Grief and Loss in the Childbearing Family

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Personal Issues Complicating Grief Age Family dynamics Gender

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

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

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

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

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

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

Early pregnancy remembrance box

Memory Box

Bereavement literature

Door card

Parents holding their deceased infant

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

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