Oxford Handbook of Midwifery (104 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

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To complete the process of grieving for their baby the parents often need to know the cause of death.
Certain blood, tissue samples and swabs may be requested from mother, fetus, and placenta, and are important for obtaining accurate information for counselling the parents at a later date (Table 19.10).
The placenta may be sent to histology for examination.
A postmortem may be indicated. A senior obstetrician or midwife should obtain consent after a full but sensitive explanation of the procedure. The parents should be given written information about the examination and have an opportunity to read it before consent.
Photographs of the baby may be required and can be requested from medical photography.
An appointment with the consultant should be arranged 4–6 weeks after the stillbirth to discuss any findings.
Transfer to the community
If the woman is physically well after the delivery, the parents may want to go home and return, as they wish, to see the baby and discuss further arrangements. The baby will be kept in the hospital until decisions have been made about postmortem and funeral.
If the fetal death occurred unexpectedly in labour, it is especially important that the parents be given plenty of time to talk through the incident with staff involved at the earliest opportunity.
The parents need to know what might have been the cause; otherwise some in their grief may irrationally blame themselves or others. A mutually convenient appointment should be arranged.
Anti-D may be given prophylactically to Rh-negative women.
If the woman’s pregnancy was more than 20 weeks’ gestation and she has no history of PIH, she may be given a prescription for cabergoline 1mg, to be taken on the first postpartum day. This will help to suppress lactation.
Give the woman and her partner literature that puts them in touch with other parents who have been bereaved; for example the Stillbirth and Neonatal Death Society (SANDS). The Child Bereavement Trust provides support for parents and siblings.
Mark the hospital notes with the SANDS teardrop logo, indicating a perinatal bereavement.
Where possible, postal advertising for pregnancy is cancelled.
Some units keep a remembrance book and hold yearly memorial services for parents and families who have experienced the loss of a baby.
Registration and funeral arrangements
If the gestation is <24 weeks, no registration is required.
All stillborn babies after 24 weeks’ gestation require a stillbirth certificate.
This certificate is taken by the parents to the registrar of births and deaths at the registry so that the registration of the stillbirth can take place.
CHAPTER 19
Emergencies
464
- The registration should be completed within 42 days.
- Unless legally married, the woman and her partner should attend together if the father’s name is to be registered on the certificate.
- The parents should ask for a copy of the certificate for themselves.
  Table 19.9
  Example of bereavement checklist for labour ward
  Signature Date
  Name of doctor examining baby after delivery Mother informed or death by
  Father informed of death by New page in bereavement diary Notes marked with SANDS logo
  Cancellation card Bounty advertising
  Community midwife informed ASAP Name: Phone:
  Is a visit wanted at home?
  GP informed.
  Name: Phone: Is a visit wanted at home?
  Cancel antenatal clinic appointment
  Health visitor (HV) referral form: HV notified by phone
  Inform chaplaincy
  Parents given time to handle baby 4 Polaroid photographs taken Medical illustration card completed Hand- and footprints/hair taken Computer details completed Congenital anomalies register
  Mortuary identification labels attached ×2 SANDS booklet and other literature given
  INTRAUTERINE DEATH AND STILLBIRTH
  465
The registrar will issue a certificate of disposal following a stillbirth.
This, when given to the funeral directors, allows them to proceed with arrangements for the funeral.
The hospital may arrange the funeral, or parents may arrange a private cremation or burial if they wish.
For further information b see Bereavement care, p. 516.
Table 19.10
Example of checklist for maternal, placenta, and fetal investigations
Maternal investigations
Viral studies: toxoplasmosis, CMV, herpes, rubella
Blood group, antibodies, Kleihauer
Bloods Signature Date Required
Virology (Yes/no)
BTS Regardless
of blood group
Haemoglobin Haematology Listeriosis Microbiology
Fetal and placental
Bloods Signature Date Required
Viral PCR studies: Virology toxoplasmosis,
CMV, herpes, rubella
Blood group and Coomb’s test
BTS
Haemoglobin Paediatric vial,
haematology
Chromosome analysis
Paediatric vial, cytogenetics; + sample of membrane, placenta, and cord. Sent in culture solution to Cytogenetics (consent required)
Placental swabs From maternal surface
and from fetal surface; bacteriology
Placenta to histology
Send as soon as possible regardless of whether a postmortem is required
CMV, cytomegalovirus; BTS Blood Transfusion Service; PCR, polymerase chain reaction. Adapted from Bereavement guidelines (2004). Jessop Wing Sheffield Teaching Hospitals Trust.
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Part 4
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Postnatal care
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Postnatal care
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Chapter 20
469
Principles of postnatal care
470
Physiological aspects of postnatal care
471
Involution of the uterus
472
Vaginal blood loss
474
The perineum
475
Perineal pain
476
Circulation
477
General health
478
Urinary output
479
Psychological and emotional aspects of postnatal care
480
Transfer home from hospital
482
Parent education
484
Postoperative care
486
Postnatal care of the breasts
490
Care of the mother with pre-existing medical conditions
491
CHAPTER 20
Postnatal care
470‌‌
Principles of postnatal care
The principles of postnatal care are mother and family centred, to meet her physical, psychological and emotional needs, in recovering from the birth experience and caring for her baby. In providing effective postnatal care, the midwife must ensure:
- The mother and her family are treated with kindness, respect and dignity
- Excellent communication that respects the views, values and beliefs of the woman, partner and her family
- A documented, individualized care plan developed in partnership with the mother and reviewed at each contact
- Timely and relevant information to enable her to promote her own and her baby’s health and well-being and recognize and respond to any problems arising
  •
  The mother is encouraged to make informed decisions about her care
  and any treatment needed
- The mother’s emotional well-being is monitored and what family and social support she has in the postnatal period. Encourage the mother and her partner and family to tell the midwife about any changes in mood, emotional state, and behaviour that are outside of her normal pattern
- Contact details of all healthcare professionals involved in her care
- The mother knows the signs and symptoms of potentially life threatening conditions and how to summon help from the midwife or doctor or emergency services, if required
- Contemporaneous and accurate records about maternal and neonatal health and well-being, information, and advice given, agreed in partnership with the mother, and readily available to all healthcare professionals involved in her care.
  The midwife must ensure that postnatal care complies with the following:
- Department of Health (2007).
  Maternity Matters
  . London: Department of Health.
- National Institute for Health and Clinical Excellence (2006).
  Routine Postnatal Care of Women and their Babies
  . Clinical guideline 37. London: NICE.
- National Institute for Health and Clinical Excellence (2007).
  Antenatal and Postnatal Mental Health
  . Clinical guideline 45. London: NICE.
  PHYSIOLOGICAL ASPECTS OF POSTNATAL CARE
  471‌‌
  Physiological aspects of postnatal care
  Aim