Doula services for Fetal Demise, Miscarriage, Stillbirth

[SuzieQ_Scrapper]

A friend of mine and I (both OB RN's with over 15 years of experience together) are thinking about offering doula/labor support for women who are going to labor (or D&C) with a known demise, miscarriage or labor where the mom knows the baby is not compatable with life and chooses to give birth.

Are there any services like that out there now? We would like to talk to someone who has experience with the business end of this.

We are trying to figure out reimbursement for the services.

What we would like to offer is labor support (not as the nurse), answer questions about what to expect, emotional support for mother and father, etc. All the things the floor nurse wishes she had more time to do. We would offer follow-up services as well.

I attended a Perinatal Berevement Seminar recently and there was a panal of mothers who spoke about there loss. The mother that struck me the most, was the one that had a miscarriage. She had 3 D&C's and everyone treated her like it was "just a surgery" after each one. She just needed someone there to help her morn her pregnancy loss.

Does anyone know of services like this. What do you think of the idea.

Susan

[flytern]

I don't know if there is such a thing. Most labor doula's build up a relationship throughout the pregnancy. Unfortunately, with a loss there isn't much time before they come to the hospital and deliver. Sometimes they come right from the MD's office or from ultrasound.

In theory, it sure would make the labor nurses job easier. In my hospital, besides lots of written material, we have a support group led by one of our nurses. She makes follow up calls to our patients.....

[Jolie, BSN]

Wow! What a wonderful service to offer. I don't know of any such services in existence, but as a mother who experienced a loss, and a nurse who has labored patients with known demises, I think both patients and staff could benefit from your TLC.

[Jolie, BSN]

d

[BSNtobe2009]

I think this is a very good idea...I understand what you are saying. Many women who discover during their pregnancy that their baby won't make it early on, still decide to take the baby to term, if the mother's health isn't at risk, b/c they see it as an abortion.

I've only known one person that this has happened to, and I didn't know until after she gave birth that she knew at 21 weeks that her baby was developing without a brain. She carried the baby full, term had a normal delivery, but of course, the baby died minutes after the cord was cut.

I feel that there is a substantial need for this service...I felt so bad when I met her 4 months before she had her baby, saying, "You must be so excited!" She said nothing of what she already knew and just smiled. The postpartum and dealing with the pregnancy with this knowledge must be very difficult on a psychological level.

I wanted to crawl under a rock when I found out.

Yup, definitely a need.

[LizzyL&DRN]

I've never heard of such services available now, but I think it would be a perfect addition to services available to grieving parents. Maybe you could talk to a local social worker or some type of local government official. This sounds like a good cause for some grant money. If we can have grant money pay for Birth and Beyond classes why not this? I don't think it would be a service you could charge the parents for, but obviously a service that would require reimbursement. I hope you figure something out. It sounds like it might be complicated but definetly worth it to your patients. Good luck.

[dragonflyRN]

Renal agenis...need I say more?

[SuzieQ_Scrapper]

I don't know if there is such a thing. Most labor doula's build up a relationship throughout the pregnancy. Unfortunately, with a loss there isn't much time before they come to the hospital and deliver. Sometimes they come right from the MD's office or from ultrasound.

In theory, it sure would make the labor nurses job easier. In my hospital, besides lots of written material, we have a support group led by one of our nurses. She makes follow up calls to our patients.....

We thought about the problem of not always being able to build that relationship ahead of time. The hope would be, that the doctor's offices would call us first (before sending the pt to the hospital--obviously if not a medical emergency) and give us a chance to talk to them about what to expect and then accompany them to the hospital.

[MuddaMia]

Renal agenis...need I say more?

ummm, yes

[SuperFlyRN]

While I have nothing constructive to add except I think that it is a wonderful idea. Unfortunately I cannot think how to execute this but, wow, I know in our hospital this would be greatly appreciated. Nothing could be worse than on a horribly busy shift and you are trying to tend to everyone adequately and there is this laboring mom that needs all the support she can get-laboring and beyond.

A very thoughtful, and much needed service. Good luck.

[SuzieQ_Scrapper]

Thank you all for your words of confidence in pursuing this.

Here are just a few other thoughts we had. We have wondered if (obviously we could do a survey/talk to nurse managers in the area) hospitals might not be willing to pay us on a contract-for-services basis for our services. Obviously, if a pt has an excellent experience at their facility while delivering a stillborn baby or miscarriage, they will certainly want to return to that hospital to give birth.

Knowing that some inductions take longer than 12 hours (thinking of a recent induction of a miscarrige that took over 48 hours) my friend and I would/could alternate in 12 hour shifts. My friend and I are very similar in our approach to laboring mothers (we taught childbirth classes together for 8 years). We were thinking that we would split our shift in the middle of the hospital's normal shift (if the hospital does 7a-7p--we would do 1a-1p) to give some continuity to the care during that shift change. I know, as a nurse, I want to be 100% present for my mother's that are also grieving, but the staffing doen't always allow for that (when you add in all the extras like paperwork, pictures, the emotional toil, etc). This would give the laboring mother some real continuity of care.

Anyway, it is obviously in the very beginning/thinking/planning stage, but any suggestions anyone has we are willing to listen to them.

Thanks,

Susan

[tofutti]

With regards to bilateral renal agenesis, the fetus is usually stillbirth in more than 40% of cases while the majority of infants born alive usually die within 4 hours of life.

(baby has no kidneys)