How many fetal demises in a month?

NawtyNurse69 · Mar 3, 2011

I think you are looking for answers that no one can give....

The information you are looking for is dependent on so many different factors... the facility you will be working for, the patient population etc.

Fetal demises happen for any imaginable and unimaginable reason-genetic issues, cord accidents, abruptions, preterm labor, or just randomly, and no one ever knows why.

If you decide to work for, say, a hospital that has a Level 3 NICU, you will likely see more bad outcomes, than, say, a hospital that has a Level 1 nursery. However, that doesn't mean you won't experience 3, or 5 or 8 demises in one month over the course of your career. Since you are considering CNM, have you considered working as a Labor and Delivery nurse while you are still in CNM school, to see how it "fits" with you???? Believe it or not, there are nurses and CNM's out there that REALLY are at their BEST, in these type of situations, where the pt is grieving. Just something to think about.

serenity1 · Mar 3, 2011

Had my first one a few weeks ago; responsible for collecting a lock of hair, foot and hand prints. Infant around 30 weeks. Did better than I thought I would have. We've had several this month due to pre-eclampsia, uncontrolled DM, cord, and genetic disorder. Went several months without any. We have a level 2 NICU. NawtyNurse69 is right--there are many factors to consider. Absolutely try to do L&D while in CNM school. At least shadow there before making your decision. It is quite different than what some people expect it to be.

BabyLady, BSN, RN · Mar 3, 2011

Eventually I want to become a CNM or WHNP but I am not sure yet how I would handle fetal demise. What are the common causes? And at how many weeks gestation?

I work for a very high-volume facility. We probably see about 2, on average, fetal demises a month.

Early miscarriages, typically happen at home or "complete" in the ER or are treated in the physicians office, if it happens during daytime hours.

In the cases of intrauterine fetal demise, that typically requires the induction of labor at the hospital, required in my state if you are over 12 weeks gestation.

Devie06 · Mar 3, 2011

Thanks for all the info! I definitely plan to work as an RN for a few y years before moving on with my scgooling. I want labor and delivery as soon as I can get in, but I hear it is tough to get in. I hope to do an externship or volunteer while I am in school, and see what happens if it can help me or not :) I had a midwife throughout my pregnancy, and attempted a home birth but my daughter actually, somehow, turned in early labor or right before and was breech. We ended up having csection. I was calm the whole time, never worried, she was stuck in my completely dilated cervix and had a faint ring around her butt when we saw her, but she never went into distress. I have never heard of any friends having difficult births either. My best friend delivered at 22 weeks, her daughter just turned 1 in January :) I have heard of miscarriages, babies passing away during second trimester, etc. I have a strong background in Psychology, esp. Clinical Psych, so maybe I would be good with comforting the families.

Devie06 · Mar 3, 2011

Sorry about misspellings! I am typing on a touch screen phone, kinda a pain!

etaoinshrdluRN · Mar 3, 2011

Before I was a nurse, I lost a mid-term boy from incompetent cervix, and the nursing care I received ranged from awful to bad (they were all clearly upset and unprepared to deal with my grief). Except for the one nurse who took care of my baby after delivery. She was the one bright spot: honest and encouraging, telling me what to expect, why he looked as he did, how he was perfect, what needed to be done, etc. She also gave him the dignity of a bath and a diaper, footprints, hand prints, portrait and so forth. She found him a hat, a tiny receiving blanket, and a sturdy white envelope box to contain him when we took him home for burial.

I was glad to go back to that unit as a nurse, see her, and thank her for her good work. The key to her success, in my opinion, was to set aside any discomfort she might have had, forget herself, and empathize deeply.

Devie06 · Mar 3, 2011

I am so sorry for your loss! It brought tears to my eyes! I am glad she was there for you!

klone, MSN, RN · Mar 3, 2011

Death is part of life, and even in a happy place like OB, it's something you need to...I don't want to say "get used to" because you never get used to it and it doesn't happen a LOT, but it's something you need to be able to deal with.

My facility does about 3000 births/year, and we probably do 1-2 IUFDs per month.

Why it happens and when it happens is for any reason. Early losses (miscarriages, which we usually don't see because they rarely come inpatient for those) are usually chromosomal. True fetal demises (after 20 weeks) are also often chromosomal disorders or other issues that are incompatible with life. Often, late IUFDs (close to term) we never know. We assume "cord accident" because we often have no other answer. Those are the saddest of all.

I've become a better nurse because I don't shy away from taking care of IUFD patients (the only time I've asked for an assignment change was when I was obviously pregnant, and it was out of courtesy and sensitivity for the patient).

MrsMoose317 · Mar 3, 2011

I was 19 years old when my son was stillborn and the nursing staff was awful. They would not look me in the eye or answer my questions. They put a black piece of paper on my door so noone would enter or would be quiet when they walked by. For this reason, I decided, now in my early thirties, to go to nursing school and specialize in L&D to make sure that at least my patients won't have the same horrible experience. I think the situation, though always horrible and difficult to handle, is what you make of it and how you handle it with the patient. Not having been there except as a patient yet, my theory remains to be seen. Good luck. :)

klone, MSN, RN · Mar 3, 2011

We tape a flower (or picture of a flower) to the patient's door so people will know it was a fetal demise. This is pretty typical, more as a warning to ancillary staff so they don't walk in and say "Hi, how are you doing! Congratulations! Is it a boy or a girl?" or other inanities.

JDougRN, BSN, RN · Mar 3, 2011

I've been a nurse for almost 20 years. One of the biggest things you can come to accept as nurses****Wisdom incoming here!*** We often can't change an outcome. BUT, as nurses, we have the position, as well as the power and training to be able to make what is often the worst time in a patients life, and make it a bit easier to bear. Dealing with IUFDs or babies who are too pre-term to live is tough, but some of the times I've felt most like a nurse, was taking care of Moms who had lost a baby. You treat them with dignity and careing, can show empathy/sympathy, and make it easier. Does it make us sad? YES. Do we sometimes cry right along with our patient? YES- But hearing your nurse tell you, "I'm so sorry for what you've gone through. I'm here to take care of you through this difficult time, and if you need someone to talk to, I'm here." This can make all of the difference in the world.