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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