Thoughts on working with a laboring patient with a deceased baby?

Specialties Ob/Gyn

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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 patients (if you have any choice in the matter)? Do you encourage the mother to hold the baby?

I don't work in labor and delivery, but I have delivered a stillborn and had excellent nurses take care of me. I was just wondering what some of you thought.

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 lady partslly. 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 lady partsl 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 lady parts +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.

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Specializes in LTC, assisted living, med-surg, psych.

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. :o

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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?

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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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Specializes in Clinical Risk Management.

My SIL & my brother experienced this tragedy a few years ago. I was present for the birth. It was a horrible experience overall for my SIL. She labored naturally & had little pain relief. My brother & I held my nephew for a time afterward. My SIL wasn't up for it.

Three months later, a friend at work gave birth at our facility. The child died a few hours later. I'd never seen a code on a newborn before...never want to see it again. My friend blamed herself for her child's death...and then the hospital gossip afterward, my word, it was terrible for her!

Both events have, naturally, left their emotional scars on all involved. My friend has had another child. My brother & my SIL have yet to conceive again. These memories still bring tears to my eyes.

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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?

We've never limited the time a woman spends with a deceased child. I can remember one case in particular where we were DESPERATE for a bed and we actually sent a healthy laboring woman out of town to another hospital and another pp patient to a surg unit and her baby to the NICU rather than rush a woman who was holding her dead child to get off the floor. I think that was the one moment in my career that I am the most proud of.

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There's generally not a time limit, per se, but there is a time limit on the fetus depending on the age of the fetus at time of birth. A full term baby will "last" longer and not start to get "weird" to the parents longer than a pre-viable- or more preterm fetus.

Unfortunately (or fortunately depending on how you look at it) the 27/34 weeker which had been deceased for a while in utero was already deep into the process of decomposition. That fact helped the family to understand why we had to get the baby to the morgue and to the refrigerator. And also since it was less "baby-like" they were less inclined to want to hold on to it longer in their room.

However, the full termer who was delivered by rep. c/s...as I said, I let that baby stay in the room for about 4 hours. That's longer than our unwritten policy...but I felt it was necessary since it was such a shock. And since that baby had passed only hours before, it hadn't yet begun any obvious (to family) decomposition.

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We've never limited the time a woman spends with a deceased child. I can remember one case in particular where we were DESPERATE for a bed and we actually sent a healthy laboring woman out of town to another hospital and another pp patient to a surg unit and her baby to the NICU rather than rush a woman who was holding her dead child to get off the floor. I think that was the one moment in my career that I am the most proud of.

And so you should be Fergus!

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I should have said I was proud of the whole group. The unit manager never complained about having to transport a woman out. The hospital that received her never complained about having another patient. The PP nurse never complained about having to go to the surg unit to assess the woman there. The NICU never complained about having a healthy baby to look after. And neither family complained about the situation. All we had to say was "We have a family who have experienced a loss and they need the room for the time being". It was comforting to see how people can pull together.

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Fergus, I hope you don't think I was being sarcastic. I guess I assumed you meant your whole group. I think it was fabulous!

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No, I got ya, I just thought I should add that bit.:) I have worked at a number of hospitals since becoming a nurse, but none of them compare to that hospital as far as teamwork went. The nurses there were amazing and focused on what was important (patient care and taking care of eachother!) and I miss them.

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Specializes in Women's Services, Dialysis.

My brother and his wife lost their baby yesterday. this was her 7th pregnancy with only 2 children that she has carried to term. The baby was due in September. The hospital kept her in the labor/delivery/recovery area for her entire hospital stay. The nurses seemed very accomodating and sweet...yet, one called down the hall to shut the door because they were rolling to delivery with someone else. and a few doors down we heard the healthy cry of a newborn. SIL lady partslly delivered her 1 lb 11oz baby yesterday evening..sometime after 6 and left the hospital around noon today.

I will be attending a funeral Tuesday. Please if you pray.....remember our family.

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