You SAY Goodbye and I SAY Hello

Sunday, June 16, 2013

Title: You SAY Goodbye and I SAY Hello

Ryman Hall B4 (Gaylord Opryland)
Kim L. C. Petrella, RN , Labor and Delivery, Christiana Care Health Services, Newark, DE
Gina M. Scott, BSN, RNC-OB , Labor and Delivery, Christianacare, Hockessin, DE
Barbara Dean, BSN, RNC , NICU, Christiana Care Health Services, Elkton, MD

Discipline: Advanced Practice (AP), Childbearing (CB), Newborn Care (N)

Learning Objectives:
  1. Apply knowledge to nurses to educate patients on the risk of infection versus delivery at 26 week gestation
  2. List ways to allow for nursing to help a family remember their stillborn and liveborn to be honored together
  3. Discuss the teamwork approarch of nursing from LDR and NICU in helping this family cope with their joy and their sadness
Submission Description:
Background:      When nature intervenes in an unusual way by both giving and then taking, providing a joyous moment and a tragedy at the same time, the role of the nurse becomes an orchestra of emotions, skilled nursing care, and support. In our Level III LDR, a G3011 pregnant with twins presented to triage at 22 weeks with bleeding. Ultrasound showed a sub-chorionic bleed with decreased fluid with twin A, a boy. Twin B, a girl, looked well. The patient was admitted to our high risk unit until delivery

Case:

Ultrasounds continued to show bleeding and increased fetal distress. The family was faced with a gut-wrenching decision; should they think about a stat Cesarean Section at 24 weeks if Twin A went into severe fetal distress and risk the life of Twin B? Should they wait knowing that Twin A would most likely die but give Twin B a better chance for survival? A multidiscipline, multi-focused team approach of individualized care was applied to this complex patient, her husband and their babies. At 22 5/7 weeks, Twin A went into severe fetal distress. The family stood by their decision to allow for Twin B to mature. At 26 weeks, the patient started running an elevated temperature and the decision for an urgent C/S was made. Staff from LDR and NICU was assembled and a C/S was performed. Twin A, a boy was born stillborn and Twin B, a girl was born screaming and fighting. Time was spent preparing Twin A for presentation to the parents while Twin B was stabilized. Both babies were seen and held by both parents.  A nationally trained local photographer captured a picture of a sister holding her brother’s hand in the NICU shortly after birth and it became the only picture the family had of their twins together. Clergy from both parent’s faiths visited and customs observed. Social work provided grieving support. NICU made posters of Twin B hanging them over her bed. LDR made a memory box for Twin A. A memorial service was held in the hospital chapel where over 150 attended.

Conclusion: This experience of caring for a complex patient highlighted teamwork in hospital wide excellence. Multiple departments came together to support this family when the day came to say both Hello and Goodbye.

Keywords:  Bereavement, Premature Twins, Multidiscipline team approach

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