Infant Loss & BereavementInfant Loss & Bereavement

ObjectivesObjectives

• Increase skills in assisting families with final choices

• Identify ways to make precious memories for parents during a loss

• List ways you can provide the best support to parents

Initial SupportInitial Support

• Time of extreme stress for family• Couples vividly remember what

happens• What we do affects them• We can make a positive difference• We can’t lessen the pain• We can provide a memory of caring

and support

Goal of Initial EncounterGoal of Initial Encounter

• To convey caring• Permission to

grieve

What Families Need to KnowWhat Families Need to Know

• Who you are• That you know (“I’m Susie, your

nurse today. I learned in report that you baby has died -- I’m so sorry.”)

• That you care• Every encounter is potentially

awkward or potentially reassuring.

What You Can DoWhat You Can Do

• Don’t make assumptions• Be respectful & careful with

statements you use with families– Avoid “at least”– If families use “at least”, that’s ok

• Use names• About about baby, pictures, etc.• Use touch to convey caring• Lots of stress, use time gently & well

Hospital LossesHospital Losses

•Can happen in variety of settings–ER–NICU–Outpatient visit–During hospitalization &

delivery

In ER or NICUIn ER or NICU•Prepare them for the news– “I’m concerned”… “they’re still

working with him/her”

•During OB visit–They can read our expressions–Be honest, “I’m concerned”–Don’t pretend–Be supportive, “I know this is

worrying you”

During Hospitalization & Delivery

During Hospitalization & Delivery

• Prepare for choices– Bring info forward as you go,

don’t leave all for later

• Identify support persons• Discuss plan of care• Prepare for delivery

– May be rapid finish/delivery at end

Hospitalization/Delivery (con’t)

Hospitalization/Delivery (con’t)

• Discuss pain medication– May not have taken prenatal classes yet– May be afraid to use pain medication– Give permission to accept comfort

• Prepare for what will happen after baby delivers– Fear of what baby will look like– Ask if they want to hold and see baby– Assist with making final choices

Seeing & Holding BabySeeing & Holding Baby

•Ask if they have ever seen someone who has died

•Help families not to be afraid•Don’t be in a hurry•How we talk about baby sets

tone– “Her fingers & toes are so

perfect”

Seeing & Holding BabySeeing & Holding Baby

• Encourage to see baby - don’t insist– Gently nudge, don’t force– Encourage by letting them know that

often families later wish they had

• Dressing baby– Invite parents to bathe & dress baby– May be one of the few parenting things

they will do for this baby– Is an option - NOT expectation!

Rights of the BabyRights of the Baby

• To be recognized as a person who was born and died

• To be named• To be seen, touched, and held• To have life-ending

acknowledgement• To be put to rest with dignity

Rights of ParentsRights of Parents

• To have opportunity to see, hold, and touch their baby

• To have photographs taken• To be given as many momentos as

possible• To name their baby• To observe cultural & religious

practices

Rights of Parents Rights of Parents

• To be given time alone with baby• To request an autopsy• To be given information in terms

they understand• To plan a farewell, burial,

cremation• To be provided with information

on support materials & resources

Saying HelloSaying Hello

• Allow parents & family to see, hold, and touch baby

• Get hand and footprints• Get hand, foot, head molds• Crib cards, name bands,

certificate of life/birth• Baby gowns, blankets, hats

Saying HelloSaying Hello

• Memory books• Time alone with baby• Play music during time if

available• Baptism, naming, or blessing

ceremony

Making Final DecisionsMaking Final Decisions• Give clear options for final decisions• Final decisions difficult to make

– Allow them to take their time, “no hurry”– Enlist help (Soc. Serv., Pastoral Care,

funeral home)– Honor what feels right for them

• Parents feel bewildered– How do you say goodbye before you’ve had

a chance to say hello?– No rules to follow, only your heart

Making Precious MemoriesMaking Precious Memories

• Important for family to have memories

• Parents are touched by the caring way we provide to their baby

• Discuss with parents if baby not presentable– Talk to them about normal tissue

changes, etc.– May choose to see only hands and feet

Picture TakingPicture Taking

• Take lots of pictures– Family holding– Naked and dressed– Placing hand next to baby– Using objects to soften & warm pictures

(basket basinet, teddy bear, blankets) – Using parents’ hands & placing baby’s

hand inside

• Remember to fill photo with baby– Too close/far away becomes fuzzy

Creating MemoriesCreating Memories

• Lock of hair• Hand or foot prints• Measurements• Infant ID bands• Keepsake Gown/blanket• Angel pins• Alginate/plaster of paris molds• Outline drawing of baby on

parchment paper

Disposition ChoicesDisposition Choices

• Private burial– Family burial plot or purchase

separate site, – Family, clergy, or funeral home

can assist– On private property (requires

permits from Register of Deeds)

• Private cremation– Can bury, scatter, or keep remains

Hospital Disposition (if available)

Hospital Disposition (if available)

• Arrangements per hospital guidelines

• Must be stillborn (SD law)– All liveborn require birth & death

certificate (In Sioux Falls, separate grave)

• Avera McKennan disposition– Cremation– Common grave (ashes co-mingled)– No marker, burial occurs only few x’s/yr

PoliciesPolicies•W&C Bereavement Policy• (located in Share File)– Infant Loss, Stillborn– Fetal Loss, Live-born Infant–Child on PediatricsChecklist policies/procedures

WC/NICU/Peds will be marked behind each procedure to designate which dept. this pertains to

Possible Forms to CompletePossible Forms to Complete• MD to visit with family about

autopsy and chromosome testing– If requested will need these forms:

•Autopsy Consent Form•Request for Autopsy form•Chromosome papers (lab will send)

* Forms to complete *– Release of Body– Death Record– Disposition of Fetus consent– applicable to Newborn/NICU infants

NotificationsNotifications

•Pastoral Care•LifeSource (federal mandate

for ALL deaths 20 weeks or >)•Social Services•Now I Lay Me Down to Sleep

Photographer (if available)

Ongoing SupportOngoing Support

• Memory card at Christmas• Card at anniversary date of

loss• Avera McKennan Grief & Loss

Support Group (for miscarriage and infant loss)– 6 week series offered in Jan.,

April, Sept.– Avera Behavioral Health Center– Call 605-322-4074 to register

Creating MemoriesCreating Memories

3-D Molds3-D Molds

• Mix alginate in mold, allow to set

• Press fetal part into mold

• Fill mold with plaster of paris, allow to dry

• Carefully remove and peel away alginate, discard.

• Add ribbon or baby’s name to mold

3-D Molds3-D Molds

ResourcesResources

•See handout–Compassionate Friends–March of Dimes–National SIDS & Infant Loss

Resources Center–SHARE–Pregnancy & Infant Loss Awareness–Amend–Centering Corporation