Terminations

gypsyatheart · Nov 15, 2003

Originally posted by tamrnmomof4
Sorry for the confusion....these babies were 21 and 22 weeks..when I said healthy, what I should have said was no visable anomalies...they looked like perfect but not viable babies. The mothers did not have infections..I am not stupid..I realize that these babies did not have the best progrosis, but know that sometimes these babies do survive to a viable age. It was a hard week...Tammy

At 21/22 wks gestation, I'm sorry, but these babies were not viable. 23 weeks is really the earliest viability point for a fetus, and even then, sometimes, there is very poor prognosis. I'm sorry you had a rough week and demises are ALWAYS hard, especially when the pregnancy is advanced. Usually, when a mom starts contracting at this stage, of course, they try and stop delivery. I can not believe any medical practioner would say "let's deliver, and see what happens..." We know what's gonna happen. More than likely, the mom's labor was unable to be stopped, or by the time she got there she was well on her way to delivery. Plus, with PROM, the labor/imminent labor and impending infection do not offer much hope. Sometimes we can keep mom in hospital, on bedrest, on abx, on tocolytics, and hope to get baby to viability. Sometimes this isn't possible. Very sad, but I also would not phrase these as "terminations". At this stage of a pregnancy, this is referred to as a "fetal demise". 1st trimester losses are referred to as a "miscarriage".

We utilize RTS also, and this is a heartbreaking time for the family. I have sufferred pregnancy loss myself, not at that gestation, but, still, I woud be upset if someone referred to the loss as my "terminating" the pregnancy. Mom had no control over PROM and I'm sure she's sufferring. My prayers are with these families, and I hope you have better shifts next week!:)

Texagain · Nov 17, 2003

At our facility, we have had about three 22 week survisors over about 6 years (that I know about- we were HIPPA before HIPPA was cool).

One came back to visit. She was 8 months old, weighed about 8 lbs, and, as I chatted with her mom briefly, I watched her eyes roll around continuously and independently of each other. She still had o2, apnea monitor and G-tube. I did not ask the mom what kind of problems the child had. She was, however, a pretty little baby and seemed well cared for and loved.

While my facility does not perform elective VTP's, we do lose pregnancies with some regularity. We are a regional specialty hospital with between 650 and 800 deliveries a month, and of course, lots of high risk pregnancies/deliveries.

If we get, say, and 18 week PROM, we will evaluate everything and support the parents decision. An 18 week PROM with no fluid and no hope of fluid may choose a different course of treatment that an 18 weeker with a slow leak and an AFI of 4. There are families that want everything done, and some that are willing to accept a loss and move on.

You simply cannot judge people in these positions for their decisions. When faced with such heart wreching decisions at work, you should first be thankful it's not you lying there.

Some here know that I have an ex 23 weeker who will be six this month. At the time of my hospitalization at 18 weeks, I was also taking care of my elderly father who was greatly debilitated with Parkinson's disease. I had modified my home to include a handicap equipped apartment for him that included flooring, shower, commode, hospital bed, and wheelchair access, and was still paying for the modifications. And I had an almost 2 year old. Imagine the pure torture of feeling that you had to choose between 2 children and a parent.

I had one memorable PROM patient whose baby had his foot stuck in her cervix which acted like poor cork for 4 long, leaky months. He managed to keep enough fluid to give him a fighting chance. He wound up on ECMO for a time following his delivery. I saw him when he was 2, and he was an unusual looking (from uneven development from the low fluid), but very alert fellow. He was seeing an ortho for his deformed foot and other bone problems.

In the end, people need all the facts with which to make their very best decisions. Then they need to proceed, knowing they have made the best decision possible for themselves. Perhaps what someone else chooses to do is not what you would choose, but there are most likely other factors that you may not even be aware of influencing their decision.

mother/babyRN, RN · Nov 18, 2003

Sounds as though you mean demises and not terminations. Those are tough because you have to deal with your own feelings as well as comfort people at a time when possibly little or no comfort really helps. I am known as the demise nurse in that I seem to bond with people in the situation. All you can do is be comforting and if you have tears, share them...When the baby is born, it is still their baby and "yours" too, so make them aware that they may not want to see him or her right away, but work gently toward having them think about seeing and touching their baby...let your own tears flow. Own them...I do what I can to make mom and dad comfortable considering the situation...Sometimes you really don't have to talk..Sometimes you have to joke.. Sometimes you do both.. Warm some lotion...give them backrubs, foot rubs, whatever...BE there for them....Right away ask nicely if the baby had a name and refer to him or her by that name to make the baby real to them...He or she is real to them at 4 weeks or 40 , alive or not....

Try to understand that this WILL affect you. How could it not...But, it is not about you...You will feel so closely bonded to these people, who will so appreciate your concern and compassion BUT you then become a reminder of their sad times so as close as they may truly want to be, they have to go home and separate from the hospital experience...You will find that if they are fortunate to come back with a viable pregnancy someday, that they will have not ever forgotten you...Let each experience shape you as a nurse. Treat them as you would want to be treated...Don't offer advice..Offer compassion...Don't forget the daddy if there is one. He has usually been taught to be strong but he is so very sad too...

Don't force them to hold the baby, but if they don't want to right away, take pictures of the baby and do the footprints and handprints as soon as possible to make a kit or give it to them...

Not long ago I had a mom who was sure she couldn't look at the baby ( 21 weeks)....So, I stood behind the curtain and told her I would come forward and at any time she wanted I could step back...Dad wanted to see the baby....Eventually, I walked in, put their two hands together, and placed their son ( never referred to as the fetus in their presence) in the palms of their two hands. Mom burst out crying, letting it all out...I remarked that he was beautiful and was an angel now....

You just have to let the sadness flow. It is not a horrible thing to feel with your patients.

I just had one of the docs introduce me to her partner as "her favorite demise nurse." In the past I might have been either insulted or dismayed but now I am honored that I can offer such small comfort at a time of such grief...Please feel free to PM me if you need to talk and discuss it....Anytime...

Sable's mom · Nov 19, 2003

Originally posted by moondancer
At 21/22 wks gestation, I'm sorry, but these babies were not viable. 23 weeks is really the earliest viability point for a fetus, and even then, sometimes, there is very poor prognosis. I'm sorry you had a rough week and demises are ALWAYS hard, especially when the pregnancy is advanced. . . Very sad, but I also would not phrase these as "terminations". At this stage of a pregnancy, this is referred to as a "fetal demise". 1st trimester losses are referred to as a "miscarriage".
We utilize RTS also, and this is a heartbreaking time for the family. I have sufferred pregnancy loss myself, not at that gestation, but, still, I woud be upset if someone referred to the loss as my "terminating" the pregnancy. Mom had no control over PROM and I'm sure she's sufferring. My prayers are with these families, and I hope you have better shifts next week!:)

I agree completely, just didn't think to comment on 'termination' vs fetal demise.

I lost one baby at 13 weeks and one at 18 - both were heartbreaking, but have made me so much more compassionate with our patients. (when I worked NNICU, the docs always asked that I be assigned to babies who were not going to make it)

I, too, hope your week is better.

Linda

unikuelady, RN · Nov 19, 2003

:kiss I am also referred to as the "fetal demise nurse" I posted a question a while back asking if anyone "enjoyed" working with fetal demises. I should have worded it differently. I have worked with over 20 fetal demises/families this past year. It felt good to be able to care for the baby/family, assist them in making memories and bonding with their child. I also comforted other nurses who worked with these families. I am RTS trained. It has also taken a very large toll on my own mental health. I have gone to counseling, talked with co-workers about how they deal with the trauma......"Yes" it is a traumatic event not only for the family-but the nursing staff caring for them. I even had a meltdown at work. What I'm trying to say is, talk about your feelings, write them down, allow yourself to FEEL the feelings, cry, whatever it takes to feel better. I believe the hardest thing to do is watch a baby die. I hate it when I see a

imenid37 · Nov 19, 2003

These are great posts. We have a team of 4 nurses who work w/ our fetal dmises. This is good because it doesn't all fall on 1 person. Of course, all of the rest of us work w/ these pt's too. These nurses are our resource people. They make follow-up phone calls and run the RTS group and memorial services. Over the past several years whenever we've had a stressful event or cluster of events we've had the nurses involved get together and have a sort of "post-event" conference where we've been able to air our thoughts and support one another. It really helps. It is very hard to deal w/ these kind of situations.

fourbirds4me · Nov 19, 2003

As I write this I am getting ready to go to work. We have a 161/2 week IUFD on the floor being "induced". They were to start her cytotec sometime today so I know she won't be delivered. I just know I'm gonna get this patient. I may even volunteer for it. I worked with 2 demises since I started in August and am no stranger to infant loss and we have had several in our family. I am dreading it and even dreamed about it while I slept this afternoon.

Anyway, wish me luck

tamrnmomof4 · Jan 20, 2004

Sorry it took so long to respond I have been very busy!!

I called these terminations because these women were not in labor, and they did not have infections....we gave them cytotec and used a laminary open their cervix and caused them to deliver early, both babies were alive when born. I do think that this is different than a fetal demise.