ROLE of the CST ROLE of the CST and the and the

CARE of the MOTHER CARE of the MOTHER with a with a

STILLBORN INFANTSTILLBORN INFANT

PRESENTERPRESENTER

SUSAN D. SHEETS ST RN BSN CNOR ASSISANT PROFESSOR PROGRAM CHAIR SURGICAL TECHNOLOGY IVY TECH COMMUNITY COLLEGE OF INDIANA COLUMBUS CAMPUS COLUMBUS, INDIANA

OBJECTIVESOBJECTIVES

1. Describe the role of the CST in the birthing process when there is a problem. 2.Define what is a stillborn

3. Discuss the procedure needed to deliver a stillborn infant.

4. Discuss the care of the mother and the staff before, during, and after the delivery 5. My way of getting here!!!!!

PUT PICTURE OF ADDY

THE DESTROYER OF A THE DESTROYER OF A DREAMDREAM

STILLBIRTH is the intrauterine death and subsequent delivery of a developing infant that occurs beyond 20 weeks of gestation.

A loss Prior to 20 weeks is termed as a miscarriage and does not require a burial.

After 20 weeks state laws assign the parents the responsibility for “disposition” of their stillborn baby by burial or cremation. Some states allow the mother who has suffered a miscarriage to bury the baby

Sudden Antenatal Death Sudden Antenatal Death SyndromeSyndrome

S.A.D.S. (the acronym) a clinical term for “stillbirth”

Like SIDS but SADS claims over 10 times as many babies’ each year as does SIDS Estimated 26,000 SADS deaths occur annually in the US alone.

Most are at or near FULL TERM or 1 in 115 deliveries is a “STILL” birth.

CAUSESCAUSES

1 in 3 are caused by cord accidents, infections, genetic anomalies, maternal diabetes , and varying placental failures of different kinds.

The other 2/3 is unknown

ARE STILLBIRTHS ARE STILLBIRTHS

Predictable?Preventable?

Run in families? Risk for future

stillbirths after experiencing one?

NONO ABSOLUTELY NOT ABSOLUTELY NOT

STILLBIRTH IS AS RANDOM AS SNOWFLAKES

How do you Deliver a StillbornHow do you Deliver a Stillborn

Preferred method is VAGINAL DELIVERY Even under perfect conditions a C-SECTION is very high risk and used only if the infant is at risk during a vaginal delivery

With the stillborn the focus changes to the Mother and her well being and safety

DELIVERY OF A STILLBORN DELIVERY OF A STILLBORN

Can be tricky depending on when the baby died May be seconds, minutes, hours, days or weeks.

Often the delivery turns from the happy joyful time into a nightmare for the mother and father

Many Mothers have no idea that anything is wrong until it is to late to do anything to save the child. Each pregnancy is different and this is an unpredictable situation. Emotionally Mothers need to know that they did NOTHING wrong!!

VAGINAL DELIVERY VAGINAL DELIVERY

*CONFIRM NO HEATBEAT tell Mom and Dad (how who when) give emotional support WHICH can be very difficult

DEPENDING ONDEPENDING ON

When in the pregnancy the diagnosis was determined : the month of gestation 5-9 months Which pregnancy is this one : the 1st, 2nd,or last

Infertility treatment

Vaginal vs. C-SectionVaginal vs. C-Section

Once the parent knows then the OB Physician and the patient must decide what to do. Do we wait ? Do we do a C-Section?? What do you do?

Again this depends on where in the gestation the Mother is or is she in labor and minutes or hours from birth !!!! If the Mother is not in labor and the MD confirms the baby has no heartbeat (by ultrasound)Then the OB Doctor and the Mom must decide how to handle the delivery.

TIME FRAME FOR THE TIME FRAME FOR THE MOTHER NOT IN LABORMOTHER NOT IN LABOR

The majority of these are full term Mom’s Ideally the mom will discuss with her OB doctor what to do. PITOCIN- to induce LABOR does not always work. Unless the mother is ready : cervix is dilated or thinned. The placenta needs to have done it’s job. IT HAS NO IDEA THAT THE BABY IS dead!!!

No right or wrong answersNo right or wrong answers

Some mother choice to wait it out. If this is a first pregnancy she may not want to limit her number of pregnancies. It is better physically to allow nature to take it’s course. Emotional she may not be able to make this choice. If she has had other viable pregnancies she and her MD may opt for the C-section. This decision is not black and white. Too many factors from multiple sides go into it.

LABORING MOMLABORING MOM

She must continue on and deliver As if she was having a healthy newborn

the body does not know or understand what has occurred . She and her spouse, or loved one need all the emotional support you can give.

WHAT is the needed emotional WHAT is the needed emotional support support

A TOUCH

A SMILE

TEARS

A HUG ALLOW VENTING THIS MAY MEAN :CRYING, TALKING

SCREAMING , OR

WITHDRAWAL

MEN respond very differently then us women!! They internalize Many will not shed a tear to be stoic for their partner . They suffer alone and do not talk about it as we may do. We talk they listen or tune us out, I’m talking about your men who are good, decent , faithful, and loving men. Yes, I personal know many!! Sorry girls most of them are already taken.

Labor continuesLabor continues

Care turns to the Mom She may now have medication to help

her through labor or She may have a general anesthetic if she is having a C-section

YOU THE CST YOU THE CST

This can be a devastating time for you and everyone caring of this mother. If you have never experienced this type of delivery you are fortunate. But, if you are in this profession you will! How you handle it will help you for the next difficult delivery. Because they too will come. You ARE often times the one closes in the room to the Mom and your EYES can be a comfort to her .

THE CSTTHE CST

You can have a check list of thing to do for the Mother and the Father. Many hospital now have a kit for the stillborn mother. This has keepsake items for them. I have brought some for my area Hospitals to show you.

THE LISTTHE LIST

PICTURE OF THE BABY NO MATTER WHAT THE BABY LOOKS LIKE!! A LOCKET OF HAIR BABY’S FOOT PRINTS AND HAND PRINTS BIRTH CERTIFICATE FILLED OUT BY THE MD FOOT OR HAND BRACLET ANY MEMETO THAT YOUR HOSPITAL MAY GIVE OUT FOR NEWBORNS SOME KNIT BOOTIES AND SO FORTH

DELIVER TIMEDELIVER TIME

Physically the same as any other deliver whether it is vaginal or c-section all the same tools and supplies apply.

demise of the child while inutero can cause blood discrasia in the mother’s if they must carry the child for a period of days or weeks. Blood work must be checked weekly or until the fetus is delivered. Carrying a dead fetus causes bleeding factors to be abnormal creating a lack of clotting factors in the mother.

BIRTHBIRTH

If the Mother has carried the baby for a week or even two “Still”, the delivery of the infant can get tricky due to the demise of the baby. As the child is delivered the skin of the infant will peel away at the mire touch of the MD handling the delivery of the infant.

VaginallyVaginally

The skin of the Stillborn may peel away as the infant is delivered through the birth canal. As horrific as this sound the Mom and Dad still need the choice to see the baby. They do not see the baby as we do. They see beyond the horrible and see their baby.

VaginallyVaginally

Some MD’S do not allow the parent to see the infant if there is to much damage by delivery. IF the infant has been “still” inutero for up to 2 weeks the demise may be too much to see.

C-SECTIONC-SECTION

The MD is very careful as he lifts the infant from the uterus. You can wrap the baby up and cover up the worst areas so the baby can look as pretty as possible. HOLDING the child is very important for the parent and allowing them to say goodbye to the baby and not the coffin!

EXPERIENCESEXPERIENCES

JESSICA MARIE 1979DECEMBER 2DECEMBER 14SUMMER of 19805 YEARS

ACKNOWLEGE ACKNOWLEGE

PLEASE TALK ABOUT THE BABY WE AS MOTHER WILL CRY AS WE TALK ABOUT WHAT HAPPEN BUT WE NEED THAT. IT IS A HEALING TO ALL TO ACKNOWLEGE THAT THE BABY EXISITED AND WAS REAL. AS TIME GOES ON THE DEEP HURT NEVER GOES AWAY BUT IT DOES GET BETTER.

THANK YOUTHANK YOU

FOR COMING TO THIS PRESENTATION

ANY QUESTIONS PLEASE FEEL FREE TO COME AND TALK TO ME.

THANKS AGAIN