for me, which actually was nice because you never know how a patient feels about people praying for them.

I could go on and on. Also, it is OK to assess the pt as you normally would. My PP nurses avoided me like the plague and DID NOT EVER assess me and checked my VS 18 HOURS after my recovery (at the time of discharge). WHAT!!??!! I had to stay b/c of a hemorrhage and meds I received which required lab work q 6 h. The lab actually was closer to me than ANY one of my nurses. I did not deliver where I work because if insurance.

Also, the parents should have a say in disposition even under 20 weeks, it is not a specimen to them!