Brenda van der Kooy looks at the importance of giving parents time to decide
Learning that your baby has died before being born is a devastating shock which most parents have never before contemplated happening to them.
Suddenly that wonderful excitement and anticipation of the future, dreams and joy are swept away. The pain of grieving is profound and there are no shortcuts in the emotional journey that must be travelled. However when a baby dies in the womb, the reality is that the baby still needs to be born.
For some parents an early reaction is to ask for a caesarean section in the hope that this will get it over quickly and prevent further distress for the mother. However, unless she has a specific medical condition, having a caesarean section would pose an increased risk for the mother in this pregnancy and importantly for future pregnancies. Therefore, having a vaginal birth is likely to be recommended as the safest option.
So if labour has not already begun, the options come down to inducing the labour or waiting for labour to start spontaneously. NICE Induction of Labour Guideline (www.nice.org.uk/guidance/cg70) recommends 'if the woman appears to be physically well, her membranes are intact and there is no evidence of infection or bleeding, she should be offered a choice of immediate induction of labour or expectant management.'
Both these options are equally valid and are a matter of the mother's personal choice. It is really important that parents are encouraged to take time to decide what is right for them given all the information about both options. During my midwifery career I have never met anyone who has regretted taking time to make a decision, but I have met families who wished they had. I have also learnt that parents' decisions can frequently change a number of times, even over just a few hours.
A general misconception is that the baby will begin to decompose in its mother's womb and therefore action must be taken straightaway. This is not true. The baby will gradually change in appearance but not decay. Some mothers have waited weeks, savouring the precious time together with their baby. For others, labour starts spontaneously within hours or days. Other parents have chosen to have labour induced. The decision to have an induction of labour can be made at any time. Some feel clear about having an induction after considering their choices overnight. Others prefer to take longer to see if labour will start on its own. The most important thing is that parents are supported to give themselves some time. Another important choice to make is where they would like to have their baby. This may be where they originally planned - an obstetric unit, midwifery led-unit or at home - or they may wish to change.
Over the last couple of decades much has been learnt about how healthcare professionals can support parents in ways that help them to come through the grieving experience. Hospitals will all have guidelines that should ensure parents are offered the full range of options and the care offered is truly parent centred and flexible. However, due to the fragmented model of midwifery care in most NHS Trusts, few women will have a midwife they already know and trust to care for them through labour and the following weeks. As it is well recognised that this is not ideal, many hospitals have a specialist Bereavement Midwife who will become directly involved and/or support the midwives who are allocated to caring for the parents. The Bereavement Midwife is a great resource for any parents who find themselves in this situation and will have the confidence and experience to support parents' choices.
The choices and decisions don't stop with the birth of the baby - how those precious early hours and days are spent can make a huge impact. If the baby is born in hospital there may be a quiet room with a double bed that parents can use and stay in for as long as they wish. Or parents may preferto take their baby home with them for a period of time. All the options should be explained and parents should be empowered and supported to do what is right for them.
If there are other children in the family, parents will be anxious for them. Again much has been learnt in recent years on how to support children who are bereaved - regardless of their age. An excellent resource is the charity Child Bereavement UK. They support families and educate professionals when a baby or child dies or is dying, or when a child is facing bereavement, with specific information about stillbirth. As does another charity, Sands (Stillbirth and neonatal death charity). Both organisations' websites can also be extremely helpful for grandparents and the extended family and friends to gain information that can help them to support the family.
When a baby dies, time to be together in which to build memories has been snatched from parents. Therefore it is vital everyone supports parents to take time to make choices that are right for them at this life-changing point in their lives.
Brenda van der Kooy
RGN, RM, PGCEA, MSc
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