Still Birth, Neonatal Loss and Withdrawal of Support

1. Still Birth, Neonatal Loss and Withdrawal of Support Lisa Walker-Vischer RN, MS, CNS

2. 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

3. 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

4. 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?

5. 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

6. Still Birth • Parental experience- • What do parents need?

7. Death Before Birth Video

8. 1 Week After

9. Newborn Death • Death of a newborn within the first 28 days of life • Causes • Birth defects • Prematurity • Complications of pregnancy • Sepsis • SIDS • Shaken Baby

10. Newborn Death • Parental Experience • What do parents need?

11. 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)

12. 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.”

13. Video on Withdrawal of Life Support

14. Role of Health Care Professionals • Provide emotional support • Provide information • Meet physical care needs

15. 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?

16. 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