Need opinions RE: Fetal Demise in ER

[dansmom6]

Hi! I am not an ER nurse, but need to know what ER nurses think about this. What I am trying to do is improve on the way we deal with fetal demise in our ER...which would help staff and patients.

I'll try not to write a book here, but it's kind of a long story.

Part of my job is perinatal bereavement counseling. On our floor, we see IUFD's, stillborn, and neonatal deaths usually > 20 weeks. Once in awhile, we admit lesser gestations. Our bereavement program is fantastic! We provide great support, take pics, provide momentos, and keep in touch, sending cards, f/u phone calls, etc...

Those who have early AB's, vag bleeding in ER or abort at home receive absolutely no bereavement services at all. I understand that some women may not see the fetus as a baby, and aren't all that upset, but some have that baby in college after the pregnancy test is positive. This can be gut wrenching and life changing for many of these women.

In our ER now (I'm not picking on them at all, it's just how it is), if a fetal demise is delivered, the baby is placed in a specimen container, the woman is kept until her bleeding has slowed, and adios. The woman then goes home, where her loss is many times never validated. If she works, she'll probably get a day or two off, and then, back to "normal".

I want to do something!!!! I feel like I need to help these women. What I want to do is provide brief (10-20 min) inservices to ER, Surgical, and Dr. office staff, develop a little packet (something the mother can take home), with a poem, a letter from bereavement making ourselves available, and a momento...something they can take home in their otherwise empty arms (a charm or small blanket, something). I also want ER to know that our services are available to them if they need us.

I just don't know how to go about this, what anyone else does, and how to get started. I know it's a big endeavor, but to me, it's sooooo worth it!

What do you do in your ER's? What would be helpful to you?

Thanks so much for any input!

[bdh359]

Having been a patient in this situation, I can tell you that the best thing you can do is talk to the mom and dad yourselves. Not necesarily bereavement counseling.. just tell them how sorry you are and how beautiful their baby is. Our nurse offered to baptise our baby, our doctor assured me that our baby was beautiful and that I would want to see him. One nurse (or CNA) just held my hand and said nothing the whole evening as I recovered. If the parents dont want pictures, please take one anyway and seal it in an envelope for them for later. They might want it after its too late.

[alaskabound]

Yeah, thats exactly my point! While doing discharge instructions, there should be an "automatic referral made for any gestational age fetal demise. then the er nurses can do what they need to do, and social work can do what they are supposed to be doing, which is finding the proper services for the patients. I would hope that it would be made hosp. policy and that the nurse doesnt need to hound the doc every time, or even ask the puter guys to amend the charting system to auto prompt the nurse to print a SW referral whenever a diagnosis of fetal demise is detected on the system. all they would do is click and print and the ward clerks call SW and in they come with the help and resources of an educated team with the time it takes to psychologically help these families.

[MassED, BSN, RN]

Hi! I am not an ER nurse, but need to know what ER nurses think about this. What I am trying to do is improve on the way we deal with fetal demise in our ER...which would help staff and patients.

I'll try not to write a book here, but it's kind of a long story.

Part of my job is perinatal bereavement counseling. On our floor, we see IUFD's, stillborn, and neonatal deaths usually > 20 weeks. Once in awhile, we admit lesser gestations. Our bereavement program is fantastic! We provide great support, take pics, provide momentos, and keep in touch, sending cards, f/u phone calls, etc...

Those who have early AB's, vag bleeding in ER or abort at home receive absolutely no bereavement services at all. I understand that some women may not see the fetus as a baby, and aren't all that upset, but some have that baby in college after the pregnancy test is positive. This can be gut wrenching and life changing for many of these women.

In our ER now (I'm not picking on them at all, it's just how it is), if a fetal demise is delivered, the baby is placed in a specimen container, the woman is kept until her bleeding has slowed, and adios. The woman then goes home, where her loss is many times never validated. If she works, she'll probably get a day or two off, and then, back to "normal".

I want to do something!!!! I feel like I need to help these women. What I want to do is provide brief (10-20 min) inservices to ER, Surgical, and Dr. office staff, develop a little packet (something the mother can take home), with a poem, a letter from bereavement making ourselves available, and a momento...something they can take home in their otherwise empty arms (a charm or small blanket, something). I also want ER to know that our services are available to them if they need us.

I just don't know how to go about this, what anyone else does, and how to get started. I know it's a big endeavor, but to me, it's sooooo worth it!

What do you do in your ER's? What would be helpful to you?

Thanks so much for any input!

we have a packet like that where we work - not including a charm or anything like that. It is all encompassing and from what I gather is quite helpful.