Perinatal Loss: How Nurses Can Provide Compassionate Care

• As a labor and delivery nurse, there are many good days, but there are also the not-so-good ones.  
• Perinatal loss is unimaginably difficult for patients, and as a provider, it can hard to know what to say or do in those moments.
• A nurse in this field must be able to read the room and understand when is and is not a good time to interact with patients after a perinatal loss.  

Emotion, silence, stillness…there are countless words that could be used to describe these heartbreaks. Each one is unique and independent from another.  

When you think of the labor and delivery specialty, it is typically known for their magical moments of new life and bonding, but there is little to prepare a nurse for the gut-wrenching, first-time experience of caring for a patient and their support system following a fetal loss.  

By no means am I saying that these experiences get easier with time, however, a nurse will truly never forget their first; it is a lot to bear. 

Regardless of the specialty, nurses have a longing to connect with people and in most cases, possess an invaluable skill of providing compassionate care to strangers who are in need. It takes a special person to do this.   

However, beyond this, a nurse’s ability to separate their emotions from their work is incredible, and in instances of loss, it can be extremely difficult to do so.

Definitions

There are two common terms used to define intrauterine fetal loss, including miscarriage and stillbirth.  

Stillbirth can be specified to represent the gestational age of when the loss occurred. Definitions may also vary between respected resources, but according to the CDC: 

Miscarriage is the loss of a baby before 20 weeks of gestation. 

Stillbirth is the death of a baby before or during delivery, after 20 weeks of gestation. This term can be broken down into three segments: 

Early Stillbirth

Death between 20-27 weeks gestation 

Late Stillbirth

Death between 28-36 weeks gestation 

Term Stillbirth

Death between 37 weeks or more in gestation

Emotions and Reading the Room

Each patient, diagnosis, and family unit are unique.  

Some nursing programs include cultural awareness, grief and loss, or communication learning modules in their curriculum.  

Although these topics are wonderful additions to a young nurse’s learning, they truly do not come close to the real-life experience. 

Emotions are one of the hardest nursing components to master. Being unbiased or non-judgmental toward a patient and their wishes are important, but handling pure, raw emotions is a completely different and unteachable circumstance.  

In instances of perinatal loss, in order to provide effective patient care, a nurse must allow connection and reaction to take precedence.  

As a nurse, one must consider themselves a blank slate. But what exactly does this mean? 

Aside from continuing to follow the same protocols provided by their facility, a nurse must become what each individual patient needs them to be, a blank slate. 

Having this blank canvas approach allows the nurse to ‘press pause’ on every thought and emotion going through their head and establish their patient’s needs first. 

When a patient has lost their child, a nurse must be able to read the room quickly. Take this visual assessment upon entering the room, for example:  

Is the patient…? 

• Crying 
• Talking 
• Yelling 
• Scared
• Nervous
• Avoiding eye contact

Who else is in the room & what are their reactions? 

• Father of the baby 
• Grandparents
• Aunts
• Uncles
• Friends

Attempting to gauge where emotions are targeted at; towards you, themselves, the father, or the doctor might help the nurse to build an understanding of the patient’s needs. It can be pivotal. 

 Emotions can change throughout the day and the nurse needs to know what their patient and the family needs the most upon entering the room. 

Resources

Each facility might have different resources available to perinatal loss patients.  

Social workers might consult to discuss community support groups, funeral arrangements, and additional resources available to these patients and families. Chaplains can come to see patients and families at their request as well.  

Additionally, some facilities offer pictures, memory boxes, footprints, or keepsakes to provide to patients and families to take home as well.  

Perinatal loss is a saddening, but potential outcome of pregnancy, and nurses must be as prepared as they can be to handle difficult circumstances like this.

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