I was just wondering what your policies were re: fetal demise... do you have different policies for <20 weeks, or is it just included on the same one? If less than 20 weeks, do you print and band them? If less than 20 weeks and they want a funeral, do you call the funeral home, or have the family do that? What about if their funeral home is a few hours away and it is nighttime? Do you keep the body on your unit until the next day, or do you call a local funeral home to keep it until the other one can come and get it? Is this different for <20 weeks? Can you send it to the lab until it is picked up?
Sorry for all the questions, but I have been dealing with these types of questions, and our policy is very vague.
Feb 20, '03
Geez, I can imagine how confusing this must be for you with no clear policy. The fetus becomes viable at 20 weeks, so the demise is handled as a fetus. The parents may decide to bury the fetus or have it cremated, keeping or burying the ashes. (We have a funeral home in the area that very generously, will handle the arrangements free of charge for the parent(s) if they wish, whatever the gestation.) Prior 20 weeks the fetus is considered non viable and can be handled as products of conception, and can be incinerated with other tissue that the hospital accumulates, if the parents so desire.
We send the fetus to the lab area for pick up by the funeral home or for autopsy if parents want it. Regardless of gestation, we try to send the fetus/POC to the lab once the parents have had an opportunity to bond and say good bye.
It isn't legally necessary to footprint a dead fetus, unless it was born alive.(If it was born alive, everything changes!) I do take prints for the parents, as well as photos, even if the fetus is below 20 weeks, but still formed. Banding is ALWAYS recommended for identification purposes.
Maybe you could participate in making a policy for fetal demises for your unit. I would at the very least insist that my manager get one put together. What is required in your area, may be different than mine, so I'd want to be in the know if I were in your shoes!
Feb 20, '03
My hospital's policy sounds very similar to sbic56's. 20 weeks is the defining line in our state for when the IUFD receives a death certificate and must be treated differently from tissue or POC specimens. After 20 weeks, the family must contact a funeral home to make arrangements for the baby. Our hospital has a packet of info that includes local funeral homes. Once they choose a funeral home, the nurse or the house supervisor will call the funeral home to come pick up the body. The body is stored in the pathology department until the funeral home comes.
For a fetus less than 20 weeks, the family has 2 options. If they wish, they can arrange for a private burial or cremation. If they do not want to do this, then our hospital (Like many other hospitals around here) will have the fetus or POC cremated and periodically throughout the year hold a memorial service for the IUFD's. The mother decides whether or not she wants to know when the memorial will take place. The cremation and memorial service are free to the pt.
The hospital chaplain is notified whenever we have an IUFD and she comes in to see the family. She is really good with these families and will come in whenever needed. Several of our nurses have gone through some bereavement training in addition to the in-services periodically offered by the hospital.
Our policies are pretty thorough and in L&D a copy is kept in a separate binder with blank copies of a bereavement checklist to ensure everything gets covered.
We will take footprints, if possible, and make baby bands. We will take pictures and, if possible, get a lock of baby's hair. For the older fetus we will clean up the body and dress it in a special top that is basically just the front of a shirt with a collar that would fasten behind the neck. The baby is also wrapped in a small blanket handmade by a local church volunteer group. The shirt and the blanket are given to the mother is she wants them. The mementos of the baby are all placed in a small box, hand decorated by the nurses and offered to the mother. If she does not want them, they are stored for a while in case she changes her mind later.
This is such a horrible time for the family and we try to do whatever we can to support them. I hope you can get your policy better defined. A clear and thorough policy makes it easier for the nurse caring for the family to do a very difficult job.
Feb 20, '03
My hospital's policy is like Indy nurse's. I have baptized a 13 week demise, though. It was at the parents' request. You know what they always say, "a person's a person, no matter how small." I try to practice with that in mind when it comes to IUFD's, kwim?
Feb 22, '03
We pretty much follow the before 20 weeks and over 300 gram policy.. That is if the fetus is below either of those parameters, it is considered a miscarriage and , unless the family desires it, is not released for burial.
We do, of course, at any gestation, gently wrap and present the baby to the parents, and attempt to honor their wishes as best we can, but the fetus is neither banded or admitted. I will do footprints in any case because I find it helps the parents to have that. I will also do hand prints if I can....
Feb 22, '03
Indy Nurse and others -
It is nice to keep the shirt or blanket or whatever the fetus may have come in contact with. My child died at 7 weeks so he was older, but the pain is still the same. I told the hospital to just keep all of the sleepers I had brought in as a donation from us. I didn't think I wanted them. Anyway, about 2 months later, the social worker mailed me the clothing. I was so glad to have them back. There was a blood stain on one of the feet of the sleepers. Although that sounds strange, the stain was proof of his life.
Feb 24, '03
That is so not strange. It was and is part of him...We do take pictures and keep things also because some moms and dads are just not ready to take all that.. When they are ready they can let us know and we will give all those things to them. My brother and sister in law lost one of their twins at 23 weeks and managed to keep the other twin, who was born at 37 weeks. Now the surviving twin has always been aware that he had a brother, and at age 5, still checks the stuff they brought home from the hospital and refers to it as "Patrick's stuff."
Thank you for sharing that with us
Feb 25, '03
Will most hospitals release the remains for burial if the parents wish it? I miscarried at 13 weeks, well under the line, but I wanted to bury my baby. It was not tissue or POC to me. But it was put in a specimen cup and the nurse said, "This is ours now." She could have been talking about a stool sample. I was in too much pain to press the issue, but I wish I had.
Feb 26, '03
Thanks for the reply's everyone. I have just been wanting to get an idea of what is done elsewhere. I had a 19 5/7 week/ 300 gram IUFD patient the other day who delivered on day shift, but didn't want to see the "baby" until 9 PM. After that, said she wanted to have a funeral, but wasn't sure if wanted it in town, or 2 hours away. Nothing in our policy stated whether or not we could keep the baby in the lab overnight, or if it would have to go to a local FH (where she would be charged). Also, I had to print and band the baby on the slick sheet. That seems silly to me. Especially for something that would normally be a "path specimen". Then there was the question of whether or not the mother had to call the FH, or if we were to do that. And also the question of if she was able to take the baby to the out of town FH herself, or if the FH would have to pick it up.
These questions are (a little bit) answered more clearly when dealing with >20 weeks/500 gm babies, but our policy on miscarraiges stinks!
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