Caring for patients who have experienced stillbirth
Friday, August 11, 2017
An estimated 2.6 million stillbirths occur worldwide annually, and each year about 24,000 (1 in 160 pregnancies) babies are stillborn in the United States.
As frequent of an occurrence that it is, many studies have reported that patients are often left to suffer in silence. It's inevitable that having these parents go through life and death simultaneously is a delicate situation, but it's one that needs to be addressed.
"Lack of supportive emotional care, insensitivity, poor communication and avoidant behaviors by physicians or nurses can increase emotional distress and resentment in parents and other family members," according to a study published in American Family Physician. "Physicians must focus on the emotional needs of all involved when addressing maternal and neonatal medical requirements after an adverse birth outcome."
So how do you do so?
The American Congress of Obstetricians and Gynecologists (ACOG) has said that the "goals of the healthcare team are to help the family start a normal grief reaction, actualize the loss, acknowledge their grief, assure the family that their feelings are normal and meet the particular needs of each family."
You want to normalize the situation and your reactions for them. Many parents experiencing stillbirth can experience a number of emotions, including shock, denial, anger, sadness, anxiety, suicidal ideation and some forms of post-traumatic stress disorder.
Though they're experiencing a loss, you don't want to jump right into medications. Unfortunately, 37.4 percent of mothers going through stillbirths were being treated with psychotropic medication, where "32 percent of the prescriptions were written within 48 hours of the death, 43.7 within a week and 74.7 within a month."
There are other ways to help patients cope with the loss instead of medications.
Make good eye contact and use reassuring touch, when appropriate. Have your patients know that they have a support system through you.
With that, get personal. Ask if the parents have a name for the baby that they would like you to use when referring to him/her. It can allow the family to have comfort knowing that their stillborn child has been referred to by their name of choice. It may also be helpful to encourage them to hold their baby and take photos for closure.
"Parents should be given the opportunity to hold their baby and perform cultural or religious activities, such as baptism," ACOG states in their Guidelines on Managing Stillbirths.
Know that it's OK to not be certain of how to react to such a loss of your patients. In this time, sometimes the best thing a person can hear is honesty — mention that you're at a loss of words, even though you've seen this happen many times.
That said, knowing that you can soothe your patients pain doesn't mean to give a silver lining. For example, "At least you know you can get pregnant" is not something your patient wants to hear. Although you may want to encourage your patients to see an optimistic view of the situation, it's important to recognize the actual loss.
Invite your patients the opportunities to ask questions during that time and time after as it's important part of healing for parents. This is especially true when it comes to the "why" of pregnancy loss. In that specific question, you can offer the opportunity to do an autopsy on the child, but note that it's an extremely sensitive topic.
"Parents want answers when they have a stillbirth, so clinicians should not be afraid to request an autopsy. Without a thorough evaluation it will be difficult to counsel women on their risk of having another stillbirth," said Dr. Ruth C. Fretts, MD, of Harvard Vanguard Medical Associates and Harvard Medical School.
No matter what, it's critical that every attempt be made in helping your patient(s) cope in the loss of their child. The roles of different healthcare providers will overlap during this course of providing bereavement and counseling services, but will have an impeccable impact on the parents.
According to the Canadian Paediatric Society, "Caregivers who provide this level of care will fulfill the unique needs of grieving parents by assisting them to have positive memories of their baby, and by giving them a feeling of being cared for in the midst of their pain and grief."
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