Non-viable baby, born alive -parent won't hold him, what do you do? - page 4

OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk... Read More

  1. by   mari31666
    Quote from bunny722
    i have seen 22 weekers survive into healthy kids. Yes, many of them have physical or developmental problems, but they do survive.
    Another thing is that in my state if a baby is born alive a birth certificate needs to be done. Where I work we always are honest with the parents whether or not their baby was born alive or not. I can't imagine telling a parent their baby was born dead and not letting the see the baby, when in fact it is alive! However, in my hospital, we only resuscitate if the baby is 24+ weeks. And, we are up front about this to parents too when a premature delivery looks likely.
    don't get me wrong, we have a bereavement process, box, pictures baptismal on request, we ask if they want to hold and we try to make the baby look as comfortable and baby like as we can. sometimes it is very hard to do this. we always try to comfort and support. sometimes though it isnt best to show all the details. we have volunteers who make hats and blankets that we overwrap the baby in (over hospital ones) that the parents may keep as something their baby wore. lets face it this thing really sucks so we go as far as we can to be there
  2. by   mari31666
    Quote from MamaLauraTo3
    This thread has me in tears. . . I plan to be a L&D nurse one day and know I will be dealing with these situations, but I can't help but to cry.
    i still cry. sometimes it helps the parents/family and sometimes just me or my co-worker, who is crying along side me
  3. by   wensday
    I would consider if the gestation was correct. Horrible situation to be in, but with any death, lots of cuddles seem to be the kindest and most natural thing to do.
  4. by   SmilingBluEyes
    Quote from enfermeraSG
    OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk baby. Well, she delivered the baby and he was alive. He lived for 3hrs. The pt only held the baby for a few moments and wanted us to take him away. To make a long story short, another coworker and I took turns so he wouldn't be alone for those 3 long hours.
    What does your facility do in that situation - when a baby is not viable, but born alive, and the parent(s) don't want to hold the baby? I mean, this was a perfect little 1 lb baby, pink with a heartbeat. We couldn't just leave him on the counter in our back room and occassionally check for a heartbeat so time of death could be recorded. (!) At least, I couldn't. Anyway, just wondering how other units handle this. thanks, SG
    We would do "everything"----e.g. NRP. And if "everything" could not be done (not allowed) i would take and hold that baby in a blanket and rock him/her myself.

    You have to respect their wishes.....

    Respect the wishes of the patient, and do proper postmortem care and preparation. We have had patients change their minds, after the baby has been taken to the morgue. We have made sure they were presentable as possible and brought them back when they changed their minds.

    Everyone grieves differently. Respect their wishes and make yourself VERY available and willing to listen. And be ready for anything---their emotions and reactions can run the gamut from anger to deep sadness to near catatonic-like states. Just be there, and respect what they wish. that is my best advice as an OB nurse and also as aperson who has had losses of her own.


    What a rough situation for you. I am so sorry this happened, for all of you.


    deb
    Last edit by SmilingBluEyes on Sep 21, '05
  5. by   fergus51
    I have to add, I am extremely skeptical about a hospital that would rescusitate a 21 weeker or even try. When a baby is not viable or is extremely premature, I believe we should respect the parent's wishes.
  6. by   SmilingBluEyes
    I so agree w/fergus.
  7. by   SmilingBluEyes
    I meant to say, before 24 weeks, we would just give comfort measures, TO INCLUDE holding, swaddling and rocking,. if the parent chose not to.
  8. by   enfermeraSG
    Sounds like the majority of hospitals are on the same page. We are a level 1 NICU, with two NNP's and 1-2 neonatalogists on at all times. In the instance of demise, we also have a protocol including memory boxes, pictures, footprints, etc. We respect the postmortem requests of pts. We have also had the parents request the baby again well after the delivery, or when the baby was already in the morgue. We retrieve the baby, and we place him/her under a warmer so they aren't ice-cold, and make them presentable.
    We don't resuscitate under 24wks, and I question the how ethical that is to resuscitate one under that GA. (Won't start that soapbox!) Anyway, this is a very difficult situation for anyone - both parents and staff. Thanks for such great input! SG
  9. by   Mermaid4
    I hold the baby. You can't make parents hold them. Even those parents without mental illness sometimes just can't do it. I will often ask if there was to be a name and refer to the fetus by the name to personalize the experience and help with greving. We then take pictures and do footprints and keep all of that on file in case they some day do think they can. Sometimes I will pull the curtain between me and them just afterwards and let them know I can stand behind it ready to take the baby away or give him or her to them as soon as they are ready. If they aren't ready I do not judge them. It is such an equisitely sad painful experience that it is just too much. I hug them in silence or make them laugh or simply follow their lead....It takes time and everyone handles it differently. Mostly you realize when you feel that something isn't right that it is usually YOUR issue and not that of the patient involved. If you are the type to confront things, that works for you and you would see this as abnormal. If you are the type to avoid conflict, this would seem perfectly natural. All you can do is take cues from the patient.
  10. by   Deidre Shiobhan
    Quote from enfermeraSG
    OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk baby. Well, she delivered the baby and he was alive. He lived for 3hrs. The pt only held the baby for a few moments and wanted us to take him away. To make a long story short, another coworker and I took turns so he wouldn't be alone for those 3 long hours.
    What does your facility do in that situation - when a baby is not viable, but born alive, and the parent(s) don't want to hold the baby? I mean, this was a perfect little 1 lb baby, pink with a heartbeat. We couldn't just leave him on the counter in our back room and occassionally check for a heartbeat so time of death could be recorded. (!) At least, I couldn't. Anyway, just wondering how other units handle this. thanks, SG
    Such cases refer to comfort care in my unit. Normally these babies' parents have agreed not to resuscitate the infant at birth but somehow they just don't die immediately.
    We'll keep them in a room, wrapped up and hook up to the monitor to watch the heart rate. There's controversies among the staff whether these babies should be kept warm under a radiant warmer.
    I've personally handled such babies, it's very pitiful. I'll wrapped them up,provide a bonnet and warmer. Sometimes we even try to give a little bit of milk to the baby to wet the lips and at least they can go without not knowing how milk taste like.
    We've came across a 23weeker whose parents have decided DNR at birth but he was crying all the way, very strong and pink even after 3 hours of life. We felt so sad and knew that he wanted to live. His dad saw him once and decided to give him a chance after seeing him for the second time. We intubated him and did what we supposed to do, he survived and went home without any complication. I guessed it was Marcus's cry that told us that he's a fighter, GOOD boy! We didn't make the wrong choice. :angel2:
  11. by   Mermaid4
    Not long ago we had parents of IVF 21 week twins who insisted we try everything. The doc was kind and informative but the mother was screaming that they would sue so the doc gave in but privately told us not to "hurt" the babies so although we did "bag" them, we really didn't, and the other nurse and I both stroked and talked to them in a quiet environment, then told the parents there was nothing more we could do, weighed and wrapped them out of their site ( just the way our rooms are set up), and handed them to them. They felt that measures had been taken, we knew they hadn't been hurt, and the parents went home starting their grief in a good way. I still feel badly about the entire episode, but the person who couldn't deal with it was the doc. I met him in the lounge in tears and had to comfort him as well...
  12. by   gypsyatheart
    Oh, geez, how sad! It is really sometimes, to me, harder to comfort the staff (nurses, docs)....than the parents! Crazy, I know. You expect the parents to be upset, it's just that we are supposed to be strong for them and yet, we are human, as well, we hurt w/them....





    Quote from Mermaid4
    Not long ago we had parents of IVF 21 week twins who insisted we try everything. The doc was kind and informative but the mother was screaming that they would sue so the doc gave in but privately told us not to "hurt" the babies so although we did "bag" them, we really didn't, and the other nurse and I both stroked and talked to them in a quiet environment, then told the parents there was nothing more we could do, weighed and wrapped them out of their site ( just the way our rooms are set up), and handed them to them. They felt that measures had been taken, we knew they hadn't been hurt, and the parents went home starting their grief in a good way. I still feel badly about the entire episode, but the person who couldn't deal with it was the doc. I met him in the lounge in tears and had to comfort him as well...
  13. by   onmyway06
    What a sad story Dutchgirl. This has obviously affected you to this very day. You're a very compassionate nurse. :icon_hug:


    Quote from DutchgirlRN
    I was in a situation about 15 years ago where a young woman came in alone and delievered at 22 wks. It was about 0400 and myself and the other nurse delivered the baby. We were in a small rural hospital.

    We called the ER doctor to come up stat. He picked the baby up from off of the bed and said to the young woman "I'm sorry your baby was born dead". He handed the baby to me and I was going to hand it to the Mom and he said "No clean the baby up first". The Mom was crying so hard she didn't say anything.

    When I got the baby to the nursery I noticed that he was alive. I ran to get the ER doctor. He said to me in the hall. "I know the child is alive but he doesn't have a chance, Let him die, clean him up and let the Mom hold him. We don't need to get sued for doing nothing." I stayed with him for 4 hours in the nursery and rocked him until he died. I let one of the day nurses take him to his Mom and I went home.

    The entire time I was rocking him I felt so guilty that it was me and not the Mom holding him. I've often wondered if he had been born at Vanderbilt would he have lived? I do know that if I had it to do over again I would have taken him to his Mama no matter what the ER doctor had said. At the time I was scared of doctors and was not the least aggressive as I am now.

close