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future pregnancies; given if mother is Rh negative and infant is Rh positive

Independent

If possible, admit the patient to a room that is isolated from the nursery, patients in labor, and crying of newborns. Often, units have some small symbol (a small bear, a heart) to hang on the

534 Intussusception door that denotes the patient has an IUFD to alert any healthcare workers who come into contact with the patient to be sensitive.

The nurse is present through the entire labor and delivery and plays a key role in assisting the patient and family through the initial grieving process. During this shocking event, encourage the patient and significant others to verbalize their feelings. Discuss the grieving process and expected feelings; use therapeutic communication skills. Be aware of the content of your messages to the patient.

Involve the patient and significant other in all decisions and discussions related to the labor, delivery, and aftercare. Before the delivery, educate them about the labor process. Prepare them for the appearance of a dead fetus (maceration of the skin, discolorations, specific anomalies, and trauma that can occur during delivery). During delivery, have only the minimum number of staff needed to provide safe care. Keep the room quiet and dim to promote a calm and peaceful atmosphere. Honor the parents' desires for seeing, holding, and touching the newborn. Prepare a "memory box" that contains tangible items, such as footprints, handprints, pictures, a lock of hair, identification bands, and any other items used for the baby. After the patient delivers, monitor her vital signs, location and firmness of fundus, amount of vaginal bleeding, ability to void, presence of edema and hemorrhoids, comfort level, and ability to cope. Provide time for the patient and significant other to be alone with the infant.

Provide reading material for the parents on coping with a neonatal loss. Offer to notify clergy if the patient desires, and respect any religious requests. Although it may be difficult to discuss, offer information regarding funeral arrangements. Discuss an autopsy and explain the advantages of determining the exact cause of death. Refer the patient to a bereavement support group, such as SHARE. Often, follow-up counseling is done by a hospital grief counselor or by the nurse who was present at the delivery.

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