Thoughts on working with a laboring patient with a deceased baby? - page 4

Hello. I was just curious to get some opinions as what anyone thinks of working with a laboring patient whose baby has died. How often do you encounter this? Do you tend to shy away from these... Read More

  1. by   Kyriaka
    We have a standard bereavement package made up of pictures and such. Some families don't want it and I just make sure they know that we will save it if they should change their minds.
    _______________
    This is a very good thing. My mother has the photos of my children in her attic. I havent looked at them. But they are there if I ever want to. And a lock of their hair also.

    So perhaps the packet could be given to a family member to keep. It would be a shame if the hospital ever lost the photos and the parent(s) wanted them later.
  2. by   Kyriaka
    Quote from CNM2B
    It still seems like in these scenarios that the patient should be able to decide how they want to deliver. I am not an advocate of c-sections for convenience, but this is one case where I would think there should be a choice.
    ____________________
    I agree. The woman may not want to be awake.
  3. by   Kyriaka
    Her baby died and they made her carry her for four days before inducing and delivering.
    ________________
    I had a great aunt who in the 1930's was about 4 months pregnant and they made her carry the full 9 months because they said if they induced it would be a violation of abortion laws!??
  4. by   Energizer Bunny
    Quote from Kyriaka
    Her baby died and they made her carry her for four days before inducing and delivering.
    ________________
    I had a great aunt who in the 1930's was about 4 months pregnant and they made her carry the full 9 months because they said if they induced it would be a violation of abortion laws!??
    These scenerios are just amazing to me! I still cannot believe that they made my Aunt carry her baby for days.....I would be seriously suing someone over that one. It was so hard on us...I cannot imagine how hard it was on her.
  5. by   Kyriaka
    Quote from CNM2B
    These scenerios are just amazing to me! I still cannot believe that they made my Aunt carry her baby for days.....I would be seriously suing someone over that one. It was so hard on us...I cannot imagine how hard it was on her.
    _________________
    What is really weird is that the Dr.'s told her that she might die from toxic poisoning, but well, they couldnt violate abortion laws.

    From what I was told, for the rest of the pregn. she knitted a little outfit for the funeral! Can you imagine putting someone thru that.
  6. by   TammyWilson808
    I have been an L&D RN for nearly three years and for the first time I cared for a woman whose baby died in utero at 24 weeks gestation. There was a large part of me to be busy with the paperwork and the necessary function of the process. That is the "nurse" part of me. My heart was another story...

    I initially walked into the room, introduced myself to my patient and the family and established a rapoir (sp?) with them. As my night progressed, in relating to this grieving woman, I understood my role clearly. I am there to provide emotional support, present both woman and father of the child with labor options and give them what they need---space to feel their loss. I felt my role is and always will be to these aching souls is to focus on this: their angel's presence, though brief with us, had a definite purpose. We not always aware of their purpose, but they are gifts to us just the same. And these precious babies are perfection, their physical bodies might not be, but their essence of who they are is perfection.

    I did share this with my patient that night---and I did share my tears of sorrow with both parents. I told her that the whole night I had a knot in my stomach and a lump in my throat and I felt her pain. But what I was feeling paled in comparison to what she was feeling and how her heart ached.

    I felt I needed to be professional in dealing with my patients and I know I am a good RN. But I also was dealing with another human being whose heart was full of pain. My gut told me that spilling tears with my patient was a good and empathetic thing to do. Not losing control kind of crying, but tearing is ok! And as an L&D RN, we are taught to trust our gut, our intuition---because it is usually the right thing to do.

    I did encourage my patient to have an epidural to diminish the labor pain after she decided to deliver baby vaginally. Also I did encourage the family to hold baby after being cleaned up and placed in a soft cotton flannel baby blanket. We have a friend of an RN I work with make baskets that baby's nameband, lock of hair, and clothing, etc. go into and the family can take home. We do footprint and provide the family with our unique baby birth certificate. The baby's cribcard with its footprints will in the basket as well.

    I have the best job in the world---and for the most part it's happy. And for the other, it's still very satisfying and rewarding. I wouldn't do anything else.

    Aloha,

    Tammy
    Last edit by TammyWilson808 on May 23, '04
  7. by   Kyriaka
    Tammy,

    May I ask where on the floor was this woman put. When my mother had me (almost 40 years ago) a woman's baby was born stillborn. She was put in a double room with a women who had a healthy baby. That poor women had to deal with happy visitors coming and going bringing gifts and such to the other women. For a whole week no less.

    Please tell me that that is not done anymore.
  8. by   TammyWilson808
    Quote from Kyriaka
    Tammy,

    May I ask where on the floor was this woman put. When my mother had me (almost 40 years ago) a woman's baby was born stillborn. She was put in a double room with a women who had a healthy baby. That poor women had to deal with happy visitors coming and going bringing gifts and such to the other women. For a whole week no less.

    Please tell me that that is not done anymore.
    Aloha Kyriaka,

    We have a beautiful five labor/delivery/recovery/postpartum rooms. My patient was put in one of the five rooms most separate from the two postpartum couplets we had that night. I have not seen a more protective bunch of nurses (I call sisters) of their patients than whom I work with now. They are my mentors and teachers. They have taught me how to cherish and hold sacred the women we care for. Really! Visitors are screened and only allowed by whom the patient chooses. She was craving chocolate and I was able to find some chocolate ice cream with chocolate syrup for her. Just spoil her rotten. And encouraged her to spoil herself when she got home and cradle herself with her very attentive family's love. I think the best came from that very sad situation.

    Aloha! Tammy
  9. by   Energizer Bunny
    Tammy, you sound like a fabulous nurse and your unit sounds like just the place I would want to be if ever in that situation. I think you are great!
  10. by   CA CoCoRN
    Quote from Browneyedgirl
    My aunt suffred through this 8 years ago. Two months after her oldest son was killed in a car crash, she gave birth to a stillborn child.

    The baby died in utero and the doctor induced her labor. She gave birth vaginally. I have never been able to understand, in situations like these, why the doctors do not do c-sections?
    Because in any situation, live or stillborn, a vaginal delivery is usually the LEAST traumatic.

    I have attended a few of these. They seem to come in cycles in our facility.

    The last one I had was last weekend. It was a 34 weeker by dates, but a 27 weeker by fetal development. Apparently, the fetus had been deceased for several weeks (her last prenatal appointment was in March, when she was ~26-27 weeks). Something had happened with her Medi-Cal and she was unable to continue receiving care. She said she felt movement up until 4 days prior to coming into the hospital (she'd begun bleeding). When she presented to us, she was 6 cm dilated. By the time she got to my room, after confirmation US, etc. the doc wanted Pit. I check all pt's prior to intiating oxytocin....she was complete, with fetal parts presenting in the vagina +2. I scanned her for presentation and she was double footling breech.
    The whole thing delivered with about 3 cycles of pushing. The fetus was completely macerated...placenta calcified and delivered alongside the fetus.
    I ALWAYS cry because no matter how it looked, how long it had been "gone", it was still her little life that could have been.
    The father looked immediately at the baby and dealt as well as could be expected.
    I work in a Catholic hospital, so there's a whole "routine" that goes along with the grieving process. I had to ask mom if she wanted to hold it. She was Spanish speaking, so I made sure that my associate explained to her what she'd see and that she didn't have to if she couldn't. She held her bundle for a couple of minutes. We're even supposed to take pictures so that if the family requests them later in the grieving process, they can get them.
    I did take Polaroids, but I didn't take the formal pix because the face of the baby couldn't be discerned due to the skin having peeled and "gathered" around his head.

    The hardest fetal demise I've had was the lady who was previous c/s x6, coming in for scheduled 7th c/s. We put her on the monitor and no one was home (baby died). All had been normal just the day/night before. On delivery, we saw it was a tight triple nuchal accident. The beautiful boy was so precious in his sleep like state that he would never awaken from.
    I cried the entire day. Selfishly, all I could do is be there for her, while at the same time thanking G-D that I had, at the time, a healthy beautiful 11 monther at thome. I went beyond rules by allowing her to be with baby for about 4 hours afterward. I did take photos of that baby. I can still see the face of that precious brown little boy with rosy lips as I type this and tears roll down my face. He was perfect.

    Things like that stay with you.

    I'm actually glad that I do cry when those patients are my responsibility. It helps me deal, and I hope, shows the family that they are not the only ones who feel their pain.
  11. by   VivaLasViejas
    It's been 20 years, but I still thank God for the compassionate doctor who did my C-section (my choice) when it was discovered that my second daughter was anencephalic. I was 25 years old, the baby was full-term, and I just couldn't wrap my mind around the concept that a child who was so vigorously alive inside of me was going to die, either before birth or shortly thereafter.

    After the surgery, I was mercifully placed on a general surgical floor, far away from the maternity ward and the happy moms with their healthy infants. The nurses felt terrible for me, and they went out of their way to spoil me (they actually fed me filet mignon for dinner, and brought me hot cocoa and tranquilizers at three AM when I couldn't sleep). I'll always be grateful for that, and I can't imagine how much worse the entire experience would have been if the staff had been judgmental about my not wanting to be awake for the birth, and not being able to handle seeing and/or holding the baby. I've wished many, many times that I'd been stronger then, that my daughter had passed away in my arms rather than those of a stranger; but I was so close to a nervous breakdown that I knew, even then, that I'd go right over the edge if I had to deal with everything at once.

    So I'm glad I had options, including the cesarean......and I've never forgotten the kindness of my nurses, who never once made me feel that I was weak, or that I wasn't doing things "right". Frankly, I still can't imagine suffering through the pain of an induced labor knowing my child was dead, or was going to die, and I admire those moms who do go through it.......they're better women than I am or could ever hope to be.
  12. by   Energizer Bunny
    Is there a time limit on how long the mother is allowed to be with her baby? Does this seem wrong to you if there is?
  13. by   Lefty26
    My sister Candace was still born. She died a day before her due date. The umbilical cord was wrapped around her neck. My mom delivered her the normal way and got to hold her afterwards. She named my next sister "Faith" because it took alot of faith and trust in God that the next baby would be ok....and she was. I always remember my mom talking about her alot. There was never any birth or death certificate issued to prove that she even existed.

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