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

camay1221_RN · May 3, 2004

I had a fetal demise, 18 weeks, five years ago. I was in an Antepartum room, however, there were pregnant moms on the floor who were having fetal monitoring throughout the time of my stay, and I had a hard time hearing the monitoring even will all of the efforts by the nurses to put me in a room farther away from those moms. I can't imagine what it would have been like to be on the floor with infants close enough for me to hear their cries. My induction began on a Friday evening, and I did not deliver until after 8pm Sunday evening. Not a big fan of Cytotec after that!

Personally, I don't think it is a good idea to put a mom of a demise on a PP floor. Like I said, that's me personally. Just having lived through the experience, I can't imagine others wanting to be among healthy newborns either...But, that's the beauty of life, we are all individuals, and respond to things as such.

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.

fergus51 · May 4, 2004

I had a fetal demise, 18 weeks, five years ago. I was in an Antepartum room, however, there were pregnant moms on the floor who were having fetal monitoring throughout the time of my stay, and I had a hard time hearing the monitoring even will all of the efforts by the nurses to put me in a room farther away from those moms. I can't imagine what it would have been like to be on the floor with infants close enough for me to hear their cries. My induction began on a Friday evening, and I did not deliver until after 8pm Sunday evening. Not a big fan of Cytotec after that!
Personally, I don't think it is a good idea to put a mom of a demise on a PP floor. Like I said, that's me personally. Just having lived through the experience, I can't imagine others wanting to be among healthy newborns either...But, that's the beauty of life, we are all individuals, and respond to things as such.

I can completely understand that. Unfortunately in a lot of hospitals, it's either plain med-surg or pp. I worked in one place that put women who had suffered losses on med-surg and it was an absolute nightmare. The nurses there have NO training to deal with these patients, and unfortunately ours seemed to have very little common sense either. There were too many "well, you can always have another" and "why waste such a pretty name on a stillborn?" type comments. Better to be with supportive staff and have to deal with seeing a baby than be on med-surg with those kinds of comments.

We were lucky though that on PP all the rooms were private, so it's not like women really saw many babies unless in passing.

camay1221_RN · May 4, 2004

Fergus,

My husband always says, "If common sense is so common, then more people should have it!" There is some truth to that!

I can completely understand that. Unfortunately in a lot of hospitals, it's either plain med-surg or pp. I worked in one place that put women who had suffered losses on med-surg and it was an absolute nightmare. The nurses there have NO training to deal with these patients, and unfortunately ours seemed to have very little common sense either. There were too many "well, you can always have another" and "why waste such a pretty name on a stillborn?" type comments. Better to be with supportive staff and have to deal with seeing a baby than be on med-surg with those kinds of comments.
We were lucky though that on PP all the rooms were private, so it's not like women really saw many babies unless in passing.

TDub, MSN, EdD · May 4, 2004

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?

Please don't feel bad--we just wanted to answer the question. You are certainly entitled to say what you think.

SmilingBluEyes · May 4, 2004

OK I have to interject an opinion here: as someone who has endured 4 losses in 2 years, I can say it's b etter to be on OB floor. At least THERE I am not a medical or surgical patient whose loss is not even recognized, unlike on medical and surgical units. I have been hospitalized on both for perinatal losses, so I can speak from personal experience here. NOBODY cares better for women experiencing perinatal loss better than PERINATAL NURSES, believe me.

AS far as offering csection to a woman with a known demise, I think it would be kind. Yes there is risk to csection; there is also serious risk in lady partsl delivery too, in the way of infection especially. I really think It's horrendous to labor 2 or 3 days before finally delivering a dead baby and the longer you are in labor and in the hospital, the greater your chances of nosocomial infection. I think a woman should have SOME say in this, anyhow.

fergus51 · May 4, 2004

Fergus,
My husband always says, "If common sense is so common, then more people should have it!" There is some truth to that!

Renee, I think that's one thing no one would debate!!!

camay1221_RN · May 4, 2004

I agree with you there. I am glad the antepartum unit was available for me to be on instead of a med/surg or PP unit. I felt for the moms who were in Antepartum because, though they were still pregnant, many were in positions that could at any time have resulted in my outcome. The only reason I was able to hear the fetal monitoring in other rooms was because of the paper thin walls!

I was also very fortunate that I was in the hospital I worked at. I was so incredibly touched by the compassion of all the nurses, the ones who cared for me in antepartum, and my co-workers in PP. I am blessed to this day to still be friends with the majority of them, even though I haven't worked with them for just over a year.

OK I have to interject an opinion here: as someone who has endured 4 losses in 2 years, I can say it's b etter to be on OB floor. At least THERE I am not a medical or surgical patient whose loss is not even recognized, unlike on medical and surgical units. I have been hospitalized on both for perinatal losses, so I can speak from personal experience here. NOBODY cares better for women experiencing perinatal loss better than PERINATAL NURSES, believe me.
AS far as offering csection to a woman with a known demise, I think it would be kind. Yes there is risk to csection; there is also serious risk in lady partsl delivery too, in the way of infection especially. I really think It's horrendous to labor 2 or 3 days before finally delivering a dead baby and the longer you are in labor and in the hospital, the greater your chances of nosocomial infection. I think a woman should have SOME say in this, anyhow.

Energizer Bunny · May 4, 2004

((((Deb and Camay)))) While I know it is not the same at all, I had a loss at 7 weeks gestation. I also watched a dear cousin go through loss after loss after loss. I'm thinking of you......

and Deb...I'm so glad someone agrees with me about a choice for a section. I thought I was going nuts here! LOL!

sbic56, BSN, RN · May 4, 2004

((((Deb and Camay)))) While I know it is not the same at all, I had a loss at 7 weeks gestation. I also watched a dear cousin go through loss after loss after loss. I'm thinking of you......
and Deb...I'm so glad someone agrees with me about a choice for a section. I thought I was going nuts here! LOL!

I just wanted to chime in and add I certainly believe in the choice for a C/S! My only concern was, the only time I saw it happen, the mom did not fair well in the grieving process aftrward and I question if this had something to do with her inability to grieve in a healthy way.

Energizer Bunny · May 4, 2004

sbic56...that would be my big concern as well.....since we are talking about this, does your hospital have grief counselors readily available or do you just rely on the chaplain or how does that work?

Cherish · May 4, 2004

My aunt suffred through this 8 years ago. Two months after her oldest son was killed in a car crash, she gave birth to a stillborn child.
The baby died in utero and the doctor induced her labor. She gave birth lady partslly. I have never been able to understand, in situations like these, why the doctors do not do c-sections?

I miscarried (stillborn?) when I was 5 mths. And was VERY glad that I didn't get a C-section. It depends on how long the baby is in your womb, as you know the longer the baby is there the more you can get infections and septic. I was on bedrest in the hospital for 4 days trying not to move and in immediate pain (they told me there was a possibility of the baby living since she had a heartbeat). But later that didn't happen, and trust me my hopes were up and praying to God every second that my baby would survive. I think the doctor's and nurses were SOO supportive. Thats the reason I want to be a nurse (CRNA is my goal). The CRNA that was dealing with me was so supportive and she came and visited me every second she had free, which was surprising and I thank her for it. I don't know if a C-section would have changed the situation, but I do know that I had a lot of support and love from family/friends and the nurses and my doctor and that was very important at that time.

lynn27 · May 4, 2004

When I miscarried, I was placed on a medsurg floor. I was very lucky that my roomate was very comforting and told me about how she had had a stillbirth and miscarriage but went on to have healthy children. I don't remember her name but I can still see her face and hear her words that were so healing for me. Thankfully, I did have 2 healthy children later. (And, unfortunately, additional miscarriages). It was after the delivery of my second son that I was really upset by a different hospital because of their inhumane treatment of a pregnant patient (22 weeks). All of us newly delivered moms were together in a big room with curtain separating some of us. Of course, we were excitedly talking about our new babies and our other children, when a new patient was brought in. Then we all heard a fetal monitor--and a doc telling this crying patient that the baby who heart was beating so steadily was not going to make it--that they could not stop her labor. We all became quiet and did not talk any further so that we wouldn't cause this pt any additional pain. So so terribly sad. Later, when I became a L&D nurse, I was determined that my patients would always be treated with respect no matter what. For awhile, it seemed, that I was the stillbirth nurse--pregnant ladies coming in c/o no fetal movement or dx with stillborn baby in doc office. I hope that I helped them somehow and that maybe they can look back and feel some comfort while looking forward to the future and the hope that it can bring.