1. Still Birth, Neonatal Loss and Withdrawal of Support Lisa Walker-Vischer RN, MS, CNS

2. Theory of Caring  Relationship based  Caring is defined as “a nurturing way of relating to a valued other whom one feels a personal sense of commitment and responsibility”  5 Categories  Maintaining Belief  Knowing  Being With  Doing For  Enabling

3. Attachment  Attachment during pregnancy is a variable process  Attachment may occur at any point  Planning the pregnancy  Confirming the pregnancy  Accepting the pregnancy  Feeling fetal movement  Accepting the fetus as an individual  Giving birth  Hearing and seeing the baby  Touching and holding the baby  Caring for the infant

4. Theory of Caregiving  Bowlby- Attachment Theory and Theory of Caregiving  Parents have a desire to be with, know and introduce their baby to others in the world as an innate need.  How does the death of a baby alter this innate need?

5. Still Birth  Fetal death at at least 20 weeks gestation and 350 grams or more  Occurs in 1 of every 160 pregnancies = 26,000 babies/year  The cause of still birth is only found in about 40%  Of those ¾ are related to the development of the baby and ¼ to problems with the placenta or umbilical cord

6. Still Birth  Parental experience-  What do parents need?

7. Death Before Birth Video

8. 1 Week After

9. Newborn Death  Death of a newborn within the first 28 days of life  Causes  Birth defects  Prematurity  Complications of pregnancy  Sepsis  SIDS  Shaken Baby

10. Newborn Death  Parental Experience  What do parents need?

11. Parental Decision Making and Withdrawal of Treatment  Religion, spirituality and hope influence decision  Parents felt it was their parental obligation  Parents want to be involved in the decision and usually present  Parents need to have trust in caregivers and accurate prognosis  Perception of pain and suffering influences decision  Parents have hope and want caregivers to be hopeful  Parents involved other people in decision (Moro, Kavanaugh, Savage, Reyes, Kimura & Bhat, 2011)

12. Parental Decision Making and Withdrawal of Treatment  One mother described holding her baby when she died this way:  “…holding her when she died… that’s not a memory I want to have, but… my feeling is, if your child has to die, what better place than in mom’s arms…so.. I try and make that a good memory, but it’s a very sad good.”

13. Video on Withdrawal of Life Support

14. Role of Health Care Professionals  Provide emotional support  Provide information  Meet physical care needs

15. Self Care for Health Care Professionals  We are taught to care for others but often don’t care for ourselves.  Compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress.  How do you take care of yourself after a death?

16. Conclusions  The relationship between the health care provider and the parents is the key  Understanding Theory of Caring/Attachment/Theory of Caregiving drive interventions  Self care is essential