Perinatal Grieving Case Studies: They are all true!
Induced Abortion: Choosing
A 17 year-old woman comes into your office requesting an induced abortion. She explains she and her boyfriend have never had sexual intercourse, but she did a home pregnancy test and it is positive. Her last period was 7 weeks ago. You repeat the pregnancy test and it is positive. The patient explains that she and her boyfriend thought they were being safe because he only ejaculated “between her legs.” “I’m a virgin,” she tearfully replies. You know she is the daughter of a Baptist minister and she describes herself as being deeply religious. However, she and her boyfriend have talked about the pregnancy and are sure they want to proceed with an abortion.
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
Advice to a Colleague Whom is Being Threatened
A nursing colleague of yours works at a Planned Parenthood that provides induced abortions on Fridays. A coalition of “Right to Life” members legally pickets the clinic every Friday. They show the patients awful pictures of dead fetuses and many clients come in hurt and angry about the protesters confrontational attitudes. Your friend’s job on Friday is to counsel the women about their options, explain the procedure, have them sign an informed consent and provide abortion aftercare. Your friend’s name and the physician’s name periodically appear on the signs the picketers carry denouncing them as murderers. A couple of weeks ago a picketer followed her home in her car and put anti-abortion literature in her mailbox. Your friend has heard about hate crimes against clinics and HCPs that provide abortions and she is frightened for her safety and her children’s safety. What would you say to her?
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
Infertility: How far do we go?
You are working at a well-known infertility clinic. A 38 year old patient and her partner have been referred to your clinic because they have been trying to conceive for one year. They have had an initial work-up with their primary care HCP including a test for ovulation and a sperm count. According to the test results, she does not appear to be ovulating and his sperm count is low (18 million). They are at the clinic for more information about assisted reproductive therapies. She really does not want to do any other tests because with each new procedure she gets her hopes up and then when she starts her period that month she is depressed. She has had enough and would like to adopt. Her partner is sure that he would like to try almost any method available so they can have their “own baby.” How would you proceed?
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
Early Miscarriage: It’s better this way
A woman comes into the emergency room on a Saturday evening because she is 11 weeks pregnant and is having bright red bleeding. An ultrasound does not detect a heartbeat and other findings indicate an inevitable abortion. Friends with her tell her that it is “God’s will” and that it is better she lose the baby now then at the end of the pregnancy. They also point out that usually a miscarriage occurs because there is something “so wrong with the baby” that they baby would either die anyway or have such horrible defects that it would have an awful life. They compassionately ask her: You wouldn’t want that would you?” As her nurse, what would you do?
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
Ectopic: Just another abdominal surgery
You are a pm nurse in a medical-surgical unit. The day nurse is giving report and gets to the two patients in room 3004. One is a patient with an appendectomy that resulted in peritonitis. The other patient had a laparotomy for a ruptured ectopic pregnancy and required one unit of blood on the day shift. Both patients are stable now. You were not assigned to these patients. The next day you come on and are sitting in report. The patients in room 3004 are doing better. They both have bowel sounds, are ambulating and on regular diets. Their vital signs are stable. The patient with the ectopic may go home tonight so the usual post-op discharge teaching has been done. The nurse who had these patients last night says she doesn't want them again because the "ectopic" is just so glum. You asked to be assigned to these patients and your request is granted. How would you approach this sad patient?
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
How Many Children Do You Have?
Lucy, is in early labor but prefers to remain in the hospital rather than going home. Her first child died of SIDS at 3 months of age. She now has a healthy three-year-old, but her third pregnancy ended in a fetal demise at 32 weeks. The nurse hadn't bothered to read her prenatal history yet. During the nurse's initial assessment, Lucy makes several comparisons of her current labor pattern to her other labors. The nurse then asks: "How many children do you have?" What difficulties might Lucy have in answering this question? (Also, think about how many times this question is asked in just about any and all social situations.)
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)
GTPAL: 2-2-0-0-2?
After one year of unsuccessfully trying to conceive naturally, Cheryl, aged 32, received a Clomid prescription from her doctor. Two months later, Cheryl conceived. This is her husband’s and her first baby. Unbeknownst to her husband, Cheryl had a baby at aged 16 and put her up for adoption. She has tried periodically to locate her daughter. Since she married, she has not made any further attempts to locate her. Her pregnancy is uneventful and at 39 weeks she goes into labor. You are her nurse in the birth room. On perusing her chart there is no mention of a previous pregnancy.
She dilates rapidly and her second stage is over in two mighty pushes. “Wow,
you did great.” You remark. “You would never know this was your
first baby!” About an hour after the birth, her husband goes home to get
some sleep. You go in the room and Cheryl is teary eyed. You sit with her for
a bit and soon she says, “She looks just like my other daughter.”
Think about: therapeutic communication (Fears, anxiety, anticipatory grieving and adaptation)