Dealing with maternal death

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Hi

This is for all the OB nurses out there. I have been an OB nurse for a couple of years and had my first death of a patient this month. I have cared for many fetal demises and neonate losses but never have I been personally involved in the care of a patient who dies. Without breaching any kind of privacy I can say that this patient was young, did not have any co-morbidity that we often see with maternal death and the death was very unexpected. I have worked on med surg floors where patients have dies and done comfort care, but this death is hitting me very hard. I think that one of the biggest factors is that I bonded with the patient and laughed with her for days. But I also have a lot of anger about her death. All of the hospitals investigation has come up that there is no problem with our processes and that there was no way to save this patient. I do not feel like this is an accurate representation and administration did not invite nurses to be part of the process review. Our directors represented us but did not really consult us prior to the meeting. I had concerns about the patient on her 1st post op day which I shared with the on call doc. He literally laughed at me (not meanly) but was completely dismissive of my assessment and told me the patient had gas. I did document this and followed his orders and encouraged the patient to follow his orders. She did not. In fact she was almost completely non compliant. I was frustrated with this and had a hard time with her not listening to the advise that I gave her. After her death I feel like I could have done more to make her understand why she needed to follow our recommendations.

I am also very angry that the last time I took care of her my patient load was so heavy that I did not then nor do I now feel like I was able to properly care for her. This is not a case of failure I think as she had many reassuring signs after this night and was due to go home two days later. Her family has expressed to all the nursing staff and our director that they thought she received excellent care. I do believe that to be true but I can't help but look back and feel an enormous amount of guilt about her death. I had a gut feeling days before and I am so mad that I was not more assertive.

Has anyone else experienced a traumatic maternal death? How do you cope? How do you stop treating all patients like they have some hidden medical problem and want to overassess everyone?

Any advise would be helpful. Thanks.

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Specializes in Hospice, LTC, Rehab, Home Health.

Not an OB nurse but had to reply just to tell you that all unexpected deaths carry a certain amount of "what could I have done differently" with them. Please see if you and any of your coworkers can access your hospitals EAP program to connect with grief counselors or similar assistance. You and your coworkers need to support each other through this process also. My condolences to your patient's family and to you and your coworkers. ((((((hugs)))))

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Not an OB nurse but had to reply just to tell you that all unexpected deaths carry a certain amount of "what could I have done differently" with them. Please see if you and any of your coworkers can access your hospitals EAP program to connect with grief counselors or similar assistance. You and your coworkers need to support each other through this process also. My condolences to your patient's family and to you and your coworkers. ((((((hugs)))))

Thank you for your post. I am going to go to a counselor on Monday as I am not coping well. I find myself crying at home but numb at work. We did have EAP come out with pastoral care and run a stress debriefing for us. I was surprised that even experienced ICU nurses were having trouble with this loss. I know that the feelings of guilt are normal but the thought that I could have contributed in any way to saving her or not preventing her death is so overwhelming.

Thanks again for reading and responding.

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What did she die from?

Is it something that could have been prevented by anyone?

If not, no reason to feel guilt.

Take care.

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:crying2: i'm so sorry. we get attached, even when we don't mean to... for what it's worth i admire OB nurses so much. i could never do L&D or postpartum...it's usually very good but when it's bad it's so very very bad! you are truly invaluable. let yourself cry it out in a safe place, grief is a natural process and it does help...when i lost a close member of my family to cancer i spent alot of time alternating between crying & throwing things like pillows angrily against the wall...it really did help. HUGS
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Allow yourself time to grieve, but keep moving forward. All losses are difficult, unexpected ones even moreso. Doesn't matter what unit you work on; we all wonder 'what if' and you will, too.

Sometimes it's hard for others' to really listen, and the message just doesn't get across.

That does NOT reflect poorly on you; I am sure you did your very best to get heard.

Speak to someone about your grief and anger as it may take a while to resolve your issues.

Best wishes.

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Specializes in OB/GYN,PHN, Family Planning.

I was the charge nurse that evening when we had a maternal death. This was over 10 years ago but I will never forget it. It was not my patient but she was young healthy and went fast after delivering from an amniotic embolism. Nothing anyone could prevent. The whole maternity floor was affected and had several group counseling sessions. Her doc also was affected and took a leave of absense- it really hit him hard. I think a maternal death hits everyone harder because 99% of the time these are healthy women who come in to deliver and go home a few days later. Except for fetal demises- labor and delivery nurses are not around death. I think that's why we work on the maternity floor -generally a "happy" floor. So when a devastating event happens it takes us longer to move on. As I said, I still remember that night vividly and probably always will.

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Specializes in Hospital, med-surg, hospice.

Death is always hard for nurses especially with young patients, it sounds like she was fortunate to have you assigned to her and that you did all you could; I will keep you in my prayersand know that we understand; this is a part of nursing that the general public cannot comprehend :heartbeat

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Specializes in ER.

I don't think a few details here would be violating any privacy rules.... what was her death cause? SBO, PE? You hinted at gas pain, was she vag delivery or section? If she was surgical, I'd have all sorts of ideas of death, but with a patient being young, you'd never expect this. I know with OB (never having worked that type of nursing beyond my ER and personal experience) there are many risks, but sounds like she was fine (post op, I think you wrote), did they tie her tubes? Perf?

It's hard not knowing more details. I'd want to be involved in the discussion if I was involved in her care. You all should be involved in a critical incident stress debriefing as well. Good that you're using your EAP. I'd discuss w/ other staff that was there that night/day who was involved in the case. It helps to purge those thoughts, what ifs, etc. It's very helpful because they have gone through the trenches with you on this. Know that your feelings are shared and you're not alone.

Good luck and take care. I don't think dealing with a young person's demise is anything you ever get used to. She did have some days with her newborn and the family has the child to give some piece of her back to them. It is so tragic and unfortunate. It's a reminder that having a child is STILL the most dangerous thing we do in our lives.

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Specializes in ER, ICU.

That whole situation is awful but sometimes patients die despite our best efforts. Stop beating yourself up. It sounds like you did everything you could in that situation. There is nothing wrong with grieving and best of luck finding a way to move on.

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Thank you all for your replies. The patient was a C/S patient who died of surgical complications. She had pain complaints but was also somewhat non compliant so gas pain was the assumption. I just feel weird about putting more details out there. I have participated in a critical staff debriefing but it only involved nursing staff. I am not sure why but it feels like there would be more closure if we could all hear the MD's side of things. I know that there is some frustation with waits for surgery consults,etc. It is most certainly not a blame game but I know that nursing has expressed that concerns were not heard.

This is just difficult and I know that I need to give it more time. I feel like I had finally reached a comfort level with nursing and felt confident in my assessment skills. I have just been feeling like a new grad again and constantly second guessing myself. I am sure some time will make this feel a lot less horrible than it does at the moment.

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I was the charge nurse that evening when we had a maternal death. This was over 10 years ago but I will never forget it. It was not my patient but she was young healthy and went fast after delivering from an amniotic embolism. Nothing anyone could prevent. The whole maternity floor was affected and had several group counseling sessions. Her doc also was affected and took a leave of absense- it really hit him hard. I think a maternal death hits everyone harder because 99% of the time these are healthy women who come in to deliver and go home a few days later. Except for fetal demises- labor and delivery nurses are not around death. I think that's why we work on the maternity floor -generally a "happy" floor. So when a devastating event happens it takes us longer to move on. As I said, I still remember that night vividly and probably always will.

I know exactly what you mean. It's the highest highs and the lowest lows. It just feels so wrong for it to be 2011 and women still die in or from childbirth.

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