Grief and Loss in the Childbearing Family

1. Grief and Loss in the Childbearing Family

2. Causes of Perinatal Loss: Maternal Complications • Preeclampsia • Abruptio placentae • Placenta previa • Renal disease • Diabetes

10. Causes of Perinatal Loss: Fetal Complications • Congenital anomalies • Fetal growth restriction • Alloimmunization

11. Diagnosis of Perinatal Loss • Spalding’s sign • Decreased maternal estriol levels • Absence of fetal heart movement

12. Nurse’s Role • Assist families in mourning process • Explore wishes for viewing and holding deceased child • Provide support, answers questions, refers for grief counseling

13. Physical Responses • Physical symptoms of shock • Palpitations • Shortness of breath • Difficulty sleeping • Nausea and vomiting • Loss of appetite and dry mouth

14. Physical Responses (continued) • Feeling of emptiness in the pit of the stomach • Weakness/lethargy • Tightness in throat • Sighing • Fatigue • Oversensitivity to light and sound

15. Cognitive Responses • Denial/disbelief • Confusion • Sense of unreality • Disorientation/time confusion • Vigilance or obliviousness • Focused or detached

16. Cognitive Responses (continued) • Poor concentration • Preoccupation • Sense of presence • Hallucinations of the deceased infant

17. Emotional Responses • Sadness • Anger/rage • Guilt/self-reproach • Anxiety • Numbness • Flat affect

18. Emotional Responses (continued) • Indifference • Withdrawal or explosiveness • Repetitive storytelling • Loneliness • Yearning • Nostalgia

19. Behavioral Responses • Withdrawal • Dependence • Fear of being alone • Memorializing the loss • Disorientation • Sleep and appetite disturbances

20. Behavioral Responses (continued) • Absent-minded behavior • Dreams of the deceased • Crying and sighing • Restlessness • Avoiding of behaviors • Treasuring of mementos

21. Spiritual Responses • Blaming God (or spiritual equivalent) • Hostility toward God (or spiritual equivalent) • Lack of meaning or direction • Wishing to join the deceased • Isolation • Feelings of betrayal

22. Spiritual Responses (continued) • Hopelessness • Destruction or strengthening of beliefs • Feelings of being punished • Acceptance as “Divine Will” • Assigning of deceased infant as an “angel” in heaven

23. Personal Issues Complicating Grief • Age • Family dynamics • Gender

24. Other Complicating Factors • Insecurity • Anxiety or low self-esteem • Psychiatric history • Excessive anger and guilt

25. Other Complicating Factors (continued) • Physical disability or illness • Previous unresolved losses • Inability to express emotion • Concurrent problems of living

26. Spirituality • Honest exchange of information • Empathy and presence • Continuing bonds • Spiritual rites • Attachment with others • Grief support

27. Nursing Diagnoses • Anticipatory Grieving related to the imminent loss of a child • Powerlessness related to lack of control in current situational crisis • Compromised Family Coping related to death of a child/unresolved feelings regarding perinatal loss • Interrupted Family Processes related to fetal demise • Hopelessness related to sudden, unexpected fetal loss • Risk for Spiritual Distress related to intense suffering secondary to unexpected fetal loss

28. Nursing Interventions • Preparing the family for the birth and the death • Supporting the family in decision making • Providing postpartum care • Supporting siblings and family members

29. Nursing Interventions (continued) • Actualizing the loss • Providing discharge care • Making referrals to community services

30. Early pregnancy remembrance box

31. Memory Box

33. Bereavement literature

34. Door card

35. Parents holding their deceased infant

37. Nonhelpful Responses • Minimizing the pain • “At least …” • Offering explanation for loss • Imposing belief system

38. Helpful Responses • Acknowledging that the infant is unique • Validate the loss • Acknowledge that future plans will not be realized • Offer reassurance that they are not alone • Address pain • Reassure them of the caring presence of nurses