dealing with a fetal demise

  1. Hey,

    Just curious how some of you experienced nurses deal with fetal demises. Had my first delivery of a 17weeker 2 wks ago, went ok, the family had known for over a week and did really as well as they could with it, I guess. But a 2 nights ago had another pt with fetal demise, however, this situation the mama came in in labor and i could not find heart tones, charge nurse couldn't find them, got the ultrasound and although we aren't trained to assess, we used it and didn't see the heart beating, called MD and he quickly came in and broke the news. I was emotional all night, on top of this we had delivered 30weeker fetal demise 2 hrs prior to this one coming in.

    How do you emotionally deal with these? What do you say to the families besides you're sorry? It was hard on me, I can not imagine how the family was feeling. Any tips tricks advice would be much appreciated!
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    About babymamaRN6

    Joined: Apr '10; Posts: 3
    Specialty: L&D RN


  3. by   cnmbfa
    You would not be human or have much of a heart if this didn't bother you. It is a loss of the future, and of hope for all of us, and maybe a lot harder than some other losses because of that.

    Some advice:

    - A few sincere tears are OK (not weepiness). It lets the mom and family know you are human, and that you feel their loss.
    - Some of the things I have said are (in additon to "I'm so, so sorry for you loss.") are "I cannot quite imagine how much this must make your heart ache." "This is never easy, no matter how early or how far you were in your pregnancy."

    - Because some women did NOT want to be pregnant, and may feel both relieved and guilty at the same time, do not assume or say things that assume she prized the pregnancy. That forces her to pretend that she did. I would say something like "Being pregnant means different things to different women. what did this pregnancy mean to you? Was it a surprise?"

    - NO matter what the reason for the loss, she will be searching for a way to explain it, and will go over and over her actions and inactions, looking for a way to make sense of this. Her family may also be looking for a way to make sense of it as well; hopefully, no one will ever even hint that she had something to do with the loss, or that her thoughts or mixed feelings triggered a pregnancy loss. We humans have difficulty accepting that random bad things happen, so we search and search for a way to get back our sense of control by placing blame somewhere.

    One of the single most important things you can say (in nearly all circumstances) is this: "When you are thinking more clearly, be sure to ask your doctor or midwife plenty of questions about this. I am sure she will welcome them, and will want to put your mind at ease. But as of right now, from what I know, I cannot imagine that there is anything that you had control of, or did or did not do, that would have kept this from happening."

    - Your hospital may have little rituals that they use to honor and help parents gireve a perinatal loss, ranging from footprints to giving them tiny booties as a momento. Follow the parents' lead in deciding what and how much to do. Ask the nurses around you who have done this before to go with you and to guide you when doing this part. They can role model a sensitive approach.

    - I practiced as a midwife for ten years, and whenever I had to break bad news or deal with this, I prayed, a lot. I am absoltuely sure that many times, the words that came out of my mouth were not actually mine; for that I am so grateful. Eventually, I realized that I could do the most good by just setting aside my fears about doing or saying the right thing (and of being blamed for a bad outcome) by totally focusing on this woman, at this time, and on her feelings, her thoughts, and her experience. By losing my ego, I became more effective, more sensitive, and more able to help her heal.
  4. by   yogamom
    I am only at the very beginning of my journey and getting ready to finally pursue a nursing degree. I have to say that your post gave me chills, and made me a little weepy. Nurses like you are originally what made me want to be a nurse. The strength, grace, and presence in your message touched me and renewed my enthusiasm for the human side of the profession. Thank you for being such a beautiful reminder of what a nurse can and should be.
  5. by   ElvishDNP
    Some FDs hit harder than others, and there may not be any rhyme or reason as to why. It's normal, and allow yourself to feel whatever you feel. I've found that families appreciate a few tears shed in their presence, it makes you human and shows you care. However, if you have to 'lose it', it's probably a good idea to do it elsewhere, so the family that needs comforting doesn't end up feeling they need to comfort you. (I've had to lose it many times; it means you are a normal human, it just needs to be a proper outlet.)

    Some families don't want to look at their babies after delivery. It's not up to you and me to decide for them what they need. Sometimes people don't want to look because they are afraid the baby is grossly deformed, other times it's because they think it will be hard to see a perfect baby and wonder forever what went wrong. I tell people that no one will force them to do anything, but that sometimes having something concrete to grieve will help them grieve more effectively, and if they want a description of the baby, I give it to them. In any case, we make the memory box with pics, a lock of hair if possible, hand/footprints, and whatever other mementos we can give them, and tell them it's all there whenever they are ready to see it.

    Ask, ask, ask if they want a chaplain or their own religious leader/clergy to visit, whatever their faith. They may not, but some people take great comfort in this.

    Please remember the baby's father, if he is present/involved. I think we (rightly) spend a lot of time meeting Mom's needs, but fathers grieve too. Their needs are different, and their grief manifests differently, but they do hurt and grieve, and I think it's easy to forget. If I can get a moment, I pull the father aside and make sure he is doing okay and see if he has any questions he wants to ask but is afraid to ask in front of mom. It makes a huge difference. I haven't always done that, but I had one FD that changed the way I practice and ever since, I have tried my best to include fathers in the process.

    Hope this helps. It don't ever get easy.
  6. by   twois
    Something else to consider in the seeing the child, memories train of thought... there's an organization of photographers called Now I Lay Me Down To Sleep who volunteer their services for free to people who have experienced a fetal demise. A lot of parents are very thankful that their nurse suggested it, even though they're grieving, so that they know they'll have some visual memories of their child to keep forever. Not all of the little ones are in good enough shape to be photographed entirely, but little things like wedding bands on little hands, etc, really give the parents something to keep with them later on.

    Just a thought. Home - Now I Lay Me Down To Sleep is their website.
  7. by   Schmoo1022
    Oh my...that website has me sobbing. I truly admire you L&D, Pediatric and ER nurses. It takes someone very special to do these jobs
  8. by   StarrySkies
    Thank you for the Now I Lay Me Down to Sleep information! I just contacted them for my hospital. We have some local nursing homes who have residents that crochet/ knit blankets and hats for us. We also go through the Mary Madeline Project for free burial gowns for our babies. My hospital serves an at-risk population that is fairly low income. It is a big deal to be able to offer them burial garments. Let alone how difficult it is for most families to go out shopping for burial garments when they are in the middle of their grief.
  9. by   levineal
    I have not yet had to experience this incredibly difficult part yet from a nursing perspective. It is with the support of a person who cares (like you) to be there in any way that you can for the family. Being on the other side of this experience I understand how important it is to have people there for you at a time like that.