Grief support in hospital after prenatal and perinatal loss event (5)
Advises for a caregivers
Parents value of empathy and kindness
Parents remember those staffs who sensitively acknowledge the enormity and the sadness of what has happened. They value those staff who remember that their baby is a person and who respect and care for him or her as a precious individual who matter. (Alix Henley, Judith Schott, 2008)
Parents value language that acknowledges their baby
The heightened emotions and stress that parent experience at a time of pregnancy and child-bearing loss often make them very sensitive to other people’s language and non-verbal behaviour. Most parents talk about heir “baby” from the beginning of pregnancy and are often upset and hurt by clinical terms such as “embryo", “fetus”. Once the baby’s sex has been identified, staff should normally use: he or she, him or her. If baby is stillborn or dies shortly after birth and has been given a name by the parents, staff should normally use the baby’s name. (Alix Henley, Judith Schott, 2008)
Parents value staffs who listen
They value staff who: are prepared to listen when they want to talk about what they are going through or about what has happened; accept what they say without or judgment. Before they go home after a pregnancy or child-bearing loss, all parents should be given opportunities to ask questions and talk at length with staff about anything that concerns or worries them. (Alix Henley, Judith Schott, 2008)
Parent value staff who keep them informed
Parents should be offered an opportunity to discuss important matters together, and in a quiet room. They should have easy access to members of staff who can answer their question. All discussion with parents should be documented so that every member of staff who cares for them knows what has been said and what has been decided. (Alix Henley, Judith Schott, 2008)
Offering choices
Some parents prefer to make decision independently once they have the necessary information.
One of way is to offer examples of things that other parents have done. Such as; “There are several options, some parent choose…”, “Others decide…” That can help them to clarify what they do not want as well as what they do want. (Alix Henley, Judith Schott, 2008)
Prior to the 1970’s parents were typically not allowed to see or hold their deceased babies. In the last 30 years, psychology experts have led the way in recommending that parents have more contact with their deceased infants and commemorate the deaths.
When the fetal demise is diagnosed before birth, parents and doctors must decide whether to induce delivery right away, to delay induction for days or weeks, or to wait spontaneous labor. Some mother reported they were unable to deal with the “double trauma of “my baby is died” and “I am going to have it”. One mother who waited describe herself as a “walking coffin”. (Gold Katherine, Dalton Vanessa, Schwenk Thomas, 2007)
Several studies reported on the rate of parents seeing their deceased babies, with total ranging from 17% to 96%. Parents with fetal death in the third trimester were more likely to see their infant than those with death in the second trimester.
During our practice gradually we have learnd to care on stillborn infant the same way as for a newborn alive baby. We use to make an effort to organize for the mother and the family condition to meet they stillborn baby what should consolidate the family even they are parents of stillborn child. We expected that the meting of mother and her stillborn baby will help of mother to remove out of her mind the scary image how ugly her died baby could be. We were hoped this is a benefit of the mother and her stillborn infant meeting, but in reality consequences were different of expectations.
However this approach could not change the mother’s inner feeling. In most of cases the mother obtains more traumatic impression from this meeting. Furthermore most of mother rejected of possibility to see her stillborn baby when doctor ask about it.
The reason of this situation straightly connected to the way of when and how to delivery a bad news.
Breaking bad news
Breaking bad news is difficult and stressful. Parent had only bad memories if the information was given badly, if the person giving it seemed not to understand the significance of what he or she was saying or was not supportive. Bad news given insensitively can affect parent’s long-term well-being. Phrases such as: "I am afraid it is bad news…”, “I am sorry to say that the result are not what we expected… , “I am afraid this is not the news you wanted…” may be helpful. (Alix Henley, Judith Schott, 2008)
A pregnant woman naturally has a beautiful image of the baby what she is carrying inside. She began to think about how he or she looks like from early stage of pregnancy and sudden dramatic new turns this “picture of an angel” to image of “an ugly ghost”. Rejection of meeting the stillborn baby is nothing but desire to keep her own mental image about how baby suppose to looks and a fear to crush on scared reality.
The best way to delivery the breaking news is to do it gradually. The mother needs a time to accept the fact of loss. There is should be an intermediate stage (c) to turn mother’s felling from “I am going to be happy mother” to “I have lost my baby” via “I am carrying My baby regardless alive or dead”. Then she will be ready to see her baby and naturally pass her loss over.
Otherwise the mother who did not accepted the bad outcome of her pregnancy will be shocked and reject the chance to meet stillborn baby or will accept the offer to see and will suffer more as result of suddenly unexpected new image of her baby. Finally her grief will be much longer with, probably strong anger reaction and deep depression stage.
Unfortunately in standard practice, physicians rush to terminate this process. There are several reasons: first of all, the reason of rapid termination of unfortunate pregnancy is they do not want to take a risk to aggravate the situation with mother’s health condition such as DIC syndrome and similar consequences of carrying in the dead fetus. Even this rare occur in medical practice most of hospitals keep this traditional approach.
Another reason is none in the hospital want to deal with family’s aggressive reaction as response on sudden bad news. So they want to finish this process as soon as it is possible before the patient’s relative will start to handle of the event.
Creating memories
If the baby miscarried or was stillborn, the parents have never seen their baby alive, and in early pregnancy loss there may no body. Many parents are too shocked and distressed to think about creating mementoes at the time of the loss, especially if it is sudden and unexpected. Most are very grateful afterwards to staff who suggested that they might want to create or collect mementoes of their baby and who have helped them. (Alix Henley, Judith Schott, 2008)
Grief is natural and expectable reaction on loss. The extend of grieving and each stage of grief depends on many factors such us age of mother, her life history and family relations, national traditional and faiths, there are given and could not be change but must to be taken notice. Also there is one factor what strongly depends on a medical staff professional approach; the proper care on family what loss they infant with big hope to be parents in the nearest future.
The unexpected tragic event keeps family members in numbness condition for a while. Then naturally arise an active stage of grieve: anger. This is not logical but high emotional stage of grief and as a most expectable target of the anger, first of all, would be the medical team what provided of care on the mother who lost her baby.
Crucially for medical staffs at this time is to deal with grieving parents in an appropriate way for avoiding the causeless lawsuit between the parents who lost their infant and innocent medical staff who have done everything what due to be done in the situation of unexpected pregnancy result.
There are several rules that should be followed during care on parents.
First of all, at the time when obstetrical pathology has been diagnosed a rapidly medical termination of pregnancy should not be insisted. Usually that suggestion makes the parents to feel there were some mistakes made by medical staffs and now they in hurry to cover its by pregnancy termination procedure .
Doctor has to explain than died baby inside of her does not make any effect on mother health condition and give her time to accept the tragic fact.
In stillbirth case a dead infant should be treated in the same way as alive newborn baby what support mother and father become the parents as they expected during all pregnancy term until obtain the disaster news. Otherwise they have feeling sort of cheating on them by the medical staff.
The parents should know the truth but they ready to listen not right soon after the loss event. Following shock and numbness arise high emotional anger stage when no any logical explanation and important information able to rich of parents emotionally unclean consciousness. Medical staffs need to be tolerant and let the patients to spill out of their anger, show up their sad feeling; even it is naturally undesirable for the doctors and nurses. Then after the emotional stage gone, a readiness to accept of the logical explanation will come. At that time the parents and medical staff can communicate effectively what leads to avoid a lawsuit at all and furthermore to mutual support in the grief. Important: do not try to explain anything before the emotional stage past away.
Undoubtedly to provide that professional care takes a lot off emotional but necessary as a self-protection way counter to a major medical staff fears: “Maybe I have done wrong?” and ”What will start from now with parent’s reactions and actions?”; and guilty “I could be more confidence and diagnosed it earlier”. There are some ways how medical staffs cope with their feeling after the loss event.
also here THCC