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

Specialties Ob/Gyn

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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

This thread has me in tears. . . I plan to be a L&D nurse one day and know I will be dealing with these situations, but I can't help but to cry.

I deduced that non-viable means that the baby is probably not likely to survive, but could someone give me a better definition?

This thread made me cry. :bluecry1: :crying2: :sniff:

God bless you nurses. :icon_hug:

it's tough no matter how you look at it. i've had 8 fetal demises in 1 yr since being hired (fair huh) i did see one 23 or so wk in the utility room that was not my patient. the tech and i were trying to help the rn and do post mortem but we saw the heart beating and it moved when we moved it. we immed went to the doc and told her and she told us not to confuse reflexes with life. but the heart was still beating. the tech and i just tried to touch it lovingly and said prayers silently and aloud and cried intermittently. when the baby passed we took it to the mother, who held it.

the baby did have brain matter coming out of the back of the head and watching something suffer is difficult enough, imagine if it's something you loved and wanted in your life. the other rn later told us that she knew baby was alive but doc insisted no. guess she felt it was best to spare mommy of having to suffer along with her baby. in a hospital not 20 blocks from my hospital they have a level one nicu with babies 21 wks and up so i question whether its a case of resources being a reason we don't go to extreme measures or a case of doing the kinder thing for the long run.

i have seen 22 weekers survive into healthy kids. Yes, many of them have physical or developmental problems, but they do survive.

Another thing is that in my state if a baby is born alive a birth certificate needs to be done. Where I work we always are honest with the parents whether or not their baby was born alive or not. I can't imagine telling a parent their baby was born dead and not letting the see the baby, when in fact it is alive! However, in my hospital, we only resuscitate if the baby is 24+ weeks. And, we are up front about this to parents too when a premature delivery looks likely.

i have seen 22 weekers survive into healthy kids. Yes, many of them have physical or developmental problems, but they do survive.

Another thing is that in my state if a baby is born alive a birth certificate needs to be done. Where I work we always are honest with the parents whether or not their baby was born alive or not. I can't imagine telling a parent their baby was born dead and not letting the see the baby, when in fact it is alive! However, in my hospital, we only resuscitate if the baby is 24+ weeks. And, we are up front about this to parents too when a premature delivery looks likely.

don't get me wrong, we have a bereavement process, box, pictures baptismal on request, we ask if they want to hold and we try to make the baby look as comfortable and baby like as we can. sometimes it is very hard to do this. we always try to comfort and support. sometimes though it isnt best to show all the details. we have volunteers who make hats and blankets that we overwrap the baby in (over hospital ones) that the parents may keep as something their baby wore. lets face it this thing really sucks so we go as far as we can to be there

This thread has me in tears. . . I plan to be a L&D nurse one day and know I will be dealing with these situations, but I can't help but to cry.

i still cry. sometimes it helps the parents/family and sometimes just me or my co-worker, who is crying along side me

Specializes in NICU and neonatal transport.

I would consider if the gestation was correct. Horrible situation to be in, but with any death, lots of cuddles seem to be the kindest and most natural thing to do.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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

We would do "everything"----e.g. NRP. And if "everything" could not be done (not allowed) i would take and hold that baby in a blanket and rock him/her myself.

You have to respect their wishes.....

Respect the wishes of the patient, and do proper postmortem care and preparation. We have had patients change their minds, after the baby has been taken to the morgue. We have made sure they were presentable as possible and brought them back when they changed their minds.

Everyone grieves differently. Respect their wishes and make yourself VERY available and willing to listen. And be ready for anything---their emotions and reactions can run the gamut from anger to deep sadness to near catatonic-like states. Just be there, and respect what they wish. that is my best advice as an OB nurse and also as aperson who has had losses of her own.

What a rough situation for you. I am so sorry this happened, for all of you.

deb

I have to add, I am extremely skeptical about a hospital that would rescusitate a 21 weeker or even try. When a baby is not viable or is extremely premature, I believe we should respect the parent's wishes.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I so agree w/fergus.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I meant to say, before 24 weeks, we would just give comfort measures, TO INCLUDE holding, swaddling and rocking,. if the parent chose not to.

Sounds like the majority of hospitals are on the same page. We are a level 1 NICU, with two NNP's and 1-2 neonatalogists on at all times. In the instance of demise, we also have a protocol including memory boxes, pictures, footprints, etc. We respect the postmortem requests of pts. We have also had the parents request the baby again well after the delivery, or when the baby was already in the morgue. We retrieve the baby, and we place him/her under a warmer so they aren't ice-cold, and make them presentable.

We don't resuscitate under 24wks, and I question the how ethical that is to resuscitate one under that GA. (Won't start that soapbox!) Anyway, this is a very difficult situation for anyone - both parents and staff. Thanks for such great input! SG

I hold the baby. You can't make parents hold them. Even those parents without mental illness sometimes just can't do it. I will often ask if there was to be a name and refer to the fetus by the name to personalize the experience and help with greving. We then take pictures and do footprints and keep all of that on file in case they some day do think they can. Sometimes I will pull the curtain between me and them just afterwards and let them know I can stand behind it ready to take the baby away or give him or her to them as soon as they are ready. If they aren't ready I do not judge them. It is such an equisitely sad painful experience that it is just too much. I hug them in silence or make them laugh or simply follow their lead....It takes time and everyone handles it differently. Mostly you realize when you feel that something isn't right that it is usually YOUR issue and not that of the patient involved. If you are the type to confront things, that works for you and you would see this as abnormal. If you are the type to avoid conflict, this would seem perfectly natural. All you can do is take cues from the patient.

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