Time between diagnosis and induction of labour
- Women delaying induction of labour from time of diagnosis more than 24 hours are at significant risk of suffering anxiety related symptoms in the future, this should not necessarily mean that women should be made to start induction immediately. The time inbetween diagnosis and induction can be used effectively to begin to come to terms with the loss and start healthy grieving processes
- Women in several studies have expressed that staff left them alone following breaking bad news to them, most of these women did not wish to be left alone during this time - this made them feel abandoned and out of control of the situation. Contrarily, fathers would rather be left alone in peace to adjust and calm down, this in combination with the amount of things they needed to deal with at the time led to fathers feeling conflicted. In accordance with NMC (nursing and midwifery council) code of conduct and SANDS guidelines best practice in this situation is to clarify with the family whether they would rather be left alone to come to terms with things or whether they want you to stay with them to begin to answer questions.
- Waiting for induction has been described by women as worse than the delivery itself, however there were ways they found to make the time useful and meaningful. For example sharing grief with others, family members, seeing other children and grieving together as well as meeting with priests and counsellors helped to clarify the situation and keep women focused on the task. Taking this into consideration it is reasonable to consider delaying induction for a short time in order to accomodate these interactions.
- The department of health and the NMC make it clear that women and partners need time and information in a way they can understand in order to begin to make choices. In the situation of intrauterine death the best way to communicate is likely to be slow-drip of information, repeated as necessary, a small study found that at times women were given more information than they could digest and needed some time to recover before moving on to the next step. Another study discovered that during this 'waiting' period women were not just waiting for delivery of the baby but also for information, sometimes that information never came. This lack of information could contribute to women and partners feeling frightened and wanting to delivery the baby as soon as possible, as the whole situation felt abnormal. Providing information and choices could help alleviate some of this fear before delivery.
- Conclusions from this chapter were that hospital policy does not include advice for midwives caring for women in terms of their psychological health and grieving - they are mainly focussed on the medical aspects of induction, therefore more psychological and grief research as well as womens views need to be included in policy. Further research into the effectiveness of interventions such as counselling in the period between diagnosis of intrauterine death and induction of labour is needed to determine whether they cause more good than harm. With this information an improvement in policy could contribute to better well-being of families in the future and possibly during prospective childbearing continuums.
References I have used for this chapter are below incase anybody would like to do some further reading.
Onto the next chapter - choices in labour following diagnosis of late intrauterine death.
References
Centre for Maternal and Child Enquiries (CMACE) (2011) ‘Perinatal Mortality 2009: United Kingdom’. CMACE. London.
Department of Health (2004) Maternity Standard, national service framework for children, young people and maternity services.
Erlandsson, K., Lundgren, H., Malm, MC., Davidsson-Bremborg, A., Radestad I. (2011) ‘Mothers experience of the time after the diagnosis of an intrauterine death until the induction of the delivery: A qualitative internet-based study’ J. Obstet. Gynaecol. Res. 37 (11) pp. 1677-684
Geerinck-Vercammen, CR (1999) ‘With a positive feeling’ The grief process after stillbirth in relation to the role of the professional caregivers. European Journal of Obstetrics and Gynecology and Reproductive Biology 87 pp. 119-121
Hibbert, G (2011) ‘The Other Side’ The Practising Midwife 14(7) pp. 16-17
Local Trust Guidelines (2007) ‘Guidelines for the care of women with an intra-uterine death’
Malm, MC., Radestad, I., Erlandsson, K., Lundgren, H (2011) Waiting in no-mans land – mothers experiences before the induction of labour after their baby has died in utero. Sexual and Reproductive Healthcare 2 pp. 51-55
NICE (2008) Induction of labour – CG70. National Institute for Health and Clinical Excellence. London.
NMC (2008) The Code: standards of conduct, performance and ethics for nurses and midwives. Nursing and Midwifery Council. London.
Radestad, I (2001) ‘Stillbirth: care and long term psychological effects’ British Journal of Midwifery 9 (8)
Radestad, I., Steineck, G., Nordin, C., Sjogren, B (1996) ‘Psychological complications after stillbirth – influence of memories and immediate management: population based study’ BMJ 312 (1505)
RCOG (2010) Late intrauterine fetal death and stillbirth – Green-top guideline No. 55. Royal College of Obstetricians and Gynaecologists.
Saflund, K., Sjogren, B., Wredling, R (2004) The role of caregivers after a stillbirth: views and experiences of parents. Birth 31 (2)
Samuelsson, M., Radestad, I., Segesten, K (2001) A waste of life: fathers experience of losing a child before birth. Birth 28 (2)
SANDS (2012) available at: http://www.uk-sands.org/ (accessed 28/02/12)
Schott, J,. Henley, A,. Kohner, N (2007) Pregnancy Loss and the Death of a Baby: Guidelines for professionals. 3rd edition. SANDS.
Scott, J (2011) ‘Stillbirths: breaking the silence of a hidden grief’ The Lancet 377 (1353)
The Lancet (2011) ‘Stillbirths’ Available at: http://www.lancet.com/series/stillbirth (accessed 10/02/2012)
Trulsson, O., Radestad, I. (2004) The Silent Child - mothers experiences before, during and after stillbirth. Birth 31 (3)
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