STILLBIRTH

NAME : UMUL NGULYA BINTI ANUAR

MATRIX NO : 2018828248
SUBJECT : NRS472 (REPRODUCTIVE & SEXUAL HEALTH NURSING)
GROUP : NHSN7B
LECTURER NAME: PN. NORIMAH BINTI SAID
Table of Contents

Definition ....................................................................................................................... 1
Chronology Case ......................................................................................................... 2
Health Education ..................................................................................................... 7
Nursing Diagnosis (1) ................................................................................................... 8
Nursing Diagnosis (2)................................................................................................. 10
Nursing Diagnosis (3) ............................................................................................. 12
Nursing Diagnosis (4) ………………………………………………………………15
Nursing Diagnosis (5) ………………………………………………………….17
References…………………………………………………………………….………………19
 A stillbirth (or fetal death) is the death of a baby in utero before or during
delivery. In the United States, fetal loss less than 20 weeks of pregnancy they called
it as miscarriage, and a loss 20 or more weeks of pregnancy they called as stillbirth.
In Malaysia Health Ministry defined stillbirth as births after 28 completed weeks or
more of gestation without any sign of life during delivery 9. Every stillbirth in malaysia
we need to investigate the

Unit of Measurement: Deaths per 1,000 total birth

Why we need to investigate all the stillbirth?It is because majority cases are actually
can prevent but because of the lack in the management of the patient than the stillbirth
still happen.But actually after 1990 the stillbirth was improved in number because of
many preventive action taken by governement.Yet from year 2000 onwards these
rates have plateaued.Majority of the causes of stillbirths are preventable.
(MALAYSIAN HEALTHCARE PERFORMANCE UNIT, 2014).

This indicator reflects the quality of the provision of maternal care. Stillbirth reporting
is to include statistics for death only of potentially viable fetus. Therefore different
healthcare institution may use different data definition depending on the capability of
the institution to care for the newborns.

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The case below happen in Klinik Kesihatan in Johor Bahru early 2020.

TARIKH TERIMA NOTIFIKASI : 2020

TARIKH PENYIASATAN : 2020

Basic Data :

Name of mother : Ms X Mother age: 34 TAHUN

Education : standard 6 IC number : 850418-01-5164
Occupation mother : clerk
Occupation father : Self bisnes
Income in a family : RM 5000.00 Family member : 3 person
Week of gestation : 40/52 GR : 2 PARA : 1
LMP : 6.4.2019 EDD : 13.1.2020

About Pregnancy :

She came for antenatal check up for 15 times at one of clinic in Johor Bahru.1st RME
was done at 15/52 of POA.7 times met doctor another 8 times with nurses.1st scan
was done at private clinic in age of 5weeks pregnancy.Mother in stable condition,
happy with this pregnancy waiting for 5 years after 1st child.No history of taking any
family planning befaore as she told only use condom for protection for spacing to
another child.Mother vital sign was in normal range 112/77 mmHg – 130/81
mmHg.Pulse also in normal range between 74bpm - 88bpm. Mother weight gain along
pregnancy is 9kg which is 81.3kg to 89.1kg at 38/52 POA.Otherwise hemoglobin
mother in 2nd trimester start to going down to 10.0g/dl but after our medical officer
change the hematinics to double dose then mother tolerate and compliance , her
hemoglobin reading were rise to 12.7g/dl.For urine albumin result always nil, and
sugar is blue.so that is normal.No other symptom of Eclampsia.

Fetal kick was teached and explained on important of doing fkc is to monitor baby’s
activity to ensure baby in good condition and well .Everytime during antenatal check
up, nurses will check on Fetal Kick Chart (FKC) part but unfortunately mother didnt
understand how to doing fkc part and somtime she default to count and chart.

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Language barrier happen between mother and nurses because of she study until
standard 6, not expose to malay language.

Mother had done 2 times for MGTT procedure.

1st result is normal : (15/8/19@ 20/52 POA) fasting: 4.3mmol & 2H postprandial :
5.7mmol

(12/12/19@35/52 POA) fasting:3.8mmol & 2H postprandial : 8.0mmol

To determine if GDM, is present a standard OGTT should be performed with 75g

anhydrous glucose in 250-300ml of water after overnight fasting of 8-14 hours. Plasma
glucose is measured, fasting and after two hours, pregnant women who meet the
criteria for DM or Impaired Glucose Tolerance (IGT) are classified as having GDM. A
venous plasma glucose cut off of ≥140 mg/dl (7.8mmol/l) at 2-hour are classified as
having GDM. (WHO, 1999)

Mother had done on bsp, everytime she came to clinic is with bsp.Her bsp normal is
accepted in normal range.sometime if she eat more than the reading a bit high which
is in 36week POA her bsp reading is 5.1mmol / 5.7mmo / 6.6mmol / 6.9mmol. After
she refer to dietician then her reading of bsp is back to normal because she get many
information how to control her bsp.She is never send to admit ward for deranged.

On 9/12/19 @35/52 of POA, Mother claim had cough, URTI symptom for 2/52, with
fetal heart 144 bpm.She is not fever with temperature 36⁰celcius.Her blood pressure
also in normal range that is 128/88mmHg, pulse 92bpm.No palpitation, no short of
breath,no chest pain, no headache but claim cant sleep well because of cough.Sputum
investigation was sent for x 3, appointment medical officer 1/52 to revies symptom
and sputum result. On 15/12/2019 @ 38/52 POA mother claim her cough had resolved
and no more, but then on 30/12/2019 @ 38/52 POA again mother claim her cough
was came back with minimal sputum,no fever and no labour pain symptom.Fetal heart
rate is 145bpm.Unfortunately mother are not chart fkc due to not feeling well and she
claimed fkc complete with no evidence. On 13/1/2020 @39/52 with POA mother
stable, no complaint off ,fhr : 130bpm.Mother is nt allow postdate and plan to admit on
estimate of date and her date of admission on 12/1/2020 with kiv iol if still not deliver.

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Results from BIRTH DEFECT (BD) - STEPS will provide researchers with more
knowledge about what factors might raise or lower the risk of having a baby with a
birth defect. These are called risk factors.A woman who want to get pregnant can
reduce their chances to having birth defect with a good lifestyle, while other things,
she can’t change. BD-STEPS aims to focus on risk factors that a woman may be able
to change:

• Diabetes, obesity, and physical activity

• Treatments for chronic (long-term) medical conditions (such as asthma or high
blood pressure)
• Treatments for infertility
• Other medication use during pregnancy
( BIRTH DEFECT – STEPS, JANUARY 2014 )

The risk of stillbirth at term in the studies varied from 1.1 to 3.2 per 1,000 pregnancies.
The overall gestation-week-specific prospective risk of stillbirth steadily increased with
gestational age, from 0.11 per 1,000 pregnancies at 37 weeks (95% CI 0.07 to 0.15)
to 3.18 per 1,000 at 42 weeks gestation (95% CI 1.84 to 4.35)

( Javaid Muglu et al 2019)

RISK FACTORS : 1.Maternal Obesiti

2.GDM D/C

About Baby :
Name Of Baby : - Date of deliver : 13/1/2020 @ 23Hour
Age : FSB
Address : No 21,Jalan Hang Lekir 9/2, Taman Skudai Baru
Date Of Addmission : 13.1.2020
Date death : 13.1.2020
Place death : Hospital Sultanah Aminah.
Mode Of Delivery : SVD
POA : 39/52 Birth Weight : 3.16kg
Number of sibling : 2 Sex : Girl

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Status Immunization :

Age Vaccine Date NO BATCH

BCG Nil
FSB
HEPATITIS B (DOS 1) Nil

Age of death And Reason Death :

age Pain Vomitti Fever & Jaundic Coug Prem Congenital . etc
of ng & Fitting e h& Abnormality
period diarhea respir
ation
syndr
ome
0-6 day √
FSB
7-27 day
28- 1 day
1-4 year

Place of Death :

Hospital Sultanah Aminah, Johor Bahru

Reason Death : FSB (Fresh Still Birth)

About Disease :

On 14.1.2020 @ 6pm mother had contraction and reached HSAJB at 8.00pm.At PAC
mother had PPROM (Preterm premature rupture of the membranes).Nurse check for
os and its open 3cm, unfortunately fetal heart rate was unavailable during placing CTG
(Cardiotocography).Base on mother information, mother claimed fetal kick was felt
before contraction happen.

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Mother was induced to easy the delivery and baby came out on 23hour as svd
(spontaneous vagina delivery) without sign and symptom baby alive, baby heart rate
also none. (Fresh Still Birth)

Social Background :

1.Mother stay with husband and 1st kids in double storey terrace house and had
electricty and water supply.

2.Distance from home to Klinik Kesihatan Taman Seri Orkid - 0.4 km ,

Distance from home to hospital is 25km.

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HEALTH EDUCATION REGARDING ANEMIA ISSUE

• To manage fatigue:
- Prioritize activities. Advice family members to assist the patient in prioritizing activities and
between activity and rest must balance so that patient will less felt of fatigue.
- Exercise and physical activity. Patients with chronic anemia need to maintain some physical
activity and exercise to prevent the deconditioning that results from inactivity.
• To maintain adequate nutrition:
- Diet. Encourage family members or patient to make a healthy diet that is full of essential
nutrients like red spinach etc.
- Nescafe or coffee intake will interferes with the utilization of essential nutrients and advise
the patient to avoid or limit his or her intake of caffeine beverages.
• Dietary teaching. Explain to patient how to prepare the food with maintain of nutrition
involve her family members
• To maintain adequate perfusion:
- Vital sign and full blood count (FBC) monitoring. The nurse should monitor the patient’s vital
signs and pulse oximeter readings closely. Inform and refer medical officer if hemoglobin
reading reduce.
• To promote compliance with prescribed therapy:
- Medication intake. Patients receiving high-dose corticosteroids may need assistance to
obtain needed insurance coverage or to explore alternative ways to obtain these
medications.
• Reassess during antenatal check up on sign and anemia symptom.
- Symptom anemia like fatigue, short of breath, palpitation, chest pain, dizziness, headache.
- Do regular home visit along pregnancy to give nursing care and advice base on home
environment.
• Instruct the patient to consume iron-rich foods to help build-up hemoglobin stores.
• Iron supplements. Enforce strict compliance in taking iron supplements as prescribed by the
physician. Teach her to take hematinic with correct way. Good to take with vitamin C or
other beverages base vitamin c like fresh orange home made.
• Follow-up. Stress the need for regular medical and laboratory follow-up to evaluate disease
progression and response to therapies such as blood taking like hemoglobin analysis.

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Risk For Infection

Risk for Infection: At increased risk for being invaded by pathogenic

organisms.

Outcomes :

- Client will have a reduced risk of infection as evidenced by an absence of

fever, normal white blood cell count, and implementation of preventive
measures such as proper hand washing.
- Client will have vital signs within the normal limit.

Assessment Rationale

Assess for local or

systemic signs of
Opportunistic infections can easily develop, especially in
infection, such as fever,
immunocompromised clients.
chills, swelling, pain, and
body malaise.

Instruct the client to

report signs and A simple fever is significant enough not to pay attention to.
symptoms of infection A need for antibiotic therapy may be indicated.
immediately.

Anticipate the need for

antibiotic, antiviral, and These agents are effective against killing an infection.
antifungal therapy.

Instruct the client to

These can be a source of infection for the
avoid contact with people
immunocompromised client.
with existing infections.

Environmental changes may be important if the absolute

neutrophil count is less than 500/mm . Protective isolation
Patient hospitalized need
3

precautions may include placing the client in a private

to placed in private room
room, limiting visitors, and having all people who come in
and limit the visitor.
contact with the client use mask, gown, and gloves. These
clients are at a significant risk for infection.

Advice patient to avoid

eating raw fruits and These food items can harbor bacteria. A low bacterial diet
vegetables and uncooked protects the client from exposure to pathogens.
meat.

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 Assessment Rationale

Stress the importance of

These preventive measures help avoid skin breakdown and
daily hygiene, mouth
lessen the risk of infection.
care, and perineal care.

Practicing hand hygiene is an effective way to prevent

Teach the client apply the
infections. Washing hands can prevent the spread of
proper hand washing.
germs, including those that are resistant to antibiotics.

Administer WBC growth Colony-stimulating factors (CSFs), long-acting

factor to stimulate the pegfilgrastim, filgrastim are medications used to stimulate
production of neutrophils. the production of infection-fighting white blood cells.

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Deficient Knowledge On Disease Process in Diabetes Melittus

Deficient Knowledge: Absence or deficiency of cognitive

information related to a specific topic.

Outcome :

- Patient will verbalize understanding of the procedures, laboratory tests, and

activities involved in controlling diabetes.
- Patient will participate in the management of diabetes during pregnancy.
- Patient will demonstrate proficiency in self-monitoring and insulin
administration,

Nursing Interventions Rationale

Assess client’s and/or couple’s knowledge Clear understanding is necessary to let them
of the disease condition and treatment, understand her condition and the rationale for each
including relationships between diet, action they need to take and make every decision
exercise, stress, illness, and insulin with correct way without make her glucometer
requirements. reading high.

Teach the client to have a serum glucose Blood Glucose monitoring can make at home as
monitoring at home using a glucometer, self monitoring, Otherwise she also can see what
and the need to record readings (usually type of food that impact to have high reading if
at least 2-4 times/day). took that type of food.

The normal total weight gain during the first

trimester is 500g per month , then 500g per week
Explain on weight that suitable to increase
depend on her BMI after that. Caloric restriction
during pregnancy.
with resulting ketonemia may cause fetal damage
and inhibit optimal protein utilization.

Provide information regarding the use and Prenatal metabolic changes cause insulin
action of insulin. Demonstrate on how to requirement to change. In the first trimester, insulin
administer insulin (by injection, nasal requirements are lower, but they double or
spray or an insulin pump) as indicated. quadruple during the second and third trimester.

Advice client to recognize signs

Important to seek medical help early to avoid
of infection and be warn the client not to
further complications. Choice of self-treatment may
self-medicate with vaginal creams
be inappropriate/mask infection.
available over-the-counter.

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Provide information regarding the impact
Sufficient knowledge can get her cooperation for
of pregnancy on the diabetic condition and
manage their need on disease.
future expectations.

Explain to client how to learn glucagon

administration. Instruct the client to follow The use of glucagon and milk can increase the
with protein-rich food such as 8 oz of skim serum glucose level without the risk of rebound
milk, then recheck blood glucose level in hyperglycemia.
15 minutes.

Encourage the client to maintain a diary of

home assessment of serum glucose The use of a diary can easy the health care
levels, insulin dosage, reactions, general provider to discuss and alter the therapy provided
well-being, diet, exercise and other as indicated.
thoughts related to the disease condition.

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Risk for Altered Nutrition: Less Than Body Requirements

Risk for Altered Nutrition: Less Than Body Requirements: At risk for
an intake of nutrients that is insufficient to meet metabolic needs.

Outcome :

- Patient will verbalize understanding of individual treatment regimen and the

need for frequent self-monitoring.
- Patient will maintain fasting serum blood glucose levels between 60-100 mg/dl
and 1-hour postprandial of no higher than 140 mg/dl.
- Patient will gain at least 24-30 lbs prenatally or as appropriate for pre-
pregnancy weight.
- Patient will be free of signs and symptoms of diabetic ketoacidosis (fruity-
scented breath, excessive thirst, frequent urination, weakness, confusion).

Nursing Interventions Rationale

To help in evaluating client’s understanding

Assess and record dietary pattern and
and/or compliance to a strict dietary
caloric intake using a 24-hour recall.
regimen.

Assess understanding of the effect of

It is proven that stress can increase serum
stress on diabetes. Teach patient about
blood glucose levels, creating variations in
stress management
insulin requirements.
and relaxation measures.

Weight gain serves as an indicator for

Weight the client every prenatal visit.
determining caloric adjustments.

Nausea and vomiting may be brought about

Observe for the presence
by a deficiency in carbohydrates, which may
of nausea and vomiting, especially
result in the metabolism of fats and
during the first trimester.
development of ketosis.

Teach the importance of regularity of

Eating very frequent small meals improves
meals and snacks (e.g., three meals or
insulin function.
4 snacks) when taking insulin.

Teach and demonstrate client to

Insulin needs for the day can be adjusted
monitor sugar using a finger-stick
based on periodic serum glucose readings.
method.
Note: Values obtained by reflectance meters

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 may be 10-15% lower/higher than plasma
levels.

Metabolism and maternal/fetal needs

fluctuates during the gestation period,
requiring close monitoring and adaptation.
Provide information regarding any
Research suggest antibodies against insulin
required changes in diabetic
may cross the placenta, causing
management; e.g., use of human
inappropriate fetal weight gain. The use of
insulin only, changing from oral diabetic
human insulin decreased the development of
drugs to insulin, self-monitoring of
these antibodies. Reducing carbohydrates to
serum blood glucose levels at least
less than 40% of the calories ingested
twice a day (e.g., before breakfast and
reduces the degree of a postprandial peak
before dinner) and reducing/changing
of hyperglycemia. Because pregnancy
time for ingesting carbohydrates.
provides severe morning glucose intolerance,
the first meal of the day should be small,
with minimal carbohydrates.

Hypoglycemia may be more sudden or

severe during the first trimester, owing to
increased usage of glucose and glycogen by
a client and developing fetus, as well as low
levels of the insulin antagonist human
placental lactogen (HPL).

Ketoacidosis occurs more frequently during

the second and third trimester because of
the resistance to insulin and elevated HPL
levels.
Provide information regarding the signs
and symptoms and difference of
Sustained or intermittent pulse of
hyperglycemia or hypoglycemia.
hyperglycemia re mutagenic and teratogenic
for the fetus in the first trimester; may also
cause fetal hyperinsulinemia, macrosomia,
inhibition of lung maturity, cardiac
dysrhythmia, neonatal hypoglycemia, and
risk of permanent neurologic damage.

Maternal effects of hyperglycemia can

include hydramnios, vaginal and urinary tract
infections, hypertension and spontaneous
termination of pregnancy.

Insufficient caloric intake is reflected by

Recommend monitoring urine ketones
ketonuria, indicating a need for an increased
on awakening and when a planned
intake of carbohydrates or additional snack in
meal or snack is delayed
the dietary plan (e.g., recurrent presence of

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 ketonuria on awakening may be eliminated
by 3 am a glass of milk).
The presence of ketones during the second
trimester may reflect “accelerated
starvation” as the diminished effectiveness of
insulin results in a catabolic state during
fasting periods (e.g., skipping meals),
causing maternal metabolism of fat.
Adjustment of insulin type, dosage, and/or
frequency must be required.

Division of insulin dosage considers basal

maternal needs and mealtime insulin-to-food
ratio and allows more freedom in meal-
scheduling. The total daily dosage is based
on gestational, current maternal body
Discuss the type of insulin, dosage and
weight, and serum glucose levels. A mix of
schedule (e.g., usually 4 times/day:
NPH and regular human insulin helps mimic
7:30am-NPH; 10am-regular; 4pm-NPH;
the normal insulin release pattern of
6pm-regular).
the pancreas, minimizing “peak/valley” effect
of serum glucose level. Note: Although some
providers may choose to manage clients with
GDM with oral hypoglycemic agents, insulin
is still the drug of choice.
Prenatal metabolic needs change throughout
the trimesters, and adjustment is determined
by weight gain and laboratory test results.
Adjust diet or insulin regimen to meet Insulin needs in the first trimester are 0.7
individual needs. unit/kg of body weight. Between 18-24
weeks of gestation, it increases to 0.8
unit/kg; at 34 weeks’ gestation, 0.9 unit/kg,
and 1.0 unit/kg by 36 weeks gestation.
Monitor HbA1C for knowing random The reading of HbA1c to determine the
blood glucose within 3 month. management toward the patient.
Provides an opportunity to review the
Coordinate multispecialty care management of both pregnancy and diabetic
conference as appropriate. condition, and to plan for special needs
during intrapartum and postpartum periods.
Diet-specific to the individual is necessary to
maintain normoglycemia and to obtained
Refer to a registered dietician to
desired weight gain. In-depth teaching
individualize diet and counsel regarding
promotes understanding of own needs and
dietary questions.
clarifies misconceptions, especially for a
client with gestational diabetes.
Prepare for hospitalization if diabetes is Infant morbidity is linked to maternal
not controlled. hyperglycemia-induced fetal

14
 hyperinsulinemia, fetal growth defect and
stillbirth.

AFTER STILLBIRTH

Risk for Altered Family Processes/Role Performance: At risk for a change in

family relationships and/or functioning.

Desired Outcomes

- Patient verbalizes understanding of role expectations/obligations.

- Patient identifies needs and resources to nurture roles/family ties.
- Patient expresses feelings freely and appropriately.
- Patient demonstrates individual involvement in problem-solving process
directed at resolution of crisis.
Nursing Interventions Rationale

Members of the family may provide support for one

another. But, disbelief, anger, and denial may
Assess present family situation
momentarily weaken parenting skills, and other children
and psychological status.
may be neglected or handled differently from the way they
had been handled before the death of the infant.

Members of the family may be depressed, may feel

Review family’s strengths,
entirely incompetent, and may need to review what has
resources, and past coping skills.
happened and what their goal in life may be.

Recognizing one’s feelings may trigger realization of their

Promote exchange of feelings and causes and can be used to verify the acceptability of
listen for verbal cues indicating these feelings. Parents may be hesitant to describe
feelings of failure, guilt, or anger. negative feelings that they consider abnormal. Realization
Discuss normalcy of feelings. that feelings of grief, guilt, and anger are normal may help
alleviate the parents’ sense of failure.

Discuss situation in terms of In some instances, grief causes immobilization, resulting

activities that need to be in dysfunctional parental patterns to the point that normal
completed or continued and the household routines are disturbed and outside assistance
available resources. is required.

15
 Foreseen changes include period of disorientation or
Recognize expected role changes breakdown in normal patterns of conduct, succeeded by a
required by the loss. period of reorganization, in which energy is properly
invested in new people and activities.

Death of a child requires unanticipated changes

Provide information and assist
in parental roles. With death of a first child, the only
parent(s) in dealing with the
parental function that occurs is grief. If there are other
situation, balancing self-care, grief
children, however, parents may express concern about
needs, and parenting
their parenting abilities. Feelings of failure or guilt may
responsibilities
lead to a sense of ultimate inadequacy.

Give patient simple choices of The patient needs to get the message that she is seen as
activities, with the opportunity to do a functional, competent person, even though she may not
more as she progresses. feel that way.

May be necessary to assist family members or to replace

Refer to resources such as social
them when they are not available to help (because of
services, visiting nurse services,
distance and/or their own lack of coping skills). Fosters
and other agencies.
growth and individuation of family members.

Give medications judiciously, as May help patient get some sleep/rest (e.g.,
needed (e.g., sedatives, following difficult or exhausting delivery or cesarean birth).
antianxiety Note: Improper use of medications can cloud emotional
agents/antidepressants). responses and inhibit the grieving process.

Others who have gone through the same process can

reaffirm normalcy of parents’ feelings and responses.
Refer to parent support groups
Note: Referral is best made when the patient/couple is
(e.g., Compassionate Friends,
experiencing depression and shock. It is more
SHARE).
complicated to refer the patient/couple during the stages
of denial and anger.

Extra support in coping with grief may be necessary.

Psychotherapy may be effective in cases of pathological
Refer for psychiatric counseling or
grief or overprotectiveness, which can negatively affect
psychotherapy, if indicated.
normal parenting and integration of loss into usual
activities.

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Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to

specific topic.

Desired Outcomes

- Patient verbalizes understanding of reasons for loss, when known.

- Patient differentiates causes of death that are controllable and those that are
uncontrollable.
- Patient discusses possible short and long-term effects of the loss.
Nursing Interventions Rationale

Emotional responses may conflict with the ability

to hear and process information. The stage of
denial is not the right time for the individual to
Assess family’s eagerness and ability to process information, and repetition of information
comprehend and retain information. may be necessary because of the individual’s
ambiguity and lack of control of the situation.
Simple reinforcement of reality may be all that
family members are receptive to at the moment.

Recognize patient’s/couple’s perceptions of Mistaken understandings need to be assessed

events, and correct misunderstandings, as on a regular basis and valid information
indicated. reiterated.

Families have varying needs for information,

Determine family’s preference when depending on the stage of family development
providing information. and on whether death was intrauterine or caused
by external factors or genetic problems.

Through the unrelenting stress that follows the

Review flow of events and diagnostic tests loss, the patient/couple understands and retains
performed, using pictures if possible and information more easily if it is performed in a
appropriate. detailed manner. Symbols such as footprints or
pictures of the infant may be significant.

Individuals learn their own willingness to

think about and talk about this possibility. The
Let patient open up the subject of another
typical recommendation is to avoid considering
pregnancy.
pregnancy until grief has been resolved, or until
at least 6 month after the loss.

17
 Family members and friends usually do
not recognize the severity of the parents’ grief.
Consider parent’s readiness regarding Role playing can ready parents for different
reactions of friends and family; role-play responses from friends and relatives, who may
responses. avoid conversation about the loss, wrongly
assuming that avoiding the topic is
therapeutic/less painful for parent(s).

In several cases, parents do not know why

their child died and may have a fear of
Provide knowledge regarding possible short later pregnancies. Causes of intrauterine death,
and long-term physical and emotional stillbirth, or perinatal death are sometimes
effects of grief, comprising of somatic uncertain even after autopsy, and families may
symptoms, sleeplessness, nightmares, feel guilty about the cause of death. Providing
dreams of the infant or the pregnancy, knowledge about these factors can be effective
emptiness, fatigue, altered sexual response, in settling the grief of these individuals. Helps
and loss of appetite. prepare couple for normal changes and
difficulties associated with usual activities of daily
living, and helps couple recognize extent of loss.

Genetic counseling may be recommended if

the parents are worried of the reoccurrence of
the problem, even if the problem is not thought to
Review appropriateness of genetic
be genetic. The terms “congenital,” “teratogenic,”
counseling as indicated.
and “trauma” should be defined and
differentiated so that parents can comprehend
risk factors.

Refer to chaplain and community support Most parents do not believe in information until
groups. they have heard it from multiple sources.

Support groups provide information

Review information provided by referral and assistance from people who have
agencies/groups. experienced the same and give reassurance of
normalcy of physical and emotional responses.

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