1. Infant Loss & Bereavement

2. Objectives Increase skills in assisting families with final choices Identify ways to make precious memories for parents during a loss List ways you can provide the best support to parents

3. Initial Support Time of extreme stress for family Couples vividly remember what happens What we do affects them We can make a positive difference We can’t lessen the pain We can provide a memory of caring and support

4. Goal of Initial Encounter To convey caring Permission to grieve

5. What Families Need to Know Who you are That you know (“I’m Susie, your nurse today. I learned in report that you baby has died -- I’m so sorry.”) That you care Every encounter is potentially awkward or potentially reassuring.

6. What You Can Do Don’t make assumptions Be respectful & careful with statements you use with families –Avoid “at least” –If families use “at least”, that’s ok Use names About about baby, pictures, etc. Use touch to convey caring Lots of stress, use time gently & well

7. Hospital Losses Can happen in variety of settings –ER –NICU –Outpatient visit –During hospitalization & delivery

8. In ER or NICU Prepare them for the news –“I’m concerned”… “they’re still working with him/her” During OB visit –They can read our expressions –Be honest, “I’m concerned” –Don’t pretend –Be supportive, “I know this is worrying you”

9. During Hospitalization & Delivery Prepare for choices –Bring info forward as you go, don’t leave all for later Identify support persons Discuss plan of care Prepare for delivery –May be rapid finish/delivery at end

10. Hospitalization/Delivery (con’t) Discuss pain medication –May not have taken prenatal classes yet –May be afraid to use pain medication –Give permission to accept comfort Prepare for what will happen after baby delivers –Fear of what baby will look like –Ask if they want to hold and see baby –Assist with making final choices

11. Seeing & Holding Baby Ask if they have ever seen someone who has died Help families not to be afraid Don’t be in a hurry How we talk about baby sets tone –“Her fingers & toes are so perfect”

12. Seeing & Holding Baby Encourage to see baby - don’t insist –Gently nudge, don’t force –Encourage by letting them know that often families later wish they had Dressing baby –Invite parents to bathe & dress baby –May be one of the few parenting things they will do for this baby –Is an option - NOT expectation!

13. Rights of the Baby To be recognized as a person who was born and died To be named To be seen, touched, and held To have life-ending acknowledgement To be put to rest with dignity

14. Rights of Parents To have opportunity to see, hold, and touch their baby To have photographs taken To be given as many momentos as possible To name their baby To observe cultural & religious practices

15. Rights of Parents To be given time alone with baby To request an autopsy To be given information in terms they understand To plan a farewell, burial, cremation To be provided with information on support materials & resources

16. Saying Hello Allow parents & family to see, hold, and touch baby Get hand and footprints Get hand, foot, head molds Crib cards, name bands, certificate of life/birth Baby gowns, blankets, hats

17. Saying Hello Memory books Time alone with baby Play music during time if available Baptism, naming, or blessing ceremony

18. Making Final Decisions Give clear options for final decisions Final decisions difficult to make –Allow them to take their time, “no hurry” –Enlist help (Soc. Serv., Pastoral Care, funeral home) –Honor what feels right for them Parents feel bewildered –How do you say goodbye before you’ve had a chance to say hello? –No rules to follow, only your heart

19. Making Precious Memories Important for family to have memories Parents are touched by the caring way we provide to their baby Discuss with parents if baby not presentable –Talk to them about normal tissue changes, etc. –May choose to see only hands and feet

20. Picture Taking Take lots of pictures –Family holding –Naked and dressed –Placing hand next to baby –Using objects to soften & warm pictures (basket basinet, teddy bear, blankets) –Using parents’ hands & placing baby’s hand inside Remember to fill photo with baby –Too close/far away becomes fuzzy

21. Creating Memories Lock of hair Hand or foot prints Measurements Infant ID bands Keepsake Gown/blanket Angel pins Alginate/plaster of paris molds Outline drawing of baby on parchment paper

27. Disposition Choices Private burial –Family burial plot or purchase separate site, –Family, clergy, or funeral home can assist –On private property (requires permits from Register of Deeds) Private cremation –Can bury, scatter, or keep remains

28. Hospital Disposition (if available) Arrangements per hospital guidelines Must be stillborn (SD law) –All liveborn require birth & death certificate (In Sioux Falls, separate grave) Avera McKennan disposition –Cremation –Common grave (ashes co-mingled) –No marker, burial occurs only few x’s/yr

29. Policies W&C Bereavement Policy (located in Share File) –Infant Loss, Stillborn –Fetal Loss, Live-born Infant –Child on Pediatrics Checklist policies/procedures WC/NICU/Peds will be marked behind each procedure to designate which dept. this pertains to

30. Possible Forms to Complete MD to visit with family about autopsy and chromosome testing –If requested will need these forms: Autopsy Consent Form Request for Autopsy form Chromosome papers (lab will send) * Forms to complete * –Release of Body –Death Record –Disposition of Fetus consent – applicable to Newborn/NICU infants

31. Notifications Pastoral Care LifeSource (federal mandate for ALL deaths 20 weeks or >) Social Services Now I Lay Me Down to Sleep Photographer (if available)

32. Ongoing Support Memory card at Christmas Card at anniversary date of loss Avera McKennan Grief & Loss Support Group (for miscarriage and infant loss) –6 week series offered in Jan., April, Sept. –Avera Behavioral Health Center –Call 605-322-4074 to register

33. Creating Memories

40. 3-D Molds Mix alginate in mold, allow to set Press fetal part into mold Fill mold with plaster of paris, allow to dry Carefully remove and peel away alginate, discard. Add ribbon or baby’s name to mold

41. 3-D Molds

43. Resources See handout –Compassionate Friends –March of Dimes –National SIDS & Infant Loss Resources Center –SHARE –Pregnancy & Infant Loss Awareness –Amend –Centering Corporation