LEC 8: Perinatal Loss

Question 1

Types of Perinatal Loss and Unexpected Outcomes

Answer 1

• Early losses
• Stillborth
• Newborn Death
• Loss of baby
• Loss of healthy baby/ uncertain prognosis

Question 2

Prenatal Loss and Unexpected Outcomes: Early Losses

Answer 2

• Ectopic pregnancy
• Miscarriage/ abortion
• Medical interruptuon of pregnancy
• Infertility/ multi-fetal reduction

Question 3

Prenatal Loss and Unexpected Outcomes: Loss of Baby

Answer 3

• Adoption
• Relinquishmnet
• Apprehension

Question 4

Prenatal Loss and Unexpected Outcomes: Loss of Healthy Baby/ Uncertain Prognosis

Answer 4

• Brith of prematur or ill infant
• Birth of infant with special needs
• Compromised newborn
• Anomalies

Question 5

Attachment During Pregnancy and Childbirth

Answer 5

• Planning the pregnancy
• Confirming the pregnancy
• Accepting the pregnancy
• Feeling fetal movements
• Seeing the fetus on U/S
• Accepting the fetus as an individual
• Giving birth
• Hearing and seeing the baby
• Touching and holding the baby
• Caring for the infant

Question 6

Grief occurs as response to what

Answer 6

Grief occurs as a response to a childbearing event that produces a sense of loss and is experienced in relation to the significance of the attachment.

Question 7

Disenfranchised Grief

Answer 7

• Occurs when the loss dose not receive normal social support, is not openly acknowledged or cannot be mourned publicly
• If the relationship with the dexeased is not recognized, when the loss it not acknowledged or socially acceptable and when the giver is thought to be incapable of mourning or the loss did not impact them
• Think abour how the individual deals with loss, their personality,a dn what where the circumstances
• If the circumstances are not dealt with an dprolinged it can lead to other issues such as maladaptive problems, metnal health- oportant to get help

Question 8

Four Tasks of Moruning

Answer 8

• To accept the reality of the loss
• To work through the pain an dfrief
• To adjust to a world without the deceased
• To find an enduring conenction while moving forward with life

Question 9

Response to Grief

Answer 9

• Parents respond in unique and indivudal ways:
  
  • Relief
  • Disappointment
  • Feelings of inadeqaucy or failure, especially for the mother
  • Previous experiences with loses/ life experiences
  • Cultural factors
  • Concerns re: health/ future pregnacies

Question 10

Effects of Grief: Physical Effects

Answer 10

• Exhaustion, fatigue
• Loss of appetite
• Weight loss or gain
• Sleep problems
• Breathlessness/ palpitations
• Headaches
• Restlessness
• Aching arms

Question 11

Effects of Grief: Social Effects

Answer 11

• Withdrawal from normal activity
• Isolation (emotional and physical) from sspouse, family, and/or firends
• Redefining rols in life

Question 12

Effects of Grief: Emotional and Psychological Effects

Answer 12

• Denial, guilt. anger. irritability
• Bitterness, depression
• Mood swings
• Time confusion
• Concentration on problems
• Failure to accept reality
• Preoccupation with deceased/ dreams
• Decreased self-esteem

Question 13

Breaking Bad News

Answer 13

• Provide ‘warning shot’ or introductory sentence before presenting distressing information. Ideal for multidisciplinary team to be present.
• Provide opportunity for supportive friends or family to be present.
• Tell news in a privet setting. Ask family to tell you about their child. Offer to assist in telling children afterward.
• Sit down near family, not across table or standing. Establish eye contact.
• Be unhurried and don’t look at watch. Delegate other assignments.
• Be specific. Present options for care. Ask family to explain what they understood. Clarify misconceptions.

Question 14

What Can you do When Caring for Families with Loss

Answer 14

• Flexibility key
  
  • Meet family where they are at with the loss
• Listen and assess needs
  
  • Significance of the loss
• Discuss and offer choices- to see, hold baby, funeral customs, placement off-service; offer more than once
• Provide consistent information/ caregiver
  
  • Caution when assigning pregnant caregivers
• Preparation for how baby may appear
• Validate their experience
• Make sure rest of the health team is aware
• A still birth- still need to deliver baby- need to explain the process to the mother
  
  • If have a c-section- will have a scar, always have a reminder
  • If mother can deliver vaginally it is the best option

Question 15

Perinatal Palliative Care

Answer 15

• A philosophy of family centred care that addresses the expectations and intentions of families who choose to continue a pregnancy after their baby is diagnosed with a life-limiting condition
  
  • Anticipate, prevent and relieve suffering (physical, psychological, and spiritual)
  • Preserve dignity
  • Promote quality of life for baby and the family
  • Honour parental preferences and wishes for their infant’s care regardless of length of life

Question 16

Providing Memories (Memorie Boxes)

Answer 16

• Collect and Offer Memories
  
  • Memory boxes
  • Lock of hair with parental permission, footprints, photos, ultrasound pictures, fetal monitor strips
  • Crib card with weight and measurements
  • Items of significance to the parents
  • Clothing (blanket, cap)

Question 18

One Chance to Get it Right

Answer 18

• Parental recovery from the experience of stillbirth can be influenced as much by staff attitude and caring behaviours as by high-quality clinical procedures.
• Themes
  
  • Parents experiences; enduring and multiple loss
  • Parent needs: making irretrievable moments precious
  • Care in the caring: the best care possible to the worst imaginable

Question 19

Final Thoughts

Answer 19

• Listen with your heart, not your head
• Be present to their pain, knowing you cannot take it away or “fix” things
• Every time a mother or father tells you their story or you speak their baby’s name, you honour that brief lifetime of their child
• You will always be remembered as their nurse and someone who made a difference