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.
So we discussed abortions.
So this refers, in this case, to a loss of the baby prior to 20 weeks gestation.
We can also experience a stillbirth, and this is a death that occurs after 20 weeks.
So you can imagine that in this case, the baby looks genetically
and anatomically completely normal and well, just very small.
So it creates a very different situation for the family.
Also, sometimes families receive the unfortunate news that their baby is genetically abnormal.
Maybe anatomically or structurally to the point that the baby is not going to be viable.
And so there may be a death that recurs related to that.
And finally, a family may decide to terminate a pregnancy electively.
And so this may be because of a serious genetic abnormality
or it may be because of a desire to do so.
I want to talk for a minute about elective abortions. This is often a very taboo subject.
I know with my students and in my school, it is, and it may be the same case for you.
But it does happen, so it's important that we talk about it.
So one in four clients have experienced a termination of their pregnancy at some point in their life.
That's 25%. That's a lot of people.
So 11.3% of abortions happen per 1,000 clients that are between the ages of 15 and 44.
Again, I want you to appreciate the numbers of people that this impacts.
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.
There are all kinds of ways that people feel and we need to be prepared to honor that.
We also need to be prepared to offer support for people that are experiencing a termination.
Just because they've chosen to terminate the pregnancy, doesn't mean that they're happy about it.
And so we need to be there to provide support to help them work through it.
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.
Now, there are other kinds of losses that may happen that are not really about the baby dying.
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.
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.
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.
And imagine laboring after hours and then ending up with a Cesarean birth at the end.
For some clients, this is really, really traumatic and very difficult, and it's another kind of loss.
Also think about clients who have had a complication.
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.
All of these are actually types of losses,
and we want to be prepared to support the families through each of them.