I'm still a student (14 days to go) and am precepting on a L&D unit (as well as antepartum) in a hospital that has about 300 deliveries per month. We have had quite a few FD's under 20 weeks lately that have been admitted for induction. The most recent were 20 weeks (possible demise at 16/17 weeks) and 17 weeks (possible demise at 16 weeks).
I feel a pull towards these patients and have had great relationships with them during my shifts. I feel that I have the right things to say (or more aptly, the things NOT to say) and they have been very open and honest with me and have thanked me at the end of the day for my kindness.
My question for discussion is this .... most of the nurses on the unit seem "upset" that they are even on our unit (they would prefer they go to a med/surg unit) at this early time and most of them would rather not be assigned to these patients. I don't feel that they are treated very well but then again I'm very sensitive and feel some sort of "pull" to these patients. Are the nurses right? Should they be home or on a different floor?
Sigh ... this is an area that I may do more research on. Just these few experiences have made me want to know more and to be able to do more for these patients, mentally, as much as physically.
What are your experiences with this? Thoughts, comments and opinions welcome ...
I don't work in OB, but I believe that my hospital gives mothers who have experienced loss, an option of staying on the OB floor or going to another floor to be cared for. Usually they seem to opt to stay on the OB floor; in fact in all the years I've worked here I only remember maybe one or two women who have came to our floor after losing their babies.
When I was in nursing school, I volunteered to care for a woman who had just lost her baby. Very sad case; the baby was term, and early on in the pregnancy, the parents were made aware that the baby had LOTS of problems and most likely would not survive birth. She opted to carry the baby to term. Unexpectedly, the baby was born alive... she let out one cry, and then soon died. Very sad.
She stayed on the OB unit, and had a wreath on her door. My hospital puts wreaths on the doors of bereaved parents, and we also have special little white outfits that we put the babies in and take their pictures in, if the parents desire.
I love the wreath idea. Our parents dress the baby in whatever they want (if they wish).
z's I can relate .....what pains me, is my sister gave birth 6 mo ago to a baby due the day I was....it's so painful for me, even now. I can so relate to yoru pain, yet no one understands it, not even my dh. I hope I can use my pain to help others in the same situation and remember ALWAYS to be sensitive to their needs. I thank you for reminding me of this most important thing.
No words but thank you for acknolwledging my post BluEyes. ((((hugz))))
I can totally relate. I had a stillborn at 37 weeks last year and I remember the tightness in my chest and the stinging tears when well meaning family members of other patients asked me what I had. It was months before I could even see a baby out in public without crying. So yes, I believe a med-surg unit or a gyn only unit would be best.
Oh~ and I am pregnant again~ 24 weeks on sunday....=)
I'm so happy to hear you're pregnant again. Hopefully all will turn out as expected this time and you will be filled with joy and happiness. :)
I'm still a student (14 days to go) and am precepting on a L&D unit (as well as antepartum) in a hospital that has about 300 deliveries per month. We have had quite a few FD's under 20 weeks lately that have been admitted for induction. The most recent were 20 weeks (possible demise at 16/17 weeks) and 17 weeks (possible demise at 16 weeks).
I feel a pull towards these patients and have had great relationships with them during my shifts. I feel that I have the right things to say (or more aptly, the things NOT to say) and they have been very open and honest with me and have thanked me at the end of the day for my kindness.
My question for discussion is this .... most of the nurses on the unit seem "upset" that they are even on our unit (they would prefer they go to a med/surg unit) at this early time and most of them would rather not be assigned to these patients. I don't feel that they are treated very well but then again I'm very sensitive and feel some sort of "pull" to these patients. Are the nurses right? Should they be home or on a different floor?
Sigh ... this is an area that I may do more research on. Just these few experiences have made me want to know more and to be able to do more for these patients, mentally, as much as physically.
What are your experiences with this? Thoughts, comments and opinions welcome ...
I lost my son, Kyle, at 37 weeks. I had an emergency C/S, he was resuscitated and on life-support for 9 hours. After he died I was given the option to stay on maternity or go to a med/surg floor. I chose maternity. My husband stayed w/me in a room at the end of the hall and a tear drop was placed on the door to acknowledge our loss. During our stay we spoke to a couple of nurses who had experienced losses and the pediatrician as well as nurses who attended the delivery also came by to see us. This was all comforting and acknowledged the fact that we were still "parents" to our son. I think if I had been on a med/surg floor it would have compounded that feeling of loss for me, the fact that I didn't have my baby with me. Losing my son gave me such an isolated feeling as it was.
The following year we were back there and had our daughter. Several of the nurses and the pediatrician that attended Kyle's birth made sure they were there to attend our daughter's birth (a scheduled C/S) which really made the moment that much more special. (There was not a dry eye in the OR when my daughter took her first breath.) I do respect the fact that everyone does feel differently about where they would want to be after a demise and I think it is a good idea to give Mom's the option, whether it's less than 20 weeks or full term.
Being in L&D for 3 years & a travel nurse @ a few different hospitals, I've seen how different units deal with IUFDs. I am personally one of the nurses who don't like to be assigned to those cases b/c it's too emotionally draining for me and I'm always afraid I'm going to say or do something wrong. I have worked with nurses who's "calling" is to have these patients with demises. They have the passion and compassion to say and do all the right things. Theses nurses have been trained in RTS and do a wonderful job. Maybe you are one of those special people who will take wonderful care of these patients.
Also, we keep our demises on the unit and just d/c them home from L&D. However, they have to be greater that 16wks.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Being in L&D for 3 years & a travel nurse @ a few different hospitals, I've seen how different units deal with IUFDs. I am personally one of the nurses who don't like to be assigned to those cases b/c it's too emotionally draining for me and I'm always afraid I'm going to say or do something wrong. I have worked with nurses who's "calling" is to have these patients with demises. They have the passion and compassion to say and do all the right things. Theses nurses have been trained in RTS and do a wonderful job. Maybe you are one of those special people who will take wonderful care of these patients.
Also, we keep our demises on the unit and just d/c them home from L&D. However, they have to be greater that 16wks.
Well, really, no one likes dealing with miscarriages or fetal demises.......it drains all of us, particularly those of us who have had losses of our own. You won't go wrong if you tell them you are sorry and make yourself available to listen if they need to talk! That is a start. Most people having lost a pregnancy/baby want others to acknowledge the profound sense of loss they feel. Generally, you are not expected to "fix" anything; you just need to be genuine and available to them. Helping them work through the initial stages of denial/shock and anger, and making arrangements, if appropriate, for them to hold the baby, dress him/her, if they choose, and make some sort of burial arrangements, as well as offering to get in touch with clergy/priests as needed is also important. Just being there counts for most of us. Sometimes, even the nurses who specialize in such things, may need a break or are too busy to deal with a particular case so.....
Truly, every nurse who is going to care for these patients, whether they do go to med-surg or OB units, needs to be at least basically-trained on bereavement issues, and how to care for such patients enduring these losses. The worst thing for me, was the sense of isolation when not one person even acknowledged I had lost a baby/pregnancy. It was profoundly sad for me---made worse by people who saw me as a "surgical" case to deal with, no more. And I did not even have a private room to grieve or cry in....no.
My roommate was the ONLY way to say she was 'sorry"--- (they hear everything thru those little cloth curtains)----and that, to me, was a HIPAA violation, but that is another thread, isn't it. I just hope those of you who have these people coming to med-surg have them in private rooms. At least my roommate realized how badly I was off, emotionally. Sad, if you ask me, that no one else understood this but another patient.
It is never easy. There is never an exact place to "put" the people going through loss and on some level, the nurse assigned to the family also goes through a sense of loss. Some of us are a bit more sensitive to that and others haven't quite worked through their own pain. Some demise moms want to be near live babies. Some do not. The best thing to do is ask the patient. They will be grateful that you did.
Well, really, NO one likes dealing with miscarriages or fetal demises.......it drains all of us, particularly those of us who have had losses of our own. You won't go wrong if you tell them you are sorry and make yourself available to listen if they need to talk! That is a start.
Truly, EVERY nurse who is going to care for these patients, whether they do go to med-surg or OB units, needs to be at least basically-trained on bereavement issues, and how to care for such patients enduring these losses. The worst thing for me, was the sense of isolation when not one person even acknowledged I had lost a baby/pregnancy. It was profoundly sad for me---made worse by people who saw me as a "surgical" case to deal with, no more. And I did not even have a private room to grieve or cry in....no.
My roommate was the ONLY way to say she was 'sorry"--- (they hear everything thru those little cloth curtains)----and that, to me, was a HIPAA violation, but that is another thread, isn't it. I just hope those of you who have these people coming to med-surg have them in private rooms. At least my roommate realized how badly I was off, emotionally. Sad, if you ask me, that no one else understood this but another patient.
Of course it makes people uncomfortable to deal with FDs....and yes I know nurses who don't acknowledge the loss. I'm not one of of those nurses. I'm sorry no one acknowledged your loss....I take care of FD's, my point was, there are nurses whose passion is taking care of these patients.
I'm sorry you were at a hospital that didnt allow you the privacy poeple deserve while dealing with a demise. I can't say that I've worked at any facilities that had semi private rooms. I wasn't trying to offend anyone.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Oh, dear, I never, ever meant you are such a nurse. I don't mean to sound accustory. I am sorry if I made you feel this way.
Nurses like the ones I had are not "bad" nurses, in my book. They are people who have no training to deal with fetal/pregnancy loss, simple as that. But if they are going to "put" a "fetal demise" on any floor, they should at least have some one there who can handle the emotional aspect of caring for such people. The surgical/medical issues are the least of it---but what we all tend to want to concentrate on as nurses. It's very uncomfortable for us all; we all fear saying the "wrong thing". I am no different. It's hard to "break the ice" with any such family, even for me.
But, when nothing is said, it leaves a person feeling very isolated in the end. She feels no one can possibly understand or even care what she is feeling, and begins to feel she may be wrong to have such strong emotions at times.....it's hard to explain for me, the turmoil that goes on inside when you go through something like this. I hope you understand....
I remember someone here saying she lost a baby in the first trimester, in the ED,---is where she miscarried. I distinctly recall her account detailing how she had to lay on the gurney in her cubicle for hours, with the products of conception in a specimen container, within full view. How awful is that. Now, surely NO ONE meant to be cruel to her, but it was cruel nonetheless. People need to understand how emotional and difficult losing a pregnancy at any stage is, even in the earliest weeks.
It does the patient a grave disservice not to address the loss she and her family just endured. Just saying "I am so sorry" is a good start. Then, you take it from there.
I believe that the choice to remain on an OB unit or be transferred is ultimately up to the mother. My Mom experienced 2 stillbirths, and with my sister (the second) I was her labor coach and therefore much more involved than when she had my brother. She was placed at the end of the unit, and they also put a sign on her door to indicate that she had experienced a loss. For the most part, the staff was wonderful. Having been through a similar experience 4 years before, she knew many of the nurses and doctors and the hospital allowed us to keep my sister in the room with us the entire first day so that all of our family could see and hold her. However, there was one nurse that came in the following day, and seeing the baby hospital bracelets on the counter, picked them up and said "Oh, these need to be on the baby in the nursery." My Mom screamed at her "My baby is dead!" She asked that the nurse never be allowed in her room again.
It was such a horrible experience, and thank goodness for those nurses who were compassionate. I honestly wish that they had placed my Mom on another unit where she didn't have to see all the new babies and hear them cry, but I realize the value of having caring people who were experienced to help her through her recovery.
I want to work in L&D eventually, and I hope that my experiences will help me comfort those in similar situations. In the end, my Mom and Stepdad discovered that they are not able to have children together - a condition known as Anderson's Syndrome. My Mom was devastated, but 9 years later, I gave birth to my daughter on my sister's birthday and she said "You made a sad day a happy one."
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Thank you for sharing that with us, Jennee. I am always grateful for insights; they help guide me in how to take care of people in such situations. Thanks, everyone, for your insights and sharing. It's great to have such a forum to learn from one another.
This was my first chance to get back to the message boards and read the replies to my thread ... and, wow, what a response we received. It's wonderful to hear each persons experience and most of you seem to agree, as I do, that L&D is the correct place for them to be in most cases. As always, there are exceptions, and the patient should be included in these decisions so that they are placed on a unit that is most comfortable for them as they go through this process.
Thanks for the referral to RTS ... I wish they had classes closer to me ... I guess I will just have to figure out how to get out to a class when I can. We do have one RN who is RTS trained and she is exceptional, even coming in on her days off if she is available when there is a FD.
I'm touched by all of the personal stories here, especially yours, Deb. The strength and courage that you have and the graciousness that you show to all of us on this board is simply amazing. To everyone who shared their own story, thank you, you have given me more to think about and have broadened my previously "narrow" mind. :)
BETSRN
1,378 Posts
I love the wreath idea. Our parents dress the baby in whatever they want (if they wish).