This is by no means anything scientific. This contains my own thoughts and what I believe to be best practice in being a patient advocate for women in the ER setting who are facing early pregnancy loss. My thoughts are based on my own experience as an ER nurse, a mother, and someone who has infertility and has had a miscarriage.
1. This baby is very real to the mother.
We may not know the full background behind the pregnancy. This mother might have had fertility problems, and this baby could have been conceived through advanced treatments such as IVF. IVF is a very expensive, time and emotionally consuming process. The mother may have already has several pregnancy losses prior to this one.
The mother may already have dreams for this child, a name, clothes, and room decorated. Regardless of the gestational age, the pregnancy and baby are very real to mother.
2. Keep your mouth closed and watch what you do say.
Do not offer much advice, especially if you have never been there before yourself. Remember the last sentence of #1. Regardless of the proper medical terminology, it is very offensive to the mother if you call it "products of conception". This is her baby, not a ball of tissue.
DO NOT offer advice like: It's ok, you can have another. It was really early, so it wasn't a real baby yet. There must have been something wrong and this is God's way of dealing with it.
That advice is a slap in the face to mothers facing infertility and miscarriage, and yes, people are stupid enough to say that stuff (having been told it myself and seeing others offer the same advice).
3. Keep nursing assignments in mind.
I got into a fight with my team leader when I was about 7 months pregnant with my child. I was assigned to several rooms that had pelvic beds, as was another nurse. I had one empty bed, he had three. My last bed was going to be filled with a woman who was probably having a miscarriage. I asked if that patient could be placed in another room or given another nurse. It happened, but not without fighting on my end.
It is a slap in the face of the woman having a miscarriage to have an obviously pregnant nurse. While this woman faces her own demons (self- blame, denial, anger), a huge pregnant belly is in there taking care of her.
I understand there might not be a choice in the matter and the pregnant nurse might have to take care of the miscarriage patient, and that's ok. If given the option, keep this is mind though.
4. Keep her pain under control.
I've had to fight with doctors over this, who wanted to give a mere 800mg ibuprofen for pain. The further along the pregnancy is, the more likely the pain will be increased (more tissue to expel=more intense cramping). That cramping is like contractions. Mentally and physically this is painful.
Give her time to grieve. Provide information on pregnancy loss, and if not available, try to make packets with information about local pregnancy loss support groups. The pain does not end once the miscarriage is over- the pain is relived with the due date and the anniversary of the miscarriage. I can still tell you the day I was due, the day I found out I was pregnant, and the day I began to miscarry. I can tell you where I was at, what I had eaten and where I was going- the pain is real.
I'm not a nurse. However, I lost a baby at 13 1/2 weeks one year ago tomorrow. I was devestated to see a perfectly formed baby that was still on the US big screen plasma screen at my peri's office when I went for the NT test. The peri called my ob. He asked me what I wanted to do and I said to take care of everything immediately. He scheduled a d&c during his lunch the next day. When I arrived on L&D, I had a wonderful nurse. She let me cry. However, a nurse not even assigned to me came pushing through my room pushing a study on recurrent mc and how if I took baby aspirin it could prevent it. The killer part, she referred to that perfectly formed baby on the US screen as an embryo throughout the conversation. I ended up throwing her out of my room and telling her my baby was a baby with a head, eyes, arms, and legs but no heartbeat anymore. My baby was way pass the embryo stage. Oh and your study, I was already on baby aspirin to prevent preeclampsia. Whoops didn't work. When I got out of the hospital, I sent a letter to the Nurse manager informing her what happened. I did receive an apology from the nurse immediately. However, I will never forget what happened that day.
Another piece of advice. When you have a mom starting ppd meds immediately after delivery, DO NOT tell her that what she is experiencing is normal. I had a rough time with my last daughter (Severe pih, an emergency d&c for retained parts and infections, baby in hospital). In addition, I had the one year anniversary of my loss coming up. I delivered a month early due to mild pe. Add that with a newborn and crashing hormones was a recipe for disaster to me. So I asked my ob to start me on something because of all of the above to help with it or prevent it. The next day the nurse brought me the ppd meds and told me you know its normal to feel like that. She had NO idea what I had been through in the last year. It was hard enough speaking up to my ob about needing something.
Thanks so much for sharing your experience and your advice. I have never had to deal with a miscarriage and have had four wonderful children. So I have always felt very awkward and inadequate when dealing with pt's who are miscarrying. Thank goodness that I have not said much more than "I'm so sorry" because I didn't know what to say but hearing your advice will definitely help in the future.
You don't have to say anything but how sorry you are and just let her cry. I will never forget the nurse that just let me cry. I got up to L&D and just started bawling when they asked me my name. Right when I was there, they wheeled by a fresh csection mom by with her baby. That nurse led me to a private room and sat with me while I cried for a long time.
I ended up stopping crying after a while. I was fine when my ob came to see me (well wasn't bawling anymore). Then I lost it when the transporter came. Cried the whole way to the OR when they knocked me out. One thing I will never forget what the transporter said when he came to get me and I started bawling (think really young guy), I don't know what to say to make you feel better. The least I could do is give you the easiest and best ride to the OR. It was all he could say and give and was enough.
Btw, when I had my daughter a month ago. The same compassionate nurse was on duty again and was estatic to see we had a new baby. She didn't forget the miscarriage a year ago that I had either.
The nurses who were the best to me for my D&C were my husband's coworkers. They sent us a card signed by all the other employees when I had my miscarriage. That meant the absolute most to me. I was only 8 weeks along when I found out the baby died.
The worst nurse to me was my own husband. He gave me the silent treatment when I told him I wanted a D&C after knowing I was carrying a dead embryo for over a week. I went to the bathroom every 10-15 minutes when I was awake looking for a spot of blood to show or some cramp or other sign of miscarriage. When I developed an infection 9 days later, I received the silent treatment from him on the way to the OB's office to see why I had a temperature of 102 and severe pain in my very low abdomen. He couldn't even be bothered to get me a sandwich at 7 p.m. after my surgery and the cafeteria was closed, since I hadn't eaten in 7 hours. My outpatient surgery was turned into an overnight stay due to infection due to ******* around getting the surgery done. That is so not like him, but I will never forget it. He was hurting too, I know, but he showed it the most wrong way possible.
The nurses who actually cared for me were below average but used decent language. It was more the nursing care than insensitivity that was the problem. However, I was kindly put on the med-surg floor and not OB. I appreciated that.
it may also help to give them some resources. in part with being the pediatric resource rn to my er, i instituted a protocol for perinatal loss/fetal demise/neonatal and pediatric loss in the er. i worked with L&D and NICU to gather resources. our hospital has two support groups for those who have suffered a miscarriage. 1 is for the loss, the other is for those who have lost and thinking about and/or trying again. we have all the information in our department now. i always felt like there was more that we should and could do for these poor women, and so far it has really helped out. there is also a committee that meets once a month to talk about changes they need to make to these protocols, etc. it's something that i implore everyone to try and implement in their appropriate dept.
I wanted to start something very similar to this in our ER and am in the process of gathering info. Would you be willing to share your protocol and any other info you have? We see so many miscarriages and occasional pediatric losses in our dept and was surprised to find out there was nothing official done for these families! Most of the info I find is just for miscarriages so anything specific for older kids would be great too!
I wanted to start something very similar to this in our ER and am in the process of gathering info. Would you be willing to share your protocol and any other info you have? We see so many miscarriages and occasional pediatric losses in our dept and was surprised to find out there was nothing official done for these families! Most of the info I find is just for miscarriages so anything specific for older kids would be great too!
Thanks!
if we have a pediatric loss in the dept we have special boxes for the family. inside the box is an envelope or container to place a lock of hair. there are supplies to create clay hand/foot prints. we keep a camera on our unit as well because sometimes the parents want a picture....especially if it was a matter of pre-term labor or stillborn. there's also the info for funeral homes, etc. like in the adult packets. there's a little teddy bear in there as well. just anything we could think of that could help the parents commemorate their loved one. oh, we have small blankets in them too to wrap the child in for pictures and then for the family to take home.
we also give anyone with a fetal/neonatal/pediatric loss our resources (i.e. support groups) so that they know they have that option to help them grieve and cope.
if we have a pediatric loss in the dept we have special boxes for the family. inside the box is an envelope or container to place a lock of hair. there are supplies to create clay hand/foot prints. we keep a camera on our unit as well because sometimes the parents want a picture....especially if it was a matter of pre-term labor or stillborn. there's also the info for funeral homes, etc. like in the adult packets. there's a little teddy bear in there as well. just anything we could think of that could help the parents commemorate their loved one. oh, we have small blankets in them too to wrap the child in for pictures and then for the family to take home.
we also give anyone with a fetal/neonatal/pediatric loss our resources (i.e. support groups) so that they know they have that option to help them grieve and cope.
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Wonderful thoughts. I hope to share this with MY unit