nursing care r/t pregnancy termination

Miller86 · Apr 11, 2011

Very interesting topic and wonderful answers from some.

I apologize my response doesn't give any information you may require but I too think some nursing programs lack important topics.

Unfortunately the program I took touched nothing on abortion and little to no information on death or dying in general. Obviously we all knew it's inevitable in certain circumstances but entering into a nursing program doesn't necessarily mean I'll automatically know how to deal with someone dying or how to provide support and comfort to loved ones.

It upsets me to have graduated and still had no idea how react to death or what to expect.

Couple months ago my patient died, which was a first for me and I fell apart so badly. Seeing the family made the process 10 times more devastating.

If only I was prepared slightly in school I might have been more supportive for that family. But at the end they appreciated me being there, giving hugs and time to spend with their loved one.

Why should abortion or death of any kind be treated as some kind of a taboo?

I don't work in a maternal child environment but if I did I would treat the patient with respect and put any biases I may have aside. Provide the best nursing care possible and be supportive and use any given opportunity by teaching that individual.

I'm going to write a feedback letter to my nursing program....maybe future students will be a little more prepared.

decembergrad2011, BSN, RN · Apr 11, 2011

Interesting topic. We discussed spontaneous abortions in good detail, but elective abortions not so much. I live in the south so that's not terribly surprising, but we did go over the procedures.

Honestly, just do some googling but look for good, solid, medically-sound websites. Planned Parenthood, Mayo Clinic, and National Institute of Health in general are good places to start for information that will openly discuss abortion procedures and care without an agenda. Often if you Google "abortion" anything it will come up with a political site because it's such a heated topic.

As far as protesters, yes, it is serious, although of course sensationalized. An abortion provider was killed in Kansas not too long ago by a pro-lifer. I'm not saying that all pro-life activists are like that, but there are radicals as in every group and it can be dangerous to work at an abortion clinic. I volunteered for about a year at one and learned a lot about how it worked. Sometimes we had protesters, but most of the time it was calm. I think on average that's about how most of them are, although more conservative communities would probably have more public outrage over an abortion clinic.

On a similar note, I feel like my nursing program does poorly in presenting end of life care. I know abortion is not the same as hospice and palliative care, but they are in the same ballpark in specialization. I feel like I've learned so much in my elective classes about end of life care that I didn't get in my core classes.

I do believe that it's good to remember that nursing school is supposed to prepare you for minimum competency rather than to walk out the door and be a seasoned nurse. As another poster stated, once you get somewhere, they will train you to some extent in what you need to know and you can refresh as needed on your own.

srerrn2 · Apr 11, 2011

Just a quick reply to CeilingCat: First, congratulations on your graduation:yeah:. As you enter the exciting, frustrating, rewarding(I could list many adjectives)world of registered nursing you will have many questions. Hopefully, you will have questions every day of your career as there is always more to learn. I am so proud that you will soon be joining our "ranks". Clearly, you are trying to find answers in a non-judgemental way in order to best treat your patients. As long as you keep doing this you will do just fine!!

I am an ER nurse with experience in treating women who just found out they are pregnant and are already expressing the plan to electively terminate, women who arrive to the ER hemorraging s/p miscarriage or termination and women who actually miscarry in the ER. I am not going to go into how I approached each patient as there have been many great posts on this.

It seems to me is you want to get the most information possible the two best resources would be OB/GYN nurses from your hospital labor/delivery unit and Planned Parenthood. Again, good luck in your new career :nurse: .

Anderson11 · Apr 11, 2011

I think some UK nurses would be able to contribute well to this as the the NHS makes elective abortion available to almost anyone free of charge - so I'd assume these nurses must have covered this topic in significant depth. Anyone?

bagladyrn, RN · Apr 11, 2011

Regarding your question concerning a provider's personal beliefs impacting safe care of the patient:

I have seen this situation occur once in a religiously affiliated hospital when the patient's condition changed for the worse after admission. In most facilities the provider should consider immediately turning care over to someone qualified who does not share those reservations. In a case where the facilitie's rules actually interfere with safe care (as was the case then) the ethics committee and administration should immediately be called in to find a solution.

For other topics you may want to look at continuing ed. online on such topics as bereavement, pregnancy loss or birth control. Consider contacting your local Planned Parenthood for resources they use in training their staff.

BabyLady, BSN, RN · Apr 11, 2011

My advice to the OP is this:

I have known women who have abortions, both electively and due to pregnancy complications...I have never seen anyone after a procedure that said, "Wow, glad to have that over with!"

It is a devastating event, no matter how you slice it. What you can do as a nurse, is to just listen, be supportive, focus on the healing aspect of it, refer to counseling if appropriate (every woman should have counseling, no matter how the choice came about)...and engage in conversations about birth control (if an elective abortion) as well as STD's because obviously, there was unprotected sex usually involved.

Post-procedure risks, will be the same as any post-operative gynological procedure, which you have already learned about.

j464335 · Apr 11, 2011

You could volunteer at a local clinic or simply ask to shadow one of their nurses for a few days, this would provide alot of insight to your questions.

dern64 · Apr 11, 2011

This is what I look for in the ER setting. Focus on the patient in front of you. Go thru your standard patient assessment.

Is she healthy in appearance? Good skin tone/color, normal responsiveness

Are the vitals stable? ie. afebrile, negative orthostatic check, not tachycardic, eupneic

If she is immediately post procedure is there a normal pad count? generally they have a heavy menstrual cycle type bleeding post procedure. Make sure there is no foul odor which would indicate possible infection

Excessive cramping? Some cramping is normal but is she is doubled over and pale, she has a problem

Able to have normal bowel movements and urinate without difficulty?

Appear depressed, flat affect, etc?

Just stick to your basic nursing skills and trust your instincts (which develop with time!)

There are complications from time to time. If the abortionist leaves fetal tissue the woman can develop a life threatening infection. Some have perforated the uterus/bowel/bladder. Some women have bleed excessively.

Educate yourself and always "watch for zebras" (what we refer to the oddity as), occasionally you find one and save a life.

Abortion is a hot topic, obviously. Our job as nurses is the care for the patient in front of us. Support her. Put the number of a couple of counselors in your work note book. If they request help be able to give them a resource.

Don't judge, that is not our job.

I am pro-life to the hilt. I stand in a prayer group outside the abortion clinic in our part of the world. I do not protest or harrass, I pray. If they ask for help it is provided, if they don't want to talk, I don't bother them. If they show up later in my ER and need help they get it, not condemnation...help and compassion...I am a nurse and it is what we do.

rn/writer, RN · Apr 11, 2011

STAFF NOTE: Someone posted a message disputing a previous staff directive to limit discussion in this thread to helping the OP gain the knowledge she seeks. The point was made that we need to be able to handle controversial topics objectively and professionally.

While there is definitely truth in that idea, the fact remains that the information that would benefit the OP now (proper care r/t pregnancy loss) was being overshadowed by an intensely negative reaction to her instructor and her program. Hence the decision to limit this thread to that which would benefit her most--the acquisition of the missing information.

Please, respect that direction.

Thank you.

Esme12, ASN, BSN, RN · Apr 11, 2011

i don't wish to start a flame war, but i have some honest questions.
i am just weeks from graduation from a public college, to become a rn. my program director admits to keeping anything remotely relating to abortion completely off-limits. her values are very conservative, so the curriculum seems to reflect it (birth control was also left out). the textbooks they chose don't mention the nurse's role when a pregnancy ends without a live birth. when i did maternity/peds rotation, it was never mentioned. as we got to the part about molar pregnancies and eclampsia, all i was told was that the "resolve the pregnancy". i still know nothing about it, other than it makes some people angry enough to picket planned parenthood and it saves the lives of other people. the internet is even worse -- everyone shouting at each other and very little medical-focused info.
nursing care: i am guessing it might be to monitor for hemorrhage and infection. but there has got to be more to it than that? is care any different depending on trimester?(viable vs non viable) on miscarriage ("natural") vs pharmaceutical vs surgical terminations? (methotrexate/induction, d&c c-section)
http://tinyurl.com/3gb8f2r
if conditions are incompatible with life later in the pregnancy, is it considered an "abortion" to use surgical intervention to remove an already deceased fetus?
http://tinyurl.com/6dul426
do nurses get training in how to handle the psych aspect for a post-abortion patient? not all women who have abortions want to terminate. is a psych or post-partum type screening typical done?
http://tinyurl.com/624rxnk
do nurses interested in a obgyn/reproductive health type specialty get any additional education? or do you just pick it up on the job as you go? and can you ask colleagues about it and be sure to get an accurate answer? or is talk relating to it greatly discouraged in the workplace, too?
http://tinyurl.com/42m8aw4
does anyone here regularly give nursing care to women following pregnancy termination (intentional or miscarriage)? forgive what might be a naive question: but if you work in a clinic setting, is it true you have to be scared of terrorists and harassment? or has television really exaggerated that?
there are crazy people everywhere!!!!!!!!!!
what is the nurse's role as patient advocate, when a dr's personal/religious beliefs cause permanent harm to a patient? http://tinyurl.com/muwm92 rule #1 do no harm eg. when a mother's life is in danger and a provider doesn't want to consider terminating the pregnancy or doesn't want to treat a recent post-termination pt who is having a complication.
http://tinyurl.com/6c4maxs
thanks for giving me your professional advice, as i graduate and head into practice. i apologize in advance if i've offended anyone by asking about this topic. i know how strongly some people belief for/against this issue, and i do respect everyone's' beliefs on this issue. i just need some factual information. thank you.

for a student nurse you sure do ask a lot of provocative questions.........surely this isn't a clever way to get research done for you ....is it? :rolleyes: interesting.......

as medical proffesionals we may disagree with someones personal choices but that should not influence wheter or not we care for another human being. if a nurse or doctor truely has an objection to something relogiously or ethically they provide another care provider to care for that person.......to not provide an alternative is negligent and unethical. i find it difficult to believe that you can find nursing text books that do not have abortion or fetal demise information and use them in an accredited school or leave such a disparing blank that will leave you at a disadvantage for nclex. if the school left you that unprepared....please prepare yourself prior to taking nclex.

good luck

ascRN · Apr 11, 2011

OP, having worked in women's health for a long time, I thought I might be able to shed some light on the topic for you.

In medical terms, any circumstance in which a pregnancy is ended prior to completion is termed an abortion. For surgical or pharmaceutical procedures performed where maintenance of a pregnancy is not compatible with the (physical or psychosocial) health of the woman or fetus, it is termed a 'therapeutic abortion'. What we commonly call a 'miscarriage' is usually a 'spontaneous abortion.' And what is typically described as abortion by the media is known as an 'elective abortion'. You may see all of these terms in a patient's medical record, and they are often carelessly used interchangeably. You may also see the word abortion replaced with termination of pregnancy (or TOP).

Circumstances in which a new graduate nurse who is not working specifically in an OB/GYN setting that provides surgical or pharmeceutical abortion services will likely be limited to patients who complain of post-surgical complications or spontaneous abortion. You are right on the money, hemorrhage and infection are of greatest concern. These can occur due to uncontrolled bleeding through the uterine wall, retained products of conception (POC), or uterine perforation. Similar assessment methods to what you learned in OB nursing are used to determine this (pallor, pulse, BP, palpation of uterus with or without a pelvic for boggyness or rigidity, excessive lady partsl bleeding, etc). A woman who thinks she is experiencing a spontaneous abortion may be in need of immediate care, and should be directed to an urgent care/ED or other clinic where she can receive a ultrasound.

Depending on the circumstances behind the loss of pregnancy, psychosocial care may vary widely. For women experiencing complications following an elective abortion, psychosocial needs may be minimal. For women who have just miscarried, they may be great. Of course, reactions of individuals to traumatic events vary widely, and the best way to determine what type of support your patient needs is by using good therapeutic communication skills. Start by listening to what your patient is and is not telling you during your initial assessment. Ask open-ended, non-leading, and non-judgmental questions. As pregnant women are at a higher risk for domestic violence, asking about safety in interpersonal relationships may be appropriate. Learning to recognize coping strategies takes time, and will come with practice. By taking a good psychosocial history, you can paint a much better picture of how to care for your patient. If you ever feel you are in over your head or that you don't know what to do, talk to a more experienced RN or call the social worker. If you carry strong personal feelings about abortion yourself and are struggling to remain objective, recognize those feelings and remove yourself from the situation.

ascRN · Apr 11, 2011

my last post was rather general. let me answer some of your more specific questions i didn't address.

is care any different depending on trimester?(viable vs non viable) on miscarriage ("natural") vs pharmaceutical vs surgical terminations? (methotrexate/induction, d&c c-section)

the risk of complication directly correlates with the age of the pregnancy at termination. surgical complications are more likely in later pregnancies that require greater mechanical or chemical (laminaria) dilation of the cervix for evacuation of the contents and/or curettage. these complications typically include hemorrhage. pharmaceutical complications often result from improper adherence to the regimen (often misoprostol/mifeprex). even proper adherence results in retained tissue in ~5% of women, which is why follow-up care is important to determine if a second regimen or surgical evacuation is necessary. pharmaceutical abortions are typically only administered up to ~8 weeks of gestation. though now rare, surgical procedures provided by untrained practitioners in non-sterile and unsafe settings are vastly more likely to result in complication.

if conditions are incompatible with life later in the pregnancy, is it considered an "abortion" to use surgical intervention to remove an already deceased fetus?

you seem to be asking two different questions here. yes, the same procedure is used (often intact d&x depending on gestation at fetal demise). whether or not you or your patient considers this to be akin to an elective abortion is a more loaded political question that doesn't have much bearing on their need for medical care.

do nurses get training in how to handle the psych aspect for a post-abortion patient? not all women who have abortions want to terminate. is a psych or post-partum type screening typical done?

if you work in a practice that specializes in providing abortion procedures you will get extensive training on pre-procedure counseling as well as access to tons of referrals. it is negligent for a practitioner to terminate a pregnancy in a woman who has not given informed consent, which means she must be able to give that consent (not under duress, distress, etc). for women who decide to undergo elective abortion but remain troubled by personal feelings about elective abortion, there are many support groups that allow them to talk about it. some practices even use social workers to follow up with these patients.

do nurses interested in a obgyn/reproductive health type specialty get any additional education? or do you just pick it up on the job as you go? and can you ask colleagues about it and be sure to get an accurate answer? or is talk relating to it greatly discouraged in the workplace, too?

nurses interested can join the association of women's health, obstetric and neonatal nurses. most training is on-the-job, and as far as i know there is not a desirable/industry-standard certification for women's health nurses. whnp and cnm are advanced practice specialties involved at all levels of women's health care.

does anyone here regularly give nursing care to women following pregnancy termination (intentional or miscarriage)? forgive what might be a naive question: but if you work in a clinic setting, is it true you have to be scared of terrorists and harassment? or has television really exaggerated that?

violence toward abortion practitioners has subsided though not disappeared in the past 2 decades. occasionally there will be a news story about threats toward physicians and nurses. in 2009 you may have heard about the assassination of dr. tiller, a provider in kansas who provided elective abortion services up to 26 weeks (which is what has been interpreted as the limit of acceptability in roe v wade). dr. tiller was one of only a few clinics in the country that provided services this late in a pregnancy, and it is likely that this is why he was targeted. women who learned of their pregnancies late (or were unable to seek care previously for another reason) but still wished to terminate would often fly from many states away to receive services. although it has declined, it is still a reality we as nurses have to accept. in the past i have worn plain clothes to work and/or entered through a back door, especially in the presence of protesters. some of us are vocal about where we work and what we do, while others simply choose to say they work in women's health, especially in mixed company.

what is the nurse's role as patient advocate, when a dr's personal/religious beliefs cause permanent harm to a patient? http://tinyurl.com/muwm92 rule #1 do no harm eg. when a mother's life is in danger and a provider doesn't want to consider terminating the pregnancy or doesn't want to treat a recent post-termination pt who is having a complication.

physicians and nurses are obligated to their patients to provide complete care. physicians and nurses may sometimes find themselves in a position in which their moral beliefs conflict with the services they are requested to provide. in these scenarios, the nurse or physician must find another practitioner who is qualified and turn over care of the patient to that individual. often times these scenarios are self-limiting as providers perform their own follow-up care. in an emergency situation where no other providers are available, it is generally accepted that the physician/nurse must care for that patient if it is needed to immediately preserve the life of the patient. this is a subject of some contention and there is a lot of case law out there if you're interested.