My story picked me on December 6, 2005, it was a normal morning at work I had just got done assessing my postpartum moms when the phone rang and Dr. Hoggarth told me she was sending a full-term, gravida 1 (first pregnancy) labor patient to me who had shown up at her regular appointment and was contracting every 5 minutes or so. She hadn’t checked her over, she was just sending her our way with the “normal labor orders.”
Some 15 to 20 minutes later they were on the OB floor and I lead them to room 401 at the old hospital. I gave her time to change and settled into the room and then went to start getting her admission process completed. One of the first steps is to hook up the fetal monitor. As I started looking for the baby heartbeat I was asking about the contractions, her pain level, if she had any pregnancy complications, health history, allergies and then the small talk: what was the weather like, how was the drive to Jamestown… by this time I’ve been all over her belly looking for that baby’s heartbeat and nothing! Internally I’m panicking! There is probably only one reason I wouldn’t be finding heart tones and I am PRAYING I’m wrong. Now, at some point I have to SAY something to these parents as to why I’m looking like the most incompetent nurse they have ever come across….finally after being across her belly back & forth, up & down at least 3 times I said “I’m not sure why I can’t find this baby on my monitor. (LIE!! I KNOW EXACTLY WHY I JUST AM STILL PRAYING I’M WRONG) I’m going to call Dr. Hoggarth.” I walked out of the room to the nurses’ station, my heart pounding the whole way! I called Dr. Hoggarth and all I could say was “I can’t find heart tones!” She immediately said “call radiology and get them up there right now for a portable ultrasound. I’m on my way over!” and hung up the phone.
Dr. Hoggarth beat the radiology tech and portable ultrasound machine to the floor. Dr. Zubernis, the OB-GYN at the time, was right behind her as Dr. Hoggarth had called him on her way over. This was back in the days of our first electronic medical record and we had what was called COWs (computer on wheels). Now, I knew if they could find ANY promise we would be going for an immediate C-section. So I pulled the COW into the hallway, right outside of her room, to get at least part of her information in that computer. The portable ultrasound machine was painfully slow to boot up! I was typing in as fast as I could and I could hear the mumbled talks from the room. Then suddenly there was a SCREAM. It was such a primal scream. Like nothing, you have ever heard before and never want to hear again! It was the scream of a mother finding out her baby is dead. Then immediately following her scream was “NO, NO, NO, what is going on? WHY?” And I knew my worst fears for this couple had just been confirmed. This poor mother was now going to have to do the unimaginable, go through labor and deliver a dead baby.
My heart had stopped. I stopped typing. I just stood in the hallway frozen and my head racing “Get it together! What is wrong with you? YOU HAVE TO GO IN THERE!” All these thoughts mashed together. At some point, I did pull it together and went into the room to hear what Dr. Hoggarth and Dr. Zubernis were telling these parents. We would get her an epidural so she doesn’t feel a thing. We would start Pitocin to get labor going full bore. We would break her water to help the process speed up. We would call their pastor and/or family if they wanted us to. We would call social services to come to talk with them as they would be able to guide them in the next steps. After some discussion, we all left their room so they could have some time by themselves to process what was happening.
At this point in my career, I had only been a nurse for 6 years and just 3 of those had been in OB. That may sound like a decent amount of time, but nothing had prepared me for that day. I had never had to be the nurse not able to find the heart tones before. I had never had to be the nurse getting all the initial stuff for our bereaved families. Throughout my time in OB at Jamestown Hospital, there had been only a small handful of stillbirths and I had not been scheduled at those times. I didn’t know what to do! When the social worker did come up to talk with them she had just a few pages she printed off the internet with some grief information (Remember, this was 2005 and the internet information was NOTHING like it is now.) We really didn’t have much for booklets or parent information.
I felt almost useless that day. I went about doing the tasks that needed to be done to get her labor going and by that evening she was delivering a perfect baby that just would never cry. By the time I got home that night my own baby who was almost 2 at the time was already sleeping. I didn’t care. I went into his room. Picked him up out of his crib and rocked him in the chair while I cried. I cried for these parents. I cried for their family. I cried for their baby. I cried for my lack of knowing how to help. Why didn’t I know how to help?? Why wasn’t there something in place that could help the nurses help these parents? Surely there must be something that I missed in our department. Surely there was information that I had just never seen. But there wasn’t. The more I looked and asked the less I found.
Several weeks later, this was still on my mind. I was talking to our manager about it. She was the type that if you had the idea you were the one she would put in charge of it. So, she said “do something! You have my full permission to put together anything you think we need.” Um, what? No, I wanted to just complain about the lack of stuff we had, I didn’t want to be in charge of anything….Well, I started doing some research. What booklets are helpful? What is good to say, what isn’t? And I slowly started pulling some stuff together. What could we do? What do other places do? What are the laws in North Dakota regarding infant loss? Gathering information became somewhat of a therapy for me. I even had these parents from my story come and talk to us at one of our unit meetings to help the nurses gain more information on how to help.
I had looked for some kind of conference on bereavement but there wasn’t anything in this area. Then one glorious day I came across Gunderson Lutheran Hospital in La Crosse Wisconsin. These guys were actually STUDYING infant loss and releasing information for teaching healthcare workers how and what to do. And then another glorious day came along: a couple bereavement trained ladies were coming to Bismarck on October 29 and 30, 2009 to hold a conference! One problem, I was due November 9th with our 3rd baby….oh well, Bismarck has hospitals! I went, much to my husband’s anxieties about me being at a two-day conference being 38 ½ weeks pregnant! (It was all good and our daughter wasn’t born until November 8th). I had another opportunity to go to a similar conference September of 2013 in Grand Forks. Through those conferences, I came to a much better understanding of infant bereavement as a whole. Not only what we should do for families but also how we can help support fellow nurses when they are caring for these families.
Today I feel infant bereavement is still a work in progress at JRMC. I still have a few improvements in mind. In the Family BirthPlace, we have improved quite a bit for parents and families suffering miscarriage or stillbirth. We have a three-ring binder of information for the nurses to use so all they need to do when we have these situations is get out the binder and start following the instructions. We have many different booklets and information on the loss of a baby for the parents and family members. We have beautiful burial gowns and blankets, made by volunteers for the parents to choose from. We give each family a memory box to keep any mementos including foot and hand prints, castings from the hands and feet of the baby, pictures, ID bands, teddy bears, hats, booties and any other important items. We now even have a Cuddle Cot which provides a cooling place for parents to place their babies to help slow the breakdown process so parents can spend extra time with their baby. In the Emergency Department, we have folders with information on miscarriage and small boxes with a teddy bear and remembrance candle. If the patient chooses the ED staff will forward her information to me so I am able to contact her so send more information as needed.
I have often felt the awareness of infant loss in the community is lacking. We all know October is Breast Cancer Awareness Month. A lot of great effort goes into breast cancer awareness and that is awesome. But, do you also know October is Infant Loss Month? Infant loss is painful and difficult to talk about but 1 in 4 pregnancies ends in the death of the baby. 1 in 4!! A little over 5 years ago this really did start to bother me. One sleepless night I decided somehow I needed to start changing this. October 15th is considered Pregnancy and Infant Loss Day and years back a group of bereaved parents had started the International Wave of Light. I decided Jamestown needed a service. I pulled together a few people I had for resources and we did the first Wave of Light Remembrance Service at St John’s Lutheran Church October 15, 2012. We do a memorial service with a message of hope for bereaved parents, parents and families are welcome to share a poem or memory, then we have candle lighting for the babies lost to miscarriage, stillbirth or infant death. Over the years a couple loss moms have wanted to help organize this event and October 15, 2016, we had our 5th annual candle lighting service. Because of their help, we added an Awareness Walk down 1st Avenue and at the end of the walk we had a balloon release for the babies being remembered. We couldn’t have asked for better weather that day! We have plans to do similar Awareness Walks and services in the future and not just on October 15th.
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