Perinatal death: a parental nightmare
Introduction
The birth of a child is a special event, loaded with emotions and feelings, however, not all pregnancies end up as expected. These expectations are truncated with death, which destabilizes the family structure and triggers a painful grieving process for parents
As the World Health Organization (WHO) considers, perinatal death is what occurs in the time that takes place from the 22nd gestation to the first week of life. Although it is a variable period, since in Spain.
In healthcare, this period of time is lengthened according to various authors, and are included in perinatal losses, ectopic pregnancy, spontaneous or induced abortion, intrauterine or intrapartum fetal death, selective reduction, premature or neonate death, and even the children assigned for adoption.
Developing
The causes of perinatal death can be classified according to their origin: fetal causes (25-40%), causes of placental origin (25-30%), of maternal origin (5-10%) and causes of unknown origin ( 25-35%). These causes are more frequent depending on the trimester of pregnancy, thus genetic causes stand out in the first quarter, infections in the second and umbilicals in the third.
A considerable decrease in the perinatal mortality rate (deaths per thousand born) is reflected at the state level of 1975, with a rate of 20.91 deaths per thousand births, until 2007, with a rate of 4 4 , 43. As of this year, and until the last record of the year 2018, it is stabilized with values around 4.3 -4.4 deaths per 1000 born.
The grieving process is a normal response from a person to an important loss and includes symptoms such as sadness, irritability, depression, sleep disorders, appetite, feelings of nostalgia. These symptoms usually decrease in the first six months, although it is something variable, their total resolution can be extended per year or two years after trauma.
The duel that follows the perinatal loss has a determining characteristic, the simultaneity between life and death. According to some authors, it should also be noted that, after a perinatal death, some women claim to hear the crying of the baby or even feel their movements in the belly.
Various characteristics influence this grieving process such as gestational age, visualization with ultrasound, the moment of death, those born with malformations, multiple birth and treatment received by the obstetric team.
There is a unauthorized duel, since there is no social recognition in the face of such a loss, it is an event that nobody speaks of. It is usually avoided by talking about the subject for fear of causing more pain, so the experience of this experience in solitude is perpetuated.
For the identification and differentiation between duel and pathological duel in a perinatal loss, a tool that has proven precision, the short version of the perinatal duel scale or PGS is used.
The attention that takes place in gestational losses has been recognized as one of the most unattended areas in the health systems of around the world, as well as the ignorance that professionals have close to this issue.
At the end of the 60s, professionals resorted to what was called "blind angle" in which the mother was seized, she was not given the opportunity to say goodbye to her dead son, she was recommended to get pregnant as soon as possible, she was He gave insufficient information and everyone did nothing happen. Events that could lead to the appearance of a pathological duel and a possible subsequent depression (7, 8, 16) (Annex V).
This form of health action that is not interested in the parents’ duel, is criticized in a publication of Kirkley-Best and Kellner, in which they first recommend that parents see and touch the dead newborn as part of the elaboration of duel. All this in a context of helping parents realize death and accept it.
It is considered that the end of the nursing is to provide care to the woman and her family, so that she can help them in the acceptance of the death of a loved one. This is a problem for health professionals because there is a lack of knowledge about how to behave in negative situations, and a tendency to avoid them. It does not educate and teach about death, and even less at a time when the opposite is expected, give life.
The field of approach to the perinatal death is very little explored, so there is little evidence about the actions and strategies that can be used with positive results. What arises is to know what meaning for parents the loss of their child, and based on this to raise the care that will be carried out.
Conclusions
One of the strategies that are currently being carried out, is the creation of souvenir boxes that allow parentsHospital bracelet and hair strands among others, in order to help them in their grieving process.
Other strategies that are used are: teaching and letting the dead newborn touch, how Kirkley-Best and Kellner introduced, facilitate an intimate space for farewell, facilitate the expression of feelings, offer all the information they require, offer psychological support, provideInhibition of breastfeeding or donation of the same. The option of support groups, and even forums and blogs to support mothers through the Internet is also raised.
For all these reasons, it is essential that nursing professionals have knowledge on the subject, and that they acquire skills and skills that allow them to carry out effective communication and support for people who suffer such a duel of this type.
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