Perinatal loss 2010 review day 3
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Transcript of Perinatal loss 2010 review day 3
Perinatal Loss
Sandy Warner RNC-OB, MSN
Certified Perinatal Grief Counselor
Grief is a process, not an event
When your parent dies, you’ve lost your past.
When your child dies, you’ve lost your future
Uniqueness of Perinatal Grief
Mother and her partner feel like parents, but have no baby to parent
Their baby was not known to others
Taboo topic: sometimes hidden and not discussed
We can never know another’s grief
Caregivers need to know how bonded mom was to pregnancy
Frequency of Perinatal Loss
Greater than 1 million pregnancy losses yearly in USA25% of all conceptions end in 1st trimesterLate losses occur 2-4% of pregnanciesStillborn rate is 10.7% since 1990
African American stillborn rate is 20%» (AWHONN, 2009)
History of Perinatal Grief
1944 – first published work on grief by Lindeman (dealt with death from fire)1962 – “Reaction of RNs with mothers of stillborns” Nursing Outlook1969 – Kubler Ross’s work published1976 – AJN and Contempory OB Gyn articles published1984 – Davidson’s 4 phases of perinatal loss1985 – ACOG and NAACOG positions statements
Perinatal Loss Definition
Nonvoluntary end of pregnancy from conception, during pregnancy and up to 28 days of the newborn’s life
– (AWOHNN)
Definitions vary from state to state with weight, gestational age etc.
– (AAP and ACOG)
Davidson’s Four Phases of Bereavement
Shock and numbnessDuration – first two weeks
Characteristics:Short attention span
Difficulty concentrating
Impaired decision making
Denial
No concept of time
“Feels like a bad dream”
Shock and Numbness con’t.
Interventions:Allow for time
Repeat, repeat, repeat
Use simple terms
Help them to think through decisions
Discourage rapid decisions
Searching and Yearning
Duration: 2nd week – 4th monthCharacteristics:
High energyAnger/guilt/dreamsWeight loss or gainSleep difficultiesAching arms, may hear baby cryingHeadache, blurred vision, palpitationsResentment
Searching and Yearning Con’t.
Interventions:Encourage support groups
Anticipatory guidance on normal process of characteristics
Disorientation
Duration: 5th to 9th monthCan last up to 24 monthsCan also last 3-5 years for multiple pregnancy
Characteristics:Low energyThinks “I am going crazy”Social WithdrawalDisorganizedDepressionLikely to loose support
Disorientation Con’t.
Interventions:Anticipatory guidance
Assurance
Support Group involvement
Reorganization/resolution
Duration: 19th- 24th month
Characteristics:Some good days, some bad days
Sense of relief
Renewed energy
Able to laugh and smile again
Milestones are bittersweet
Reorganization/resolution
Interventions:Be available to listen
Acknowledge baby’s presence
Use baby’s name in conversation
Remember important dates
Meaningful remembrances:Tree, rose bush, flowering plant etc
Donation to memorial fund
Men and Women Grieve differently
Women:Body image issues
Emotional swings
Need to talk, cry
Increased dependency needs
Fear of intimacy, resuming sex
Jealously
Differences in Gender Grief cont’
Men:Increase sense of responsibility
Withdrawal from partner/lack of communication
Financial worries
Physical symptoms
Sense of failure
Resentment of attention to partner
Difficulty dealing with tears
Need to “stay busy”
Cultural Diversity
Baptism is important for Catholics and other Christian religionsMuslims: see death as natural stage of life. May not want to view baby. Loud crying is discouraged.Jewish: mourning rituals (family member stays with baby but not general viewing). Questionable if baby is named. No autopsy.
Cultural Diversity con’t.
Native American: vary widelyFocus on transition to afterlife
Ceremonies with food, possessions at gravesite. May leave body exposed.
Amish: Simplistic lifestyle with large
number of children. Loss of child is profound but viewed as God’s will.
Cultural Diversity cont.
Hispanic/Latino: females vocal with grief and may even shake
Males are stoic and can appear uncaring but are deeply affected.
Mementoes and photos very important.
Respect caregivers
Usually family spokesperson – if caregiver establishes rapport, better outcome.
Cultural Diversity Cont.
African American:Variety of religious denominationsStrong spirituality and reliance on GodPrayer is common at bedsideFuneral delay until extended family presentVocal grief acceptableImportance of grandmotherAppreciate inclusion of family minister
Self reflectionfor care giver
Loss is profound experience and invokes own feelings of lossEmotionally draining, review of past experiencesNeed for staff supportEach nurse needs to examine their feelings as well, but not burden grieving family.Tears are OK with grieving family
What to say:
“I’m sorry.”
“I’m sad for you.”
“How are you doing with this?”
“This must be hard for you.”
What can I do for you?”
“I’m here, I want to listen.”
What NOT to say:
“You’re young, you can have others.”
“You have an angel in Heaven.”
“This happened for the best.”
“Better for this to have happened now, before you knew the baby.”
“There was something wrong with the baby.”
Calling the baby “It” or “fetus”
Nursing Care
Provide physical and psychological support
Refer to chaplain, grief support etc.
Include family members if appropriate
Photos, mementoes
Allow parents and family opportunity to hold infant and say goodbye.
Families see nurse as role model with baby.
Anticipatory guidance for discharge home
Prepare them for the reaction of others.
Encourage offers of help from loved ones
Suggest a plan on how to inform friends.
Supply a few phrases:“We’re not pregnant any more”.
“Our baby has died.
Sibling and grandparent grief
Grandparents often don’t want mom to view baby. (taboo)
Siblings:Developmentally appropriate care
May want to see baby
Many books for children
Fear they themselves or parents might die
Relate to pet’s death sometimes easier
than baby.
Subsequent Pregnancy
Listen, talk and keep open communication.Allay fearsOffer guidance about potential difference in “bonding” to next pregnancyTry to make this birth experience different from loss experience
Know your patient’s history
Resources
Compassionate Friends – Illinois
Pregnancy and Loss Center – MN
Resolve through Sharing – WS
SHARE – Missouri
Richard Paul Evans – Angel Statue and memory walk
Local support groups