June 22, 2015

A few warnings… 

  • *potential trigger* This is Felix’s birth story
  • It’ll probably take you longer to read my birth story than it took for the actual birth story to happen. I didn’t want to forget a thing.  
  • I don’t skimp on details, gross or not.  Take heed if you’re squeamish.

I first started feeling contractions in the late afternoon/early evening. They didn’t faze me because I had very similar contractions the previous weekend and they went away. Plus I was early- 36 weeks and 6 days. This baby had no issues, s/he would likely come closer to the due date. I had already discussed a plan with my midwives. I really preferred not to be induced, plus I had no medical indication for induction, but I knew my anxiety would start skyrocketing as we approached my due date. I also knew that birth doesn’t always go as planned (a lesson learned by my patients and with Mabel) and so I didn’t have many specific wishes on my list when it came to labor and birth this time. I knew these things:

  1. I didn’t want to go past 41 weeks (and there’s medical reason to be induced then)
  2. I wanted my midwives to sweep my membranes starting at 39 weeks, and they agreed. I had two appointments scheduled back to back to do so (and I was going to have my midwife friends I work with give it a go too! I knew I’d be wiling to have practically anyone get their fingers up and in there if it got things started naturally)
  3. I wanted the gas! I wanted to try to avoid the epidural this time. I had one with Mabel, which I still have mixed feelings about. As a midwife, I had some expectations of myself- believing I could have had a drug free childbirth. And under different circumstances I probably could have. I console myself, reminding me that birthing a child that would likely die changes everything. Expectations go out the window. BUT this time, expecting a child that would live, I hoped to avoid it- to prove to myself that I could do it. I’d accept nitrous oxide because to me it felt like a minor intervention- and it was NEW at our hospital. I frankly wanted to know what it felt like so I could tell people. I made it clear to anyone who would listen- I wanted the gas! I even had the consent form in my purse so there would be no delays!

And that’s about it. Seemed reasonable. I also thought this labor would be longer than Mabel’s. My midwives warned me it would likely be fast, because Mabel was fast for a first baby. But I thought otherwise- this was going to be a bigger baby, likely 8-10lbs if I went to my due date and I thought the size would make the labor longer (ignoring the general obstetric knowledge that second babies usually come FAST).

So when I started contracting, I thought little of it. They weren’t painful- I called them pressure contractions. I felt them in my butt as pressure that was somewhat uncomfortable but not debilitating. I was still able to function- walk and talk. I went grocery shopping, cooked and ate dinner, watched tv. Chris said occasionally I’d shift and make a small groan for a second but he wasn’t concerned either. At one point while watching tv, I downloaded an app to time them. They seemed regular and I was just curious how frequently they were coming. After hitting the button a bunch of times I looked at the app and saw they were basically 2 minutes apart. And then I stopped timing. When I relayed this story to a friend, she asked “why did you stop???” Because the timing of the contractions wasn’t going to make me call my midwives- I needed to be in pain as well. When they became painful- unbearable- that’s when I’d call. I also knew if I called them at that point (regular but just pressure), we would all agree that I was either dehydrated from the earlier road race (likely) or at most was in early labor and I should drink water and call when I was in pain. So I was my own midwife and drank water- and a glass of wine (a well known obstetric trick to stop contractions). After a second episode on Netflix, I decided I was ready for bed.

I fell asleep with the help of unisom (what I would usually take after a day of intense exercise- because the bone pain would be so uncomfortable I needed some help to sleep somewhat through the night.) I dropped into sleep pretty easily, woke an hour later to pee and fell back asleep again. It is also well know that you don’t sleep through labor- so I knew I wasn’t in real labor yet.

I remember waking up at one point with an intense pressure contraction in my butt- intense enough to put my on my hands and knees and breathe through it. Though when it was over, I fell right back asleep. It happened a second time (how many minutes later? I have no idea- I didn’t even open my eyes to look at the clock to time them) and this time Chris heard me and asked if I was ok.

“Yup. I’m fine. Go back to sleep”

And so he rolled over was snoozing pretty quickly. After it was done, I did the same.

The third time it happened I felt a little pop and small gush of fluid.

I was instantly brought back to when I first noticed bloody show with Mabel. At the time I cried “I’m not ready!” I had such similar feelings this time, though this time for some different reasons- I had a bunch of work deadlines July 1, which was over a week away and so I truly wasn’t ready. We hadn’t installed the carseat or packed a hospital bag. And in truth, though sometimes I would admit to wanting to hang up my pregnant belly for a few hours, I wasn’t done being pregnant. I loved having a big belly and being publically pregnant. I was so busy with my two jobs that I hadn’t mindfully spent time bonding with the baby or nesting.

I stood up out of bed and said to Chris, “I think my water just broke.” Not having had the experience with Mabel since she had no fluid, I still was hoping the little pop and little gush was just discharge or something. But then I felt a huge gush while standing up. “Yup. It did, “ I affirmed.

Chris jumped out of bed. “Ok! What do we do?”

“Nothing,” I said blandly, “we wait for labor,” knowing that since I was GBS negative, the water seemed clear and I wasn’t in pain, my midwives would say call in the morning or when I’m contracting up a storm. (That’s essentially what is stated in their written directions- so I wasn’t taking too many liberties with myself, just simply following the instructions). “wait- what time is it? That’s important.”

“1:45” Chris said, looking at the clock.

Before I waddled into the bathroom to clean myself up, I looked at Chris and said somewhat sadly, “I’m not ready.”

“It’ll be ok,” he reassured me.

While in the bathroom, I shouted to Chris “Remind me to change my top! I don’t want to go to the hospital in this bra.” I was wearing a old sports bra and wanted a newer one, frankly, to look nicer in those laboring and immediate post birth photos I imagined. I always thing of the green striped sports bra as Mabel’s because it’s in all the photos I have with us together. I even thought that might be the one I wanted to wear.

But a moment later I was forgetting all about what I was wearing. As I stood over the toilet, the first real contraction hit like a brick.

It. Was. Blinding.

With Mabel, I had early labor that quickly morphed into active labor within two hours. There was a rev-up period, where each contraction got a bit stronger and stronger. This time was different. This contraction was off the charts.

I’m going to need an epidural. I thought. I knew I had SO MANY more contractions to go and if they were that bad, I would need real pain relief. As it began to subside, I started sweating profusely- so much so that the floor was getting wet and slippery. Chris grabbed me a fan and plugged it in and then retrieved some ice packs for my neck and forehead.

After it left, I sat back down on the toilet, emptying myself- figuring my active bowel was part of the start of labor. I felt nauseous so Chris found me a trash can to vomit in, remembering how I threw up all the sushi and ice cream we ate before I went into labor with Mabel.

After what felt like seconds later, another contractions hit. I stood to withstand the pain, letting moans rise up from somewhere deep inside me. Chris says I’m noisy in labor and he’s right. At the peak of the contraction, I literally thought I’d pass out from the pain. As it began to leave I thought:

I want to call my midwives! This pain is so bad! But I can’t call my midwives. I’ve only had two contractions. No one calls after two contractions. Especially not a midwife.

The third contraction hit and the room was a blur.

How am I going to get into the car? I can’t even move. How will I survive the thirty minute drive to the hospital? I was thinking how I still had hours to go before birth. It seemed impossible.

As the fourth contraction peaked and released, I looked at Chris and grunted “Call! Midwives!” I was done. This was just too much! I put embarrassment aside and called my midwives after ten minutes of labor.

When Chris got the answering service, the operator asked what was happening. I heard him say calmly, “My wife broker her water,” and I quickly interrupted him, yelling.

“no- I’m in LABOR!”

I knew that getting the message about water breaking might not seem urgent, but labor would get a quicker call back. Luckily, the operator just transferred him directly to my midwife- the same one who delivered Mabel, in fact. Chris put her on speaker.

“What’s happening?” she asked.

“Well, Meghan’s broke her water, “ Chris started to tell the midwife the details about the timing and how my contractions started just after.

I interrupted again with the next contraction.

“I’m puuuushing and I feel the head!” I had reached between my legs and felt the hard tip of a baby’s head and found myself involuntarily grunting and bearing down.

“Chris, you need to call 911,” my midwife instructed him. Apparently this was only the second time ever in her career she instructed a patient to do so. She had him keep her on speak and he went to the bedroom to grab his phone and dial emergency services. While he was walking back to the bathroom, I called out.

“Chris!!!”

I felt the head coming. I had two thoughts as the pressure of the head pushed against my skin. First I wondered if I should get in the bathtub- would it be easier/cleaner to deliver the baby there? I didn’t take into account the fact that I had been physically unable to move an inch due to the pain. The second thought I had was which way I should flex the head. As midwives, when we deliver babies, we often put a little pressure on the head in one direction to flex it- making the diameter of the head a tiny bit smaller and hopefully reducing tearing. I put my hand on the head as it crowned- trying to flex it (in retrospect- I was flexing it the wrong way! Hah!)

Chris heard my call and rushed in juggling the two phones trying to get 911 on speaker.

“What can I do?” he asked me.

In a voice I didn’t recognize as my own I said to him “CATCH! BABY!”

And with that final word, I felt a slippery wet little being slip from me as my skin tore. As I stood over the toilet, unmoved from when I first entered the bathroom, I instinctively put one hand between my legs from the front and one from the back, like I was dribbling a basketball between them, and caught my baby as he slipped from me.

“Eh! Eh!!” my baby squeaked, announcing his safe arrival.

“Oh my gosh! Oh my gosh!” I laughed, unbelieving that the pain was over and I actually had a live, squirming baby in my arms- one that breathed!

Chris handed me a towel and I wrapped the baby in it as I sat back on the toilet, still in shock. I suddenly had a realization and I held my baby away from me, looking down.

“It’s a boy!” I said, laughing again. My instincts were right the whole time.

“What’s his name?” my midwife chimed in.

“Felix. Felix Odom,” we told her.

Chris asked what else we should be doing.

“Nothing! He’s crying which is a good sign. And I’m sure Meghan is holding him skin to skin.”

I looked at Chris, eyes wide, and quickly brought my baby to my chest. I had been holding him away, mesmerized at his little body and boyhood, that I forgot abut the first thing we do after birth. I held him skin to skin after hearing my midwife’s words and Chris brought me a dry towel to keep him warm.

Moments later we heard a female voice calling, “Hello?” from downstairs. At some point Chris had run down and unlocked the front door, as instructed by the 911 operator.

“We’re up here,” Chris shouted and we were shortly joined by Gretchen, one of our local town cops. At first I thought she was an EMT- her uniform looked more like that of an EMT than a police officer. It wasn’t until later that I learned she was an officer.

The EMTs soon followed and began telling me what would happen next.

“Well, first we’ll cut the cord and then you have this thing called your placenta…”

My midwife was still on speaker phone on the counter right by my ear. “Meghan,” she instructed softly, “tell them you’re a midwife.”

I hesitated, worried what everyone there would think- this midwife trying to have a homebirth on her own.

I looked up at the EMTs and officer and said sheepishly, “I’m a midwife. But I didn’t mean for this to happen!” I explained how I wanted the gas- our hospital recently instituted nitrous oxide (or laughing gas) as a method of pain relief (those who watch Call the Midwife might be familiar with “gas and air”). I reaaaallly wanted to know what it felt like and be able to tell my patients and colleagues. I had even procured the consent form ahead of time and was carrying it around in my purse so I could have it as soon as possible in the birthing room.

I then took the lead in my bathroom-birthing room. The EMTs handed the cord clamps to the cop who was closest to me and I showed her where to place them as I milked the cord. “I’d like my husband to cut the cord,” I instructed. The EMTs handed a scalpel to chris, letting him know which was the sharp end, much to his chagrin. And with a little swipe of the scalpel, my son became his own entity. I was able to lift him up (his cord was short and so I couldn’t lift him too high until then) and really see him.

As I held him, the EMTs were bustling in the hall- doing I don’t know what- and I made small talk with the cop.

“Is he your first?” she asked

“My second.”

And then she asked a question that made me respect her even more. “Oh, where is your first?” A good police officer, ensuring the safety of everyone!

“She died last year.”

She relayed the appropriate “I’m sorry” and I said the first of many “And so we are so lucky to have him”s

Soon enough I realized my placenta was ready to come- I felt the telltale signs: gushes of blood, cord lengthening, pressure. I looked at the cop and said,

“I’m ready to deliver my placenta now. Can you help?”

I saw a glimpse of panic and excitement in her eyes, but she said okay in her calm, officerly way. I explained that I was going to stand up and push and have her catch the afterbirth, but we needed something for her to catch it in. I asked for a chucks pad, but the paramedics were insistent on a bowl. I found this humorous as the traditional way to catch a placenta is in a bowl. I was even symbolically given a “placenta bowl” when I went off to integration in midwifery school. So after the paramedics became intimately acquainted with my kitchen cabinets, a bowl appeared (funnily not the midwifery school placenta bowl”, and the police officer caught my placenta in a chucks pad, as I requested and then it was put into the bowl. Everyone was happy.

The paramedics then helped me into a chair contraption to carry me down stairs and on my front step they transferred me onto a stretcher. Wrapped in a sheet, I was loaded into the ambulance to be transferred to the hospital.

As I sat on the stretcher, my baby boy skin to skin in my arms, I realized that I was still wearing that ratty sports bra. It was the only thing I didn’t want to wear to the hospital and lo and behold it turned out to be the ONLY thing I actually wore to the hospital.

In the ambulance, I reminded them to take me to my preferred hospital, since it was 20 minutes farther than the closest one and where my midwife would be waiting. The paramedic reached for IV supplies and I stopped him.

“Is that for an IV?” I asked. Once he nodded, I said, “I’m going to respectfully decline, thank you.” My midwife’s last words on the phone to me were to remind them to take me to the right hospital and that I could refuse an IV if I wanted. Her patient population often forgoes an IV in labor because there isn’t really a reason for one unless there is a medical need (like pain medication, Pitocin, high risk issues, etc). Both of us chuckled later, thinking how I probably shouldn’t have refused, being that I was known to be anemic and had a precipitous (ie extremely fast) birth, both are good reasons for an IV because of risk of hemorrhage. Luckily, I was stable, and also happy that I was IV free.

Upon arriving at the hospital, I was greeted with familiar faces, those of nurses I have worked with for years, despite not having delivered babies for a year and a half. I saw the look on the face of my nurse, a sarcastically funny woman who I had seen grow from a new nurse to one in charge.

“Meg…” she began, calling me by my shortened name that a few people use.

“I didn’t mean to!” I cut her off. “I really didn’t! I was asleep! I woke up and 15 minutes later he was here!” I knew that my story would cause much of my community to think I waited too long- tried to do most labor at home and then it got too late. “I wanted the gas!” I told her.

As my midwife examined me, I told her and the nurse the whole story. I was supposed to have an appointment with that midwife two days later. I told her I had the consent form for nitrous oxide in my purse and was going to give it to her at my next visit. As my midwife put in some stitches, she offered me gas for pain relief, but I declined. I had wanted to see what it did for labor and now that my baby was here I didn’t want to be affected. I opted for the traditional lidocaine. I had a bigger tear than with Mabel, unsurprising because of Felix’s fast entry into the world and his weight. At the hospital we learned, weighing in at 7lbs 3oz, he was almost 2 pounds bigger than Mabel.

As the repair was under way, I asked my nurse which other nurses were on the floor. She told me and when I heard one name, I lit up. “Is she busy? Can you tell her to come by and say hi?”

When I was put all back together, the second nurse popped her head into the room, beaming. We laughed together as I told her the story. And then we took a photo, me, Felix and her. I felt warmed that Felix could meet Mabel’s nurse.

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Thank you nurses and midwives

This week is a big week in my healthcare world.  It is Nurses’ Appreciation Week and tuesday was International Day of the Midwife.  In honor of both celebrations, I wanted to thank my beloved nurses and midwives.

*********

Dear Nurses,

thank you for bringing some laughter into my triage room as we waited for the maternal fetal medicine doctor to come and give me terrible news.

Thank you for being the protector of my privacy- making sure I was ready for visitors in the midst of emotional turmoil.

Thank you for telling me about the “secret menu” the hospital offers where I can order quesadillas and pork bacon.

Thank you for sitting and chit chatting during my two week stay, keeping me sane and reminding me that things were happening beyond the fetal monitor I was trying not to watch.

Thank you for watching that fetal heart rate monitor so I could have the freedom just to be pregnant, knowing my baby was safe.

Thank you not commenting on how ridiculous i must have looked in in my sleeping outfit- it was just too hot to wear pants even though I knew you’d be coming in to readjust the monitor.

Thank you cheering me along in my in hospital exercise regimen.

Thank you agreeing to be my labor nurse, knowing my case would be emotionally hard and would likely sit in your memory for a long long time.

Thank you for taking photos of Mabel’s birth- not in your job description, but so meaningful to me.

Thank you for watching my baby in my stead, while she was whisked away to the NICU and I got my stitches.

Thank you for repeating everything the neonatologist said, right after he left because I could barely process it all.

Thank you for getting Mabel skin to skin with me for as long as humanely possible.

Thank you for the footprints, in ink and in clay, that turned out amazing, all done while she was on my chest.

Thank you for making sure she wasn’t in pain.

Thank you for taking out her breathing tube, gently, allowing me a first good glimpse of my daughter’s face free from medical equipment.

Thank you for taking photos, during her life and her death and in the after.

Thank you for feeding me, which I needed direly, but was unable to recognize myself.

Thank you for being present but unobtrusive.

Thank you taking her gently when I gave her up that very last time.

Thank you for giving me peace and solitude to sleep and to grieve in the hours after I gave her up.

Thank you for coming to her wake, taking me for walks, bringing me food in the aftermath.

Thank you for being part of it all and keeping her safe, in pregnancy, in labor and in the NICU.

**************

Dear midwives,

Thank you for all the extra care

Thank you each for calling and checking in when we got the news about Mabel’s Down Syndrome.

Thank you for letting me make tons of extra visits to help keep me sane.

Thank you for letting me use my appointments as mini therapy sessions

Thank you listening for a heartbeat first thing, so I knew she was still alive, before doing the rest of the visit

Thank you for having the hard conversations with me- the ones that were hard for me and hard for you.

Thank you for being honest, saying “I don’t know,” when I asked how I was supposed to return to midwifery if my baby died.

Thank you for giving me the few things I had hoped for- skin to skin, Chris cutting the cord and announcing gender (if he could figure it out!).

Thank you coming to meet her in the few hours she lived- so that you are part of the proof that she actually existed.

Thank you for her dress, an outfit given with love and purpose, the only outfit she worse outside her grave.

Thank you for eating wings with me, bringing me cabbage leaves for engorgement and looking at photos in the aftermath, reminding me that you are not only my midwives, but my friends.

Thank you for the donations you made in Mabel’s memory

Thank you for the lilac bush that you gave me because you know purple is my favorite.  It’s beginning to bloom right now.

Thank you for remembering dates- due dates and anniversaries.

Thank you for saying her name, easily and freely, just like she was any old living child.

Thank you for keeping her safe in my womb and alive in memory.

 

 

 

 

 

A little gift

 

From the individual who took cupcakes to my care teams on Mabel’s birthday

nurse

“As I walked out of Labor & Birth I heard someone call out to me. It was the girl at the front desk at the NICU where we had dropped off cupcakes earlier. She said one of the nurses wanted to see me. The nurse came out with tears in her eyes and gave me a huge hug. She told me that walking through Mabel’s life and death with her family was one of the most profound, beautiful experiences she has ever had. “It changed me and the way I practice. Please give Meghan and Chris my love and tell them I still think of them and Mabel every time I walk by that space.”

Future midwives

I’m sure I received some training on loss when I was in midwifery school. I don’t remember the specific lecture or chapter in the books, but there had to be some educational experience I received. I remember more the on the job learning. I worked as a Labor and Birth nurse while I was in midwifery school. I helped woman as they worked hard laboring for a baby that was extremely premature, that was unlikely to live, that had already died. I was scared at first- I think scared of saying the wrong thing, of not knowing what to say, of doing something that would make the situation worse.

During school, while I was working as a nurse, I remember caring for one woman who was being induced around 24 weeks, the cusp of viability. Her uterus and amniotic fluid were infected, meaning the baby who already faced significant life threatening struggles that came with extreme prematurity, also faced life threatening infection. Truth was, this baby had very poor chances of survival. The neonatologists knew this and gave her the option of resuscitation or comfort care. As her labor was induced she talked and cried with her family, with her healthcare providers about what was best for her baby. She had a family member who had extremely preterm twins who suffered many long term effects from being born so early. She was unsure if she wanted that outcome for her baby, but also could not imagine not doing something for her child. When my shift was done, she was just getting into active labor and had not decided what to do. I found out later from the nurse who relieved me, that her baby came suddenly, without the doctor even in the room, and she still had not decided. Her baby did not survive. The worst part of being part of her story, was not knowing how to help her. I know, even with all the training and experience in the world, I still might not have been able to help her decide, but maybe I could have. I’ll never know.

I have since been with mothers as the doctor couldn’t find a heartbeat on the ultrasound. I’ve had mothers whose babies come prematurely and die sometime after birth. I’ve had mothers who choose to terminate for a fatal diagnosis and a mother who has carried to term despite one. I helped mothers through subsequent pregnancies and subsequent miscarriages. Each woman I have cared for, I have learned from- more so than in any class in school. Ultimately I have learned most from my own experience.

This week I’ll be joining the program director of my local pregnancy and infant loss non profit in a guest lecture about loss to the local midwifery students. It is at the school I went to, I worked at and I still (though rarely these days) precept at. I sort of invited myself when the program director mentioned it to me- how could I not? This is what I do- I’m a midwife and I’m a babyloss mom.

As we talk to the students, I want to give them all I can. I want them to remember the talk and I hope, being given by someone who knows both sides will help. But I need your help too- I only have my own experience. I’ve come up with some points I wish to make- I know it’s not a perfect list, and so I encourage you to give me your suggestions to. I also know that these do not apply to everyone’s situation and it’s not a comprehensive list encompassing nearly everything- I am trying to look at it from both perspectives- a provider and a patient.

Tell me: What did you want your midwife or doctor to do? What did they do that was great? What did they do that you wish they didn’t?

 

Stillbirth

  • Be honest. There is no good way to say your baby is dead. Don’t sugar coat; just be clear.
    • I was with a mom with a stillbirth at term. She had been sent from the office to OB triage when the midwife couldn’t find a heartbeat on the Doppler. I sat by this woman as the APRN did a scan looking for a heartbeat. We were waiting for the Maternal Fetal Medicine doctor to come and make it official. Since he was tied up, the APRN started scanning, all of us hopeful she’d find something with the ultrasound that the Doppler could not. The room was silent as she scanned, the parents on edge, the nurses and I staring at the screen. It felt tortuous for me- I can only imagine what it felt like for the parents. Finally, because no one was saying anything, I said simply, “they don’t see a heartbeat. I’m so sorry.” I explained how we had to wait officially for MFM doc and I stayed by her side until he came. There were a lot of “whys?” and I was honest there too “We don’t know. We may never know. But here’s what we can do to try to find out…”  
  • Describe the process- let the patient know what happens next (do they want to go home, gather things, wait at all? Induce right now?) Discuss induction and pain management. Discuss the baby coming out- mention about skin color changes and bruising that might be apparent. Offer to call NILMDTS

 

General Loss Guidelines

  • Say “I’m sorry”
  • Use the baby’s name…. over and over.
  • It’s ok to cry- in front of the patient too.
  • Get familiar with the process- offer autopsy, karyotyping, TORCH titers, thrombophilia workup. Talk to the hospital social worker to learn what happens to the baby, how parents arrange services (cremation, burial?)
  • Sit. Be with patient.
  • Coo at the baby- talk about all the aspects of a baby you would otherwise- the hair, whose nose she has. Encourage parents to explore- undress baby, open eyelids. I never opened Mabel’s eyes- I wish I did, just to see the color (likely dark gray as most newborns are, but now I’ll never know)
  • Be a photographer- take photos, encourage parents to take photos. Call professional photographer. Since no one from NILMDTS was available for me, my nurse and midwife took photos- so many photos and I am so grateful they did.
  • Let parents stay with baby as long as needed. Encourage patient to call and invite any support they choose.
  • Send patient to a floor without babies for PP recovery
  • Early discharge
  • Prevention of lactation (also milk donation)
  • Offer sleep aids
  • Referral to resources- counseling, local bereavement groups, books, websites.  Go through your hospitals bereavement box, so you know what’s in it.

 

Follow up

  • Call patient- some potential questions beyond “how are you doing?”
    • How are you sleeping?
    • Who is around to help you?
    • Are you eating?
    • How are you spending your days?
    • Services?
    • Have you looked through bereavement box yet?
  • Postpartum visit
    • Plan first morning appt- so pt does have to wait in waiting room with other pregnant patients
    • Plan extra time for appt
    • Be prepared to go over autopsy
    • Discuss birth control or preconception- no judgement on whether it is “too soon”
    • Ask about photos- ask to see if she has some and wants to show
  • Remember due dates- good time to call or send a card
  • Anytime you are reminded of that patient, tell her-call or text her- she would love to know she is not forgotten
  • Attend services if you are invited and can go

 

Fatal diagnosis (if carrying to term)

  • Frequent appointments if pt desires
  • Listen to FHR first thing
  • Plan for longer appointments
  • Consider frequent ultrasound if pt desires
  • Help patient with birth plan
  • Coordinate care with specialists- NICU, pediatric specialists to discuss immediate care of baby
  • Encourage special plans- blanket, outfit, photographer for baby
  • Discuss logistics- funeral home, cremation, burial
  • Connect- give resources
  • Help patient celebrate pregnancy

 

Subsequent Pregnancy

  • may need more frequent appointments, reassurance of FHR
  • If previous stillbirth- testing (level II, NSTs, early delivery)

 

Miscarriage (also applicable with fatal diagnosis choosing to terminate)

  • Say “I’m sorry”
  • It’s ok to cry
  • Discuss logistics- expectant management, miso, D&C, D&E
  • Discuss “why” (most common known cause- chromosomal, but often we have no idea why…)
  • Listen
  • Discuss future fertility if patient desires
  • Call patient for emotional follow up (“just wanted you to know I’ve been thinking about you)
  • Referral if indicated (recurrent pregnancy loss, genetics)

What am I missing?

Day 12: Music

On a slow night on the labor floor, I downloaded this song to my phone so a nurse friend and former ballroom dance instructor could teach me a few dance moves. I dipped and spun and promenaded with Chris to this song at our wedding. As I held my daughter in my arms after she died, I wanted to play her a song. This was the only one I had on my phone, so we played it for her just before we gave her away to the nurse. It was once our song, but now it’s her song too.

I wrote about it recently here.

#CaptureYourGrief