Sara Mahoney/Clinical Group 6 Murray Chapter 24 (pages )

Early Pregnancy Loss Spontaneous Abortion or Etopic Pregnancy Etopic pregnancy can result in damage or loss of the fallopian tube Etopic pregnancy is more frequent in women over 35 years old. Causes increased stress on the parents – fear that they may not be able to have children Parents may feel intense grief

Conflicting feelings of joy and grief. They do not grieve less for the dead infant. In fact, the grieving process can be more complex! They fear for the health of the other infant(s). They may not be able to grieve because of their concerns for the surviving child. They may experience problems with attachment because of fear of loss. May have less support from other parents who have experienced loss through single gestation.

Previous Pregnancy Loss These mothers are extremely prone to having their newborns preterm or with low- birth-weight. For this reason, they should be counseled about early prenatal care and will need extra emotional support if they become pregnant again. Sense of reliving the loss of the previous pregnancy. High levels of anxiety. Decreases attachment during subsequent pregnancies. Depression has higher incidence. The mother may want more frequent visits with the HCP to ensure the health of the fetus.

Acknowledge the Infant The response to perinatal death changed as nurses discovered that the most helpful interventions for grieving parents were those that acknowledged the rights of the baby. To be recognized as a person who was born and died. To be named. To be seen, touched, and held by the family. To have life-ending acknowledged. To be put to rest with dignity.

Presenting the Infant Preparing a Memory Packet Because these are the memories the family will retain, presentation of the infant is very important. Prepare the parents for any abnormalities in the infants appearance. Wash and wrap the infant in a soft, warm blanket. Try to bring the infant to the parents warm (it may be necessary to place the infant in the warmer to achieve this). If warmth is unachievable, warn parents that the skin may feel cool. When deformities are present, try to cover the most severe portions with the blanket. Allow as much privacy and time as needed by the family. Offer the parents opportunities to bathe or clothe the infant if they wish. Always stick to what is comfortable for the parents. Confirms infants existence and helps parents complete the grieving process. Nurses should also consider different cultural beliefs concerning death (many cultures may find photographing the dead unacceptable – Native Americans, Hindu, Eskimo, Amish, and Muslim). If possible, take photos before the death occurs. Memory packets usually include: Photographs Handprints Footprints Birth identification band with the date and time of the birth Crib card with the infant’s name, weight, height, and length Tape measure and blanket used for the infant Lock of hair (if possible)

Families with other children Help the parents plan how to tell the other children about the death of the newborn. Give them information about sibling responses and needs based on the age of the other children. Provide parents with written information about perinatal loss, grieving, and children’s responses to death. Explain the cause of death in understandable terms. Some children may blame themselves. Offer clergy for counsel, funeral arrangements, memorial services, and baptism. Discuss the grieving process and normal reactions. Discuss common reactions that family and friends might have, and mention that some may minimize the loss or urge them to have another baby in a misguided attempt to offer comfort. Let the parents know that grandparents also go through grief because of the loss as well as the pain their children must endure. Other Considerations

Couples usually want to know the cause of death, an autopsy may be recommended even if the cause of death is obvious. This gives the parents the most accurate diagnosis for risk of reoccurrence in a future pregnancy. Refer parents to organizations and support groups designed to help them cope with loss of a child. The following are organizations that could be useful: Resolve Through Sharing; AMEND; SHARE; and HAND.