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26.1 Pregnancy Loss

Pregnancy loss at any stage in the pregnancy is devastating to the parents. They are grieving the loss of their child and the family they had envisioned. During this grief, they must then make decisions about what treatment plan is best. Treatment options are dependent upon the gestational age of the fetus and the patient’s preference. During this time of discussing treatment, the nurse and health-care providers use shared decision making and allow the parents sufficient time to make decisions.

The cause of early and late pregnancy loss is many times related to chromosomal abnormalities. Early prenatal testing can detect some anomalies and allow patients to determine a plan of care during the first trimester. At other times, fetal abnormalities or maternal risk factors are not apparent until after the first trimester, making options for care more limited. Parents should be offered fetal autopsy and placental pathology to determine the cause of stillbirth or IUFD.

Bereavement care is provided throughout the process of perinatal loss. Nurses and health-care providers should be trained in bereavement care and should offer patients individualized care based on their culture, religion, and personal beliefs. Families should be offered bereavement care as well. Mental health resources should be provided to all family members.

Nurses will give education on postabortion or postpartum care at discharge. Use of support groups and counseling experts is encouraged. Nurses caring for families with perinatal loss experience emotional distress and should practice self-care.

26.2 Intrapartum Fetal Death

Intrapartum fetal death is devastating to the birthing person, their partner, support persons, family, health-care providers, and nurses. The common question is, “How could this happen?” Causes of fetal death during labor can be infection such as chorioamnionitis, hypertensive disorders, placental abruption, a cord problem or accident, growth restriction in the fetus, or a congenital anomaly. Unfortunately, many causes of fetal deaths are unknown.

Nurses caring for a family during an intrapartum fetal death can feel grief, sadness, anger, guilt, and fear. Nurses must support one another, and debriefing is a great way to provide support and allow them to talk about their feelings. Debriefing is part of self-care.

After an intrapartum fetal death, the role of the nurse is to provide routine nursing care for the postpartum person and also to meet the needs of a grieving patient, their partner, and family. The nurse can provide a cooling cot to allow the patient, their partner, and families more time with the newborn, create a memory box with mementos, contact social workers and religious support, and discuss lactation and what to expect. The nurse also screens for postpartum depression and anxiety, as this is much more prevalent after an infant loss. This process of loss affects everyone, and nurses must also care for themselves after caring for these families.

26.3 Newborn Loss

Neonatal deaths occur for multiple reasons, such as prematurity, childbirth complications, infection, and birth defects. The loss of a newborn affects all caregivers, nurses, parents, and family. Nurses must support the parents and family through the grief process. Nurses can offer resources for support groups and ensure that the family’s culture and beliefs are respected. Nurses should also debrief with their colleagues as a form of self-care. Grief is a process, and everyone involved in a neonatal death will navigate the process in different ways. Grief support is essential.

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