Thoughts on working with a laboring patient with a deceased baby?

[kar212]

Hello. I was just curious to get some opinions as what anyone thinks of working with a laboring patient whose baby has died. How often do you encounter this? Do you tend to shy away from these patients (if you have any choice in the matter)? Do you encourage the mother to hold the baby?

I don't work in labor and delivery, but I have delivered a stillborn and had excellent nurses take care of me. I was just wondering what some of you thought.

[Energizer Bunny]

It still seems like in these scenarios that the patient should be able to decide how they want to deliver. I am not an advocate of c-sections for convenience, but this is one case where I would think there should be a choice.

[TDub, MSN, EdD]

It still seems like in these scenarios that the patient should be able to decide how they want to deliver. I am not an advocate of c-sections for convenience, but this is one case where I would think there should be a choice.

Because the chances of complications and /or death are much, much less with a lady partsl delivery. No doc would run the risk of sacrificing the mom for a dead baby.

[Energizer Bunny]

I just said what I "think" and I am entitled to that. I know what my Aunt went through and cannot imagine putting anyone through that. Why does everything have to turn into a debate around here?

[Energizer Bunny]

Besides..some dr's do c-sections routinely just to fit the birth into their schedules, etc....so in this instance I still think it should be up to the mom. It would be HER risk.

[sbic56, BSN, RN]

It still seems like in these scenarios that the patient should be able to decide how they want to deliver. I am not an advocate of c-sections for convenience, but this is one case where I would think there should be a choice.

It is a choice, but not recommended for reasons stated above. I question if sometimes mom is less able to grieve in a more complete way if she doesn't deliver lady partslly. I attended a C/S where the mother insisted upon having it. In respect for her, I won't go into detail, but she did not grieve in way that would allow her to let go of this baby. It was extremely sad. I wondered if by not going through the process of delivering, she delayed her ability to grieve. Perhaps I am off base on this, but I had never seen someone behave this way after the loss of a baby as she did. She is the only woman I saw go to section over lady partslly with a demise.

[Energizer Bunny]

I had thought of that as well.....that maybe they couldn't grieve as well with a section....it's a thought, but how are we to really know? I wonder if there have been any studies done? It would make for an interesting paper too, wouldn't it?

[sbic56, BSN, RN]

I had thought of that as well.....that maybe they couldn't grieve as well with a section....it's a thought, but how are we to really know? I wonder if there have been any studies done? It would make for an interesting paper too, wouldn't it?

It would be interesting to know. There's got to be literature on it somewhere. It makes sense to me, especially after caring for the woman I mentioned. She went from the expected hysterical response in learning her baby died then right to the OR. No processing. I can see why she was unable to grieve.

[Energizer Bunny]

If I can find any extra time, maybe I'll look it up on the net. Don't know if I'll find much, but I'll see and then pass it on.

[fergus51]

I had thought of that as well.....that maybe they couldn't grieve as well with a section....it's a thought, but how are we to really know? I wonder if there have been any studies done? It would make for an interesting paper too, wouldn't it?

It's the same rationale for not shielding these women from newborns. In some hospitals these women are sent straight to med-surg, in others they are on postpartum. The rationale is they WILL see babies and they DID lose a child and the longer you delay dealing with it, the harder it is for the mother. It happened. With a c-section it seems to be easier for people to pretend that they just went in for minor surgery and never suffered a loss. It is a matter for debate. In my experience, staff that trained earlier tend to shield more.

I have looked after a few families in the NICU who have lost one baby, but still have a surviving twin. The common theme is that they don't want us to pretend they didn't lose a child because it negates that child's existence. Can you imagine if one of your children died and no one ever acknowledged it or ever spoke about them again? It would be as though you were never that child's mother. It's like stripping you of a part of your identity. I mean, you just have to look at your sig and you realize being a mom of three is who you are. Speaking of a deceased child allows a parent to grieve.

It may have been easier for your aunt to have a section. On the other hand, if she had a c-section she might today be sad at always having that scar or be upset that we "ripped" the baby from her. I really don't know.

[dawngloves, BSN, RN]

Interesting thought fergus. At my facility and the one I delivered at, moms that have had a fetal demise or had a baby sent to NICU go to a different floor entirely, (still a GYN floor, but no nursery).

[BabyRN2Be]

That's what happens at our hospital. Mom of fetal demise is sent to a GYN floor instead of OB. Moms of NICU babies are usually kept on PP. It's closer to the NICU if they want to go see baby.

It depends on the facility.

[sbic56, BSN, RN]

I am sure we think we are protecting or being kind to move these moms to another floor, but really could be thwarting the grieving process or at least failing to truly acknowlege the loss of their child in the most sensitive way. All done with the best of intentions, but maybe not really the best thing to do. At the hospital where I work, we keep moms on the floor but try to give them and their families as much privacy as possible.