9/17/2019

1

Resources and protocols/guidelines

Refuge and Grief

https://www.refugeingrief.com/

Megan Divine

The Million Dollar Question

What do I say?

9/17/2019

2

Toothpaste on a Plate

Amy Beth Gardnerhttps://www.scarymommy.com/toothpaste-lesson-amy-beth-gardner/

What to Say

“I am sorry”

“I’m here, and I want to listen”

“I am sad for you”

“How are you doing with all of this?”

“This must be hard for you (family, significant other etc.)”

Refer to the child by name

What to Say

9/17/2019

3

Do not be afraid of silence

Some people need time to reflect prior to answering

What Not to Say to a Person Who is Grieving…..

WTG What’s Your Grief www.whtsyourgrief.com

I know

how you

feel…

You can always have other children…Everything

happens for a

reason….

It could be

worse, I know

this one person….

Don’t

Cry…

He is in a better place now

God never gives us more than we can handle….

God has a plan

Now you

have an

angel in

heaven

Time heals all wounds

I

understand…….

What Not to Say

https://grief.com/10-best-worst-things-to-say-to-someone-in-grief/David Kessler grief.com – retrieved 2/2019

9/17/2019

4

Why Would Someone Say This??

Are people trying to be malicious????

“Remember not only to say the right thing in the right place, but far more difficult still, to leave unsaid the wrong thing at the tempting moment.”

• Ben Franklin

So how can health care providers help families as they go through the grief

process?

9/17/2019

5

PRAM

(Pause, Reflect, Acknowledge, be Mindful)

http://www.gundersenhealth.org/resolve-through-sharing/shop-our-products/product-3/

Evidenced Based Clinical Practice

Nurse-Clarke, Dicicco-Bloom & Limbo (2019)

Based on Swanson’s Theory of Caring 1. Try to understand the events surrounding the loss.

The meaning of the loss to the woman and her family

2. Be emotionally present when interacting with the parents and family

3. Protect and preserve the mother’s dignity

4. Provide explanations for information the parent’s may not understand

5. Facilitate the grieving process through therapeutic interventions

• Nurse-Clarke, Dicicco-Bloom & Limbo (2019)

9/17/2019

6

You can focus on delivering compassionate care to all

families going through a loss by remembering:

• Finding just the right words may seem impossible

• Each family is different

• Even if you say “the right thing” it may not work

because each situation is unique

• Remember your purpose is not to FIX everythingMicrosoft Clip Art

Be Aware of Your Body Language& Voice

Head nods, facial expressions, eye contact, body posture, silence, space,

tone of your voice, and touch are examples of non verbal behaviors

that you are listening

9/17/2019

7

Compassionate Care

• Listen to the families requests

• Don’t be task-orientated

• Be with the family, don’t hide

• Healthcare providers grieve too, create a healthy & supportive environment

Microsoft Clip Art

Remember We All May Grieve Differently

• Intuitive Styles of Coping

• This style of coping may be more receptive to support groups, discussion, and wants someone to sit and listen to them.

• Instrumental Styles of Coping

• This style of coping may come across as being cold or removed because they are not talking about feelings. They tend to use action to process their grief.

Grief Counseling Resource Guide

Try to avoid these when helping families who experienced a loss:

•Responding too quickly

•Changing the subject

•Talking too much about yourself

•Asking “why” questions

•Giving advice

•Preaching, placating, lecturing

•Over-interpretingWheeler-Roy, S. & Amyot, B. (2004). Grief counseling resource guide: A field manual. https://www.omh.ny.gov/omhweb/grief/

9/17/2019

8

Things You Can Encourage Others To Do for The Couple

Avoid asking-

“What can I do” instead suggest “When can I..”

• Meals (in disposable containers), milk, bread, fruit, healthy snacks

• Breakfast items

• Gift cards

• Cleaning services

• Offer to carpool other children http://stillbirthday.com/familyfriends

Common Questions Parents may Ask

• What happened

• Why did this happen

• Why did this happen to us, we did all the right things

• Did I do something wrong to cause this

• What can I do to get through this pain

• How long will this grief last

• What do we tell our children

• What do we tell other friends and family

• Will this happen again

• When can we try to have another child

9/17/2019

9

Let’s talk about when a patient finds out she is experiencing an early incomplete miscarriage… what are her options?

For Early Incomplete Miscarriage

Options for the family include:• Expectant Management

• Wait for the miscarriage to occur without intervention

• Surgical procedure• Suction Curettage

• Treated with medication• To start the process of the miscarriage

Being Sure – Women’s Experience with Miscarriage. Limbo et. al. (2014)

Assess the woman’s level of “Being Sure”

• Discuss the options and see if she feels there an option that seems to be a better fit for her

• If a women feels rushed to make a decision it may lead to an increase in stress and also regret

• Ask her what is important to her in order to help her make this decision

• May need to provide additional ultrasounds

• Having proof that this pregnancy was not viable may help women be more certain about their treatment option

9/17/2019

10

Expectant Management

Inform them of :

• Expected amount of bleeding • Description of pregnancy tissue • Level of pain• Directions for collection of tissue • When to seek medical attention

• The woman should go home with a miscarriage care package, and educated about what the kit includes

• Limbo et.al.(2014)

Limbo, Glasser,& Sundaram(2014).

• Plastic collection container

• Sanitary Pads• Plastic lined

pads• Plastic gloves• Small plastic

jar

Mementos families may receive in the hospital

9/17/2019

11

Nebraska’s LB 1040

• On April 18, 2018, Governor Ricketts signed LB 1040 into law in Nebraska.

• Women and families in Nebraska can now choose to receive a state-issued commemorative birth certificate for babies

• Nebraska’s is the first to be retroactive so women who have experienced a miscarriage prior to the law taking effect can receive a certificate, and there is no minimum gestation required to qualify for the certificate.ost prior to 20 weeks gestation.

Details

• A health care practitioner/health care facility will advise a patient who experiences a nonviable birth that the patient may request a commemorative certificate and, upon request of the patient, shall provide a letter verifying the nonviable birth to the patient.

• If a health care practitioner/health care facility letter is to be used then the following information must be provided in the letter:

– Full name of baby (if named)– Month, day and year of loss– City, town and county of loss– Mother’s full current legal name (first, middle last, suffix)– Father’s full current legal name (first, middle last, suffix) (if

known)

• In lieu of the letter the health care practitioner or his/her designee may provide the patient with the completed Nonviable Birth Worksheet.

9/17/2019

12

Application for Certificate

Physician Worksheet

https://nebraskafamilyalliance.org/miscarriage/

9/17/2019

13

Foot Molds

Additional Mementos

• Books

• Pictures

• Recording of the child’s heart rate

• Foot prints

• Hand print molds

• Locks of hair

• Gowns and caps

• Memory Boxes

• Weighted Teddy BearsMicrosoft Clip Art

9/17/2019

14

MWH Employees

Please complete the yellow card inside the memory box and give the yellow card to your service leader. This will ensure a replacement box will be delivered to your area.

Michelle Stahlecker

Caring Cradle – Replaces the Cuddle Cot at MWH

https://caringcradle.com/

https://www.youtube.com/watch?v=MkrI7YSZxRQ

Additional Resource In The Hospital

The Cuddle Cot may be used to allow families more time with their baby

9/17/2019

15

Discharge Instructions for Mom

Discharge Instructions for Mom

Should include information regarding:

• Pain management

• Self care including– Incision or episiotomy

– Lochia

– Lactation and general breast care

Part of a mother’s discharge instructions will include breast care. Informing her that her milk may come in, and she has the option to suppress or promote the production of her breast milk.

• “Providing a mother the choice about how to handle her lactation often empowers the mother and allows her to take control when other things seem to be spiraling out of control”.

• Carney (2014)

• Welborn identified:– Participants in her focus group did not receive enough

support regarding lactation

– Option to donate breast milk should be included in resources given to bereaved mothers

• Welborn (2012)

Lactation and Loss

9/17/2019

16

Resources and Community Events

Month of October

• In 1988 President Ronald Reagan designated the month of October as Pregnancy and Infant Loss Remembrance Month

• In 2002 three women petitioned to designate October 15th

as the Pregnancy and Infant Loss Remembrance Day

– Adapted by all 50 states

Wave of Light

9/17/2019

17

Support for Parents

and Families

Resources for Families

Resources for Families

9/17/2019

18

Resources for Families Centering Corporation Infant Loss Resources for familieshttp://centering.org/infant-loss-resources/Toll-Free Number 866-218-0101

Through the HeartA resource for families to share stories, gain knowledge and feel supported. The non profit organization will send out free ‘comfort kit’ to parent(s) that experienced a losshttp://www.throughtheheart.org/

Share pregnancy & Infant Loss SupportTo serve those whose lives are touched by the tragic death of a baby through pregnancy loss, stillbirth or in the first few months of life. http://nationalshare.org/about-share/

9/17/2019

19

Resources for Families

Healing Embrace

https://www.healingembrace.org

https://www.meetfaithsfriends.org/

No Footprint Too Small

http://nofootprinttoosmall.com/who-we-are/

9/17/2019

20

• GRIEF SUPPORT• Star Legacy Foundation provides live, online support groups for

families who have experienced a perinatal loss and for individuals experiencing a pregnancy after a loss. Groups are held via HIPAA-compliant videoconferencing and facilitated by trained health professionals. Registration is required only for the first time you attend. After that you will receive a reminder before each session that will include login information specific to each session.

• Bereaved Parents of Perinatal Loss – 1st & 3rd Mondays of each month at 6:30 pm central.

• Pregnancy After a Loss – Every Monday at 7:30 pm central.• Parenting After a Loss – Every Wednesday at 10:00 am

central. Grandparents & Extended Family – 1st Wednesday of each month 6:30 pm central.

http://starlegacyfoundation.org/nebraska-chapter/

Star Legacy Foundation – Nebraska Chapter

Some families choose to send an announcement to inform family and friends of their loss

9/17/2019

21

Rainbow Child

What does this term mean?Parents may use this term to identify a pregnancy after the they have experienced a loss due to stillbirth, miscarriage, or neonatal death.

The rainbow appears after the rain, or the storm. Signifying a symbol of hope after such a dark time.

Rainbow Grandchild

Remember………….

You do not need to have personally experienced a perinatal loss to give your patients excellent care. You need only possess a willingness to care and a healthy

dose of compassion

9/17/2019

22

Memory Makers

You are all memory makers

ReferencesCarney, G. (2016). Lactation after Loss. Webinar retrieved https://uslca.org/lactation-after-loss

Devine, Megan – Refuge and Grief https://www.refugeingrief.com/

https://www.meetfaithsfriends.org/

Garnder, A.B. https://www.scarymommy.com/toothpaste-lesson-amy-beth-gardner/

Hughes, K., and Goodall, U. (2013). Perinatal bereavement care: Are we meeting families’ needs? British Journal of Midwifery, 21 (4)

http://stillbirthday.com/familyfriends

https://grief.com/the-five-stages-of-grief/

https://grief.com/10-best-worst-things-to-say-to-someone-in-grief/

References

Limbo, R., Glasser, J., Sundaram, M. (2014). American Journal of Maternal Child Nursing, 39 (3). DOI: 10.1097/NMC.0000000000000027Nurse-Clarke,N.,DiCicco-Bloom,B. & Limbo, R.(2019). Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth. American Journal of Maternal Child Nursing, 44(1), 27-32.

Welborn, J.M. (2012). The Experience of Expressing and Donating Breast Milk Following a Perinatal Loss. Journal of Human Lactation,28(4), 506-510.

Wheeler-Roy, S. & Amyot, B. (2004). Grief counseling resource guide: A field manual. https://www.omh.ny.gov/omhweb/grief/

WTG What’s Your Grief retrieved from www.whtsyourgrief.com