do you allow fetal demise infants to stay with mother in her postpartum room?

  1. Hi all, I am the bereavement nurse specializing in fetal demise/neonatal death. Our hospital policy has changed to be more accommodating to our families that have fetal/neonatal loss. To facilitate the grieving process we allow the mother/family to keep the infant with them as long as they desire for bonding and to say goodbye. Most of the time a few hours is enough and the family is able to relenquish the baby to the morgue. We have on occasion had a mother want to keep her baby with her in the room until her discharge - this can be up to 4 days later. The issue is the staff nurses caring for these patients on the units. Many staff have given me feedback that they can care for and deal with the family - but NOT the deceased infant in the room for so long. These nurses do NOT have to do ANYTHING with the infant with the exception of placing it in a shrowd and calling for a runner to take it to the morgue if the parents request it. Do any of you have suggestions for teaching/training the nursing staff in the care of these special families. Since death is a part of life-should all the staff be "made" to take turns caring for these families or should it be on a voluntary basis unless no-one volunteers? Any feedback will be appreciated.
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  2. 18 Comments

  3. by   Blee O'Myacin
    I have no experience with this. I come from a heme/onc critical care unit, where death is a common outcome. Often, our patients are under 30, but its not nearly as shocking as parents losing a newborn, so I am really not in any position to give advice on that end. But my gut reaction is that it just isn't healthy to keep a decomposing body in a hospital room with a patient, both for infection control issues and for the parents/family not having to see that process.

    I think that giving the family unlimited time - like days - may backfire for those reasons. I think that four or five hours is extremely sensitive, gives family enough time to arrive and say goodbye - etc. We also allow the funeral homes to come up to the floor on night shift or at the manager's discretion (we had an 18 year old pass away and her family just couldn't bear the thought of the morgue, so our manager let the funeral home take her from the room).

    I don't think I would want to be forced to take care of a patient in a situation like that.

    JMHO,

    Blee
  4. by   MarySunshine
    Both as a nurse (not post-partum) and as a mom who had a fetal demise, I think gentle boundaries are very appropriate. It cannot be mentally and emotionally healthy to have your dead child in your room for several days. And, as a caregiver (even one who would willingly take care of bereaved parents and their dead child), I would be highly uncomfortable with that situation. Once the child has passed, you need to facilitate a gentle, special "goodbye" -- not let it draw it out into something morbid -- these people are (understandably) not in their right mind.
  5. by   shazbo
    boy,you've got a hard job. thanks for doing it. i imagine your nurses are going to need a little while to adjust to the new policy.have inservices been given along with this policy change? perhaps your senior nurses can take those mothers that need extra time and by example the others will see how this has helped. i hope if it were me i'd put aside my issues for the sake of a heartbroken new mom. in the end it's not about us,is it? this probably hasn't helped at all but i just wanted to offer my support.
  6. by   hamlj
    Quote from MarySunshine
    Both as a nurse (not post-partum) and as a mom who had a fetal demise, I think gentle boundaries are very appropriate. It cannot be mentally and emotionally healthy to have your dead child in your room for several days. And, as a caregiver (even one who would willingly take care of bereaved parents and their dead child), I would be highly uncomfortable with that situation. Once the child has passed, you need to facilitate a gentle, special "goodbye" -- not let it draw it out into something morbid -- these people are (understandably) not in their right mind.
    I'm not a nurse yet (although my goal is to be a L&D nurse when I'm done w/ school), but I have had two stillborn babies, 3 live births and 3 miscarriages.
    I agree 100% with MarySunshine. Having some time to spend with your baby, and having some time to bond and say goodbye is SO important. But I think it does become more of a mental health issue to have the baby with you for days.
    It's a very grey area as to who/what decides is the 'correct' amount of time to allow the bonding/goodbye process to go on...but clearly 3-4 days is not a good idea for anyone involved. I also don't think any mother in that situation can make a rational decision. I know I wasn't able to think clearly at all when it was me.
    I would recommend finding some grief counseling/training program for the nurses who work on your floor. Something to help them understand better what the family is going through. I don't think forcing everyone to do it is a good idea (again, the mother/family needs SUPPORT, not a disgruntled employee) but perhaps there is a group of nurses who would offer to take this particular step in helping out in these situations. Maybe you could establish an 'on call' program, as I know fetal demise/stillbirth is not something planned or scheduled.
    There is probably no 'right' answer for this question...but I give you the greatest amount of credit in taking the steps to help out these families.
    It is so very important to have the kind and caring support every mom deserves during what is one of the most difficult times in her life.
    Best wishes.

    ~Amy
  7. by   tryingtomakeit
    Quote from MarySunshine
    Both as a nurse (not post-partum) and as a mom who had a fetal demise, I think gentle boundaries are very appropriate. It cannot be mentally and emotionally healthy to have your dead child in your room for several days. And, as a caregiver (even one who would willingly take care of bereaved parents and their dead child), I would be highly uncomfortable with that situation. Once the child has passed, you need to facilitate a gentle, special "goodbye" -- not let it draw it out into something morbid -- these people are (understandably) not in their right mind.

    Very well said.
  8. by   NurseCard
    I have to concur with everyone else... there really should be a limit, and there should be a counselor available at all times to help the mother grieve and then help her be able to relinquish the baby. Keeping the baby in the room with her for DAYS? Definately doesn't sound healthy in any way.
  9. by   Fiona59
    Our Mums usually don't go to the Maternity Unit, they go to Gyne. The infant is in the room with them and are taken to the morgue when the parents request it. We have had Mums who ask to have the baby kept nearby because Grandparents will be coming in to see the infant and the bassinet is then taken to an unused room, with the door closed and a towel draped over the handle.

    Our Mums are given a picture of the child, taken shortly after birth. The baby is washed and dressed and then photographed, we will take footprints if the family ask. Our volunteers have knitted caps, booties, and matinee jackets for the child to be dressed in.

    Most of our Mums only stay 24 hours as they were usually vaginal deliveries, section Mums can stay 72 hours but many opt to return to the community sooner.
  10. by   bagladyrn
    I agree with the above posters - keeping the baby with them for hours is appropriate, days is not. And to bring up an unpleasant but realistic fact that no one really wants to think about or mention - after a period of time you will be dealing with decomposition and the attendant health issues and environmental effects.
  11. by   Princess74
    I think that keeping an infant that has passed away in the room for days is going to cause even more mental problems for everyone involved. It's not heathy in anyway and honestly I'm surprised its legal. My heart goes out to these family's, it really does, but something about this just seems very wrong.
  12. by   dawngloves
    I've never been in a situation were a parent wanted to keep a baby for days in their room. Often, after holding the baby for a few hours, a mother will want to see the baby before she is d/c'd and we have to bring it up from the morgue.If a parent will not relinquish a decesed infant for that long you need to get social work in there.Also, that becomes an issue for the morgue and the funeral director as the decompostion of the body is a problem for them in different aspects. I know we need to get a pt in the morgue in at least 4 hours.
    Otherwise, your staff needs an inservice on care for deceased neonates and their families.There is a thread in this forum about different companies that d0 bereavement training.Perhapes you can arrange a group session or have a few representitives attend and present to the staff later.
    Last edit by dawngloves on Sep 18, '06
  13. by   rpbear
    On our unit families are allowed to keep the infant for as long as needed, usually a few hours then the baby is either taken to the morge, the funeral home comes to pick up the baby or the baby is placed in a fridge on the unit that the mom will be staying, the baby then can be brought to the family form the fridge if the family requests, most don't want to see the baby after it has been placed in the fridge, but sometimes family memebers are not able to be there and will arrive the next day and want to see the baby. I think this may be a good compromise for your unit, the families will have access to the baby , but it will not be in the room the entire time. Then when mom is d/c'd the baby either goes to the morge to be picked up by the funeral home or the funeral home comes to thte unit to get the baby. We have had several native american families that will take the baby with them back to thier pueblo and have a proper cerimony for the baby, this is a special cultural consideration that we accomidate.

    Nurses shouldn't be forced to take care of these families, the family needs someone who is going to be there for them. But, this is a part of the unit and everyone may not like to care for these families they need to accept that they will have too and if they can't then they need to find another unit to work on.
  14. by   unikuelady
    I want to thank you all for your excellent advice. Some of you have given me perspectives I didn't think of regarding the possiblility of abnormal grieving. I've only had one patient requesting to keep her 21 wkr (who maintained a heartbeat up until delivery). for her entire stay of 48 hours. The infant was kept wrapped at all times. Parents are informed of the natural degradation process. This infants skin remained in good condition.
    The parents of macerated infants are also informed of this process-but that it has already started days before-so the infant will deterioate quickly. All of the parents in this situation have requested the infant be taken to the morgue within a maximum of 8 hours-and that was to wait for family members to arrive. We have taken the infants to the morgue and have returned them to the parents when requested-although this is one of the sticking points-because no-one wants to go to the morgue to retrieve the infant.

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