Issues of Loss and Grief in Maternity Nursing

The client has given birth to a full-term stillborn male as a result of placental abruption. The grandparents have come to visit. The nurse anticipates that the grandparents will do which of the following? A. Role model acceptance about the fetal loss. B. Experience a more intense grief reaction than the parents. C. Avoid talking about the dead fetus. D. Go through the same grief phases as the parents.

ANSWER D

Maceration

Changes undergone by a dead fetus as it is retained in utero; characterized by reddening and loss of skin, as well as distortion of features over time.

The client has just given birth to full-term twins. One twin was stillborn. The nurse concludes that this family will need to do which of the following? A. Simultaneously grieve the loss of one infant while becoming attached to the other. B. Be passive in accepting the death in order to form an attachment to the living infant. C. Control their emotions to prevent undue stress for the surviving twin. D. Minimize the time spent with the dead infant to facilitate attachment to the survivor.

ANSWER A

The nurse determines that teaching about sudden infant death syndrome has been effective when the client makes which statement? A. "No definite cause of death is found at autopsy." B. "Infants who sleep on their backs are more at risk for sudden infant death syndrome." C. "Bottle-feeding causes sudden infant death syndrome". D. "Genetic disorders are the cause of SIDS."

ANSWER A

Which statement indicates to the nurse that the client is expressing somatic symptoms of the grieving process? A. "If our doctor hadn't insisted on doing that extra blood work our baby would be alive now." B. "I told God I'd never again smoke another cigarette if our baby could just be born alive." C. "I feel nauseated and don't want to eat. Please the tray out of my room." D. "My mother can't stop crying. She says she feels like she failed me by letting this happen."

ANSWER C

The plan of care for a pregnant client who experienced an unexplained intrauterine fetal demise during her last pregnancy should include which of the following? Select all that apply. A. Education about the causes of intrauterine fetal demise for both parents. B. Encouragement to think positively and not dwell on the previous fetal loss. C. Support for increased fears as this fetus reaches the gestational age of the previous fetal loss. D. Facilitation of grieving of the lost fetus through carrying a photo and a lock of hair at all times. E. Asking open-ended questions to determine how the parents are coping and identify any concerns.

ANSWER C and E

The pregnant client has been told that the fetus has a neural tube defect. Which strategy by the nurse will facilitate anticipatory grieving during the pregnancy? A. Quietly and consistently encourage the family to terminate the pregnancy. B. Protect the family from the information about what effects the defect will have on their child. C. Promote inner strength and avoiding asking for help from others after the child is born. D. Educate the client as to realistic expectations of the medical care the child will receive after birth.

ANSWER D

Fetal anomaly

Abnormality of fetus, can be genetic or non-genetic causation,may be detected prior to or not until after delivery.

Mourning

Behavioral process through which grief eventually becomes resolved; influenced by culture, religion/spiritual practices, and customs; experienced by parents of infant who has died as well as siblings, grandparents, other close friends, and relatives.

Stillbirth

Birth of a dead infant at greater than 20 weeks gestation.

Bereavement

Subjective responses experienced after death of a loved one.

The nurse plans to facilitate bereavement after a fetal demise in utero by doing which of the following? A. Protecting the parents from having to see the dead fetus. B. Encouraging culturally determined naming and burial practices. C. Encouraging the client to tell the older children nothing. D. Avoiding the financial stress of an autopsy.

ANSWER B

The nurse interprets which of the following as somatic complaints of a postpartal woman who is grieving for her deceased infant? Select all that apply. A. Tingling on the back of the neck and hearing a baby's cry. B. Heaviness in the chest and fatigue. C. Increased taste sensitivity and deep sleep. D. Stiffness in the legs and arms. E. Weight loss and decreased appetite.

ANSWER B and E

The family is experiencing a fetal loss. Which statement indicates that the nurse's teaching about family involvement in the birthing process needs clarification? A. "We can have our child baptized." B. "We can decide not to stay on the postpartal unit after the birth." C. "We will be able to name our infant." D. "We should have the funeral through the mortuary the hospital uses."

ANSWER D

A stillborn baby was delivered in the birth suite a few hours ago. After the delivery the family remained together, holding and touching the baby. Which statement by the nurse would further assist the family in their initial period of grief? A. "What can I do for you? B. "Now you have an angel in heaven." C. "Don't worry, there is nothing you could have done to prevent this from happening." D. "We will see to it that you have an early discharge so that you don't have to be reminded of this experience."

Answer A

Neonatal death

Death of a live-born fetus from any cause within first month of life.

Intrauterine fetal demise

Fetal death from any cause that occurs in utero prior to onset of labor.

Anticipatory grieving

Grieving done prior to and in preparation for actual death.

Infertility

Inability to conceive after 12 months of unprotected intercourse.

Sudden Infant Death Syndrome (SIDS)

Infant death without apparent cause after autopsy, death scene investigation, review of symptoms or illnesses infant had prior to dying, and any other pertinent medical history.

Regrieving

Renewed sense of grief that occurs at anniversaries of a fetal loss.

A woman is undergoing induction of labor for an intrauterine fetal death. The nurse considers that which plans should be made for the woman's partner? A. Should be included for support and to facilitate the partner's acceptance of the fetal death as real. B. Should be included to decrease misunderstanding of medical procedures by the mother. C.Should be excluded to prevent the additional emotional strain of the birth on the partner. D. Should be excluded because another child can be conceived soon and help to forget this death.

ANSWER A

The family has just received the amniocentesis report that their daughter has trisomy 21 (Down Syndrome). The nurse concludes that which statement made by the father is the most common initial response? A. "There has to be some mistake. This is someone else's results." B. "If I pay for it myself, will you redo the test?" C. "This can't be right. One of you must have made a mistake reading the results." D. "This is difficult, but we'll get through it together."

ANSWER A

Which of the following tokens of remembrance would be appropriate for the nurse to provide to parents who are grieving the death of their infant? A. Lock of hair, footprints. B. Baptism or naming. C. Visit from chaplain. D. Sympathy card from staff.

ANSWER A

The client being seen for a postpartal exam after delivering a stillborn girl six weeks ago asks the nurse, "When will I feel normal?" The nurse's reply reflects the understanding that grief work takes approximately how long? A. Two to three months. B. About one year. C. Four to six months. D. Not more than eight months.

ANSWER B

The father of a stillborn infant tells the nurse he wants to hold the child. What is the nurse's best response? A. Encourage him to discuss this with his wife first. B. Dress the infant in a t-shirt and diaper and let him hold the infant. C. Tell him that it would be better not to hold the infant. D. Give him photographs of the infant that the nurse took instead.

ANSWER B

The nurse is making assignments for the next shift. The nurse assigns the same nurse to the family experiencing a fetal loss as cared for them yesterday because continuity of care will have which benefit? A. Decrease the family's need to interact with many others. B. Increase support for the family. C. Prevent the family from needing to ask questions. D. Facilitate dependence on the nurse.

ANSWER B

The nurse who is reviewing all subjective and objective prenatal assessment data interprets that which data is an indicator of intrauterine fetal death? A. Diminished fetal activity over a three-day period. B. A bluish discoloration in the vaginal and cervical mucosa. C. Absence of fetal heart tones and fetal movement. D. Mother saying "the baby is just not moving today".

ANSWER C

The client who experienced a perinatal demise states, "Sometimes I feel like I left my baby somewhere, and can't remember where she is. Then I remember that she isn't alive." The nurse interprets that this client is experiencing which of the following? A. Anticipatory grieving B. Disorientation C. Reorganization D. Searching and yearning

ANSWER D

The client who had a stillborn infant at term has come to the clinic for her postpartal exam accompanied by her husband. What should the nurse anticipate at this time? A. Both parents will express their grief in the same way. B. The parents will use similar coping mechanisms. C. The parents will be in the same grief work stage. D. The parents will have differences in how they are grieving.

ANSWER D

The maternal newborn nurse interprets that anticipatory grieving is likely to occur in a client who has experienced which of the following situations? A. Sudden Infant Death Syndrome. B. Ectopic pregnancy. C. Placental abruption during labor. D. Fetal anomaly identified during pregnancy.

ANSWER D

The mother of a stillborn infant tells the nurse that she feels like she is missing a part of herself. The nurse understands that this is not related to which of the following? A. Parents simultaneously grieving and resolving their attachment to the lost infant. B. The unborn child having been incorporated into a mother's physical and emotional being. C. A significant loss of self-esteem that often occurs with both parents after perinatal loss. D. Mothers of stillborns finding a way to justify their desire to become pregnant again.

ANSWER D

Grief

Total response to emotional experience of a fetal loss; experienced by parents, siblings, grandparents, and other close friends and relatives.

Incongruent grieving

When partners are in different stages of grief, can create additional stress within family due to perceived lack of support or understanding.