Mar, Vol. 28, Issue 1
Database:
CINAHL
Death of a newborn: healing the pain through Carper’s patterns of knowing in nursing During a six-week childbirth education course, I teach expectant couples ways to cope with the physical changes they can expect during pregnancy and delivery, as well as the emotional changes they might go through.
I encourage them to draw on personal experiences and accomplishments, which will enhance their sense of inner strength and lessen their fears. I tell my pregnant couples they can call me if they have any questions, concerns, or problems related to their birth experience or during the postpartum period. Living in rural upstate communities, many young couples have moved far from the support networks of family and friends, so I extend my role to that of a “community” nurse who offers guidance and encouragement in the early days of parenthood.
Jane and Jim Olsen enrolled in my Lamaze class to relieve their anxiety about childbirth. After several infertility work-ups and one miscarriage, this pregnancy was a testimony to their love and commitment to each other.
They wanted to do everything possible to ensure the health of their baby and a positive birth experience. They diligently attended class, read numerous books about childbirth, and openly discussed their fears and expectations. I promised to share with them everything I knew about childbirth. My knowledge was gained through graduate education in parent-child nursing, ASPO certification as a childbirth educator, and through my own lived experiences of pregnancy, birth, and parenthood.
Although in Lamaze classes I discuss all possible variations in birth experiences and potential birth complications, I focus on birth as a natural process, requiring intense work, which most often culminates in the joyful birth of a healthy child. The possibilities of death of a newborn or mother are approached as an unlikely reality, given the expertise and technology offered by current prenatal and obstetrical care.
Yet my work on a high-risk obstetrical unit has etched in my memory the grief and loss experienced by parents who have lost their newborns. Such experiences involve intense nurse-patient relationships requiring not only scientific knowledge and skill, but a nurse’s love, respect, empathy, obligation, and commitment.
Through this work, I realized the importance of encouraging grieving parents to spend time with their critically ill newborns, and in the event of death, the opportunity to hold their son or daughter as they mourned a life that was never given a chance. Some health providers and family members express concern that this would add to parents’ pain. Yet I remembered that amid the suffering and loss, the healing process can begin.
As parents hold and kiss their babies, the nightmares about deformed, monster-like children are put to rest. Looking at their newborn’s features, mothers and fathers recognize family traits and decide on names. This is not only important in coming to terms with reality, but it gives them tender memories of their precious infants to hold close to their hearts.
Jane and Jim Olsen had already experienced the grief and loss of having a first-trimester miscarriage. As we shared the excitement of childbirth through our Lamaze classes, I didn’t know that one day I would be called upon to holistically integrate empirical, esthetic, ethical, and personal knowledge to help this couple heal the pain of their newborn’s death. I realize now that my teaching and nursing practice were guided by what Carper (1978) describes as “patterns of knowing in nursing.”
Keeping a Promise
One evening early in May, my phone rang. Through his tears, Jim pleaded “Please come to the hospital. We need you right away!” I quickly made arrangements for my own children and sped off to the obstetrical unit of our community hospital. When I entered the unit, the nurses greeted me saying “Your Lamaze couple, Jane and Jim Olsen, are still in the recovery room. The delivery went okay, and the baby looked perfectly nominal, but she had trouble breathing and we couldn’t resuscitate her.” I asked if Jane and Jim had seen and held their baby. The nurse answered, “No, we don’t do that.”
I instantly asked myself, “Do you know what to do for this grieving couple?” The answer was yes. I had the nursing education and background to make a difference. I must be their advocate and do everything possible to support them in their grief and create a healing experience. As I had promised, I would share with them everything I knew about childbirth. Now I must go one step further and integrate the science and art of nursing with the ethical obligations of an advocat
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