About 2 months ago I started working as an OB nurse on an antepartum unit. We mainly care for moms experiencing a high risk pregnancy, a few postpartum moms and the occasional GYN patient. Recently though, we have had a few mothers whose babies were stillborn. These moms are almost always placed on our unit since it's emotionally easier for them to not be placed on the routine PP floor with the mothers and their healthy babies. I am having a hard time figuring out the best way to care for these mamas. I meet all of their physical needs but as far as knowing what to say and how to address their loss, I am finding myself struggling with the right words. Nothing seems appropriate and I almost feel when I do talk with them about it that it makes them more sad/upset. Does anyone have any advice on how to care for these mothers? Everything seems so insignificant in contrast with their colossal grief.
The first IUFD I had (just a few weeks ago), I had to go and get the baby's body out of the morgue because Mom and Dad wanted to spend some extra time with him. I will never forget that sweet little one's face as I wrapped his tiny body in a blanket, put a handmade hat on his head, set him in a basket and tried my best to fix him up to be presentable to his parents that he will never know in earth (it had been a day since delivery and death was really setting in). Tears streamed down my face as I prayed over him and told him I was sorry this happened to him. It was heartbreaking but I knew I had to pull it together before I walked in to hand him to Mom and Dad. I think I will keep that memory with me for a long time.
Please feel free to share your stories and advice for dealing with these situations. This is all new territory for me and I'm sure it will get easier as time goes on and I have more experience, but right now it is very difficult.
I had a stillborn daughter in 1987. Still hurts to this day. There was nothing anyone could have said to make it better. As said previously, let the patient guide you.
OP, you have some really good advice above. As an L&D nurse, I deal with everything from miscarriage to fetal demise to neonatal death fairly often. The points below are a few things I have gleamed over time.
(Please note that as previously discussed, these measures should be gauged based on the response of the parents and/or their expressed wishes for how they want to be approached. With little exception, however, parents will appreciate it if you take the steps below).
1. Refer to baby by sex if possible. Use the appropriate pronouns (he/she) and try to avoid calling baby "it" as this dehumanizes baby and also reinforces that baby is deceased (most people would never call a live baby "it"!). If the sex is ambiguous or undetermined and you feel comfortable doing this, ask mom if she thinks baby was a boy or girl. Sometimes, mom and dad will already have been referring to baby as one sex or the other. See if you can get onboard with that trend.
2. Refer to the baby by name if possible. Some parents will choose not to name their baby, so keep this in mind if you inquire as to baby's name. Be ready to turn on your heel and validate the parents' decision not to name the baby if this is their choice.
3. If you are physically handling baby, treat baby like you would any other infant. Talk to baby, hold baby like you would any other, comment on baby's clothing, etc. One of my coworkers lost her baby at 36 weeks and still remembers that the nurse caring for her patted her baby's butt while holding her--a small but almost unconscious reaction to holding a baby. This not only models healthy bonding for the parents, but it reinforces that even though baby is no longer living, baby is still a baby.
4. If appropriate per the parents and you feel comfortable, I would argue that praying with the parents or making comments of a religious nature is completely acceptable. Again, take your cues from the parents. Let them initiate that kind of discussion or activity. But if they are looking for that kind of connection from you, that can make a huge impact not only in their care, but their overall experience. I still remember the people who were brave enough to look me straight in the eye in the midst of my grief and tell me, "I know this is horrible, but it's going to be OK. The Lord has your baby safe and sound." Those were some of the most powerful and positive experiences I had in the midst of my miscarriage.
5. Try to support mom and dad in their decisions, but also help them see through their fear and into what they might someday want. As an example for this rather ambiguous suggestion, if mom and dad don't want to see the baby after baby is born, try to gently offer options such as pictures, clothing, and other mementos that they may want in the future. Sometimes, fear of the unknown and grief can keep parents from really understanding what they're giving up by declining to see/hold/interact with baby. In presenting this discussion to parents who don't want to see baby, make sure you explain your motivation--you're trying to make sure that they as parents don't miss out on something they might regret later. Some patients (especially if they are really bonded to their nurse) will do whatever the nurse tells them to do, even if they don't want to. Make sure you clarify--even if you have to outright say it--that you're looking out for them and you have no dog in this fight. Be respectful of course, but also make sure you leave the door open to seeing baby later as it's fairly common for parents who initially don't want to see baby to change their minds (at least in my experience).
6. Springboarding off #5, if mom and dad are hesitant or nervous about seeing baby, be there with them to help them through. Understandably, some parents are really afraid of what they'll see, especially if baby isn't newly delivered. Help them to see baby as a little person. Point out those tiny hands, the little feet, the nose that looks like mom's, the eyes that look like dad's, etc. Sometimes, nursing plays a huge role in not only helping parents bond, but helping them to see their deceased child as one of their own.
7. Ditto, ditto, ditto the advice about what not to do: don't say it wasn't meant to be, it's ok because they can have another, etc. Acknowledge the uniqueness of both baby and the loss thereof. I think losing a child in pregnancy is such a personal thing that other people sometimes have difficulty understanding it as losing an actual human being. There is something about being born and being a known entity that frees you from this misconception. After all, you'd never console someone who had just lost their 4-year-old by saying, "It's OK--you can have another one!"
8. Make sure the parents know it isn't their fault. Many women will have serious identity questions to answer after a loss ("Who am I as a wife/girlfriend/woman if I can't have live children?"). It sounds a bit archaic in this feministic culture to ask those questions, but the bottom line is that the responsibilities of pregnancy and childbearing still belong solely to women, and even as much as we value our freedoms and our rights in this country and this era, the inability to perform what are considered basic functions of being female still has the great potential to cause a lot of confusion and distress.
9. Keep in mind that addressing mom' s emotional distress can help assuage her physical pain, too. I've seen on many occasions where physical pain (which there's plenty of in a miscarriage or fetal demise) is amplified and compounded by the emotional distress of loss.
10. Finally, if mom and dad are open to it, ask them if there is anything they want or don't want to have happen in their hospitalization. Ask if there's anything that hasn't been done that they want. Ask if there's anything that they don't want that they're concerned will happen anyway. As much as possible, just like in a live birth, tailor the experience to the desires and needs of the parents.
11. If you do say something that was taken incorrectly or insensitive, be the first to apologize. Those parents will probably remember you the rest of their lives, but they will really, really remember you if you say something thoughtless and either refuse to own up to it or choose to ignore it. To this day, my husband and I still talk about the ultrasound tech and the midwife who were with us when we found out our baby had died. The midwife was a sweetheart and very nurturing. She was adept at not only empathizing with us in our grief, but guiding us gently through the reality of losing our child. On the other hand, my husband still refers to the ultrasound tech, who was cold, correcting and rude as "the *****".
You have such an incredible opportunity to help these patients through something that, for many of them, will be one of the hardest experiences of their lives. All the best to you, OP. Thank you on a personal note for caring enough to ask for advice. You are already an asset to the patients who will come your way!
Try to remember to be sensitive to the dad's loss as well. Many times I see not just medical personnel but family and friends concentrate so much on the mother's grief that the dad sort of gets lost in the background. He often needs the message that someone acknowledges the enormity of his loss as well and that he doesn't have to be "the strong one".
A lot can be addressed in your discharge teaching. When you're talking about dealing with breast engorgement, especially if she was planning to breast feed, an opportunity may arise. It will arise when talking about PP depression, you can warn her about reaching her due date, the first Mothers Day or whatever and how that may bring an unexpected grief. Resolve Through Sharing is an organization dedicated to helping families with the loss of an infant and has good in hospital resources. If yours isn't involved, check it out and perhaps you could bring it into your facility.
A lot can be addressed in your discharge teaching. When you're talking about dealing with breast engorgement, especially if she was planning to breast feed, an opportunity may arise. It will arise when talking about PP depression, you can warn her about reaching her due date, the first Mothers Day or whatever and how that may bring an unexpected grief. Resolve Through Sharing is an organization dedicated to helping families with the loss of an infant and has good in hospital resources. If yours isn't involved, check it out and perhaps you could bring it into your facility.
Along these lines, some mothers of late term loss infants find healing in breast milk donation. Tread carefully when you consider mentioning this, as that may be something that offends them.
Future pregnancies will be terrifying to these moms. Every day will have some level of fear, second guessing. While pregnancy is so joyous to those who haven't experienced this loss, those who have experienced it live with constant hesitation to enjoy the pregnancy at all. Some find relief at learning the next pregnancy is with a baby of the opposite gender. Every milestone will be a reminder of what they lost the last time they were pregnant. And, they may feel this every single pregnancy thereafter.
Again, yes, yes, yes to all of the above. Make sure your hospital has a system for identifying moms in these rooms. In my workplace, we put a flower with a teardrop on the door so everyone from the housekeepers to the dietary folks to transporters know what kind of situation they're entering when they walk into that room, especially because it isn't your usual for our L&D/antepartum unit.
A small consideration but an important one--in the course of rendering non-emergent care, make sure none of the staff going in to that room are pregnant. We've had this issue lately on our day shift. We've had a high number of demises and every other nurse on days is about to pop. It's tough to make assignments and it can be tough to render non-emergent care that way (looking for a non-pregnant nurse to help with a repositioning, etc), but it can be so painful for that grieving couple to face head-on what they've lost, especially that early, though even after time has passed, sometimes that pain will rear its head when you least expect it.
Even a year after miscarrying, I still feel a twinge of anger and jealousy when I see my friends go through pregnancies that result in live babies. I don't wish any harm on them or anything like that; it's just painful and a hard reminder of my own loss when I see all that happiness that I didn't get. Like a previous poster said, make sure mom and dad are both aware that there will be things that they are sensitive to after their loss that probably wouldn't have bothered them before.
As another example, a few weeks after we lost our baby, my husband and I were at a social gathering where a man was telling the group about seeing his baby's heartbeat on the ultrasound for the first time at 10 weeks. At 10 weeks at our first ultrasound, we found out our baby had died a few weeks earlier. This man described his child and this incredible experience as a nothing more than a "blob on the monitor with a heartbeat". I was so offended. How dare he so casually discuss his living unborn child? How dare he take for granted what my husband and I didn't get? How dare he diminish the experience like that? Of course, that isn't how he meant it, but that's how I took it. I was so livid at his flippant description of his living child that I nearly came across the table at him. Thank goodness my husband has quick reflexes.
As much as you can, prepare your patients--let them know that they may experience the same moments of unexpected anger, grief, sadness, and loss. Other people's joy will be painful to them, sometimes even years later. Take steps to shield them from direct exposure while they're under your care and reassure them that it will get easier.
There are so many resources out there, too, and it's important for many people to be involved with other parents who have lost. No one understands you like someone who had a similar experience. It also helps ensure that if people are having difficulty grieving or are experiencing an unhealthy level of depression that someone is likely to notice and help that person or that couple get the help they need.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I can verify the horrible feeling you get when you have a lost pregnancy and NO ONE mentions it. I had one some years back and was put on a med-surg floor as overflow. NOT ONE person mentioned my loss or how sorry they were. ALSO to add insult to injury, I was in a double room and my roommate overhead enough to know I had lost a pregnancy. She was the only one who said she was sorry. I appreciated it, but would rather not have had a stranger AND her family privy to my private pain.
It hurts when NO ONE acknowledges you had lost a baby and in suffering that loss, your future, hopes and dreams are lost to you at that time, too.
I had a stillborn in 2008. For *me* it was my own personal hell as we'd tried for YEARS to get pregnant with her. Pretty much everything anyone said to me went in one ear and out the other. The only thing that stuck with me was the physician coming in and asking, "So, what do you want us to do with the products of conception?".
That. That one sentence did it. I understand he was uncomfortable, as many people are in those situations, but to try to back so far away that you end up saying something like that will stick with someone for years. It still infuriates me when I think about it.
So, I guess my advice/takeaway is to just acknowledge that the baby was a real person whom those parents loved with every last drop of their soul and understand that nothing you can say will ease that pain. Just being there silently can be a comfort.
Taken care of many many families after losses at gestations from early 2nd tri to full term. It sucks, and it's horrible, no two ways about it.
Every patient's grief and situation is going to look a little different so don't be upset or too hard on yourself if what worked in one situation does not work in another. Some patients will immediately take you up on your offer to see the baby. Others will be absolutely adamant that they don't ever want to see. It's ok to ask, and it's ok if they accept or decline.
If there is any way at all your floor can make a memory box for these families, I highly encourage it. We make hand- and footprints if the baby's condition will allow. We dress the baby in a tiny hat and blanket and take pics....if at all possible we try to get closeups of hands and feet. The hat/blanket, foot- and handprints, cord clamp, and plaster mold of feet all go into a little memory box that parents get before discharge. I used to take the pics and put them in an envelope and put it face down in the bottom of the box. That way if the parents really didn't want to see any pics there would be no way they'd accidentally see them, but everything would be there if they ever changed their minds and wanted to see.
It's absolutely ok to cry with families. The key (and this will come with time) is to not fall to pieces and be nonfunctional, but it is absolutely okay for families to see that you care.
One other thing which has already been alluded to is to support this family spiritually. Offer the hospital chaplain, or if they prefer their own clergy, that should be allowed as well. They may not have any specific religious belief, but it's important to help them incorporate this life into theirs in whatever way is most meaningful to them.
Remember that in the first few days some families may be numb. They may not be very teary because they're on autopilot. Every reaction is normal. If a person isn't crying that's ok.
To the poster who mentioned fathers, thank you. Grandparents may need support too, but fathers most definitely. One of my most profound experiences ever as a nurse was after a father held his dead baby in a separate room (not in mom's room by his choice). After he was done and I walked back into the room to take the baby down to the morgue, if I live to be a hundred I will never ever forget the sight of the wet marks all around where this baby lay from the tears that had fallen over him from his father's eyes.
From personal experience as someone who has lost a baby, when you mention the baby and they start crying, it's not because of anything you've done. Their grief is bubbling so close to the surface, it doesn't take anything at all to make it spill over. You aren't 'reminding' them of their baby. No one could ever 'remind' me of something that I hadn't forgotten. If anything, it was a relief when people asked, because it gave me an outlet when it felt like the world had gone on without me and my lost baby.
Kudos to you for wanting to take good care of your patients. If you genuinely care, patients will pick up on that and it will go a very long way.
I just wanted to share this list from the organization Now I Lay Me Down to Sleep. Much of this is tailored towards friends and family members of those who have suffered a loss, but I think it is good to put this information out there. This and the MISS Foundation are excellent resources for families and caregivers. This topic is very near and dear to my heart.
I too lost a child quite far along in to my pregnancy. I was lucky enough to be at a hospital that had excellent perinatal palliative care resources and supports, even though this took place in the early 90s. Ixchel and others have given excellent advice. For me personally, having the nurse acknowledge my daughter, say her name, and encourage me to spend some time with her was critical. It also helped that I knew she did not pass alone. I had an emergency c-section that went bad very quickly, so while she was born alive, she passed in the NICU without me there.
I cherish the photos, hand molds, and photos to this day. When I delivered my living daughter at the same hospital a couple of years later, the nurses remembered me and presented me with a beautiful bouquet of roses.
Leaving the hospital without my child, having to stay on the regular PP unit, and my breastmilk coming in where the hardest moments. I appreciated the education that I received that was both compassionate AND direct/matter of fact. I'm someone who doesn't like a big fuss made over me, and wanted as many of the medical facts as I could get. Never be afraid to ask the patient what they need; give options, etc. Active listening, letting the parents process their experience out loud can be very helpful.
I have lost my mother, my grandparents, my best friend, and a brother, and there is no loss that comes close to the loss of a child. I went on to volunteer as a parent advocate, a NICU volunteer, worked as a family counselor, and am now a nurse. My experiences changed the entire course of my life; I had been pursuing a law enforcement career until my daughter died. Thanks for taking the time to seek out information...and so many kudos to all the amazing posters here who have provided information and shared their experiences.
Hoosier_RN, MSN
3,968 Posts
I had a stillborn daughter in 1987. Still hurts to this day. There was nothing anyone could have said to make it better. As said previously, let the patient guide you.