Still Birth, Neonatal Loss and Withdrawal

of Support

Lisa Walker-Vischer RN, MS, CNS

Theory of Caring Relationship based

Caring is defined as “a nurturing way of relating to a valued other whom one feels a personal sense of commitment and responsibility”

5 Categories Maintaining Belief

Knowing

Being With

Doing For

Enabling

Attachment Attachment during pregnancy is a variable process

Attachment may occur at any point Planning the pregnancy

Confirming the pregnancy

Accepting the pregnancy

Feeling fetal movement

Accepting the fetus as an individual

Giving birth

Hearing and seeing the baby

Touching and holding the baby

Caring for the infant

Theory of Caregiving Bowlby- Attachment Theory and Theory of

Caregiving

Parents have a desire to be with, know and introduce their baby to others in the world as an innate need.

How does the death of a baby alter this innate need?

Still Birth Fetal death at at least 20 weeks gestation

and 350 grams or more

Occurs in 1 of every 160 pregnancies = 26,000 babies/year

The cause of still birth is only found in about 40% Of those ¾ are related to the development of

the baby and ¼ to problems with the placenta or umbilical cord

Still Birth Parental experience-

What do parents need?

Death Before Birth Video

1 Week After

Newborn Death Death of a newborn within the first 28 days of

life

Causes Birth defects

Prematurity

Complications of pregnancy

Sepsis

SIDS

Shaken Baby

Newborn Death Parental Experience

What do parents need?

Parental Decision Making and Withdrawal of Treatment

Religion, spirituality and hope influence decision

Parents felt it was their parental obligation

Parents want to be involved in the decision and usually present

Parents need to have trust in caregivers and accurate prognosis

Perception of pain and suffering influences decision

Parents have hope and want caregivers to be hopeful

Parents involved other people in decision(Moro, Kavanaugh, Savage, Reyes, Kimura & Bhat, 2011)

Parental Decision Making and Withdrawal of Treatment

One mother described holding her baby when she died this way: “…holding her when she died… that’s not a

memory I want to have, but… my feeling is, if your child has to die, what better place than in mom’s arms…so.. I try and make that a good memory, but it’s a very sad good.”

Video on Withdrawal of Life Support

Role of Health Care Professionals

Provide emotional support

Provide information

Meet physical care needs

Self Care for Health Care Professionals

We are taught to care for others but often don’t care for ourselves.

Compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress.

How do you take care of yourself after a death?

Conclusions The relationship between the health care

provider and the parents is the key

Understanding Theory of Caring/Attachment/Theory of Caregiving drive interventions

Self care is essential