How do you handle miscarriage/ IUFD?

Burnt Out, ASN, RN · Dec 16, 2005

Do you not have a RTS program at your hospital?

There is a lot of wonderful info at the MISS Foundation: they have an area for professionals and caregivers there as well. There is a chart about things that are helpful and are not to bereaved parents. Here is the link to the professional/caregiver area: http://missfoundation.org/pro/index.html

Maybe this will help you some.:) On behalf of bereaved parents everywhere, "Thank you" for wanting to be sensitive.

mstigerlily · Dec 16, 2005

This is a touchy subject for me. I lost a baby in the second trimester in the ER of our local hospital seven years ago and that experience really scarred me for awhile. I was not a nurse then, but I remember the one nurse who was kind to my husband and I.

I am now a postpartum nurse and recently this was brought up at a fetal demise inservice. I know that moms less than 20 weeks pregnant are not allowed to be on the L&D floor - and I understand that. We can't have every woman whose test has come up positive passing tissue and taking up beds on the L&D floor. I understand that. But 18 week fetus is clearly a baby, and the mom has most likely felt that baby move already, maybe even had a sonogram. I did - I was 16 wks, I'd had a sonogram just the day before due to mysterious bleeding but baby was alive and well and sucking his thumb. I still have the picture actually.

Anyway, even if the mom is only 6 weeks pregnant and the loss is nothing more than a heavy period, there is a grief process and I know that during my visit to eh ER, the staff didn't understand that. Once it was clear I wasn't bleeding to death they were done with me and made some very callous statements and I was sent home very quickly. To top things off, I was going through a bad patch in my life - lost my job, my husband and I had just started dating so this pregnancy was unwanted to begin with, and since I was jobless and without insurance I'd filed for Medi-Cal to help pay for the unexpected pregnancy and it had not yet been approved so I can't tell you how badly they treated me because of this. Like I said, out of all the health care staff who I met with that day, from the triage nurse to the PA, to the doctor, to the other nurses, there was one older nurse that was kind to me, actually took the time to put her arm around my husband as he cried, got teary eyed with him and brought my son over in a little box all cleaned up so I could look at him before she took him away. I don't remember exactly what she looks like, it's all a blur, but I wish I could thank her.

It would have been nice to have either a L&D or postpartum nurse come to visit me there to speak with. Or, a social worker that works on the L&D/postpartum floor to visit with the moms. It would have been nice to hear what to expect, danger signs to look for, when I would get my period, when to try again, how can I find it what caused this miscarriage (if anything). I know ERs are in a rush to get you out so I'm not going to be invited to stay for awhile. But someone to visit me (other than the person asking how I'm going to pay for my visit!!) would have been nice.

At our hospital, our fetal demise or late miscarriage patients (after 20 wks) stay overnight on the L&D or postpartum floor in a quiet corner away from crying babies to recuperate. We work with the social worker to help them recover from their grief and they have a brief postpartum stay just like everyone else (only more brief) - where they get abx if necessary, pain meds, fluids, assessments, etc - just like everyone else. I know that's not practical for everyone having an early miscarriage - and they don't need that. But again, a little more attention would have been nice.

That is lovely that you are so sensitive to their loss, esp at a time when you are so obviously pregnant. For all you know, this could be the woman's third or more loss with no live births and seeing you would be quite painful. Thank you for realizing that :) I guess to answer your question my advice would be to have a nurse or social worker who specializes in OB care come and assess or speak to the patient. Don't hassle her for money, even if she is uninsured - or at least wait until she's off the exam table. Tell her you are so, so sorry. Read the list of things NOT to say like "Oh well at least you have a baby already" or "You're young, you can try again" or "Oh it was just some tissue, not a baby yet". Let her talk a little bit about her feelings and let her cry. Take the five minutes to just do that - we know you are busy. But it really means a lot to the patient.

I often find myself at a loss when I have a pt in the ED who is told she is having a miscarriage. I don't know what to say, what's right, other than "I'm sorry".
Any advice? Words of wisdom?
I have been trying to steer clear of them lately though. I feel it would be wrong for an 8month pregnant lady to come in with discharge paperwork with the words "miscarriage" on it- talk about a slap in the face. :stone

SmilingBluEyes · Dec 16, 2005

Thank you for seeking knowledge on how to care for those of us who have experienced losses. I think it's great you care enough to ask.

I suggest you attend a class on perinatal loss/grief and how to deal with it, if at all possible. Too few ED nurses do or have, because usually OB handles this. However, as you have seen, these cases DO present in the ED often, and you are left to care for and deal with them---particularly if the loss occurs prior to 20 weeks' gestation.

Just being there, being earnestly caring and sensitive is important. NO trite phrases or words, please, to try and make a person feel better. Nothing you say can make her feel better. Just saying you are sorry and you are there if she needs to talk, and have resources ready for her to take home are critical. Really that is the best you can do. I know how busy the ED is----I know how pressed for time you all are. Just be there as much as you can and know what resources are available for the mom/couple experiencing perinatal loss--and offer to contact anyone they wish, e.g. minister, priest, rabbi, and funeral home, as appropriate. These things overwhelm them----try and take some of the burden off them wherever possible---and just be emotionally and physically present, like I said. That is the best you can do.

selulion · Dec 18, 2005

I lost a baby when I was 15 weeks pregnant. I am actually resentful of the staff at the hospital I went to for letting me suffer with horrible pain for about 4 hours, but I digress...anyway, I do remember a wonderful nurse who came in to talk to me. I did not want to hear "it will be alright" or "you will have a baby when it is meant to be", but she did not say that. She simply opened her heart to me. She told me she , too, had lost a child. She held my hand and told me it was o.k. to feel insurmountable grief for the child I lost. Basically, she validated my feelings and comforted me in the most wonderful way. I hope someday I can do that for someone.

tiffanycmt · Dec 18, 2005

When i was 16 i was having what i thought was my normal period however i started passing big clots of tissue and for some reason even though i didn't know i was pregnant before i knew i was having a miscarriage so i called the hospital and they said yeah you better come on in so i go up there and they give me a pregnancy test and it comes back positive. Well they do tests on me and confirm my miscarriage just a few days prior i had gotten the depo shot and they had asked me if i was pregnant and i said no im on my period which i was bleeding then lightly like i always did durning my period It just so happened that the same dr. that gave me my shot (very small town) was the dr that seen me when i was having my miscarriage and she had the nerve to ask me while i was crying my eyes out if that was an easy way for me to have an abortion to this day i'll never forget that and after she said that to me for a long time i felt like it was my fault even though i knew when i got the shot i didn't have any reason to believe i was pregnant so i'll i can say is that was the WRONG way to handle it and i think it's really great that you are so concerned about your pt's god bless tiffany

RaeT,RN · Dec 19, 2005

After reading this thread, my pt the other night was 29 weeks with twins, preeclampsia/CHTN and twin B had suffered an IUFD. Thank you so much for posting that link - it helped me to take care of her and I didn't feel as awkward as I might have before.

Dayray, RN · Dec 20, 2005

There is some very good advice already posted here. There are fetal loss classes as Deb said and they are very good things. They say some things that make allot of sense but that you might not think of until you have either been threw it personally or been to a class.

What I do is to just be there for the patient. Eye contact, soft touch and an expression of compassion are paramount. For a patient experiencing a loss it is invaluable for them to feel that others understand and empathize with their pain. All to often these patients are told "to look at the bright side" or that "it's really a blessing".

What they need is to have their feelings validated and be given permission to grieve for a child they never got to know. Also both parents (especially mom) will look for reasons to blame themselves. They think " I wonder if that glass of wine I drank did this" or "I bet it was because I walked up the stairs too fast". You must assure them (even if you're not sure it's true) that this was not their fault. Also many feel that it is a punishment from god for things they have done. It's important that you help them to feel that this is a random thing. Tell them that god would not punish them in such a way and that nothing they could have done was horrible enough to deserve this.

I always say things like "I am so sorry" or "this is a horrible thing I am so sorry this happened to you". I also reassure them that it's okay to cry and to grieve. Sometimes you might feel that you are making things worse by encouraging them to be sad but it is necessary for them to grieve in order to recover from the experience. Saying things like "your baby died, its okay to cry" feels uncomfortable but it helps them put things in the proper perspective. Without knowing the right thing to do it's easy to try and cheer them up but that's the worst thing you can do. If you try to cheer them up you are sending a message that it's wrong for them to be sad and that leads to feelings of guilt and hopelessness.

Once the patient has grieved they will find their own bright sides and words of encouragement. Attempts at cheering them up are like putting a toddler behind the wheel of a running car. They aren't ready for it and it will only cause harm.

Hold their hands, make sure they are as pain free as possible, always say "the baby" not "it" and above all listen to them. If you find yourself not knowing what to do, reach out , touch their hand and just be silent.

Danianne · Dec 20, 2005

I lost a baby too... the dr. just told me to buck up and these things happen. I snapped. I actually don't remember a whole three or four days after they told me the baby was dead. I was alone in a dark hospital room whe the actual miscarriage happened and I was terrified. All I wanted was a hand to hold and some one to listen... that would have been enough.

SmilingBluEyes · Dec 20, 2005

I do know, we never "get over" these losses. I still spend each holiday, wondering what it would be like with those children, at the ages they would have been now. I also feel it sharply on the day(s) they should have been born (EDD) and on the days I actually lost them. September is a horrible month for me, I have lost 3 that should have been due then.

The pain is as real as it was the days these losses happened to me. Handle with care, is all I can say. Dayray, excellent post, as always.

SC RN, RN · Dec 21, 2005

One of the reasons that I became a L&D RN was to help patients throught the trauma of miscarriages and fetal demises. And one of my deepest sorrows is that our hospital, as most, does not let any mother under 20 weeks come up to L&D for this loss. It kills me that a mother can miscarry at 19 6/7 weeks down in the ER, where the nurses hate OB cases even when they are healthy, and where the traumas take priority, and where it's loud and crowded with sick people and children ... I wish, wish, wish that they could come up to our floor to be taken care of. Because that is what they need more than medicine, they need to feel comforted and not alone. Maybe someday our hospital will allow a L&D RN to go down to the ER and talk to the mother (and father and family). Just one more thing to put on my list of things I'd change if I were in charge.

My heart breaks for those that felt so alone in the ER. Please know that there are nurses who are thinking of you even when they can't be with you. For those nurses who wish to learn more and help these patients, RTS is a great program/service and we utilize its components with every fetal demise we take care of. Not only that, but my mom knits hats and blankets to give to the parents after pictures have been taken of the baby wearing the items (my mom makes two sets so that the parents get an exact replica of what the baby wore in the pics). Not many parents have clothes for a 24 week old baby and this gives them something "tangible" to take home with them.

Aneroo, LPN · Dec 21, 2005

What is RTS?

I'm an ED nurse, so I don't believe we have anything like that down there (that I've heard of). -Andrea