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ABOUR AND BIRTH Be aware that it is:• common for the parents to have second thoughts
• appropriate to initiate antenatal counselling
• advisable to encourage the parents to read about all the options available so that informed choice may be employed.
• germane to encourage parents to write a birth plan
• necessary that all health professionals caring for the couple are nonjudgmental regarding the parents’ decision
• appropriate to inform parents of the likely scenarios surrounding induced termination, i.e. fever, chills, diarrhoea, nausea, vomiting etc.
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EETING THE BABYHe was born alive and my husband and I held him in our arms for the 20 minutes his tiny heart beat.We cried the entire time and told him how much we loved him. I was afraid to look at his abnormalities but what I can now only really remember seeing is his sweet little nose and lovely little fingers and toes. It wasn’t nearly as bad as I thought it would be.
Parents may have no idea what to expect when they see their baby. It is natural that they may be afraid to look at and cuddle their baby.
Wrap the baby in a warm blanket. Describe the baby first, then introduce the baby. Hold the baby yourself, stroke and talk to the baby using his name, then slowly approach the parents with the baby in your arms. If the parents remain unsure put their hands over yours.
Often parents will take their cue from you. How you handle and speak of the baby will be watched and, in many cases, emulated by parents.
Gross abnormality should not preclude contact. Encourage parents to have contact with their baby by looking first yourself and then giving them a description of what you see, always remembering to start with positive comments. Point out the baby’s normal features then give the parents an explanation of the abnormality. Let them investigate the abnormality when they feel ready to do so.
When encouraging parents to see their patently abnormal baby tell them that, if they look, what they are most likely to remember will be their baby’s perfect features. If they don’t look they are likely to live with their imagination of what the abnormality looked like and they won’t have the other memories to offset their imagination. As one mother said:
His tiny head was extremely enlarged and disfigured due to the hydrocephalus. His tiny back had a hole exposing his spinal column and spinal nerves. But still I thought of him only as beautiful.
Small, fragile babies may be wrapped in a lightweight cloth such as muslin. Attempting to dress the baby may lead to damage and is best left to a mortician.
Indicate gender only if you are certain. Be especially cautious if the genitalia are ambiguous or the baby is very immature. Don’t offer an opinion unless you can have it confirmed by another experienced midwife then document it in the medical record. If parents are given an incorrect gender there can be quite disastrous psychological consequences for them when the autopsy results show a different gender.
No-one was completely sure what sex our baby was and so we had to wait for the autopsy results (24 hours) to find out.
It was a horrible wait but still preferable to being told the wrong thing.
It is important for parents to be reminded prior to discharge that they can see their baby again if they wish. It is especially important to make this offer if they have chosen not to see their baby, as this mother found:
My social worker said she’d bring him back later if I wanted to and I still said
‘NO, no no’ . . . and of course I got home and I had lots of time to think about it and I just assumed he’d be gone, that everything would be finalised. But she rang and she said ‘Timothy’s still here’ . . . so we came in and had a lovely cuddle and a hold . . . It was 7 days later, you need that time . . . you need some space.
(SAFDA, 1995)
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AYING GOODBYEBabies born prior to 20 weeks’ gestation (later in some countries) do not require a funeral. However many parents may wish their baby to be buried or cremated. It may be particularly difficult for parents who have interrupted a pregnancy to decide what they want to do about their baby’s remains. Some parents choose to leave the hospital still wondering whether to hold a funeral. Reassure them that their baby will be kept in the hospital mortuary until they make a decision.
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ISCHARGE PLANNINGGoing home is almost always difficult for the parents. It is helpful for discharge information to be written as well as spoken. Discharge planning may include the following kinds of information.
• Tell the parents where the baby will be and whether they will still be able to visit after they go home.
• Introduce them to local support agencies or other support people.
Provide information about who to contact if they need to talk, including self-help support groups as well as social workers, chaplains etc.
• Warn them of likely reactions from family and friends. Some bereaved parents may find their family and friends are judgmental about their decision to terminate the pregnancy because of a genetically abnormal baby. Genetic termination is often an emotive issue. It may be wise to counsel the bereaved parents to be selective about confiding in their friends.
• Alert bereaved mothers, before they leave hospital, to the fact that loss in the second trimester may be accompanied by the need to suppress lactation. Some lactation suppression tips are given in the next chapter.
• Let parents know there will be bad days for some time after their baby’s loss.The reason for a bad day may not be apparent immediately, as this mother found:
I had a really bad day 3 months after her death and couldn’t figure out why until I realised that this was the day I was supposed to give up work to make some last minute preparations for the baby. Instead I was already back at work without the baby. No-one knew the significance of the day but it was very painful for me.