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Perinatal loss 2010 review day 3
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Perinatal loss 2010 review day 3

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  • Tears are normal. If this is too uncomfortable, please feel free to step out.
  • IE: teenager relieved, or grand multip relieved. Ambilence is normal in pregnancy, componded by grief now
  • Ectopic or tubal pregnancy, spontaneous abortion – ie miscarraige, late pregnancy loss, stillborn, vanishing twin, neonatal or newborn death
  • Other folks think they should be over this by now
  • Beginning to find meaning in life again Due date, delivery date, kindergarten, milestone of nieces, nephews close to their loss
  • If subsequent pregnancy when taking history, ask about other loss
  • Wants to make it “all better”, gets tired of listening
  • Autopsy viewed as desicration
  • Autopsy seen as desecration
  • Pregnancy is natural state – decreased PNC Even seizure like activity with grief – normal in their culture
  • Open ended questions, sometimes just your presence is enough Don’t be afraid of silence
  • If grandparent wasn’t allowed to grief prior loss, may want to spare child this pain
  • Transcript

    • 1. Perinatal Loss Sandy Warner RNC-OB, MSN Certified Perinatal Grief Counselor
    • 2. Grief is a process, not an event
      • When your parent dies, you’ve lost your past.
      • When your child dies, you’ve lost your future
    • 3. Uniqueness of Perinatal Grief
      • Mother and her partner feel like parents, but have no baby to parent
      • Their baby was not known to others
      • Taboo topic: sometimes hidden and not discussed
      • We can never know another’s grief
      • Caregivers need to know how bonded mom was to pregnancy
    • 4. Frequency of Perinatal Loss
      • Greater than 1 million pregnancy losses yearly in USA
      • 25% of all conceptions end in 1 st trimester
      • Late losses occur 2-4% of pregnancies
      • Stillborn rate is 10.7% since 1990
        • African American stillborn rate is 20%
              • (AWHONN, 2009)
    • 5. History of Perinatal Grief
      • 1944 – first published work on grief by Lindeman (dealt with death from fire)
      • 1962 – “Reaction of RNs with mothers of stillborns” Nursing Outlook
      • 1969 – Kubler Ross’s work published
      • 1976 – AJN and Contempory OB Gyn articles published
      • 1984 – Davidson’s 4 phases of perinatal loss
      • 1985 – ACOG and NAACOG positions statements
    • 6. Perinatal Loss Definition
      • Nonvoluntary end of pregnancy from conception, during pregnancy and up to 28 days of the newborn’s life
            • (AWOHNN)
      • Definitions vary from state to state with weight, gestational age etc.
            • (AAP and ACOG)
    • 7. Davidson’s Four Phases of Bereavement
      • Shock and numbness
        • Duration – first two weeks
        • Characteristics:
          • Short attention span
          • Difficulty concentrating
          • Impaired decision making
          • Denial
          • No concept of time
          • “Feels like a bad dream”
    • 8. Shock and Numbness con’t.
        • Interventions:
          • Allow for time
          • Repeat, repeat, repeat
          • Use simple terms
          • Help them to think through decisions
          • Discourage rapid decisions
    • 9. Searching and Yearning
      • Duration: 2 nd week – 4 th month
      • Characteristics:
        • High energy
        • Anger/guilt/dreams
        • Weight loss or gain
        • Sleep difficulties
        • Aching arms, may hear baby crying
        • Headache, blurred vision, palpitations
        • Resentment
    • 10. Searching and Yearning Con’t.
      • Interventions:
        • Encourage support groups
        • Anticipatory guidance on normal process of characteristics
    • 11. Disorientation
      • Duration: 5 th to 9 th month
      • Can last up to 24 months
      • Can also last 3-5 years for multiple pregnancy
      • Characteristics:
        • Low energy
        • Thinks “I am going crazy”
        • Social Withdrawal
        • Disorganized
        • Depression
        • Likely to loose support
    • 12. Disorientation Con’t.
      • Interventions:
        • Anticipatory guidance
        • Assurance
        • Support Group involvement
    • 13. Reorganization/resolution
      • Duration: 19 th - 24 th month
      • Characteristics:
        • Some good days, some bad days
        • Sense of relief
        • Renewed energy
        • Able to laugh and smile again
        • Milestones are bittersweet
    • 14. Reorganization/resolution
      • Interventions:
        • Be available to listen
        • Acknowledge baby’s presence
        • Use baby’s name in conversation
        • Remember important dates
        • Meaningful remembrances:
          • Tree, rose bush, flowering plant etc
          • Donation to memorial fund
    • 15. Men and Women Grieve differently
      • Women:
        • Body image issues
        • Emotional swings
        • Need to talk, cry
        • Increased dependency needs
        • Fear of intimacy, resuming sex
        • Jealously
    • 16. Differences in Gender Grief cont’
      • Men:
        • Increase sense of responsibility
        • Withdrawal from partner/lack of communication
        • Financial worries
        • Physical symptoms
        • Sense of failure
        • Resentment of attention to partner
        • Difficulty dealing with tears
        • Need to “stay busy”
    • 17. Cultural Diversity
      • Baptism is important for Catholics and other Christian religions
      • Muslims: see death as natural stage of life. May not want to view baby. Loud crying is discouraged.
      • Jewish: mourning rituals (family member stays with baby but not general viewing). Questionable if baby is named. No autopsy.
    • 18. Cultural Diversity con’t.
      • Native American: vary widely
        • Focus on transition to afterlife
        • Ceremonies with food, possessions at gravesite. May leave body exposed.
      • Amish: Simplistic lifestyle with large
            • number of children. Loss of child is profound but viewed as God’s will .
    • 19. Cultural Diversity cont.
      • Hispanic/Latino: females vocal with grief and may even shake
        • Males are stoic and can appear uncaring but are deeply affected.
        • Mementoes and photos very important.
        • Respect caregivers
        • Usually family spokesperson – if caregiver establishes rapport, better outcome.
    • 20. Cultural Diversity Cont.
      • African American:
        • Variety of religious denominations
        • Strong spirituality and reliance on God
        • Prayer is common at bedside
        • Funeral delay until extended family present
        • Vocal grief acceptable
        • Importance of grandmother
        • Appreciate inclusion of family minister
    • 21. Self reflection for care giver
      • Loss is profound experience and invokes own feelings of loss
      • Emotionally draining, review of past experiences
      • Need for staff support
      • Each nurse needs to examine their feelings as well, but not burden grieving family.
      • Tears are OK with grieving family
    • 22. What to say:
      • “I’m sorry.”
      • “I’m sad for you.”
      • “How are you doing with this?”
      • “This must be hard for you.”
      • What can I do for you?”
      • “I’m here, I want to listen.”
    • 23. What NOT to say:
      • “You’re young, you can have others.”
      • “You have an angel in Heaven.”
      • “This happened for the best.”
      • “Better for this to have happened now, before you knew the baby.”
      • “There was something wrong with the baby.”
      • Calling the baby “It” or “fetus”
    • 24. Nursing Care
      • Provide physical and psychological support
      • Refer to chaplain, grief support etc.
      • Include family members if appropriate
      • Photos, mementoes
      • Allow parents and family opportunity to hold infant and say goodbye.
      • Families see nurse as role model with baby.
    • 25. Anticipatory guidance for discharge home
      • Prepare them for the reaction of others.
      • Encourage offers of help from loved ones
      • Suggest a plan on how to inform friends.
      • Supply a few phrases:
        • “ We’re not pregnant any more”.
        • “ Our baby has died.
    • 26. Sibling and grandparent grief
      • Grandparents often don’t want mom to view baby. (taboo)
      • Siblings:
        • Developmentally appropriate care
        • May want to see baby
        • Many books for children
        • Fear they themselves or parents might die
        • Relate to pet’s death sometimes easier
        • than baby.
    • 27. Subsequent Pregnancy
      • Listen, talk and keep open communication.
      • Allay fears
      • Offer guidance about potential difference in “bonding” to next pregnancy
      • Try to make this birth experience
      • different from loss experience
          • Know your patient’s history
    • 28. Resources
      • Compassionate Friends – Illinois
      • Pregnancy and Loss Center – MN
      • Resolve through Sharing – WS
      • SHARE – Missouri
      • Richard Paul Evans – Angel Statue and memory walk
      • Local support groups

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