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

[enfermeraSG]

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

[BlueYYsRN]

I think anyone who works in OB-GYN, Nursery or NICU for awhile is confronted with this.

I remember about 12 years ago, there was an emergency c/s for a preterm, non-viable baby to save the moms life. I dont remember why she had to deliver but she was very sick and it was done under general anesthesia. I took the baby to the nursery as it was born alive and had to call in a pediatrician in order to pronounce it once it died. We took turns holding the baby and listening for a heartbeat. The poor little guy didnt want to give up. The pediatrician got there, looked at the baby and told me to go ahead and take it to the morgue. I told him to go ahead and sign the death certificate and I would send the baby to the morgue after it was really gone. We kept the baby in warm blankets and once the mom came out of the OR I asked her if she wanted to see him. She was very happy and held him for awhile telling him all the plans she had had for him. She was very grateful. I couldnt imagine taking a child to the morgue while it was living.

[Deidre Shiobhan]

May I know how old is this baby ( gestation age )? why didn't the doctor attempt to salvage this little kid if he's still alive, was he too small and maybe medical technology wasn't so advance then?

[enfermeraSG]

i just want to let you know that where i work we don't have policies about such things. usaully the parents hold their baby past the point of death. the other night i was covering another nurses pt. the couple did not want to see the baby at all. 17 wks multiple genetic anomalies. baby was born alive with heart beating and it beat for several hours. the nurse asked me about paper work and i then learned that it was still alive and she placed it in the dirty utility room. i was horrified. her reply to me when i asked who was with it was "what do you want me to do? hold it?" i went back and saw it and held it and talked to it (sex undetermined) prayed something and i rested it back comfortably to check on my own two patients in triage. when i came back, the poor sould had passed. needless to say i was sickened and disgusted by this nurse, whom i never really had a great liking of to begin with. and she is senior and i'm only new nurse of 1 yr, and hear all the comments of how i will learn and change. everyone pray that i never lose this sensitivity. otherwise i will have to have someone tell me it's time to move on when i do.

I can't stand it when people say that. I have been around this field for 8yrs, and (regardless of the specialty) I think that if I ever start "not feeling" or become calloused etc, then it will be time for me to find a new line of work. SG

[SweetieRN]

I work in a high-risk OB unit were fetal deaths are pretty much a weekly event . The bottom line here is to respect the patient's wishes. It is hard as a nurse to imagine a baby being all alone to die, but then that's where we need to step in. We wash and dress our babies, put diapers on them, and swaddle them just as we would a normal full-term live infant. We even take digital photos of them and put them on a disk to give to the parents. It's a very sad event for everyone, even the nurses - the stress level is very high and emotions are very strong

[Nurse-To-Be-Joy]

I cried the whole way through this thread. Bless you all for taking care of these poor little babies who have no one else. I can't believe ANY hospital would allow an infant to die alone like that. That is so sad and would never do that for an adult. I can't wait until I'm a nurse. I would love to work in the NICU.

[rgrgray]

you woman are amazing, i hope one day to be a compasionate nurse just like all of you! whether it is acknowledged (sp) or not you make a difference! those little babies are born with a soul and you might have been the only person to have touched it! godbless

[RuralNP4KIDS]

Great job to all of you!!!!

My only experience with this was when I was a nurse in the ED at a children's hospital. We were notified of paramedics coming in with a newborn not breathing. I was in the trauma room to receive the pt and a big burly medic came in with tears in his eyes with a tiny baby cradled in one hand. He apologized to me "I'm sorry I just didn't have an ETT small enough". We put the baby on the bed and lucky for the baby neonatology was in the room and estimated gestational age at about 21 weeks and told us not to intervene. The baby had a HR and agonal breathing. (You know us ED nurses we would have put in lines, gave meds, etc if neonatology wasn't there. Not enough experience with gestational age!) There were 3 nurses in the room. We all took turns holding and rocking the baby until she passed. It was probably the most difficult night of my life.

I give credit to those of you who have had this experience more than once and have treated your patients and their families with the compassion and love they deserved.

Kathy

[Q.]

I am not a mother, or a nurse, but I don't think there's anything unusual about your reaction. I think that once you become a mother, you gain a whole new perspective because children are now a huge part of your life. I guess it helps you to truly understand what it's like.

ITA. As an L&D nurse I would hear of and most certainly deal with these tragedies alot. I would cry. It would hurt.

As a mom now, I think it hurts me a bit more because I envision my own 2 going through that. I think of my poor little girl or sweet boy being born non-viable. They were both 32 weeks and survived and thrived.

I'm not sure I could hold them either, especially if they were ancephalic or some other major deformity. I think as an expectant mom you have a vision in your head of what your child will look like; if born premature and under those conditions, you almost want to preserve that thought in your head rather than remembering them as they probably were, with half a brain or oozing brain matter.

[Altalorraine]

Believe it or not some people think it is a sick, grotesque mockery to diaper and dress a dead or previable fetus. People are no doubt well intentioned, but any one person's passionately held beliefs may not be shared by others, including the parents. People can be sentimental about beating hearts regardless of whether there is an intact nervous system, but the absence of such sentimentality does not equal callousness.

Altalorraine

[Q.]

Believe it or not some people think it is a sick, grotesque mockery to diaper and dress a dead or previable fetus. People are no doubt well intentioned, but any one person's passionately held beliefs may not be shared by others, including the parents. People can be sentimental about beating hearts regardless of whether there is an intact nervous system, but the absence of such sentimentality does not equal callousness.

Altalorraine

I don't know.

It's one thing to find it sick and grotesque to go through the whole dressing and photographing of a dead fetus, which is actually a baby now that it is born, but another to leave this human being to die in a dirty utility room, no matter what the gestational age.

Nervous system intact or not, I DO find it callous that any human being could not acknowledge a human life, no matter how fragile, fragmented or deformed, and no matter whether or not the baby registers that it is alone or not. Just because the baby doesn't realize (s)he is dying in a dirty utility room doesn't mean it's right.

[wannabeL&D73]

Believe it or not some people think it is a sick, grotesque mockery to diaper and dress a dead or previable fetus. People are no doubt well intentioned, but any one person's passionately held beliefs may not be shared by others, including the parents. People can be sentimental about beating hearts regardless of whether there is an intact nervous system, but the absence of such sentimentality does not equal callousness.

Altalorraine

The mothers I know who have actually experienced such a loss do not consider it a sick and grotesque mockery, they cherish and treasure the time they had to hold their child, however premature or whatever the deformity. They do not consider it sentimentality, but their only chance to hold and love the baby they hoped and prayed for. And the mothers I have spoken to who chose not to hold their diapered and dressed baby (I don't know anyone who has suffered such a loss who persists in calling it a fetus) have universally expressed regret for not saying goodbye to their child in the way they now wish they would have.

Of course I would never presume to judge any parent's reaction in such a circumstance, but I don't think that most mothers in that position see dressing and holding their baby as sentimentality, but rather love.

Shannon

Edited to add: for the medical professionals, treating a baby who has been born deformed or previable with respect is simply the humane thing to do, not an act of sentimentality.

[Q.]

ITA Shannon; great post.