Caring For Families Choosing Pregnancy Termination For Anomalies: The Role Of The Office Nurse

Purpose for the program: When severe or fatal anomalies are diagnosed during pregnancy, the decision to end a pregnancy is a difficult decision, with parents struggling with grief and guilt due to the stigma associated with this choice. Their regular obstetric provider may transfer their care, and they may feel abandoned and have fragmented follow-up support for the loss. The purpose of this program is to provide improved continuity of care and support for these families.

Proposed change: When care is disrupted by a transfer of provider, the office-based nurse can do much to assist these parents through sensitive prenatal care, counseling & education, memorial planning, postpartum visits, referrals, and interconception care.

Implementation, outcomes and evaluation: The office-based women’s health nurse identified the need for an improvement in care for these families throughout their pregnancy and afterwards. Care was changed beginning with intake, as women or couples were arriving with poor comprehension of fetal diagnosis, prognosis, or options. More time was allocated to provide further education, and couples were encouraged to explore pregnancy interruption and effects of the decision on the family within their cultural and religious framework, which promoted a trusting relationship. The nurse also provides resources specifically associated with grief, as well as assists with determining options of memory items to affirm the existence and importance of the pregnancy. The office nurse now ensures contact with the hospital-based personnel to ensure communication of the patient’s arrival, pertinent history, plans for delivery, and plans regarding autopsy or burial arrangements, alleviating some of the discomfort for woman arriving in labor, while providing time to consider options most appropriate for them. Postpartum care now includes time to review pathology reports and interconception planning with the same provider and assessment to identify need for long term support. Patient comments confirm the couples’ feeling supported throughout the process by knowing there is a single nurse who can address their concerns, communicate their plan, and follow up with them afterwards.

Implications for nursing practice: Having a dedicated nurse-physician team to coordinate patient care through difficult decisions is essential to help couples make a truly informed decision in a supportive environment, by arranging couples’ access to consultation both before and subsequent to pregnancy termination, as well as coordinate care with the inpatient facility. Implications for research include the need for more studies exploring couples’ care during and afterwards.

Keywords: collaborative care, pregnancy termination, perinatal loss