Friday, August 1, 2008

Saying Hello and Saying Goodbye..


...this will be a difficult subject to blog on; but one that needs to be shared.

Childbirth is something we go into fully expecting to finish with a fresh pink lusty crying baby. But sometimes that's not the case. In fact, Until I worked in the L&D dept. I never realized how many baby didn't get to have that chance.Everyone feels being an L&D nurse is attractive because most of the time the "patients" aren't really patients. Because they're not sick, they're in their prime of life. There is loads of suffering tho. Women in labor, even with epidurals which are so popular today Still have alot of discomfort. There is always some mucous, feces, urine, blood and usually vomit. As a nurse there is only so much you can do to alleviate the pain. It's difficult sometimes to remain composed while helping a mom deal with these discomforts of delivery.

So we like to think its always happy in L&D. But death is always lurking on the unit. Its a common occurrence. More than I realized! As you monitor the mom's strip closely evaluating the FHT's (fetal heart tones) you always have to keep in mind the real possibility that this new little baby might not get to see the light; and may quickly decelerate and god forbid, die on you.

Sometimes the Mom goes to her doctors visit and he has to tell her that there are no heart tones; that they baby's died. And they just don't know why. This can happen at any stage of pregnancy unfortunately.

My patient the other night had been told her baby was gone. She was scheduled to come into the hospital the next day and have her labor induced. As I approached this young couple I could see the pain they were carrying. Tears were dried on both their faces and the veil of death hung over them. It felt strange to walk them down the hall past mothers with healthy infants sat just feet away in their safe rooms. It just felt so wrong.

As I explained what I was going to do; I tried to be most respectful of their pain. I first told them how sorry I was for their pain. For their loss...
Its a hard thing to put into words. But we know that its best dealt with face on. Their baby died. Not their fetus, nor did they lose a "pregnancy". They lost their child, no matter what the gestational age. That's how I feel and that's how I deal with it. Its a real child and needs their place in the family recognized.
This mom was 23 weeks along. It seems to be a common time of fetal death. There must be a very important transformation that happens around that time; and sometimes it just doesn't happen.

I hooked her up to a monitor to see her contractions after having her change into the gown. They I started her IV and her pitocin. I then told her when her contractions became difficult to manage to let me know and I'd call the anesthesiologist for her epidural. This mom did Not need to get any award for her stoicism during labor.

The labor took almost 10 hrs to produce a birth. A stillborn baby girl was delivered and placed in my hands. I wrapped her gently in a blanket and took her to the warming table to tidy her up. It is policy to encourage parents of dead infants to see, touch and hold their babies after delivery. At first, most parents are horrified and decline quickly. But usually after a bit, they tentatively ask to at least see the baby, after we explain how this helps with the grieving process. Research has shown that parents are better able to resolve their loss better if they see their baby and know what they look like. This also gives them the opportunity to say goodbye.

As I carefully cleaned and wrapped this little baby, my heart was breaking. With tears in my eyes I went to the bedside and told the parents they could see and hold her when they were ready. They knew how to get in touch with me, and I left the room to allow them to have their time together. Then I went into the bathroom and just cried until I felt empty.

The parents did want to see and hold their baby after about 30 mins. I gently picked her up and placed her in her mothers arms. The mother broke down and just sobbed. That's when my tears started up again. I bent down and hugged the mom and just said "I'm so sorry..so sorry". The parents held that baby for 5 hrs before they were ready to give her up. They had the grandparents come visit and everyone had their chance to say goodbye. It was heart wrenching but I felt a sense of peace that they were dealing with their horror face on. They were so strong...
So this is the dark side of my job. Lucky for me, they rotate the IUFD's amongst the staff so its fair and distributed evenly. I should not have another demise for weeks, hopefully months. Its very hard and very heartbreaking.

We as nurses do everything we can to facilitate healing of this suffering. We take photo's and wrap the little one in precious clothes handmade by women somewhere who make extra small gowns and bonnets just for these babies. You can see the love sewn into these garments. We give the parents a memory box filled with things to remember their child by. The measuring tape, the clothes the baby was dressed in, photo's and a small teddy. This teddy appears in the photo next to the baby. As harsh and terrible as this all sounds, it really does validate this child's life as best we can.

If the parents don't want the box at the time of discharge, its put into storage for a time when they probably will want it.

My heart was heavy that day as I walked off the floor. But I knew I had done all I could to tenderly and carefully care for this family.
I was glad to come into my next shift and have someone just getting ready to push. To see that 8lb 9oz baby enter the world screaming made me dizzy with joy!

..I go back to work tonight. I never know what is waiting for me..but I Love my job. This is why I became a nurse.

12 comments:

AtYourCervix said...

So sad when a baby dies. I've written about this very topic a couple of times on my blog as well. I cry at every one.

Jody said...

Oh yeah. It's incredibly hard on the nurse. Like I said, I never knew so many little ones didn't make it. And I certainly didn't realize what My job would be when it did happen..

Theresa said...

8 years....and I still cry at every one.

Marlene said...

I'm not a nurse....but I cried my eyes out reading this post, imagining not only the pain the parents were feeling, but how you must have felt being there for the event. How sad. I don't imagine any amount of training prepares you for the depth of these kind of emotions.

Jane said...

Thanks for all you do for us moms out there. I have two great boys and am thankful for the wonderful nurses that helped bring them into this world. What a sad and difficult time when a mom is not as lucky.

San Diego Momma said...

That breaks my heart.

I'm glad these parents have someone with your compassion there during such a devastating time.

You described this beautifully. Still, it breaks my heart.

Lyn said...

You don't know me but I just happened across this blog. My baby died when I was 39w1d pregnant. The nurses were wonderful. I got the teddy bear and the box full of all the stuff you mentioned. They also took polaroids and a disposable camera with pictures on it. On Bradens' first birthday, I had them developed and it did help with my healing process. We also held Braden for as long as we wanted...I don't remember now how long that was but it was so cleansing...it also eliminates the denial that I surely would have felt. My nurses were so good to me. Thank you for doing what you do, even when you do draw the short straw.

Jody said...

Well Lynn, I'm glad I decided to post this Very delicate and difficult post. And first off I want to say how very sorry I am that your little one died. I can't even imagine the pain. Horrible. I hope you are slowing doing better. My prayers go towards that recovery. Thanks for posting. Its people like You that I wrote about this ...

Nene said...

i have to admit that this is probably the one thing that has me the most scared about going into Labor and Delivery (which I DO hope to do) - I've always wondered how the nurses deal with these situations. I've always know and still know that i will be one of the ones that cries every time but i wasn't sure if that was appropriate - especially in front of a patient. i guess i always though that maybe in some way it would undermine how the patient was feeling despite the fact that I was grieving FOR her and her family... does that make sense?? in any case, I'm glad to know that others have the same reaction as i know i will and that (i assume) it is OK...

Kim said...

Before working in OB I worked in the ER where I had my fair share of Patients die on me, there are a few that I remember very vividly but I do not remember crying after any of them. Over the last two years I have had two babies die on my watch both of which were pre-termers at 21 and 24 weeks. I remember the night, the time of birth, the mom's name, the baby's gender, the room they delivered, and who delivered them. I have cried and still morn those two babies that never had their first of anything. Thanks for so eloquently describing your story. Kim

Anonymous said...

ive always said even after over 20 yrs of ob nursing, if you get where it doesnt effect you and you dont cry for your patient, her family and her baby then you need to get out of that field of nursing. compassion is the meaning of nursing

DeDah said...

Thank you for this post. On January 12, 2009, I gave birth to a 9lb 10oz angel. The nurse I had went above and beyond what some nurses would. it was such a horrible, traumatic time, that I don't even remember her name, but she will forever be in my heart as the nurse angel who took care of me.