Grief and Loss in the Childbearing Family

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Grief and Loss in the Childbearing Family
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Causes of Perinatal Loss Maternal Complications

• Preeclampsia
• Abruptio placentae
• Placenta previa
• Renal disease
• Diabetes

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Causes of Perinatal Loss Fetal Complications

• Congenital anomalies
• Fetal growth restriction
• Alloimmunization

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Diagnosis of Perinatal Loss

• Spaldings sign
• Decreased maternal estriol levels
• Absence of fetal heart movement

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Nurses Role

• Assist families in mourning process
• Explore wishes for viewing and holding deceased
  child
• Provide support, answers questions, refers for
  grief counseling

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Physical Responses

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

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Physical Responses (continued)

• Feeling of emptiness in the pit of the stomach
• Weakness/lethargy
• Tightness in throat
• Sighing
• Fatigue
• Oversensitivity to light and sound

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Cognitive Responses

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

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Cognitive Responses (continued)

• Poor concentration
• Preoccupation
• Sense of presence
• Hallucinations of the deceased infant

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Emotional Responses

• Sadness
• Anger/rage
• Guilt/self-reproach
• Anxiety
• Numbness
• Flat affect

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Emotional Responses (continued)

• Indifference
• Withdrawal or explosiveness
• Repetitive storytelling
• Loneliness
• Yearning
• Nostalgia

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Behavioral Responses

• Withdrawal
• Dependence
• Fear of being alone
• Memorializing the loss
• Disorientation
• Sleep and appetite disturbances

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Behavioral Responses (continued)

• Absent-minded behavior
• Dreams of the deceased
• Crying and sighing
• Restlessness
• Avoiding of behaviors
• Treasuring of mementos

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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

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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

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Personal Issues Complicating Grief

• Age
• Family dynamics
• Gender

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Other Complicating Factors

• Insecurity
• Anxiety or low self-esteem
• Psychiatric history
• Excessive anger and guilt

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Other Complicating Factors (continued)

• Physical disability or illness
• Previous unresolved losses
• Inability to express emotion
• Concurrent problems of living

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Spirituality

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

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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

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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

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Nursing Interventions (continued)

• Actualizing the loss
• Providing discharge care
• Making referrals to community services

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Early pregnancy remembrance box
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Memory Box
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Bereavement literature
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Door card
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Parents holding their deceased infant
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Nonhelpful Responses

• Minimizing the pain
• At least
• Offering explanation for loss
• Imposing belief system

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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