Question

Amanda is a 28-year old primigravid at 39 6/7 weeks of gestation who is admitted to the Labor and Delivery unit in early labor. She has no known risk factors. Amanda tells the nurse that she has not felt the baby move since yesterday. The nurse is unable to hear the fetal heart rate. The nurse notifies the resident who performs an ultrasound, which confirmed fetal demise. Amanda is induced with Pitocin, ands 8 hours later she delivers an 8 pound 10 ounce stillborn baby girl. The cord was wrapped tightly around the baby’s neck three times. Amanda is recovering in the labor room, and her husband, Gary, is at the bedside. Pastoral care has already met with the couple to discuss autopsy, organ donation, spiritual rituals, and disposition of the body. After report, the nurse goes into the room and assess Amanda.

1. Amanda asks the nurse to dress the baby in the outfit and hat that she was going to wear when they left the hospital. The nurse washes and dresses the baby, wraps her in a blanket, and carriers the baby into the room. How should the nurse hold the baby? Explain your answer.
2. While Amanda and Gary hold their baby, the nurse talks with them about the special features of their child. What would be an appropriate question for the nurse to ask the parents?
3. Amanda and Gary spend an hour holding their baby and then tell the nurse they are done holding her. The nurse complete postpartum care and transfers Amanda to a medical-surgical unit instead of the mother-baby unit. Amanda and Gary thank the nurse for her care during this painful time. How important is supportive nursing care after a perinatal loss? Explain your answer. Explain supportive nursing care after a perinatal loss, meaning identify the appropriate interventions.
4. What should the nurse say and what not to say to the bereaved parents?

Answer 1

Answer

1. The nurse should always support the died newborn's head and neck like a live baby. To pick up baby, slide one hand under baby's head and neck and the other hand under their bottom. Bend your knees to protect your back. Once you've got a good hold, scoop up your baby and bring baby close to your chest as you straighten your legs again.

2.Supportive nursing care and interventions after a perinatal loss

• The nurse should Acknowledge the shock of their bereavement.
• The nurse should provide answer to any questions the family may have. These parents initially may have difficulty trusting the medical community, but nurses and others can play a critical role in regaining this trust by fulfilling promises in a timely fashion..
• Assess the parents’ knowledge base about the situation.
• Ask them if they completely understand the situation and if they have had any previous experience dealing with a death.
• Ask them if they would like to have clergy visit them, and ask if anything else can be done to assist them at this time.
• While Assisting with late pregnancy loss. If the pregnancy is at or near term, help the parents revise their birth plan and educate them about options for pain management. Some parents may not have started, or not have finished, prenatal classes yet. It may be necessary to give them an overview of the labor and delivery process.
• This can come from almost any parents who are told the diagnosis of fetal death—that this is all a mistake and their baby really isn’t dead. Although parents may appear to be dealing with their grief quietly, they may actually be in denial and bargaining for the miracle of a live baby.

• Encourage parents to see and hold their baby, explaining the benefits of this contact. Refer to the baby by his or her given name whenever possible and describe the baby to the parents before handing him or her to them.
• If the baby has been in the morgue, let the parents know in advance that their baby will feel cold and will appear to have a blue color.

• Help the parents undergo a claiming phase. Give them as many details about the baby as possible, such as the baby’s weight, sex, and physical appearance.

• Encourage parents to have photographs taken of their baby. This helps document for them that they are parents. Over time, these photos may become the family’s most significant mementos and memories of this baby.

• Make footprints and hand prints of the baby, and, if the baby has enough hair, save a lock of it for the parents. Parents may also want linens and things that came into contact with the baby for their later remembrances.

• Label the bereaved parents’ room with a special sign or symbol. This indicates that the patient’s baby has died so that inappropriate comments about the baby aren’t inadvertently made to parents by support service personnel.

• Mother may have a strong, supportive relationship with nurses on the antepartum unit; however, most parents prefer to go to the gynecologic unit so that they don’t have to hear babies crying or watch other families with their babies.
• Encourage parents to have an autopsy performed. This procedure and its findings can allay much guilt and anxiety for parents by demonstrating the normalcy of the baby.
• Prepare parents for the changes ahead. If this was a woman’s first pregnancy, inform her that breast milk may come in and prepare her to deal with this physical and emotional discomfort. Explain that she will have lochia and educate her about the process of uterine involution.
• Advise the woman to be aware of postpartum danger signs of endometritis, retained placental fragments, urinary tract infection, and deep vein thrombosis—this is standard information for all new mothers, but sometimes such discharge information gets overlooked because women who suffer pregnancy loss may go home more quickly.
• Provide all instructions and information in writing. Parents may be in shock after their loss and may not listen well to instructions.

3.What should the nurse say and what not to say to the bereaved parents?

• "The baby has died." "The baby has passed." The nurse should use words such as "has died," which most clearly conveys the situation. ... Therefore, the nurse should avoid using these words while conveying perinatal loss to the parents and family.
• The most appropriate statement that the nurse can make to bereaved parents is: A. "You have an angel in heaven."
• Give a hug instead of saying something
• We all need help at times like this, I am here for you
• I am usually up early or late, if you need anything