Perinatal death guidelines

From: briana.tiemann@und.nodak.edu
Wed, 23 Oct 2002 11:25:29 -0500

Hi, my name is Briana Tiemann. I am a junior nursing student from the University of North Dakota and am currently in my OB rotation of clinicals. Although OB seems like such a “happy” place to work, sad situations like perinatal deaths do occur. Perinatal deaths include losses due to miscarriages, stillbirths or neonatal deaths (Robinson, Baker, & Nackerud, 1999). When a perinatal death occurs we are taught several interventions to help facilitate the grief process for the parents. These include reducing the trauma of hospitalization by allowing the parents time alone with their infant and allowing the mother to recover on a unit besides the post-partum unit, validating the loss by allowing families to hold and name their baby, and pictures and momentos (footprints or a lock of hair), making the loss more real with rituals and remembrances and teaching and referring parents to support groups (Robinson, Baker, & Nackerud, 1999). While we may think these interventions are helpful and beneficial to the recovering parents, a recent study has shown the opposite. Hughes, Hopper and Evans (2002) found that women who saw and held their deceased infant had a higher rate of depression and anxiety in the third trimester of subsequent pregnancies than women who did not see or hold their deceased infant. Depression occurred in 39% of women who saw and held their infant, in 21% who only saw their infant and in 6% who neither saw nor held their infant (Hughes, Hopper, & Evans, 2002). In the women that held the infant, having a funeral made no difference in the outcome. All but one of the women that held her infant kept a momento, this woman had a “good outcome”, but Hughes, Hopper and Evans state no conclusions could be made in this woman’s case (2002). Another study I found stated that despite implications of protocols for caring for families experiencing perinatal deaths, patients still report hurtful comments by nurses (DiMarco, Renker, Medas, Bertosa, & Goranitis, 2002). This study examined the effects of an educational bereavement program on health care professionals’ perceptions of perinatal loss (DiMarco, et al. 2002). The study found that the health care professionals' perceptions of the emotional needs of the families experiencing a perinatal loss greatly increased after attending and educational program. The largest change in scores occurred in the miscarriage vignette (DiMarco, et al. 2002). What are the policies and procedures in your hospital when caring for families that have experienced a perinatal loss? What have you found in practice is helpful for families going through the bereavement process? What, if any, educational programs are available to help educate nurses on how to care for parents experiencing a perinatal loss? Any information would be greatly helpful and appreciated. Thank you, Briana Tiemann, SN References DiMarco, M., Renker, P., Medas, J., Bertosa, H., & Goranitis, J.L. (2002). Effects of and educational bereavement program on health care professionals’ perceptions of perinatal loss. The Journal of Continuing Education in Nursing 33(4), 180-188. Hughes, P., Hopper, T.E., & Evans, C.D.H. (2002). Assessment of guidelines for good practice in psychosocial care of mother after stillbirth: A cohert study. The Lancet 360(9327), 114-123. Robinson, M., Baker, L., & Nackerud, L. (1999). The relationship of attachment theory and perinatal loss. Death Studies 23(3), 257-270.

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