Types of Perinatal Loss (Nursing)

00:01 Now, we're going to categorize perinatal loss a little bit differently because it's important to understand that the type of loss can very much impact the childbearing family and also our management plan.

00:12 So we discussed abortions.

00:14 So this refers, in this case, to a loss of the baby prior to 20 weeks gestation.

00:20 We can also experience a stillbirth, and this is a death that occurs after 20 weeks.

00:25 So you can imagine that in this case, the baby looks genetically and anatomically completely normal and well, just very small.

00:33 So it creates a very different situation for the family.

00:36 Also, sometimes families receive the unfortunate news that their baby is genetically abnormal.

00:42 Maybe anatomically or structurally to the point that the baby is not going to be viable.

00:47 And so there may be a death that recurs related to that.

00:51 And finally, a family may decide to terminate a pregnancy electively.

00:56 And so this may be because of a serious genetic abnormality or it may be because of a desire to do so.

01:03 I want to talk for a minute about elective abortions. This is often a very taboo subject.

01:10 I know with my students and in my school, it is, and it may be the same case for you.

01:14 But it does happen, so it's important that we talk about it.

01:18 So one in four clients have experienced a termination of their pregnancy at some point in their life.

01:24 That's 25%. That's a lot of people.

01:27 So 11.3% of abortions happen per 1,000 clients that are between the ages of 15 and 44.

01:34 Again, I want you to appreciate the numbers of people that this impacts.

01:38 Now, the reactions to elective abortions are all over the spectrum in terms of people that feel relief, people that feel guilt, people that feel sad, people that are happy.

01:49 There are all kinds of ways that people feel and we need to be prepared to honor that.

01:54 We also need to be prepared to offer support for people that are experiencing a termination.

02:00 Just because they've chosen to terminate the pregnancy, doesn't mean that they're happy about it.

02:04 And so we need to be there to provide support to help them work through it.

02:08 We want to assess for any psychological distress around the time of the abortion visit, but also, doing that a little bit later as sometimes, those feelings are delayed.

02:17 Now, there are other kinds of losses that may happen that are not really about the baby dying.

02:24 So remember, the family comes in with this hope of having a perfect, wonderful Cletus, perfectly wonderful birth, and unfortunately, that doesn't happen for everybody.

02:34 So think about the families that may experience a preterm birth and how that looks so different than the wonderful, maybe low intervention or even an epidural birth that they had planned.

02:44 Also a cesarean birth. Most people don't come to the hospital saying, "Oh, I'd like to have surgery. That's what I want to do." Now, some people may make that choice, but most people don't.

02:56 And imagine laboring after hours and then ending up with a Cesarean birth at the end.

03:01 For some clients, this is really, really traumatic and very difficult, and it's another kind of loss.

03:07 Also think about clients who have had a complication.

03:10 So maybe they've had a lot of providers that had to be at the bedside, or maybe they've had a near miss with their baby, or maybe they've been listening to the fetal heart monitor, and there've been lots of decelerations or all kinds of scary things.

03:24 All of these are actually types of losses, and we want to be prepared to support the families through each of them.