bottomlesspit

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Jan 31, 2007
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as a new ob-gyn intern, i admitted my first IUFD yesterday. depressing as all hell, and shocking how little support there was for the patient and her husband/family. she was placed on the normal L&D floor in a normal L&D room (with the baby warmer, baby goodies, nursery stuff, etc. etc.), and as far as i could tell (though i do need to confirm this later), she and her family wwere left in the room alone with her family while we gave her miso. and while i respect her need for privacy and time to grieve, i wish we had had at least a social worker or grief counselor come by. i couldn't even find a box of tissues, and could only offer her a wadded up ball of toilet paper ... how pathetic is that?!

is this how your hospital handles such admissions? if not, would you mind describing how IUFD admissions different?

many thanks....
 

KentuckyOBGYN

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Dec 12, 2007
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Our grief counselor is a LDR RN who commits her time after hours, perhaps you could find a volunteer. We also have a program where little tear drops are placed on the frame around the door so someone doesn't walk in, like even the lab people and say something like "how far along are you" or something intended to be well meaning which ends up worsening the situation. It's actually helped quite a lot. Simple things which go along way to help patients through a very difficult time.
 

anamarylee

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At my hospital, patients with FDIUs are in LnD in the far removed rooms. There is a checklist the nurses go through (psychological support, spiritual referal if needed, etc). There is a special drawer cart with plush angel bears, baby clothes of all sizes, hats of all sizes, cards for footprints and handprints, etc. We try our best to have the same providers follow the case all along so as to not have 5 different people managing the patient throughout the process. There is a camera under lock and key and if the parents wish so, pictures are taken and the memory card is given to them. It's really an emotionally charged process and can be very demanding, but from what my fellow residents and the nurses have said patients are usually very gratefull for what you do for them. I've only had 1 case @ 17 weeks and eventhough she was having probably the worst day of her life, she kept thanking me. I felt kind of guilty about it but I just let her say whatever she needed to to get through the experience.
 

AnotherOBGYNapp

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Sep 7, 2008
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We have two rooms in highrisk/antepartum that can be delivery rooms, so we use those. We have an entire department dedicate to IUFD/intrapartum/neonatal losses that generates helpful protocols, guides for nursing/ancillary staff and follows the patients out several years down the road to provide support. Of course, we have a very high volume of high risk, and have a very busy triage/ER type area that sees lots of 2nd tri losses as well, so we need a system in place. Those nurses/counselors help manage what to do as far as how much time (if any) the family/mom wants with the baby after delivery, etc... dealing with autopsy discussions (along with us & neo's), dealing with setting aside appropriate memorial type things-locks of hair, outfits, etc... They also help manage different religious and language preferences. I don't know how we would deal with these situations without these RN's and SW's who can spend hours and hours bedside.

The other interesting issue I've seen is pain control during an IOL following a previable IUFD. Some of our anesthesia have resistance to epidural for these patients and suggest PCA. I've seen epidural work very well, almost to just calm the process down rather than having to feel each cramp/ctx as a reminder.
 

gaspasser2004

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The only reason I don't put an epidural in an IUFD patient is if they are coagulopathic from DIC. Otherwise, there is no reason someone should't get an epidural for an induction.