The experience of receiving a prenatal diagnosis of a life-limiting condition leaves families with many questions and complicated emotions to navigate. A key part of feeling fully-informed and equipped following a diagnosis, throughout pregnancy continuation, and in the bereavement period that follows loss, is having access to the insight and support provided by a multidisciplinary care team. Each member of a family’s care team serves a unique purpose, and Carrying To Term is here to help shed light on the role of each professional.
Carrying To Term was fortunate enough to have the chance to talk with Kat Sherman, a Certified Nurse Midwife and former labor and delivery nurse, about the importance of labor and delivery nurses, both for families and as contributors to a care team. Kat has a passion for serving families who are facing the loss of their baby, and her insight, compassion, and dedication are evident in how she speaks about her work. It is our hope that this conversation highlights the critical role that labor and delivery nurses play for families facing a prenatal diagnosis of a life-limiting condition.
What inspired you to become a nurse? Why did you choose to dedicate your nursing career to supporting women and families during labor and delivery?
My first bachelor’s degree was in English, and as graduation neared, I found myself feeling passionless and aimless, so I signed up to volunteer at my local hospital. I was amazed by the kindness and altruism I saw from the nurses there, and I felt called to be a part of that. I became a nurse because I witnessed the difference that skilled, compassionate nursing care could make in people’s lives, and I ached for that level of fulfillment.
Once I decided to become a nurse, I immediately knew I wanted to work in women’s and newborn health because it offered such a profound opportunity to make a difference in women’s lives. Caring for families during one of the most special times of their lives was something I yearned to be a part of, both the highest highs and the lowest lows. Whatever the circumstances, woman will never forget her birth experience, and I knew a kind, compassionate nurse could have an amazing impact during that time.
What is the role of a labor and delivery nurse before, during, and after childbirth?
A labor and delivery nurse’s primary purpose is to care for the mother and baby (or babies) during every step of a woman’s labor and birth as well as to advocate on the patient’s behalf. This nurse will spend more time with the patient than anyone else during the labor and birth experience. He or she will monitor the health status of the mom and baby, educate the patient and family on the birth process, give medications, coach the mother through labor and pushing, communicate with providers, assist the doctor or midwife during delivery, and care for the mom and baby after birth. A skilled nurse will make a world of a difference during this life event and will tend to the woman’s physical and emotional needs.
How does a labor and delivery nurse- as an individual and as a part of an interdisciplinary care team, offer support in preparation for and during labor and delivery in cases where families know that their child will either pass away prior to or shortly after delivery? How does a labor and delivery nurse help families protect and make memories in the precious time they will have with their child during and after delivery?
My hospital has a wonderful Perinatal Loss Committee, consisting of nurses, doctors, social workers, and other specialists, that meets with families whose babies receive a potentially life-limiting diagnosis and helps them create an individualized care plan for before, during, and after birth. The committee helps parents think through questions like: Who do they want present for the birth? How soon do they want to hold their baby? Do they want pictures taken? Do they want a religious representative present? The nurse might also offer different options to families regarding bathing the baby, making handprint and footprint mementos, and even the option to have their nurse and other providers step out of the room to leave the family together for some alone time. We are also there to inform and prepare the families for how the baby might look or act and how long the baby may live.
Losing a baby is so terrible, and there is so much that is out of the parents’ control, but there are things about this experience that are in the parents’ control. They are still that child’s parents, and they still have choices in their care and the care of their baby. They can still choose what kind of labor and birth experience they want, and this process helps the parents make a care plan that is right for them. This plan helps guide nursing care because a family has already had time to consider what is important to them. Many hospitals are moving towards providing this type of interdisciplinary care, but I encourage families to seek out the options for their care during pregnancy and to gather their own interdisciplinary support team if one does not already exist where they are getting care. The best way to start is by talking to their doctor or midwife and go from there.
As an individual care provider, a labor and delivery nurse spends more time with the patient and family than anyone else. We are there to advocate for the patient’s emotional and physical needs, and the most important thing a nurse can offer is sensitive, individualized support because no two women, families, or babies are the same. Since each patient’s needs will differ, sometimes the nurse’s role is to just be present, by holding a hand or crying together. Sometimes, families just need a support person to listen and validate what they are experiencing. Each family needs to be allowed to grieve in whatever way feels right to them, and a nurse is there to support them in that grief. There is no one way to go through this process, and that is okay.
During the labor and birth, the nurse is there to coordinate other specialists in providing care by contacting chaplains, photographers, social workers, etc. The nurse also advocates strongly for the family’s wishes, doing whatever they can to accommodate the patient. It is very important to us as nurses to honor the family’s wishes during this precious, limited time with their baby. Trust me when I say, there is nothing that a nurse wants more than to protect this time for the families.
Many families worry about the potentially traumatic elements of laboring and delivering a baby only to have to say goodbye shortly after. Some families worry about how their baby will look. Other families wrestle with the decision to have pictures taken or allow family members and friends to visit. Some families struggle to know how long to hold their baby, especially after he or she has died. What advice do you have for our families about such an emotionally charged and complex experience?
Show yourself and each other kindness. I don’t think anyone can truly know how they will feel or what they will want until they are going through this. Educate yourself on your options and discuss with your loved ones and provider what you might want but understand that it’s okay to change your mind when the time comes. There are no right or wrong choices, and there is no right or wrong way to navigate this experience or to feel this grief. Be kind to yourself, and let yourself feel these feelings. Make the best choices for you and your family.
And in the same vein of kindness towards yourself, give yourself permission to use appropriate pain medications in labor and after. Your heart is already hurting enough, there’s no reason to endure extra physical hurt. Get the epidural or take the pain medications, if you want to. That’s okay. There is no shame in that choice.
Finally, never feel guilty spending time with your baby, both before and after they have died. There’s nothing weird or wrong about it. This is your baby. You get to choose how much time you want to spend with your baby. I tell my patients that, no matter what, their baby will only know love, and that is an incredible thing.
“Never feel guilty spending time with your baby, both before and after they have died. There’s nothing weird or wrong about it. This is your baby. You get to choose how much time you want to spend with your baby. I tell my patients that, no matter what, their baby will only know love, and that is an incredible thing.”
The experience of being discharged from the hospital and going home without their baby can be very overwhelming and devastating for parents. How do labor and delivery nurses help prepare families for discharge and the difficulties of going home after such a tremendous loss?
While there is no way to truly prepare for leaving the hospital without your baby, the family’s nurse is there to acknowledge the family’s pain, validate their experience, and support their grieving process. One of the best ways that we as nurses can do that is to give the family as many mementos from this experience as possible. This includes pictures, handprints and footprints, blankets, hats, and anything else they might want to take home as a reminder of their baby.
Nurses must also support families at the time of discharge by giving them good resources to help navigate and cope with grief at home. At my hospital, we give books and brochures on grieving the loss of a child as well as lists of local child loss support groups. Our social worker also reaches out and follows up with the families after discharge. We also prepare the mother for the changes she will experience after she goes some. For example, we prepare the mother for the experience of having her breast milk come in and the physical and emotional discomforts she may experience as a part of that process.
Do you have any recommendations of specific items that our families should plan to bring with them to the hospital?
The hospital will have basics and essentials like underwear and pads, but I always tell families giving birth to bring things that will make them feel comfortable and more “like themselves.” Even the best hospitals can feel impersonal and alien at times, and something like wearing a comfortable nightgown or “birthing gown” instead of the generic hospital gown or bringing their favorite slippers or blanket can help them feel more grounded and more like themselves.
I also think music is a great idea! Sometimes women will make a playlist that is meaningful to or calming for them, and it can help them through the discomforts of labor and birth. Music can be really powerful. And of course, mementos. These are especially important for families losing a child, because they will be the only tangible objects after they leave the hospital. These families can never too many of them. A memory book for handprints and footprints or a stuffed animal to tuck next to their baby and take home when they leave. I also tell families who are unsure about having pictures taken, that they can have the pictures put in an envelope or on a USB stick. They may choose never to look at them, and that’s okay; but, at least, the photos exist if they change their mind. If they choose not to have pictures taken, they may someday change their mind and wish they had those pictures.
As a nurse who has played a critical and emotionally impactful role in the lives of grieving parents, what have these experiences been like for you? How does being present for these beautiful, broken, life-changing moments affect you? How have they shaped how you continue to serve families as a labor and delivery nurse?
My most memorable experiences as a nurse are the ones spent caring for families whose baby has died or may die. I remember every one of these families and think about them often. Caring for families in these cases certainly takes its toll, and I have cried after many shifts. But these are also some of the most fulfilling experiences I’ve had as a nurse and as a person, and being present for these births has had a profound effect on me. They have made me kinder, more empathetic, more patient. They have also made me immensely grateful for my own blessings in my life.
Many of our families feel very grateful and connected to the professionals who helped them navigate their experience and who were present during the most difficult moments of their lives. Many families have shared that they have stayed in contact with their nurses and doctors over the years. What has that been like for you?
I am lucky enough to have stayed in touch with a few of the families I have cared for when they’ve lost a baby. I feel really thankful to have met them, and I sincerely hope that my care helped ease the pain of their experience a little bit. It has been really fulfilling for me to stay in touch with some of these families. I have even seen some of them go on to have more children, which brings me greater joy than almost anything could. In fact, I’ve kept in touch with Stephanie Schoonover and had the incredible joy of meeting her beautiful second daughter. I’m so proud of her as a mother and person, and of her hard work with creating and growing Carrying To Term.
WHO WE ARE
Kat Sherman is a Certified Nurse Midwife in Austin, Texas, where she works in a hospital delivering babies and teaching residents and medical students. Prior to graduate school and becoming a CNM, she was a labor and delivery nurse for seven years, with advanced training in perinatal loss and bereavement. She is passionate about empowering and educating women and families about all their options in healthcare, and she especially cares about supporting families whose babies have died or have received a life-threatening diagnosis. Kat has a BA in English from the University of Florida, a BSN from Johns Hopkins School of Nursing, and an MSN from Frontier Nursing University. She has a wonderful husband and toddler and two goldendoodles.
Carrying To Term is a national 501(c)(3) nonprofit organization dedicated to broadening access to non-directive educational, logistical, and emotional support resources for prenatal diagnoses of life-limiting conditions. For more information, please visit www.carryingtoterm.org.