The . crisis for the mother and midwife . when a baby dies at birth. .. Aim of the project. What is a “life crisis” and “life crisis theory”?. To explore the crisis that ensues when the impact of stillbirth is encountered, in both health professionals and families . ID: 561475
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Stillbirth - The Shattered Dream
crisis for the mother and midwife
when a baby dies at birth
Aim of the project
What is a “life crisis” and “life crisis theory”?To explore the crisis that ensues when the impact of stillbirth is encountered, in both health professionals and families Raise cultural awareness and customs relating to stillbirth in Independent State of Papua New Guinea (PNG)
Develop an educational package for nurses and midwives to assist patients in this life crisis whilst managing our own nursing experienceHighlight cultural differences towards stillbirth in PNGSlide4
In order to be able to explore the impact of stillbirth, in relation to cultural differences surrounding the experience, and the subsequent fallout; we need to define both the term “Stillbirth” and the “Life Crisis” phenomenon.
In this project we will explore the theories and principles behind life crisis. Then develop a meaningful educational package reflecting best practice principles and latest research surrounding care after stillbirth.Slide5
What is a Stillbirth?
“Stillbirths are deaths of unborn babies” (WHO 2004)
WHO defines “stillbirth as the death of a baby after 22 completed weeks of pregnancy, or when the baby weighs at least 500 grams.” (WHO 1950)
Its worth noting that there is no international standard definition that can be used across all countries. It makes collating research on a level playing field challenging when defining if and when a baby is considered “stillborn”
Sweden considers babies stillborn only after 28 weeks. In the United States and Australia, a baby who has passed the 20-week mark is considered stillborn, while in Norway it is at 16 weeks
Australia, Canada, UK and United States all have differing definitions of stillbirthSlide6
The World Health Organization (WHO) states that approximately 4.5 million stillbirths transpire every year For developing countries that statistic are more alarming. One out of every 100-200 pregnancies concludes in stillbirthIts clear through research that many are potentially avoidable and preventable (Smith & Fretts, 2007; Di Mario et al., 2007)Slide7
Definition “a crucial stage or turning point in the course of anything, a time of extreme trouble or danger” (Collins 2006) and comes from the Greek word “krisis” meaning decisionA life crisis like stillbirth carries diverse meaning, outcomes and grief to numerous cultures
There are many levels of victims when disaster strikes.
The death of a baby has been by many recognised in some cultures as one of the most stressful.
The parents, grandparents other siblings, friends health workers, are all victims of the psychological trauma. Taylor and Frazer (1981) identified six levels of victims.Slide9
Six Levels of Victims
Taylor & Frazer’s Six Levels of Victims (1981)
Relatives & Friends
Heath care workers directly involved, e.g. Midwife, Doctors
Community share the grief
Individuals psychologically distressed by the news but not directly involved
Individuals indirectly affectedSlide10
Emotional response to a
Individuals respond in various ways and vary in the severity and types of responses.
A broad range from emotional, cognitive, and behavioral responses (Fink, 1967; Murray & Zentner, 2001).Slide11
Crisis Intervention Theory
It originated after the 1942 Coconut Grove Night Club Fire and the victims were interviewed by Eric Lindeman and a theory was formulated on the grief process and short term intervention and therapy.
Caplan in 1964, went through histories of psychiatric patients and he found that during a life crisis some clients coped poorly and emerged “less healthy”.Slide12
Individual Responses in the Crisis Phases (Murray & Zentner,2001; Langan & James 2005)
Impact - ShockDuration 1- 48 hoursAnxiety, Detached, Hopeless, disorganizedLacks initiative for daily tasksDefense - RetreatDuration hours to weeksSuperficially calm, Apathetic or euphoric, avoids the event, memory loss, unable to plan, usually withdrawsAcknowledgement of RealityTension & anxiety rise, loneliness, irritable, apathetic, low self esteem, grief and mourning occur gains ability to cope, becomes aware of the facts, change, events physical status, validates personal feelings, exhibits mourning, resumes roles, coping skills improveResolution - Adaption Duration 6-12 monthsPainful feelings integrate into self concept, new sense of worth, gradual lowering of anxiety, finds meaning in situation, discovers new resources, adapts
Jan Becker | Stillbirth | Professional Development | EducationSlide13
1 in every 140 babies dies
In Australia in the ten year period from 1992 to 2003, the stillbirth rate went down by 1.3 per 1,000 births (Australian Bureau of Statistics - ABS). In Australia one in every 140-150 births ends in stillbirth (ABS). In UK it is one in every 200 babies are stillborn.The parents are often confused with their reactions for guilt, anxiety, sadness, and for the men studies have found themes including self-blame; loss of identity; and the need to appear strong and hide feelings of grief and anger. (McCreight 2004)
Time immediately after birth
“For the first 30 minutes, a stillborn baby feels soft and warm, just like a live baby. The time immediately after birth can be seen as an “acute” situation – a time that can never be relived” (Rådestad & Christoffersen, 2008).
Within 30 minutes…
If the parents hold and see their baby during the critical 30 minutes immediately after birth many describe this as the single most valuable time they had with their baby (Rådestad & Christoffersen, 2008).
Kowalski (1987) states that perinatal death symbolizes many things they have been robbed of, including the loss of the most significant person to each other, the loss of pieces of themselves, the loss of a symbolic time in their lives, the rites of passage into adulthood and parenthood, dreams once imagined lost forever, the loss of conception and creation of life. Culturally, a couple whose first pregnancy ends in a loss has not completed the “rite of passage into parenthood”, which symbolizes adult status (Layne 1990).
Mental Health Triage Physiological First Aid
Preliminary intercession subsequent to a crisis: (Langan & James 2005)
Comfort and consoling
Facilitate venting of feelings and link support
Foster some sense of mastery
Refer to counseling (Aguilera, 1998., Hoff, 2001)Slide18
Maslow's Theory on Hierarchy of Needs
Focus also needs to be on the primary needs according to Maslow. They are:Provide physical needsEstablish safety & protectionFacilitate sense of belonging – connect them to othersHelp parents regain a sense of positive self esteem and control (Maslow, 1971)Slide19
“When your parent dies, you have lost your past. When your child dies, you have lost your future” (Luby 1977)
The role of parenthood is long dreamt about usually before the conception takes place, as outlined below. The loss of a baby heralds failure for the women – she may feel her body is not reliable, she grieves the loss of special attention, loss of self esteem, feelings of failure, guilt, inadequacy if genes are abnormal further eroding self esteem.
Free Image: http://www.gettyimages.com/Search/Search.aspx?contractUrl=2&language=en-S&family=creative&assetType=image&p=still%20birth&src=standard#4Slide20
Table 1: Psychological Process of Becoming a Parent
Feelings of procreativity and generativity- sense of continuity through the generationsFears and expectations about the coming babyEffect on expectant parents’ relationshipResponse to quickening and bodily changesAttachment to real and idealized aspects of the infantSelf-esteem buildingReference: Kay J, Roman B, Schulte HM. Pregnancy loss and the grief process. In: Woods JR, Woods JLE, eds. Loss During Pregnancy or in the Newborn Period. Pitman, NJ: Jannetti Publications, Inc, 1997:5-36
Free Image: http://www.gettyimages.com/Search/Search.aspx?contractUrl=2&language=en-S&family=creative&assetType=image&p=still%20birth&src=standard#4Slide21
Causes of Stillbirth
In Australia, stillbirth accounts for more than 70% of all perinatal deaths.
Unexplained deaths account for approximately 30% of stillbirths.
Usual causes found:
Problems with the placenta - placenta praevia or bleeding from the placenta
Poor fetal growthSlide22
Contributing factors in developed countries include:
Infections by bacteria or virus (15 -24% of stillbirths),
Malformations or genetic abnormalities (7-20%),
Placental abruption (tearing away from the uterus) in 15-20% of stillbirth
Other problems with the placenta including clots, malformations and scarring (15-20%),Slide23
Contributing Factors in developed countries include:
Umbilical cord knots, loops, twists, and compressions resulting in lack of blood flow in 3-10% of cases
Blood loss (from twin to twin in 25% of twin deaths)
Blood loss from baby to mother in 3-9% of stillbirthsSlide24
Perinatal Mortality in NSW, Australia
According to a report of the New South Wales Chief Health Officer on Aboriginal and Torres Strait Islander peoples -Perinatal deaths and antenatal care:“The perinatal mortality rate is the number of stillbirths and deaths within 28 days of birth, per 1,000 live births. The perinatal mortality rate among babies born to Aboriginal mothers in NSW decreased from 19.7 to 12.5 per 1,000 live births between 1993-95 and 2002-04. However, this figure remained higher than the perinatal death rate for non-Aboriginal babies (8.7 deaths per 1,000 live births in 2002-04).”
Still Birth ~ What to Do
When a still birth has occurred there are important actions to take during and after the death of the baby.
Following are actions, valuable direction on appropriate words, to assist and guide health professionals during this life crisis event.Slide26
Actions to Guide Health Professionals after a Baby has Died
Table 2: Important actions to take during and after the death of a baby Assure parents that it is normal to feel uncomfortable at this timeAllow parents to spend as much time as they need with their babyMake repeated offers for holding the babyName the babyProvide privacy, but do not abandon the parentsEncourage relatives and friends to see the baby, according to the parents’ wishesWarn about gasping and muscle contractionsReassure parents that their baby was not alone, not afraid and not in pain at the time of death
Free Image: http://www.gettyimages.com/Search/Search.aspx?contractUrl=2&language=en-S&family=creative&assetType=image&p=still%20birth&src=standard#4Slide27
Actions to Guide Health Professionals after a Baby has Died
Table 2: Important actions to take during and after the death of a baby Reassure parents that nothing more could be doneProvide mementos to create memoriesEnsure that spiritual support is availableTake picturesExplain the need and procedure for an autopsyExplain options and procedures for memorial services Momento’s like foot/hand moulds may be able to be arrangedTable direct from Canadian Paediatric Society (CPS) Paediatrics & Child Health 2001 6(71): 469-477.
What you can
Say and Do
Use simple and straightforward languageBe comfortable showing emotionsListen to the parents and touch the baby“I’m sorry”“I wish things would have ended differently”“I don’t know what to say”“I feel sad” or “I am sad for you”“Do you have any questions?”“We can talk again later”Answer questions honestly
Education Direct from Canadian Paediatric Society (CPS)
Paediatrics & Child Health
2001 6(71): 469-477.Slide29
What Not to Say
“It’s best this way”“It could be worse”“You can have more children”“Time will heal”Do not use medical jargonDo not argue with parentsDo not avoid questions “It’s good your baby died before you got to know him or her well”
Education Direct from Canadian Paediatric Society (CPS) Paediatrics & Child Health 2001 6(71): 469-477.
With education and cultural understanding we can go along way to bridging the gap of grief for parents who have lost a baby through stillbirth. The words of Leon (1992) reflect the importance and value in being prepared, educated and professionally able to manage this life crisis event in the workplace.
"Bereaved parents never forget the
understanding, respect, and genuine
warmth they received from caregivers,
which can become as lasting and
important as any other memories
of their lost pregnancy or
their baby’s brief life.” (Leon 1992)