A diagnosis of trisomy 18 occurs in approximately one of every 3,000 live births. The devastating news of any diagnosis that is incompatible with life affects the parents, their families, and the healthcare worker. Though uncommon, lethal fetal diagnosis needs to be dealt with proactively. An effective perinatal bereavement program can be used to work with the family to make a plan of care that is realistic and expectant. Once shared, this plan can be an effective way for nursing, physicians, midwives, clergy, and social work to create the best of an imperfect scenario for all involved.
A 39-year-old multigravida patient presented to her routine office visit after a diagnosis of fetal trisomy 18. The physician wanted the patient's labor and delivery experience to be well coordinated with the obstetric (OB) nursing department. Once the patient and her husband met with the OB nurse manager, she realized that the family had a knowledge deficit and somewhat unrealistic expectations for the potential outcome. The OB nurse manager arranged for the patient and her husband to meet with the perinatal center's bereavement manager to discuss a plan of care that would meet their needs. The plan was then shared with the obstetrician, the OB staff nurses, the hospital clergy and social service department, and the pediatrician who would be caring for the infant. Despite having a heart rate during labor, the infant delivered in frank breech position with no heart rate. Per the patient's request and plan of care made in advance, no resuscitation was performed. The patient was able to spend several hours with the infant and was discharged home on postpartum day 1. The family was very pleased with all of the planning and care that went into the delivery of the infant, the postmortem care, and the compassion displayed by the healthcare team.
Despite not having a perinatal bereavement program available at a small community hospital, the regional perinatal center's bereavement program was utilized to create a multiagency, multidisciplinary approach to the care of a patient with a lethal fetal diagnosis. Creating a collaborative effort is essential to assist patients in all aspects of care delivery. Communicating the needs of this patient to all departments involved prepared the healthcare providers to meet and exceed the needs of this family.