Non-viable baby, born alive -parent won't hold him, what do you do?

Deidre Shiobhan · Sep 22, 2005

OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk baby. Well, she delivered the baby and he was alive. He lived for 3hrs. The pt only held the baby for a few moments and wanted us to take him away. To make a long story short, another coworker and I took turns so he wouldn't be alone for those 3 long hours.
What does your facility do in that situation - when a baby is not viable, but born alive, and the parent(s) don't want to hold the baby? I mean, this was a perfect little 1 lb baby, pink with a heartbeat. We couldn't just leave him on the counter in our back room and occassionally check for a heartbeat so time of death could be recorded. (!) At least, I couldn't. Anyway, just wondering how other units handle this. thanks, SG

Such cases refer to comfort care in my unit. Normally these babies' parents have agreed not to resuscitate the infant at birth but somehow they just don't die immediately.

We'll keep them in a room, wrapped up and hook up to the monitor to watch the heart rate. There's controversies among the staff whether these babies should be kept warm under a radiant warmer.

I've personally handled such babies, it's very pitiful. I'll wrapped them up,provide a bonnet and warmer. Sometimes we even try to give a little bit of milk to the baby to wet the lips and at least they can go without not knowing how milk taste like.

We've came across a 23weeker whose parents have decided DNR at birth but he was crying all the way, very strong and pink even after 3 hours of life. We felt so sad and knew that he wanted to live. His dad saw him once and decided to give him a chance after seeing him for the second time. We intubated him and did what we supposed to do, he survived and went home without any complication. I guessed it was Marcus's cry that told us that he's a fighter, GOOD boy! We didn't make the wrong choice.

Mermaid4 · Sep 22, 2005

Not long ago we had parents of IVF 21 week twins who insisted we try everything. The doc was kind and informative but the mother was screaming that they would sue so the doc gave in but privately told us not to "hurt" the babies so although we did "bag" them, we really didn't, and the other nurse and I both stroked and talked to them in a quiet environment, then told the parents there was nothing more we could do, weighed and wrapped them out of their site ( just the way our rooms are set up), and handed them to them. They felt that measures had been taken, we knew they hadn't been hurt, and the parents went home starting their grief in a good way. I still feel badly about the entire episode, but the person who couldn't deal with it was the doc. I met him in the lounge in tears and had to comfort him as well...

gypsyatheart · Sep 22, 2005

Oh, geez, how sad! It is really sometimes, to me, harder to comfort the staff (nurses, docs)....than the parents! Crazy, I know. You expect the parents to be upset, it's just that we are supposed to be strong for them and yet, we are human, as well, we hurt w/them.... :crying2:

Not long ago we had parents of IVF 21 week twins who insisted we try everything. The doc was kind and informative but the mother was screaming that they would sue so the doc gave in but privately told us not to "hurt" the babies so although we did "bag" them, we really didn't, and the other nurse and I both stroked and talked to them in a quiet environment, then told the parents there was nothing more we could do, weighed and wrapped them out of their site ( just the way our rooms are set up), and handed them to them. They felt that measures had been taken, we knew they hadn't been hurt, and the parents went home starting their grief in a good way. I still feel badly about the entire episode, but the person who couldn't deal with it was the doc. I met him in the lounge in tears and had to comfort him as well...

onmyway06 · Sep 22, 2005

What a sad story Dutchgirl. This has obviously affected you to this very day. You're a very compassionate nurse. :icon_hug:

I was in a situation about 15 years ago where a young woman came in alone and delievered at 22 wks. It was about 0400 and myself and the other nurse delivered the baby. We were in a small rural hospital.
We called the ER doctor to come up stat. He picked the baby up from off of the bed and said to the young woman "I'm sorry your baby was born dead". He handed the baby to me and I was going to hand it to the Mom and he said "No clean the baby up first". The Mom was crying so hard she didn't say anything.
When I got the baby to the nursery I noticed that he was alive. I ran to get the ER doctor. He said to me in the hall. "I know the child is alive but he doesn't have a chance, Let him die, clean him up and let the Mom hold him. We don't need to get sued for doing nothing." I stayed with him for 4 hours in the nursery and rocked him until he died. I let one of the day nurses take him to his Mom and I went home.
The entire time I was rocking him I felt so guilty that it was me and not the Mom holding him. I've often wondered if he had been born at Vanderbilt would he have lived? I do know that if I had it to do over again I would have taken him to his Mama no matter what the ER doctor had said. At the time I was scared of doctors and was not the least aggressive as I am now.

DeeSki · Sep 22, 2005

I read all these posts and cried my eyes out :crying2: . It is so amazing to see all of the nurses with so much love and compassion. I have to say I have not experienced that brand of nursing care here in NY. My oldest son was born five weeks early, weighed 6 lbs 8oz. Doesn't seem very small but he couldn't breath and eat so he was placed in the NICU. The nurses there were the pits. At least they were when I was around to see, maybe they were loving when I was back in my room :uhoh21: . It got so bad that I had to get my husband (ex now) and pediatrician up to the hospital to "save" my baby from the NICU nurses! He was oozing what looked like ground beef from the sites on his head where the internal monitors had been placed and they wouldn't even let me feed him because they were "busy". Those oozing sites were scars under his hair for the rest of his life. He did leave the hospital in good shape and turned out to be very healthy and so smart (IQ of 141). We survived the NICU. That was eighteen years ago. Tomorrow is the 10th anniversary of his death. He survived at birth but ultimately died accidentally-tragically 8 years later. The Trauma nurses left crying that day. What can I say but that God works in mysterious ways. :saint: I often read all the posts in the different specialty areas to help decide what area of nursing I'd like to go into. I know I love L&D, NICU and ED but sometimes I wonder how I could care for a dying child and stay detached. KWIM?

CatLVNRN · Sep 23, 2005

Thankfully, I haven't had to deal with this (yet).

However, I have heard of it, and in some places, I know that the chaplain is called not only for the baby, the mom, but for the nurses as well. It's emotionally draining. I have never heard of anyone leaving the little alone to die..

**canoehead, BSN, RN** · Sep 23, 2005

Deeski- that is so unfair. I'm so sorry.

melissa13820 · Sep 23, 2005

I delivered my baby girl at 22 weeks and im proud to say that i have a healthy 5 year old child that just started kindergarden!!!!!

CatLVNRN · Sep 24, 2005

As I read through these posts, tears fill my eyes. I reflect on what it was like to be an expectant mother: you have a vision of your baby deeply etched into your heart and mind's eye. You see your baby-whether it's a boy or girl-as this perfect tiny being, with faint little eye lashes, tiny fingers and toes, round little tummy and fine downy hair. You see this baby with your heart, long before your eyes do. To give birth to a baby that is anything less than this envisioned dream is incomprehensible. I dont know how I would react personally, as it would be so completely devastating. Every parent that has had to go through an ordeal like this is a true saint, and every nurse that has supported the little ones and comforted them as they transition from life to death are true angels. I have always wanted to be a NICU, L&D, NN nurse. When that time comes, I hope I too can live up to the caring reputations of my predecessors. :redpinkhe

TweetiePieRN · Sep 24, 2005

All of these posts made me cry my eyes out!! I just had my first baby in July 2005 (he is fine). I just noticed that since I have become a mother it is much much harder for me to hear stories or see children/babies in pain or suffering, etc. Before I had the baby, stories like these would upset me, but I actually feel the sadness in my BONES and deep in my heart now. Is this normal? Do others moms feel this too?

midwife2b · Sep 25, 2005

"I guess the point of this is to let you know that the nurse who held your daughter was probably very touched and felt privileged to have been part of her short life. I'm sure she thinks of you on occasion, and wishes you peace."

I'm a third generation nurse. Many years ago (in the 1960's) I remember my grandmother coming home and telling me that it was as much a privledge and honor to be present at a persons death as it was to be present at their birth. With tears in her eyes she told a story of how she held a premie for several hours until she died.

I never forgot what she said... and I do feel honored that Our Lord picked me to be present at deaths as well as births. It is sad for all, but I get strength in knowing that I helped a family create a very special memory.

Every September our community has a balloon ceremony honoring our tiniest patients: miscarriages, stillbirths and neonatal deaths. It is well attended and many parents return to offer support to the newly grieved parents. This year we had almost 100 losses over 18 weeks. All parents experiencing a loss are invited (even first trimester losses). Balloons have the babies name, date of birth, date of death, weight, and any special verse the parents choose. It is a very sobering half hour.

Our patients will never forget our kindness and compassion. :balloons:

akcarmean, LPN · Sep 25, 2005

I had a still born daughter 8 yrs. ago in June. I was 4 days away from due date. When she was born she had been dead less than 8 hours. She weight 7 lbs. and 3 or 4 oz. can't quite remember, was 21 in. long. Perfect little baby.

We had great nurses. Helped take photos let us spend as much time with her as we needed. Let dh clean her up and everything. They cried with us. To be honest I found it very touching, I know as nurses we are suppose to be strong for the patients. But as a patient at that time and not even a nurse it was very touching.

Still today I run into the nurse that was assigned to me during my stay and delivery. She still remembers us and always ask how we are doing. Still very touching to this day.

Angie