1. Grief and Loss in the Childbearing Family

2. Causes of Perinatal Loss: Maternal Complications Preeclampsia Abruptio placentae Placenta previa Renal disease Diabetes

10. Causes of Perinatal Loss: Fetal Complications Congenital anomalies Fetal growth restriction Alloimmunization

11. Diagnosis of Perinatal Loss Spalding’s sign Decreased maternal estriol levels Absence of fetal heart movement

12. Nurse’s Role Assist families in mourning process Explore wishes for viewing and holding deceased child Provide support, answers questions, refers for grief counseling

13. Physical Responses Physical symptoms of shock Palpitations Shortness of breath Difficulty sleeping Nausea and vomiting Loss of appetite and dry mouth

14. Physical Responses (continued) Feeling of emptiness in the pit of the stomach Weakness/lethargy Tightness in throat Sighing Fatigue Oversensitivity to light and sound

15. Cognitive Responses Denial/disbelief Confusion Sense of unreality Disorientation/time confusion Vigilance or obliviousness Focused or detached

16. Cognitive Responses (continued) Poor concentration Preoccupation Sense of presence Hallucinations of the deceased infant

17. Emotional Responses Sadness Anger/rage Guilt/self-reproach Anxiety Numbness Flat affect

18. Emotional Responses (continued) Indifference Withdrawal or explosiveness Repetitive storytelling Loneliness Yearning Nostalgia

19. Behavioral Responses Withdrawal Dependence Fear of being alone Memorializing the loss Disorientation Sleep and appetite disturbances

20. Behavioral Responses (continued) Absent-minded behavior Dreams of the deceased Crying and sighing Restlessness Avoiding of behaviors Treasuring of mementos

21. Spiritual Responses Blaming God (or spiritual equivalent) Hostility toward God (or spiritual equivalent) Lack of meaning or direction Wishing to join the deceased Isolation Feelings of betrayal

22. Spiritual Responses (continued) Hopelessness Destruction or strengthening of beliefs Feelings of being punished Acceptance as “Divine Will” Assigning of deceased infant as an “angel” in heaven

23. Personal Issues Complicating Grief Age Family dynamics Gender

24. Other Complicating Factors Insecurity Anxiety or low self-esteem Psychiatric history Excessive anger and guilt

25. Other Complicating Factors (continued) Physical disability or illness Previous unresolved losses Inability to express emotion Concurrent problems of living

26. Spirituality Honest exchange of information Empathy and presence Continuing bonds Spiritual rites Attachment with others Grief support

27. Nursing Diagnoses Anticipatory Grieving related to the imminent loss of a child Powerlessness related to lack of control in current situational crisis Compromised Family Coping related to death of a child/unresolved feelings regarding perinatal loss Interrupted Family Processes related to fetal demise Hopelessness related to sudden, unexpected fetal loss Risk for Spiritual Distress related to intense suffering secondary to unexpected fetal loss

28. Nursing Interventions Preparing the family for the birth and the death Supporting the family in decision making Providing postpartum care Supporting siblings and family members

29. Nursing Interventions (continued) Actualizing the loss Providing discharge care Making referrals to community services

30. Early pregnancy remembrance box

31. Memory Box

33. Bereavement literature

34. Door card

35. Parents holding their deceased infant

37. Nonhelpful Responses Minimizing the pain “At least …” Offering explanation for loss Imposing belief system

38. Helpful Responses Acknowledging that the infant is unique Validate the loss Acknowledge that future plans will not be realized Offer reassurance that they are not alone Address pain Reassure them of the caring presence of nurses