The loss of an infant through miscarriage, stillbirth, or neonatal death is perceived as a traumatic life experience. It is recognized as a tough life event, which can oftentimes cause complicated grief (CG) reactions that risk negatively influencing psychological and physical well-being. Generally, when pregnancy ends in the death of a fetus or neonate, the loss is both unexpected and devastating for the mothers or the couple. They usually struggle with post-traumatic stress disorder (PTSD), anxiety, and depression especially when not approached or managed properly.
Nursing Care Plans
Perinatal loss is a crisis within a crisis. Women and their partners undergoing pregnancy loss frequently talk of not getting on with their life goals, plans, and dreams. They appear stuck, off track, as if they are running in place as life is passing them by. This plan of care is directed on the emotional needs of the postpartal patient who must cope with the death of a child.
Here are five (5) perinatal loss nursing care plans:
- Risk for Altered Family Processes/Role Performance
- Situational Low Self-Esteem
- Risk for Spiritual Distress
- Deficient Knowledge
- See Also and Further Reading
Grieving: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.
May be related to
- Death of fetus/infant
Possibly evidenced by
- Verbal expression of distress, anger, loss, guilt
- Alteration in eating habits or sleep pattern
- Patient participates in self-care activities of daily living (ADLs), as able.
- Patient recognizes impact/effect of the grieving process (e.g., physical problems of eating, sleeping) and inquires proper help.
- Patient identifies and expresses feelings (e.g., sadness, guilt, fear) freely.
- Patient looks toward/plan for future, one day at a time.
|Label patient’s chart, room door, and/or head of bed, as indicated.||Alerts hospital staff and volunteers so they are informed about the patient’s loss.|
|Allot a private room if patient wants it, with regular contact by care providers. Encourage of feelings unlimited visiting by family and friends.||A place where family and friends can open up and share their feelings without restriction promotes comfort.|
|Support free flow of emotional expression. Only restrict behavior that is dangerous to well-being of patient/couple (e.g., pulling out IV, using fists to pound on abdomen).||Expression of grief is influenced by cultural/religious beliefs and expectations running the gamut from stoic silence to screaming and pounding one’s chest/throwing objects, etc. While expression of loss is cathartic, extended stoicism may impede mourning process.|
|Include partner in planning care. Grant opportunity for partner to be seen individually. Reinforce discussion of concerns.||Partnership in planning and decision making acknowledges that partner has also lost a child and may need time to express feelings of loss and receive support without having to be supportive of patient and others.|
|Discover the magnitude of the loss for both members of the couple. Regard how strongly couple desired this pregnancy.||The magnitude or weight of the loss is a factor (e.g., whether pregnancy was planned, whether couple has lost other pregnancies, length of time associated with trying to conceive) in the extent and duration of the grief response. In addition, parents may feel the loss throughout their lives, mourning for the child they will never know or watch grow up.|
|Consider the individual nature of movement through the stages of grief; tell patient/couple that delays in the grief process or relapses of grief are normal.||The process of grieving is not usually a fluid progression through the stages to resolution; it is rather a fluctuation between stages and possibly involves skipping of stages. Knowing that grieving is individual helps the couple let each other grieve at his or her own pace. Note: There is no set time limitations for resolution of grief and it is not unusual for the family to be actively dealing with the loss 1-2 yr later.|
|Assess patient’s/couple’s information and understanding of events surrounding the death of the fetus/infant. Provide more accurate information and correct misconceptions based on couple’s readiness and ability to listen effectively.||Emotional reactions may prevent the couple’s ability to process information and interpret the significance of events. Concrete thinking patterns (literal interpretation) may be the only available means of coping with information at this time.|
|Recognize stage of grief being displayed, e.g., denial, anger, bargaining, depression, acceptance. Use therapeutic communication skills (e.g., Active-listening, acknowledgment), respecting patient’s desire/request not to talk.||If the process of grieving is not completed, grief may become dysfunctional, resulting in behaviors that are disturbing to personal safety and to the future of the family and marriage/relationship.|
|Regard communication patterns among members of the couple and support systems.||In various instances, parents display anger and blame toward one another. Anger may arise from fear of losing another child or threat to self-esteem.|
|Reinforce family’s expression of feelings and listen (remaining calm or commenting as appropriate). Observe body language. Promote relaxed atmosphere.||Grieving families need repeated opportunities to verbalize their experience. Verbal and nonverbal cues provide hints about family’s degree of sadness, guilt, and fear. Active-listening conveys caring, which demonstrates an awareness of the unique significance of the loss to the patient.|
|Recognize what has happened as often as necessary, reinforcing the reality of the situation and encouraging discussion by the patient.||Many families have no earlier struggle of coping with the death of a young person and have few role models to whom they can relate. The nurse can act as an educator and facilitator concerning ways to act and talk about the experience and can explain and correct misconceptions.|
|Take pictures of the child wrapped in newborn attire. Allow couple to accompany or hold the child, if appropriate. Offer the couple footprints, hospital bracelets, or lock of hair, if desired.||Pictures and touching or holding infant can be effective and may begin acceptance of the reality of the loss. Note: Couple may not be able to cope with the loss. Remembrances of the infant, if not taken by the parents, should be filed with the chart, so that they are prepared if couple requests them at a later time.|
|Observe patient’s activity level, sleep pattern, appetite, and personal hygiene.||These areas may be neglected because of the process of grieving and associated depression. Sleep patterns may be disrupted, leading to fatigue and further failure to cope with distress. Patient may require support in meeting physical needs and may need assurance that it is acceptable to resume with usual activities.|
|Render physical care (e.g., bath, back rub, nourishment) as needed. Allow patient to engage at level of ability.||Displays caring and nurturing and helps patient conserve energy required to meet the demands of the grieving process. Involvement in self-care maintains self-esteem and sense of competence.|
|Talk about anticipated physical and emotional responses to loss. Evaluate coping skills. Consider religious beliefs and ethnic background.||Aids the couple in recognizing normalcy of their initial and subsequent responses. Grieving is individual, and the extent and nature of the response is influenced by personality traits, past coping skills, religious beliefs, and ethnic background.|
|Review role changes and plans to deal with loss. Note presence of siblings.||Most families anticipate a healthy pregnancy and positive outcome and are not prepared to focus on funeral arrangements, what to do with the nursery, how to carry on their lives, and how to plan for the care of the other children.|
|Consider means for parents to talk with siblings. Emphasize importance of words that are used, such as when the word “sleep” is replaced with “death.” Allow parents to give simple, honest explanations, using correct words, at the level of the child’s understanding.||Provides parents with approach for handling challenging new experience. Siblings’ sleeping patterns may be interrupted by their perception that they may also die. Siblings may feel guilt or responsibility for the death, especially if they had negative thoughts about the pregnancy or infant.|
|Assess severity of depression.||Patient/couple may detach themselves and have problem making decisions.|
|Observe the patient’s/couple’s verbal cues often. Recognize signs of developing or increasing somatic complaints, preoccupation with the death, loss of normal behavior patterns, overactivity with no apparent sense of loss, excessive hostility, or agitated depression.||May mean sudden alteration in patient’s/couple’s way of coping with the situation. Guilt, failure, and depression may be more pronounced in couples who have had previous child loss(es). Other signs may suggest dysfunctional grieving.|
|Refer to, or contact, clergy, according to family’s wishes.||The family may want to meet with a minister or spiritual advisor to provide baptism, last rites, cultural rituals, and/or counseling. Note: Baptism is not acceptable in some religions (e.g., Jehovah’s Witness, Seventh Day Adventist).|
|Help in obtaining requests and signatures for performance of autopsy if appropriate. Review benefits and limitations of autopsy.||Families may want or need explanation of cause of death, which may not be possible.|
|Give information about disposition of infant’s body. Contact mortician of family’s choice if assistance is required.||Bodies of children, like those of adults, must be transferred from hospitals to mortuary facilities or other disposition, usually within 24 hr of death. While burial may be delayed in most instances, Jewish tradition requires burial within 24 hr, which may further complicate patient’s grieving process if
she is not able to attend ceremony.
|Refer to, or contact, social services, if necessary.||Family may need support in planning for cost of funeral and other necessities.|
|Plan follow-up meetings or phone calls, as appropriate. Refer to community resources/support groups (e.g., visiting nurse services, Compassionate Friends, etc.).||Provides patient/couple with opportunity for discussion and asking questions. Assists patient/couple at crucial moments in the grief process, providing role models and opportunity to discuss loss with others who share the same experience.|
|Refer for counseling or psychiatric therapy, if necessary.||Severe grief response may be noted in older women and those with longer-term pregnancies. In addition, carrying the fetus for 1 or more days after death increases risk. In cases of pathological grief, ongoing counseling may be necessary to help individual(s) identify possible causes of the abnormal reaction and to achieve resolution of the grieving process. Note: Risk of major depression episode is highest during the 1st month following the loss, whereas women without other children or who have had a prior depressive episode remain at increased risk for 6 months.|