Fundamentals of Midwifery: A Textbook for Students (160 page)

Box 17.4 Mementoes of the baby

Photographs (and video footage for some neonatal death in NICU).

Hand and/or foot print cards.

Lock of hair.REMEMBER CONSENT IS NECESSARY BEFORE MAKING THESE MEMENTOESCot cards and name bracelets can also be given (name bracelets will have to be replaced as per policy for transfer to the mortuary).Figure 17.3 is an illustration of a memory box.
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Figure 17.3
Abbie’s Fund box with permission from Abbiesfund. Access the websites for more information about the charity [available online] www.abbiesfund.co.uk; www.facebook.com/ abbiesfund. Source: abbiesfund.co.uk. Reproduced with permission of Katy Cowell.
Termination for fetal abnormality
Caring for women undergoing termination for fetal abnormality is particularly challenging. Because diagnosis is not made until quite late in the pregnancy most women have to endure a labour and delivery which can be quite difficult. From a grieving perspective the women and their families are not only struggling with the loss of their baby, but also their expectations of that baby. The presence of an abnormality creates guilt and anxiety as many women and their partners wonder if it was something they had done or not done that caused it. They also worry about any future pregnancies being affected in a similar way. The decision to terminate a fetus with abnormality is not an easy one and it is very important that care is non-judgmental. It is also essential that the family are allowed to make their own choices about seeing the baby. Some abnormalities can be quite frightening, but there is a danger that an overly protective approach by midwifery staff causes more harm than good as what is imagined can be worse than reality. It can be important for some families to see the baby and the abnormality to confirm their decision. Preparing the women and her family effectively can minimise the distress as can a supportive approach that gives them space to make the decision to see the baby and to spend time with him/her. Families experiencing this situation may have questions about the condition affecting their baby, so access to the paediatric team following delivery may be neces- sary and most will need follow up for advice regarding future pregnancies and/or genetic counselling.
Maternal death
Maternal death is fortunately rare in the United Kingdom. The national report on maternal death(Centre for Maternal and Child Enquiries (CMACE) 2011) which is published every three years identified several factors such as: obesity, social exclusion, domestic abuse and substancemisuse. These are challenges that are increasingly evident in midwifery practice. An important factor in reducing maternal death is early identification of those at risk and the advocacy of a known midwife. Any maternal death is subject to formal enquiry (in order to compile a national report as noted above) and midwives will be asked to complete documentation relating to this, as will obstetricians and any other relevant healthcare professionals. This is so that any lessons that can be learnt from each individual maternal death can lead to any appropriate changes in practice.‌The woman’s partner and family will need emotional and practical support. They may be trying to deal with the loss of both mother and baby or to cope with the care of a baby in the absence of his/her mother. Grief may affect their behaviour and there may be dis- agreements about who should be doing what which will need tact and diplomacy from the midwives. There may also be legal issues to be addressed where the parents of the baby were not married.
Peer support for midwives
Midwives providing care in any situation where life is lost will be affected by their own feelingsof loss and grief. This will not be as intense as the family’s emotions, but will nonetheless affect their overall wellbeing. Peer support is essential in helping midwives deal with their feelings. The need for confidentiality means that unless they can talk to a colleague things can get ‘bottled up’. The role of the Supervisor of Midwives is central to support following difficult situ- ations and midwives should always access their Supervisor of Midwives for this. However, the support of close colleagues can make a significant difference. It is very easy to forget the needs of our colleagues when everyone is busy, but some will feel isolated and perhaps even feel that their peers are blaming them if people do not make an effort to speak to them. Just asking if they are alright or if they need to talk can make all the difference.
Support groups
There are a number of support groups available for parents and families who have lost a baby.SANDS the Stillbirth and Neonatal Death Society provide a helpline, an information service; publications and have local groups run by bereaved parents throughout the UK. SANDS also provide support and information for healthcare professionals.The Miscarriage Association support women and families who have experienced miscarriage, ectopic or molar (hydatidiform mole) pregnancies. As with SANDS they provide information and have a helpline. The association also provides information for professionals.There are also organisations that provide support in relation to specific conditions such as Anencephaly Support Group and general bereavement support organisations such as Cruse Bereavement Care who provide support for all those experiencing bereavement. There are also faith-based organisations.Most organisations have websites and can therefore be found by a quick internet search, including many details for the three major organisations relevant to bereavement within mater- nity care, but remember that each woman and family member may have individual needs and there may be a group or organisation that will be better placed to meet that need, so it is important to talk to them about what they expect from bereavement support. Support groups may help, but access to formal counselling services should still be made available.
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Key points

Theories of loss and grief are useful in understanding reactions and providing effective care.

Care needs to be respectful and sensitive to individual needs not prescriptive.

Working with other agencies and voluntary organisations can enhance care.

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Fortunately midwives do not have to deal with loss and grief too often, but this can make it