The nightmare...dealing with fetal demises

rpbear · Jan 31, 2005

Whenever I have a question to whether I am tracing mom's HR vs baby HR I put a pusle ox on mom, our pulse ox traces on the paper as well in a lighter line, then you are sure that it is mom and not baby.

We did have a similar case, we could hear that he machine was tracing double the mom's HR, we said nothing to the mom about it and called the MD, he then went in and scanned the baby, the baby was dead. It is very sad, but I feel that it is the MD's responsibility to confirm and tell the parents.

Why did they scan the baby if even the MD thought that it was the FHR?

Mat-ctr-Rn · Jan 31, 2005

He scanned her because she was there for decreased fetal mov't and I relayed she felt no movement since she had been here and I had not felt or heard mov't against the U/S.

Whenever I have a question to whether I am tracing mom's HR vs baby HR I put a pusle ox on mom, our pulse ox traces on the paper as well in a lighter line, then you are sure that it is mom and not baby.
We did have a similar case, we could hear that he machine was tracing double the mom's HR, we said nothing to the mom about it and called the MD, he then went in and scanned the baby, the baby was dead. It is very sad, but I feel that it is the MD's responsibility to confirm and tell the parents.
Why did they scan the baby if even the MD thought that it was the FHR?

akcarmean, LPN · Jan 31, 2005

I can say that I have been on the Pt. side of the story. So I know how I felt as a parent. If you have any ? please feel free to ask. I can tell you what was done for me and what they did for me which I now treasure.

Angie

CHATSDALE · Jan 31, 2005

we had a situation once where the ob pt was brought to cardiac floor d/t heart condition

no one could detect fetal pulse then one nurse waltzed in listened and said 'oh yes i heard it loud and clear' next shift also could not hear anything and so she send to ob floor for a nurse to come over....ob nurse said she couldn't hear anything so then they did the scan and the heart was not moving...

to make matters worse the mother was a worker at the hospital cafeteria...this was the second baby she had carried almost to term and the baby had died before it was born....she requested a hysterectomy but this was refused [it was a catholic hospital and anything that could be construed as birth control was refused

i believe that she later did have a hysterectomy at an other hospital...that has been 25 years ago but i can still remember her laying in that bed with her little dead baby inside her waiting for an empty labor

Mat-ctr-Rn · Feb 1, 2005

I would love to hear anything that would help me be a better nurse to families in this situation in the future. Like what if anything was said to you that was especially comforting. Really, anything you want to share about your situation would be helpful

I can say that I have been on the Pt. side of the story. So I know how I felt as a parent. If you have any ? please feel free to ask. I can tell you what was done for me and what they did for me which I now treasure.
Angie

Jess-RN in 2006 · Feb 1, 2005

:uhoh3: I'm also one of those who have been on the side of the parent....ask away, I'll be more than happy to share my situation...all I can say is this...if the doc knows the baby is dead, do not allow him to let the mom lay in the room for hours,waiting, wondering, crying, freaking, wondering if her child really is dead or not...yes, it happened to me...doc decided to wait till after office hours to tell me my son had died....I pretty much knew, but I wanted that medical confirmation......the nurses were very upset with him....needless to say, i dont go there anymore.... :crying2:

I read these types of threads with interest...I like to see how other nurses/hospitals deal with these situations....

BabyGuide · Feb 1, 2005

"i would love to hear anything that would help me be a better nurse to families in this situation in the future. like what if anything was said to you that was especially comforting. really, anything you want to share about your situation would be helpful."

i recently downloaded an article that was based on a very sensitive swedish study in which parents shared their feelings about losing a baby. it spoke of how parents can be nearly overwhelmed with shock, a sense of loss, guilt and helplessness. it recognized that most mothers have established a relationship with their babies long before birth, but that not all mothers had "instant mother feelings." it spoke of the "ambivalent transition into motherhood" that mothers eperiencing loss undergo that includes "broken expectations when understanding that something was wrong with the fetus or neonate; total confusion when confronting the fact that the neonate would die; 'reality awareness' when facing the actuality of the neonate's dying and death; 'consious leave-taking' when encountering the dead infant; and 'elusive grief' when adapting to the death of the infant." although most women found that holding and caring for their babies after death helped them with their transitions, some didn't want to hold or take care of them, preferring to keep the memory of a "living infant." "almost all women had a great fear of forgetting what had happened because they were in a state of shock. they could not comprehend all that had taken place in such a short time." the article concludes: "for health care professionals, it is important to 'be there."

i downloaded the full text article from cinahl. hopefully, you can access it with help from your medical library. here's the citation: lundqvist, anita, nilstun, tore, and dykes, anna-karin. experiencing neonatal death: an ambivalent transition into motherhood. pediatric nursing. 2003. nov-dec, vol. 28 (6), pages 621-25.

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BeccaRN · Feb 1, 2005

I too have been on the patient side of this. The doctor sent me for a sonogram the next day and said to call afterwards. They confirmed the baby had died and when we called the nurses wouldn't let me through to the doctor. I even told them he was expecting the call. I finally had to lose my temper with them before they would let me talk to him. He told me I could either be induced or to wait and I would probably go in to labor on my own. My husband and I chose the induction. When I delivered the baby she was delivered by a nurse. The doctor was no where to be found. The nurses were fantastic. They were very comforting and concerned about my well-being. That was the longest night of my life and I will never forget what they did for me and my husband.

Mermaid4 · Feb 6, 2005

It is so sad isn't it? I think we may all have had that situation, where the maternal pulse is mistaken for baby. I try to immediately take the moms radial pulse if we have a low fh, but in the case you describe that might not have helped. You will learn from this. I also had an early pregnancy loss, and as a result seem to mesh with those demise patients who come in. Always an emotional time for both nurse and patient. I wrote a piece concerning a fetal demise (George and Martha), that nurses who deal with this might identify with. Don't beat yourself up...Hang in there.

akcarmean, LPN · Feb 6, 2005

I was high risk pregnancy anyways. I went b/c I had not detected any fetal movement which we had been counting so many moves every hour. Anyways The nurses called the Dr. he came right over did sonogram told us and then immediatly started labor. After words, the nurses let us take pictures, did the foot and hand prints, cleaned her up and let us take pictures, wrapped her up and then let us hold her and spend as much time with her as we needed. Made sure I wasn't in any pain and that I had everything I needed or wanted. I wanted a lock of her hair they got that for us. gave us her (what would have been) her wrist band, etc. do everything for a grieving parent as you would do for parents with new borns. Do encourage them to spend some time with the baby. They might reget it later on if not. I don't reget taking pictures, having her hand and foot prints I even took pictures of her in the casket. It was something I needed to due for closure. Every parent will be different but do those things even if the parent says no do it anyways give it to them on check out and tell them that they are there and they can think about what they want to do with them later when things are clearer. Arrange for preacher, counsoling, they will need these things in this time of need. After leaving the hospital I had to be placed on Valium and I don't remember much of the next couple of weeks so I am so glad that I had those items for me at a later date when I could handle the situation. Hope this kinda sheds some light on things from a parents eye. JUst make sure that you NEVER treat the deceased baby as it never existed b/c to the parents that baby did exsist and had exsisted for several months. Be caring and don't be afraid to show emotion and touch with the parents it shows that someone besides the parents really do care.

The funeral was on a week day. The doctor shut down his practice to come to the grave side services. He also ran every test under the sun that you could think of to find out why. It wasn't until 6 yrs. later after another miscarriage did we find out. I have protein S Deficiency. We figured that is what caused her death b/c nothing could be found, from blood work, x-rays, atopsy, test on cord blood, bld. test on mom and dad, She weighed 7lbs 3 oz and was 21 in. long beautiful full head of black hair. It was very hard not to have an anwer but it took a long time but we finally found out. after my miscarriage then had to take blood thinning shots through out my pregnancy of my last son. and he only came 4 weeks early 5 lbs 5 oz and 18 in. long.

Have anymore ??? please feel free to ask me,

Angie

FutureNrse · Feb 6, 2005

I was high risk pregnancy anyways. I went b/c I had not detected any fetal movement which we had been counting so many moves every hour. Anyways The nurses called the Dr. he came right over did sonogram told us and then immediatly started labor. After words, the nurses let us take pictures, did the foot and hand prints, cleaned her up and let us take pictures, wrapped her up and then let us hold her and spend as much time with her as we needed. Made sure I wasn't in any pain and that I had everything I needed or wanted. I wanted a lock of her hair they got that for us. gave us her (what would have been) her wrist band, etc. do everything for a grieving parent as you would do for parents with new borns. Do encourage them to spend some time with the baby. They might reget it later on if not. I don't reget taking pictures, having her hand and foot prints I even took pictures of her in the casket. It was something I needed to due for closure. Every parent will be different but do those things even if the parent says no do it anyways give it to them on check out and tell them that they are there and they can think about what they want to do with them later when things are clearer. Arrange for preacher, counsoling, they will need these things in this time of need. After leaving the hospital I had to be placed on Valium and I don't remember much of the next couple of weeks so I am so glad that I had those items for me at a later date when I could handle the situation. Hope this kinda sheds some light on things from a parents eye. JUst make sure that you NEVER treat the deceased baby as it never existed b/c to the parents that baby did exsist and had exsisted for several months. Be caring and don't be afraid to show emotion and touch with the parents it shows that someone besides the parents really do care.
The funeral was on a week day. The doctor shut down his practice to come to the grave side services. He also ran every test under the sun that you could think of to find out why. It wasn't until 6 yrs. later after another miscarriage did we find out. I have protein S Deficiency. We figured that is what caused her death b/c nothing could be found, from blood work, x-rays, atopsy, test on cord blood, bld. test on mom and dad, She weighed 7lbs 3 oz and was 21 in. long beautiful full head of black hair. It was very hard not to have an anwer but it took a long time but we finally found out. after my miscarriage then had to take blood thinning shots through out my pregnancy of my last son. and he only came 4 weeks early 5 lbs 5 oz and 18 in. long.
Have anymore ??? please feel free to ask me,
Angie

I'm sorry for what you suffered. Though I have not lost a child of my own, I was there when my step-sister lost her baby, who was to be my godson. I remember how great the nurses were, encouraging her to give him a bath, dress him, and spend some time with him. As in your case, they did all that could to see that she had every memory possible, even giving her the blanket that he'd first been wrappen in after he was born.

One thing that I've always wondered about, is why there aren't any required follow-up services from the hospital. To lose a child is such an awful thing for parents to go through, and while the staff was wonderful to all of us when we were there, eventually you go home and really begin to deal with it. In my sister's case, she was unable to deal with the reality of it, and made several suicide attempts. Nearly 5 years later she is no longer in touch with reality and heavily medicated at all times. I hate the thought of others going through this. I don't know how helpful it would be, but I've thought it would be nice if the hospital followed-up, possibly even have some of the nurses that were involved call the parents after they've gone home.

One nurse did attend my godson's funeral and we were all extremely touched. To some degree, we all bonded with those nurses over the course of about 72 hours, and I assume that we're not alone in doing so. So, maybe others would appreciate a quick phone call in the days that follow, just to ask how they're doing.