Very early this morning, approx 0200, L&D took a 32 week gestation woman back to the OR for a c-section. The baby had multiple anomolies and died shortly after birth. I was not the shift coordinator for the shift, but the nurse who was shift coordinator came to me and asked my opinion about L&D transferring this patient to us, the postpartum unit. I told her to refuse transfer of the patient. First, because we are not trained in handling bereavement care. Second, L&D is supposed to keep the women with a demise, and finally, because it is cruel and inhumane to subject a woman to living, breathing, crying babies when she has just lost her own infant. The shift coordinator in L&D accused me of being unprofessional and said I was yelling at her. Yelling? No, but I was firm in my decision not to accept this. The reason I got for them wanting to send her up was because she was a c-section and that's the way it has always been done in the past. Well, I have worked on our postpartum unit for almost four years and only once in that four years have I seen a patient with a demise transfer up to our unit. That patient's family complained because they thought it was incredibly insensitive to put a grieving mom on the same floor with healthy, crying babies.
I think this is an ethical issue. I lost a baby nine years ago at 18 weeks gestation and would have been utterly appalled at the mention of transferring me to the postpartum unit. Am I off the mark on this one, or just being overly sensitive because of my own loss?
I like the idea of a choice. I think I would want that if I ever had a fetal demise or a miscarriage that was being dealt with in a hospital situation.
Being a bereavement facilitator at my facility, I have to say that anytime there is a loss, it is hard for everyone involved. Though there are many sides of this situation, and many positions can be justified, there is really no easy answer. Put a grieving mom with laboring women where they hear cries of the newly born, or in post partum where babies are everywhere with happy parents? Unfortuately for this mom, she is a surgical patient who won't go home after stable (like a vag delivery would most times). She is in for a longer haul than most. Where would this patient be better suited? Did anyone ASK the patient where she might like to be? Some moms feel BETTER when they are around people that know how to care for them, can get answers readily and knowledgeable care when it comes to the post partum period. Let's face it, med/surg nurses are just plain skeered of the dreaded FUNDUS. You must also factor in that they aren't trained to deal with perinatal loss, and usuallly will stay away from these patients for fear of "saying the wrong thing". I have dealt with many moms with losses over the years, and for the most part, I would have to say a large percentage choose to stay on our floor before moving to another. Of course, when possible, they just go home. I think it is important to let the patient have some say in her care, after all...she has lost a great bit of control, and having a bit given back means the world to them.
I have to say that I am surprised that a post partum floor has no training in perinatal loss. I would think at least a basic guide to caring for those who have lost a baby would be prudent. Remember, just because their baby died, doesn't mean they aren't going to go thru normal post partum issues....milk coming in, bleeding, recovering from surgery (when applicable). Sometimes, at first, moms just wanted to be treated like nothing happened, like they are "normal"...even thought their world isn't. You care for them just the same, except you may have to wipe a few more tears, give extra hugs, or just listen for a bit. To me..that is being a nurse.
I agree with the above poster....get a class going...attend one. It is a powerful experience. I love working with these moms. There is strength in these women, though they feel they have none. It is an amazing experience.
Thank you for your thoughtful reply!
It seems from reading everyone's posts that we all base our opinions and thoughts on how things are done at our respective institutions.
There is an isolation room in our L&D that the women who have a fetal demise stay in. It also has the small ante room between the main hall and the patients room. Also, the rooms in L&D are farther apart than they are on the postpartum unit, as there are not as many rooms.
There are many factors I didn't cover in my OP. One of which was our unit was three beds shy of being full, there were a couple of women in labor who were going to deliver within a couple of hours and would need postpartum care with their newborns. L&D was going to be down to four patients on the floor with four nurses staffed. Doesn't it seem to make more sense to keep the grieving mom in L&D in the isolation room and let the few remaining rooms on our unit be used for women who will come up with a baby? There just isn't a great deal of logic used. Many of our L&D nurses have admitted, once the baby is out, they want the mom and baby off their floor. Now where's the compassion there?
I have to admit, my experience with my personal loss has made me biased. I wouldn't have ever wanted to be on a postpartum floor and since grieving families are cared for by the L&D staff 99% of the time, I don't see how they justified not caring for this patient.
I have to admit, my experience with my personal loss has made me biased. I wouldn't have ever wanted to be on a postpartum floor and since grieving families are cared for by the L&D staff 99% of the time, I don't see how they justified not caring for this patient.
But what would have happened if L&D got busy? Would they have to move this mom in the middle of her stay? She was a c section so probably there for at least 2 days right? I completely understand not wanting to subject the mom the crying babies, but it wouldn't be good to move her in the middle of her hospital stay.
Am interested in what specific training one requires to work with bereaved parents? Isn't that called nursing/midwifery care? Our women go back to our ward area, in a single room. We have a small fridge on the ward so the baby can be kept with the parents for as long as they wish.
I certainly understand your feelings and opinion, I am in this profession because a close family members experience with a loss, that has profoundly affected her whole life. and I am very much an advocate for the families that have lost a baby. our hospital is a large facillity and our patients that have suffered a fetal demise do go to postpartum/gyn ,we have a resolve through sharing counselor on staff to assist these moms. one of the first things you are told in resolve through sharing is that it is better to say I am sorry than to say nothing at all or saying the wrong thing, we do try to separate them from the other moms and babies, It has been my experience that the room assignments have been made depending on the patients acuity and her personel feelings. some of my patients over the years have wanted to be on postpartum in fact many more have prefered to stay on postpartum than to be placed on a med surg unit where the nurses have no experience caring for a postpartum mom. Resolve Through Sharing is a great program, when I went through the class years ago we had women with a great multitude of personal backgrounds and we all came away with a greater understanding of the grief process that is involved when a family suffers the loss of a child. I may be benificial for your hospital to look into providing this class for all the staff associated with new families.
I work in an LDRP unit so there is no where where babies can't be heard crying. We offer our patients with demise the choice of staying there or going to Med/Surg. We also offer the M/S nurses support with PP care and stay in touch with them if they need any help with a fundus or with bringing the baby back for another visit.
I'm surprized at how many of the the moms choose to stay in our OB unit. I like the idea that they get a choice.
Bereviement happens everywhere. I think it would be a good idea for the nurses in all OB areas to have some training in dealing with it.
Specializes in L&D, Antepartum, Postpartum, MB, Special.
My 2 cents....We have one large unit that cares for women from antenatal to postpartum including babies. We are not able to transfer our patients anywhere. That being said...we are all trained in dealing with a loss and pt's with a loss are 2 nurses to 1 pt until all of their recovery is done and pics, momentos, etc. Then they go in with the normal assignments and are counted the same a NICU moms for staffing purposes. We get alot of feedback b/c we also run a support group and we do not have complaints. Like someone said before..we keep them away from the nursery, there is a white rose on their door so everyone knows and we make every attempt to keep them away from laboring moms also.
I understand your issue but there are units that dont have a choice and are able to make it work with some adjustments. I realize that your loss makes it a little more personal and I have had 2 myself. Maybe you would like to start some type of program or protocol. I joined our RTS (Remember Through Sharing) coordinator to provide services and do the support group and it really does help with healing and you have a personal understanding of what the families are going through.
Bereavementservices.org is the place to go if you are interested in taking a RTS training course. They have a sundry of different kinds of courses, one being a two-day training course that teaches everything you need to know to get you started in working with those who have experienced a loss at any gestation. It is a powerful, emotional experience and well worth it. They also have great resources there at the website.
My 2 cents....We have one large unit that cares for women from antenatal to postpartum including babies. We are not able to transfer our patients anywhere. That being said...we are all trained in dealing with a loss and pt's with a loss are 2 nurses to 1 pt until all of their recovery is done and pics, momentos, etc. Then they go in with the normal assignments and are counted the same a NICU moms for staffing purposes. We get alot of feedback b/c we also run a support group and we do not have complaints. Like someone said before..we keep them away from the nursery, there is a white rose on their door so everyone knows and we make every attempt to keep them away from laboring moms also.
I understand your issue but there are units that dont have a choice and are able to make it work with some adjustments. I realize that your loss makes it a little more personal and I have had 2 myself. Maybe you would like to start some type of program or protocol. I joined our RTS (Remember Through Sharing) coordinator to provide services and do the support group and it really does help with healing and you have a personal understanding of what the families are going through.
First of all, I'd like to Thank everyone for your thoughtful responses! It is very enlightening how a situation is approached so differently in different institutions.
Many of your responses have gotten my wheels turning and I plan to be proactive.
So, to give you the update...My supervisor sat down with me this morning and explained she, the director, and the L&D supervisor were going to stand behind my decision based on the low census in L&D that night and our unit being near being full. Our L&D also functions as our antepartum unit and that night with the patient who had the fetal demise, their census would have been four antepartum patients and the mom with the loss with four nurses staffed. That was one of the things I took into account when I refused to take her as a transfer. I guess you have to know the personalities of some of the nurses on our L&D noc staff to fully appreciate where I'm coming from on this one. That could be true for me too. If you knew me as a person, not just a post on a computer, you'd know I acted in what I felt was in the best interest of the patient. Someone mentioned showing some compassion. Well, I believe I showed far more compassion to this young lady that night than the nurses who were on L&D .
I sincerely Thank you all again! My plan is to use some of your suggestions and look into the class offered by Resolve Through Sharing.
I'm a new nurse but I'm a woman first and I have lost a child and I would be DEVESTATED if I was put on a floor with new moms and babies after losing my child. I can't even imagine. I think in our unit very rarely does a demise case come to our side (pp) but normally I think they go on the AP (antepartum) or the med surg areas.
I think you were on the mark. I'd document everything.
smk1, LPN
2,195 Posts
I like the idea of a choice. I think I would want that if I ever had a fetal demise or a miscarriage that was being dealt with in a hospital situation.