Perinatal Bereavement: How Nurses Can Help
By Judy Cohen, RNC, MSN &
Jacqueline Nicholson, RN, MA
Where is the happiest place in the hospital? Ask nurses and theyll probably tell you its the maternity unit and yes, its a great place to work when a nurse gets to care for proud parents and their smiling, healthy newborn. But whats it like when the outcome is less than happy? Loss can occur through miscarriage, ectopic pregnancy, stillbirth, or neonatal death, and its a stressful time for everyone nursing staff included.
In moments like these, nurses often find themselves at a loss, uneasy in large part because they may lack knowledge and skills when caring for grieving families. Sadly, this aspect of care is so necessary and yet often missing in the basic nursing curriculum, as well as unit-specific nursing orientation.
At Boca Raton Community Hospital, our perinatal bereavement support group aims to give grieving parents an outlet for their grief. What weve learned from these sessions could help maternal-child RNs who want so much to help, but cant quite find the right words and gestures.
Society often makes it difficult for parents to grieve because the loss of an infant may be considered less significant than the loss of an older child. Well-meaning friends and family members make efforts to lessen the hurt by minimizing the loss. The grieving couple might be told, Youre still young you can have another. But when parents arent allowed to properly mourn the loss of their baby, their grief can linger sometimes for years.
The nurse needs to make sure parents understand that while they did not have a lot of time with their baby, their hopes and dreams for the child, no matter how brief, made it a part of them and their reality. This holds true no matter what condition or circumstance caused the babys death.
Along with helping parents validate their grief, nurses need to realize that an extreme sense of failure and guilt often accompanies the loss. Why did this happen to us? parents may ask. Will it happen again? It is always best to avoid cliché responses to such questions, like Youll have another or Its better it happened now rather than later. Instead, RNs should try to get parents to talk at length about their fears and concerns. One way to do that is to use open-ended questions, such as: Have you been thinking about your pregnancy? What preparations had you made for the baby? This will give parents the opportunity to talk about their feelings and perhaps start to work through the process of eliminating self-blame and often a sense of guilt.
At Boca Raton Community Hospital, weve found that certain guidelines can help nurses provide a family-centered approach in dealing with perinatal loss. The expected standards of care are based on the idea of offering choices to the bereaved family.
One such guideline involves providing mementos, such as photos, name bracelets, footprints, a lock of hair, or similar items. Even when parents say they dont want mementos at the time, such items should be kept on file months later, once moms and dads have had a chance to heal a bit, they very likely will return to get them.
Similar wisdom applies to the issue of holding the baby. Initially, parents may say no but later change their minds. Nurses should allow ample time for parents to say their goodbyes to their newborn. Pastoral care should be provided and a baptism or special blessing offered. Parents should also be given information on what to expect physically and emotionally during the grieving process, as well as where they can find local support groups. Other options, such as genetic studies, autopsy results, organ donor information, and help with funeral arrangements should also be made available to bereaved families.
What Dreams May Come
Parents need to be prepared for the physical and psychological effects of loss, and thats where nurses can be particularly helpful, given their holistic education and philosophy.
Grieving mothers and fathers need information on how others may treat or respond to them. Its also helpful to explain that men and women grieve differently knowing that in advance can prepare partners to be more sympathetic with each other during what is very likely the hardest time in their relationship. Nurses should prepare mothers for possibly feeling pain or aching in their arms a psychosomatic condition caused by a deep-seated yearning to hold the baby.
Grieving parents should also be alerted to expect dreams about infants its a common occurrence, but no less disturbing for that. They may also find themselves startled from sleep by what they think is a babys cry but which, again, is only their imagination.
Nurses must attend educational inservices to acquire the knowledge and skills needed to work with families experiencing perinatal loss. Such preparation should be a part of nurses annual mandatory competencies. Its an expected standard of care for all obstetric and neonatal nurses.
Follow-up phone calls may be difficult, especially if the nurse has spent little time with parents during the hospitalization again, it may be hard to know where to begin or what to say. At a minimum, though, its important during the follow-up call to inform families about perinatal bereavement support groups in the area. These groups give grieving parents a safe place to mourn, a place where theres no loss for words.
Judy Cohen, RNC, MSN, and Jacqueline Nicholson, RN, MA, are facilitators of a perinatal bereavement support group at Boca Raton Community Hospital, Boca Raton.