1. ROLE of the CST and the CARE of the MOTHER with a STILLBORN INFANT ROLE of the CST and the CARE of the MOTHER with a STILLBORN INFANT

2. PRESENTER SUSAN D. SHEETS ST RN BSN CNOR ASSISANT PROFESSOR PROGRAM CHAIR SURGICAL TECHNOLOGY IVY TECH COMMUNITY COLLEGE OF INDIANA COLUMBUS CAMPUS COLUMBUS, INDIANA

3. OBJECTIVES 1. Describe the role of the CST in the birthing process when there is a problem. 2.Define what is a stillborn 3.Discuss the procedure needed to deliver a stillborn infant. 4. Discuss the care of the mother and the staff before, during, and after the delivery 5. My way of getting here!!!!!

4. PUT PICTURE OF ADDY

5. THE DESTROYER OF A DREAM THE DESTROYER OF A DREAM STILLBIRTH is the intrauterine death and subsequent delivery of a developing infant that occurs beyond 20 weeks of gestation. A loss Prior to 20 weeks is termed as a miscarriage and does not require a burial. After 20 weeks state laws assign the parents the responsibility for “disposition” of their stillborn baby by burial or cremation. Some states allow the mother who has suffered a miscarriage to bury the baby

6. Sudden Antenatal Death Syndrome S.A.D.S. (the acronym) a clinical term for “stillbirth” Like SIDS but SADS claims over 10 times as many babies’ each year as does SIDS Estimated 26,000 SADS deaths occur annually in the US alone. Most are at or near FULL TERM or 1 in 115 deliveries is a “STILL” birth.

7. CAUSES 1 in 3 are caused by cord accidents, infections, genetic anomalies, maternal diabetes, and varying placental failures of different kinds. The other 2/3 is unknown

8. ARE STILLBIRTHS Predictable? Preventable? Run in families? Risk for future stillbirths after experiencing one?

9. NO ABSOLUTELY NOT STILLBIRTH IS AS RANDOM AS SNOWFLAKES

10. How do you Deliver a Stillborn Preferred method is VAGINAL DELIVERY Even under perfect conditions a C-SECTION is very high risk and used only if the infant is at risk during a vaginal delivery With the stillborn the focus changes to the Mother and her well being and safety

11. DELIVERY OF A STILLBORN Can be tricky depending on when the baby died May be seconds, minutes, hours, days or weeks. Often the delivery turns from the happy joyful time into a nightmare for the mother and father

12. Many Mothers have no idea that anything is wrong until it is to late to do anything to save the child. Each pregnancy is different and this is an unpredictable situation. Emotionally Mothers need to know that they did NOTHING wrong!!

13. VAGINAL DELIVERY *CONFIRM NO HEATBEAT tell Mom and Dad (how who when) give emotional support WHICH can be very difficult 

14. DEPENDING ON When in the pregnancy the diagnosis was determined : the month of gestation 5-9 months Which pregnancy is this one : the 1 st, 2 nd,or last Infertility treatment

15. Vaginal vs. C-Section Once the parent knows then the OB Physician and the patient must decide what to do. Do we wait ? Do we do a C-Section?? What do you do?

16. Again this depends on where in the gestation the Mother is or is she in labor and minutes or hours from birth !!!! If the Mother is not in labor and the MD confirms the baby has no heartbeat (by ultrasound) Then the OB Doctor and the Mom must decide how to handle the delivery.

17. TIME FRAME FOR THE MOTHER NOT IN LABOR The majority of these are full term Mom’s Ideally the mom will discuss with her OB doctor what to do. PITOCIN- to induce LABOR does not always work. Unless the mother is ready : cervix is dilated or thinned. The placenta needs to have done it’s job. IT HAS NO IDEA THAT THE BABY IS dead!!!

18. No right or wrong answers Some mother choice to wait it out. If this is a first pregnancy she may not want to limit her number of pregnancies. It is better physically to allow nature to take it’s course. Emotional she may not be able to make this choice. If she has had other viable pregnancies she and her MD may opt for the C-section. This decision is not black and white. Too many factors from multiple sides go into it.

19. LABORING MOM LABORING MOM She must continue on and deliver As if she was having a healthy newborn the body does not know or understand what has occurred. She and her spouse, or loved one need all the emotional support you can give.

20. WHAT is the needed emotional support A TOUCH A SMILE TEARS A HUG ALLOW VENTING THIS MAY MEAN : CRYING, TALKING SCREAMING, OR WITHDRAWAL MEN respond very differently then us women!! They internalize Many will not shed a tear to be stoic for their partner. They suffer alone and do not talk about it as we may do. We talk they listen or tune us out, I’m talking about your men who are good, decent, faithful, and loving men. Yes, I personal know many!! Sorry girls most of them are already taken.

21. Labor continues Care turns to the Mom She may now have medication to help her through labor or She may have a general anesthetic if she is having a C-section

22. YOU THE CST This can be a devastating time for you and everyone caring of this mother. If you have never experienced this type of delivery you are fortunate. But, if you are in this profession you will! How you handle it will help you for the next difficult delivery. Because they too will come. You ARE often times the one closes in the room to the Mom and your EYES can be a comfort to her.

23. THE CST You can have a check list of thing to do for the Mother and the Father. Many hospital now have a kit for the stillborn mother. This has keepsake items for them. I have brought some for my area Hospitals to show you.

24. THE LIST PICTURE OF THE BABY NO MATTER WHAT THE BABY LOOKS LIKE!! A LOCKET OF HAIR BABY’S FOOT PRINTS AND HAND PRINTS BIRTH CERTIFICATE FILLED OUT BY THE MD FOOT OR HAND BRACLET ANY MEMETO THAT YOUR HOSPITAL MAY GIVE OUT FOR NEWBORNS SOME KNIT BOOTIES AND SO FORTH

25. DELIVER TIME Physically the same as any other deliver whether it is vaginal or c-section all the same tools and supplies apply.

26. demise of the child while inutero can cause blood discrasia in the mother’s if they must carry the child for a period of days or weeks. Blood work must be checked weekly or until the fetus is delivered. Carrying a dead fetus causes bleeding factors to be abnormal creating a lack of clotting factors in the mother.

27. BIRTH If the Mother has carried the baby for a week or even two “Still”, the delivery of the infant can get tricky due to the demise of the baby. As the child is delivered the skin of the infant will peel away at the mire touch of the MD handling the delivery of the infant.

28. Vaginally The skin of the Stillborn may peel away as the infant is delivered through the birth canal. As horrific as this sound the Mom and Dad still need the choice to see the baby. They do not see the baby as we do. They see beyond the horrible and see their baby.

29. Vaginally Some MD’S do not allow the parent to see the infant if there is to much damage by delivery. IF the infant has been “still” inutero for up to 2 weeks the demise may be too much to see.

30. C-SECTION The MD is very careful as he lifts the infant from the uterus. You can wrap the baby up and cover up the worst areas so the baby can look as pretty as possible. HOLDING the child is very important for the parent and allowing them to say goodbye to the baby and not the coffin!

31. EXPERIENCES JESSICA MARIE 1979 DECEMBER 2 DECEMBER 14 SUMMER of 1980 5 YEARS

32. ACKNOWLEGE PLEASE TALK ABOUT THE BABY WE AS MOTHER WILL CRY AS WE TALK ABOUT WHAT HAPPEN BUT WE NEED THAT. IT IS A HEALING TO ALL TO ACKNOWLEGE THAT THE BABY EXISITED AND WAS REAL. AS TIME GOES ON THE DEEP HURT NEVER GOES AWAY BUT IT DOES GET BETTER.

33. THANK YOU FOR COMING TO THIS PRESENTATION ANY QUESTIONS PLEASE FEEL FREE TO COME AND TALK TO ME. THANKS AGAIN