Providing comfort when you lose a patient

quazar · May 10, 2016

It's normal to be scared of taking care of a perinatal loss patient, and to be worried about what to say/not say. I would say the best advice I ever received on the subject was that if you can't think of anything to say, or are unsure, simply saying, "I'm so sorry" is best, and then active listening/just being present with the mother is good.

While time may heal for some, to say that to a grieving mother is not something I would ever recommend and would absolutely caution against.

Usually, in my experience, I will say that students are not allowed to care for perinatal loss patients simply because of the sensitive nature of the case. It is something that is learned on the job, after you are hired to L&D as an RN. When that happens, the way you learn is through training (there are wonderful courses taught that will help) and through your coworkers. Usually there is a nurse on the unit who specializes in perinatal loss, and she is a wonderful resource. See if the unit you are going to has one of those, and if so, talk to her.

Best of luck to you. :)

nja06, MSN, RN, APRN, NP, CNM · May 13, 2016

Sometimes the best thing to do is say nothing at all. you can still provide comfort with your presence or by gestures that you do that are nonverbal. Some ways you can comfort parents without talking are making a memory box, or offering to take photos of the family and/or child Something you can actually say is a compliment such as he has such cute eyelashes or a sweet face. You can tell them how sorry you are for their devastating loss and that is usually all that really matters. Sometimes families want to talk about it and sometimes they don't. The best you can do is offer your time and support. Never say anything about a future pregnancy or time will heal. Be careful with the absolutes.

PoultryGirl17, BSN · May 14, 2016

Good advice already given. I'm a mom and student RN who experienced the stillbirth of one of my seven children, and have presented the topic on occasion to other professionals. And after dealing with other deaths at a fairly early age (my father died when I was 15, mom dx with BR CA when I was 19), I've always reminded myself when speaking to others that there is no perfect thing to say; NOTHING I can say will ease their pain.

This article makes a really good distinction between grief "comforter" (no such thing) and grief "supporter". The nurse is the latter. There are some good tips in it and is worth the read. What's your grief?Stillbirthday.com is a great site, too, with lots of stories from parents.

I highly recommend gently encouraging parents who initially refuse to see their babies (usually because they think it will hurt less) to have some time at least holding their baby (bathing and dressing is good, too). It will be the only memories they have. Of the parents who do refuse contact with their babies, many later regret that they didn't; this is something you many have to straight out tell them. Many facilities today offer wonderful memory boxes, scrapbooks, photographs, etc., which are all awesome and appreciated. This international organization also offers an invaluable professional, FREE, photography service that many hospitals now promote: https://www.nowilaymedowntosleep.org/

Some moms may not realize--primips especially, or even after a late miscarriage--that they will produce milk. Many moms find comfort in donating theirs to a milk bank, so please offer that information to them. Human milk is a gift.

My stillbirth occurred twenty-one years ago, but I still remember the kindness extended to me by the nursing staff. Everyone, including the nurses and doctor, cried quietly with me as they performed their duties, which made me realize that they were not hardened by previous losses and felt it with me. That was a comfort. The next day, my family doctor popped his head in my room, not realizing I had lost my son. He walked in and said, "Congratulations!" and immediately his face dropped when he saw my infant in my tear-soaked arms. He responded with remorse and apologies when he realized his mistake, but honestly, it certainly didn't bother me. It wasn't the outcome I was expecting, either.

There is one thing that stands out that I wish the medical staff could've understood better. I had given birth to my two previous babies totally unmedicated, and I wanted to do the same for this baby. It was an induced labour, and as I'm sure you may know, when the baby can't help the process, labour is often much slower (my second birth was precipitous, unexpectedly at home and unattended). The physician, having nothing else to help ease my grief on top of labour, kept pushing me to use demerol (this was a small, rural hospital and at the time, epidurals were only available during the day shift). I appreciated that he was trying to help, but my grief would've been compounded if I had not given that baby my same effort as my previous and future ones. I needed to feel everything about this birth, without the cloudiness of medications, because these would be my only memories. I understand that's not a very common reaction when about 95% of births in my area are medicated, but it was really important to me and he just couldn't seem to wrap his head around that. "Take the medication, you don't have to go through all this pain." Taking the medication would've made him feel better, not me. Not a therapeutic relationship. But he meant well.

Sorry for the long post. All that to say that there are a few excellent resources to help you feel more useful for your patients, and to remember that what we think is best for the parents ("take the meds") is maybe not what they need. I think it's wonderful that you care enough to ask about the topic so you can be the best support possible to your patients. I'm sure they will appreciate that.