nursing care r/t pregnancy termination - page 4

by CeilingCat

8,159 Unique Views | 39 Comments

staff note:please, answer the op's questions about how to provide proper care for patients following the loss of a pregnancy (for whatever reason) and the other things she wanted to know. do not post about the inadequacy of her... Read More


  1. 0
    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.
  2. 3
    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.
    fromtheseaRN, Elvish, and Esme12 like this.
  3. 1
    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.
    Gator Girl 2000 likes this.
  4. 0
    Quote from ceilingcat
    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? 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
  5. 4
    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 vaginal 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.
    Elvish, Anderson11, Esme12, and 1 other like this.
  6. 4
    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.
    everwonder_y, Anderson11, Esme12, and 1 other like this.
  7. 6
    Hi.

    I cannot give you the input of a nurse (yet) because I am just a student but I can tell you what I know so far from my experience. I lost my daughter at 18 weeks 1 day due to PPROM (preterm premature rupture of membranes)... There was no warning it just happened and unfortunetly I was part of that 3% (or less) of women this occurs to. No infection, no other issues.

    Anyway, when I got to a hospital they barely let me get admitted into OB since they don't take anyone under 18 weeks. Finally, the nurses tried to calm my husband down saying it may not be my water and it may be urine. I knew better. I will never forget the smell of amniotic fluid. After getting an iv and the basics, they tested me with the strip and it turned blue right away. I burst into tears before they could even say anything. They called for an ultrasound and there was no fluid around her and I was basically told my only option is to induce labor because trying to keep the pregnancy was not an option. I realize the risk of infection, death and birth defects were very high and we had to make the decision to terminate the pregnancy.

    It was the HARDEST thing I have ever gone through but I will be honest. If it wasn't for the nurses who cared for me I don't know how it would have went. My doctor was a...aheem I won't say the word but he didn't even bother to come and gave all orders by phone. They made it the best experience it could have been given the situation and circumstances.

    I was placed in my own room and given time to think and grieve, to process everything, to cry, signed the papers and got the process started. I remember a student nurse being there and when they inserted the pill to start the process she couldn't reach my cervix and the regular nurse had to help. I was so distraught I didn't care or mind. They hugged me, talk to me, spent as much time with me as possible and were always there when I needed. Like I said it was a horrible experience and complete shock. I had my 18week appt that morning and there I was losing my daughter. They made it bearable.

    When I delivered about 7 hours later both were there to help me, and then they gave us a long time to hold our daughter, take pictures, etc. We even bathed her and dressed her into the little clothing they give you. It was a package where you were given clothing, a blanket, some prayers, how to deal with grief, foot prints, etc.

    A couple of weeks later I got a call that they had also taken her pics and got them back and when I am ready to come pick them up. This is a free service the hospital offered which helped tremendously to deal with things. I left work at 12am one night and went to pick them up and one of the nurses sat with me in the room for almost 30 mins talking to me while I was crying (flashbacks)...


    Anyway, sorry the post is so long but I wanted to answer even though I don't have all the technical experience on the nurses's side, I thought it would be helpful to get the patient side of things so you can better understand that although it may seem like you make a difference because you cannot change the situation, you can.

    I am grateful for the nurses I had and I have alot of respect for them. I wasn't the easiest patient and the sounds of a baby being born sent me into tears and screams but... they were there and understood. They made sure the physical pain was not something I had to think about also because I just couldn't bare the reality and the pain together.

    Best of luck to everyone!

    PS. In front of your patients or paperwork they may see, never call it an abortion if it was not optional. Just my input.
    Last edit by Aly529 on Apr 11, '11
    fromtheseaRN, Elvish, Anderson11, and 3 others like this.
  8. 2
    Aly - I'm so sorry to hear of the loss of your daughter.
    I want to commend you on your posting to give the OP (and others) a view from the other side of the bedrails.
    The care you describe receiving from your nurses is a perfect blueprint for the kind of care anyone going through such a tragic situation should receive.
    I would like to add a note for caregivers - if there is a partner involved please remember that even though they are not going through the physical ordeal they are also experiencing a trmendous loss and need your consideration also.
    Anderson11 and Bella'sMyBaby like this.
  9. 0
    Thanks BagladyRN. I got to a point where it helps to share my experience. Thanks to everyone who read it. I think although it was a very horrible and traumatic experience it now makes me a perfect canidate to care for someone going through something similar and I definetly am pretty much an expert at PPROM now. I have read so many studies, books, forums that I could take a test on it.


    And yes, I agree. The partner or family do need some attention as well. My hubby didn't want to leave my side even though I wasn't even dialated 2 cm yet and the nurses tried to convince him to go and get coffee, a snack or something. He had just worked a 10hr shift when it happened so he was exhausted. He still didn't want to leave so they brought him coffee. Certainly not in the job description but so worth it. Its something I won't forget.
  10. 0
    Thank you for posting these questions! I am very interested to read through the responses and learn something as well! I go to a Catholic university and needless to say anything along the lines of abortion in my program is never spoken of! The nuns still have a great influence on how everything is ran from the money to the curriculum (as much as they can control with that). Several of my teachers are nuns, the dean of the university is a nun, they have a mother house on campus, and they even have a very large nursing home on campus for the nuns that have retired!


Top