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My baby was put in a shared grave

Years after losing her son through hospital blunders, Alvina Carrington discovered a new horror
Denis Campbell, health correspondent
Sunday December 2, 2007
The Observer

In late 2004, on a visit to her son's grave, Alvina Carrington was surprised to find fresh flowers. 'I knew I hadn't put them there, so I thought it was odd,' she recalls. But Alvina assumed a friend or member of her family had brought them, and was touched someone had made the journey to Alperton cemetery on the north-west fringes of London to remember Luke, who had been stillborn at seven months.

After his death in October 2003 Alvina's life fell apart. She had lost the first child she desperately wanted and had spent six years trying for. An appalling series of blunders by doctors and midwives meant her pre-eclampsia went unidentified, with fatal consequences. Amid the shock, grief and anger, her relationship broke up. Previously very sociable, the 33-year-old became introverted and virtually housebound. She gave up her job, unable to stop crying every night after she got home. Alvina thought she had reached the lowest point of her life.

But more than a year after that trip to the cemetery, in early 2006, she suffered another heartbreak. In the course of asking what sort of headstone she could put on Luke's grave, Alvina discovered that what she thought was her son's final resting place also contained the bodies of several other babies. The flowers were for one of them, not Luke.

'I'd rung the cemetery, told them Luke was buried there, given them the plot number and asked them what size of headstone I could erect. I'd decided that I was going to have gold lettering saying "Blue: in our hearts always", because that was the nickname I'd given him, and then 'Luke' underneath.

'That would have been the final act. But the cemetery people explained to me that it wasn't my property, that it belonged to Brent Council, that I'd need to get their permission for the headstone and that there were other babies in the grave,' says Alvina. 'I was devastated. I thought it was Luke's grave and only Luke's grave, and that it was my property. I thought the cemetery had got it wrong. But they said to me: "It should have been explained to you that the grave belongs to the council and that other babies are there."

'I wanted to know how many other babies were in there beside Luke, and whether they were on top of each other or side by side. I wanted to know if there was another baby on top of Luke.'

More

Half of Stillbirths Related to Placental Pathology

Thanks to Niobe for sending in this article

Interview with Dr. Gordon Smith, MD
November 16, 2007 - Insidermedicine

Most stillbirths occur as a result of a failing placenta, and understanding placental development and functioning may hold the key to identifying those at high risk for stillbirth early on, according to research published in The Lancet.

According to the Antepartum Fetal Surveillance Guidelines put forth by the American College of Obstetricians and Gynecologists (ACOG):

• Women with high-risk factors for stillbirth should undergo antepartum fetal surveillance using the nonstress test (NST), contraction stress test (CST), biophysical profile (BPP), or modified BPP. Testing should be initiated at 32 to 34 weeks for most pregnancies and at 26 to 28 weeks for very high risk women.
• An abnormal NST or modified BPP usually should be further evaluated by either a CST or a full BPP. Subsequent management should then be predicated on the results of the CST or BPP, the gestational age, the degree of oligohydramnios (if assessed), and the maternal condition.
• In the absence of obstetric contraindications, delivery of the fetus with an abnormal test result often may be attempted by induction of labor with continuous monitoring of the fetal heart rate and contractions. If repetitive late decelerations are observed, cesarean delivery generally is indicated.

In an effort to better understand why stillbirth rates have remained the same or even risen slightly over the past several decades, the investigators reviewed the literature on this condition dating back as far as 1997. They discovered that the standard screening technique, consisting of measuring the height of the uterus with a tape measure, has not changed in four decades. While other more high tech screening procedures have been tried, none has been shown to improve outcomes.

We had a chance to speak with Dr. Gordon Smith from the University of Cambridge about his findings, and what must be done in the research community to address stillbirth.Most cases of stillbirth can be linked to a failing placenta, including premature detachment from the uterus, failure to provide the fetus with adequate oxygenated blood, and problems associated with pre-eclampsia.

When the placenta fails late in a pregnancy it typically failed to develop properly in the first place. As a result, a stillbirth that occurs late in pregnancy may be the result of improper placental development occurring very early on in the pregnancy.Today's research highlights the role of the developing placenta in stillbirth. One way of reducing the rate of stillbirth may be to further investigate how the placenta develops and functions. Such research may provide important insight into how to develop screening tools that identify those at highest risk for stillbirth.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.

The Approach of the Holiday Season

We had twins in May, and lost our daughter, Lydia; she was stillborn. We also have 2 older children.

I want to find a way to remember and honor Lydia over the holiday season. This is so important to me especially since it was in December of last year that we discovered we were having twins. We typically get all our children new ornaments for the tree each year, something that represents something special to them that year. I plan on getting Lydia an ornament, too – but I’m not sure what kind. Do I start a tradition and buy her a similar item each year? (An angel, a bird, a teddy bear?)

And what else can I do over the holiday season, to honor her memory? I’d really love to hear what other parents have done or will be doing this year.

Thanks,

Michelle
zoromski.blogspot.com

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The Loss of an Infant -- Universal Grief and Transcultural Education

Updated to include the whole article so you don't have to sign in or register.

The Loss of an Infant -- Universal Grief and Transcultural Education CE
Maureen O'Reilly, RNC, APNP Disclosures

Universal Grief and Cultural Funerals

Nurses who work in neonatal intensive care units (NICUs) may believe that dealing with the loss of an infant improved immensely in the late 20th century -- suddenly, parents were encouraged to hold their infant at death, given hair locks to keep, and given pictures to share with family. Remembering that parents in the 18th and 19th centuries dealt with much more frequent infant loss, Marylouise Martin, MSN, RNC, Clinical Nurse Specialist, McLeod Regional Medical Center, Florence, South Carolina, pointed to diaries, letters, and postmortem pictures those long-ago parents used to comfort themselves. Martin's presentation on the "Transcultural Perspective of Perinatal Loss and Bereavement"[1] made it plain: not much in parental grief has changed. NICUs, however, have continued to expand their understanding of how to work with grieving parents of many ethnicities and religions as they express their culture while mourning in the 21st century.

Martin's summary may have begun with history, but her take on the transcultural outlook on dealing with grieving parents was thoroughly modern. Developing cultural proficiency assists nurses in dealing with families of varying ethnocultural and religious backgrounds during their grief, and has 5 elements: (1) knowing your own cultural values, (2) developing cultural knowledge, (3) awareness and acceptance of differences, (4) understanding the dynamics of those differences, and (5) adapting practice to fit the family's cultural background. Callister wrote that, "Support received by professionals is critical in the long-term adjustment of childbearing families coping with perinatal loss."[2] Cultural proficiency forms the basis of such support.

Mourning Rites and Culture
Caregivers need to know basics of cultural traditions -- that Jewish families bury their dead within 24 hours and the Old Amish will not accept photographs of the infant. Beliefs about the afterlife may also affect a family member's actions at this time -- Muslims may see death as a natural stage of life, Native American mourners may see death as another step in life when the spirit must be released, and African Americans may believe death is not the end and have a fervent belief of reunion in Heaven with their lost child.

What is "normal" in funeral rites varies widely also. Asian-Chinese families minimize recognition of a child's death because formalities are reserved for those over 18, as "adults." American Christians may have a full funeral following "anointing of the sick" rites and baptism predeath. Roman Catholics will plan a funeral where the body is on view and eschew cremation in favor of burial. Muslims prefer to have the body washed in running water and wrapped in white cloth, with the body placed in-ground, positioned on its right side and facing Mecca.

The outward expression of grief after the loss of a child is directly tied to the family's cultural backdrop. Martin pointed out that Hispanic/Latino families, especially women, may be vocal in grief, and display "ataque de nervios," with shaking and seizure-like activity accepted as normal within their culture but upsetting to culturally unaware caregivers observing the event. On the other hand, Latino fathers may appear especially stoic, as part of the tradition known as "machismo," and seem uncaring to onlookers, while actually being deeply affected.

African Americans may delay funeral and burial until distant family members arrive, in the belief that all must have the chance to mourn directly, and vocal grief is acceptable, especially during church services and at the graveside. Muslim families accept tears at death, and dignity at interment is highly valued, with the family walking behind the body on its way to the mosque. Amish families prize privacy in their grief and may discuss their loss minimally in public.

Developing Culturally Proficient Caregivers
Most labor and delivery units and NICUs currently offer "remembrances" to families after a perinatal loss, including items such as the identification bracelet, photographs, hair locks, clothing worn by the infant, footprints and handprints, and ultrasound prints. Martin emphasized that, even with well-developed cultural awareness, every family should be asked about the items that may have meaning to them and have their wishes met on an individual basis.

As families acculturate in the United States, it's not uncommon for them to incorporate at least some changes that are acceptable within their own culture. As Davies reported in 2004, traditional perspectives on grief, emphasizing separateness, are being transformed into a new stress on "connectedness" and the mourner's role in the social world.[3] Remembrance items and their restrictions due to family culture may apply in the most general manner, but astute caregivers ask parents to voice their needs -- as Clements and colleagues noted, "Death, grief, and bereavement are very personal experiences."[4]

Nursing units dealing with perinatal loss have several avenues open to them in developing transcultural awareness of grief practices. First, educators may make available brief summaries, such as current articles dealing with common cultural beliefs, for staff to read and use in practice. A more in-depth summary of varied beliefs is available in texts such as Death and Bereavement Across Cultures[5] or Ethnic Variations in Dying, Death, and Grief: Diversity in Universality,[6] which includes facts such as a withdrawal from community life for up to 7 years may be "normal" for the Egyptian mother, following the loss of a child.

In a further step toward integrating transcultural awareness, Martin has developed a Transcultural Training Program, and she encouraged listeners to consider this in their own practice areas. The program provides basic cultural education and methods for nurses to incorporate cultural assessment and proficiency into their daily work. Capitulo advocated for online grief support groups, where the theme was "shared metamorphosis," allowing transcendence of cultural beliefs and the sharing of remembrance and memories.[7] Although not all family members will have access to the Internet to join such groups, it's clear such methods offer hope and support to geographically or socially isolated mourners and are worth the effort of caregivers to offer to all cultural perspectives.

When loss occurs in a family, the ability to find meaning in the death and involve family members in rituals and mourning offers comfort and support to parents, siblings, and grandparents. Martin offered an overview of specific practices found in a wide array of ethnic and religious backgrounds, with the caveat to always remember the individual's wishes. A culturally proficient caregiver offers respect for the family's beliefs and dignity for the dead.

Link to article

Handle with care

Handle with care
October 6, 2007
Sydney Morning Herald
Kate Benson and Bellinda Kontominas.


Karina Jensen was halfway through delivering her dead baby at Sutherland hospital when a midwife handed her funeral brochures, suggesting she read them between contractions because "we have other people with live babies that are our priority".

After holding her daughter, Amber, for less than two hours, Jensen said farewell on advice from a midwife who wanted her "cooled at the morgue because it's better for the post-mortem" - only to find her dead baby then spent 10 hours alone and uncovered in a corridor of the busy maternity unit.

"It was a horrifying experience," she says. "Amber was right outside my room all night and I didn't know it. My husband, Jack, found her. She had been born at 9pm and he had left to go home about midnight. He saw her in a crib in the hallway and thought she'd be taken to the morgue soon. But the next morning when he came back she was still there in the corridor, with mothers walking past."

Jensen says she spent all night listening to other women in labour and the piercing cries of newborns, before discharging herself the next morning.

"It's such a small thing, but being in the maternity ward that night made a painful process that much more painful. It rubbed salt in my wounds."

A day later Jack Jensen received a phone call from a staff member at the hospital asking him to bring Amber back for a hearing check as they had "rushed off" before it could be done. Stunned, he replied: "Our daughter is in your morgue. If you find out that she can hear anything, you give us a call and we'll come get her."

But their agonising experience does not ring true for all parents.

Fiona van der Plaat's first child, Nicholas, died hours after birth at Royal Prince Alfred Hospital in 1998 and, even though she spent five days on the postnatal ward with mothers and newborns, apologetic staff gave her a room of her own as far from the sound of crying babies as possible.

Van der Plaat and her husband, Paul, were allowed to hold Nicholas for as long as they needed after his death. They were given photos of them as a family, a lock of his fair hair and prints of his tiny hands and feet. For days afterwards, midwives would bring Nicholas back from the morgue so relatives could meet him and find closure.

"He had had a post-mortem but they had dressed him in a knitted cap and a blanket so we couldn't tell and they were very encouraging that we should all hold him," van der Plaat says. "It was an extremely painful experience but we couldn't have been treated any better."

For Michael Grosvenor, those emotionally charged weeks after the stillbirth of his daughter, Amelia, left him with little time to mourn. Funeral arrangements and phone calls had to be made to inform family and friends of the couple's loss, but he says he and his wife, Suzanne, were treated with great sensitivity at Calvary Health Care, formerly Hurstville Private Community Hospital.

"You couldn't fault them. The nursing staff went beyond the call of duty, and one even came back to see us on her day off," he says.

The Grosvenors were given all the time they needed with Amelia. Their family and close friends were allowed to visit at all hours and midwives comforted and supported them. More

Blog day for the MOTHERS act, October 24, 2007

Bloggers across the country encouraged to call their U.S. Senator on Wednesday, October 24, 2007 in support of The MOTHERS Act.

Postpartum Support International, the world largest non profit organization devoted to the support of perinatal mental health, has joined forces with BlogHer, the web number one guide to women bloggers and Postpartum Progress the leading blog in the U.S. on postpartum mood disorders to galvanize support for the passage of The MOTHERS Act - The Moms Opportunity to Access Help, Education, Research and Support for Postpartum Depression Act. On Wednesday, October 24th, bloggers across the country will write about taking action on this critical legislation by placing calls to their state's senators urging sponsorship and support of The MOTHERS Act.

The MOTHERS Act, sponsored by U.S. Senators Robert Menendez, (D-NJ) and Richard Durbin (D-IL) will ensure that new moms and their families are educated about PPD, screened for symptoms, and provided with essential services. It will also increase research into the causes,
diagnoses and treatments for postpartum depression.

Specifically, the MOTHERS Act will help new moms by:

Providing important education and screening on postpartum depression (PPD) that can lead to early identification and treatment. The legislation includes two grants to help health care providers educate, identify and treat PPD.

Expanding important research to improve and discover new treatments, diagnostic tools and educational materials for providers. Since the exact cause of PPD isn't known, research continues to be the key to unlocking the mystery of this condition.

Postpartum depression is a serious and disabling condition that affects up to 20 percent of new mothers - 800,000 American women each year. Yet only 15 percent of these women will receive any assessment or treatment .Untreated, consequences of maternal mood disorders range from chronic, disabling depression to death. Consequences of untreated
maternal depression on infants/children range from behavioral and learning disabilities to depression and death.

Susan Dowd Stone, president of Postpartum Support International states "The good news is that perinatal mood disorders are preventable and easily treated once detected. The MOTHERS Act legislation is key because its initiatives are preventive, educational and treatment oriented. PSI urges you to participate in this important campaign."

Lisa Stone, BlogHer Co-founder and CEO, said "The BlogHer community has chosen Global Health as the focus for our year-long blogging activism initiative, BlogHers Act. Blog Day for the MOTHERS Act is exactly the kind of project where BlogHer's community can make a
difference on legislation that will save women's lives."

Katherine Stone, author of the Posptartum Progress blog, adds "Postpartum mood disorders are a disease of motherhood -- they can affect any woman who becomes a mother, regardless of who she is. If we don't do something to better educate and treat the mothers who may suffer, we are doing a disservice to all mothers, children and families everywhere. All it takes is a phone call to let the Senate know that the women of America want the MOTHERS Act to pass."


Postpartum Support International is the world's largest nonprofit organization offering support, referrals, education, training, and resources to health care providers, women, and families coping with perinatal mood disorders. With coordinators in 49 states and 29
countries around the world, PSI is well-positioned to continue its mission of eradicating perinatal mental illness in every community worldwide. Thousands of women and concerned family members call our national warm line each year, attend our annual conference for
healthcare providers and consumers, and visit our website to find local resources and support. PSI's website www.postpartum.net warmline 1-800-944-4773.

MISS Foundation-From Hopelessness to Hope

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For grieving parents, an investigation

By Lee Bowman Scripps Howard News Service

It starts with a phone call about a small life suddenly ended, about a baby found lifeless, unable to be revived.

Almost all of the more than 4,000 sudden and unexpected infant deaths in this country each year prompt an autopsy and a detailed investigation into the circumstances.

Details vary from jurisdiction to jurisdiction, but most of the time, the investigation begins at a hospital. Emergency medical workers usually try to resuscitate infants who aren't breathing, and rarely concede the fight before getting a baby to an emergency department.

But whether an infant is pronounced dead at a hospital, the home or some other setting, the need for police or investigators from the local coroner or medical examiner to quickly begin gathering facts inevitably intrudes on grieving families.

"The shock hit me so hard at the hospital," said April Poole of Huntsburg, Ohio, of the moments after she lost her daughter, Sommer, in 2005.

"After they pronounced her, they let me into the room to see her, but they'd left the breathing tube in her throat. It just seemed so cold to me."

Rachel Yerbich, whose son, Benjamin Allen, died suddenly in Granite Falls, Minn., last September, recalls spending much of the night holding her son in a family room of the ER.

"They unhooked him from all the machines and let me carry him in there and say goodbye, let my family gather with me to say goodbye," she said.

But other parents report not being able to hold, or even touch, their dead infant at a death scene, even at the hospital.

"There are some medical examiners who are totally against allowing contact with the infant's body before the investigation," said Dr. Deborah Kay, assistant chief medical examiner for the Virginia Office of the Chief Medical Examiner's central region in Richmond.

Kay said the Virginia medical examiner is issuing new guidelines for physicians and hospitals caring for infants and children who die suddenly and unexpectedly and whose deaths are subject to investigation.

"We wanted to have some consistency in what's being done around the state, while trying to be compassionate to the families," Kay said. More

'I set up website to commemorate son'

'I set up website to commemorate son'
Jane Elliott Health reporter, BBC News

When Helen Savage lost her first baby at 39 weeks she and her entire family were devastated.

Little Samuel was to have been the first grand-child on either side of the family and his arrival was very much anticipated.

But just a week before being born he had died from Group B streptococcus - one woman in four carries this bacteria in her vagina, although she may have no symptoms and be unaware it is there. Babies can come into contact with it while still in the womb or during birth. Some develop serious conditions like pneumonia, meningitis or septicaemia, while, others, like Samuel die.

Some women know they are at risk of the infection, because of previous problems, a premature rupture of their membranes, or because a urine test during pregnancy, reveals that they have the infection. But in Helen's case there were no indication and she only found out the cause of death six weeks later.

"I had a trouble free pregnancy," said Helen, 29, from Lisburn, Northern Ireland.
"We first found out we were expecting Samuel in June 2004, and from the moment we saw two lines on the pregnancy test we were so excited about his arrival. Daddy was sure he was a boy right from the start, but Mummy took a bit more convincing. More

Many baby deaths 'can be stopped'

Growth problems could be spotted during pregnancy

As many as 1,000 stillbirths each year could be prevented if clinicians were able to spot when foetuses were not developing properly, a study suggests.

The NHS's Perinatal Institute will unveil research this week which points to "restricted foetal growth" as the key factor in many stillbirths. If this was picked up in pregnancy, these babies could be delivered earlier and have a greater chance of survival.

Britain has one of the highest stillbirth rates in Western Europe.

The 10-year-study by the Perinatal Institute found that some 40% of the 4,000 babies stillborn each year have growth problems. Of these, around two thirds may have survived if action had been taken.

"We are excited about these findings," said the institute's director, Professor Jason Gardosi.

"If we can recognise that babies are not growing as they should then they can be further investigated and, if necessary, delivered at the right time, and in a good condition, rather than being left in the womb and at continued risk of dying."

Professor Gardosi said in addition to the findings on foetal growth in relation to stillbirth, researchers were also starting to identify "an issue about resources", particularly when it came to the number of cases midwives must deal with.

These remarks chime with statements made by the new president of the Royal College of Obstetricians and Gynaecologists, Professor Sabaratnam Arulkumaran, who believes there are too few consultants and midwives to guarantee the safety of mothers and babies.

In a speech next month, he will cite data showing that most babies die during the night when hospitals have fewer consultants on duty. In an interview with the BBC last month, he said he believed there was too much focus currently on allowing women to give birth at home, and not enough attention on improving conditions in hospital where the majority ultimately give birth.

The tragic human cost of NHS baby blunders

Errors and negligence that result in stillbirths or disabled babies are costing Britain's hospitals billions in compensation. In this investigation, The Observer reveals how staff shortages are wrecking the lives of countless parents.

Denis Campbell
Sunday September 23, 2007
The Observer

What began as a routine pregnancy but turned into a tragedy for one family will finally end this week in a West Midlands courtroom. The hospital charged with caring for the mother will finally agree to pay £5m in damages to the parents of a boy left in a wheelchair, unable to communicate or do anything for himself, after suffering cerebral palsy because of mistakes made by staff during his birth.

It might sound like a lot of money. But consider - it costs £120,000 a year to provide the 24-hour, all-year-round care needed by the boy, who is now 16. The imminent award also reflects the fact that he will never be able to work, and that his parents have had to move to a bungalow and had it specially adapted to cope with his needs, such as a therapy room where he tries to do gentle exercises to stop his muscles from wasting away from moving around so little.

His parents, who have asked not to be named for legal reasons, would rather it had never come to this. 'When I told the boy's father that the report into the case we had commissioned from an independent obstetrician had said that it was negligence, that someone at the hospital hadn't done their job properly and that the care was sub-standard, he began crying,' recalls the family's lawyer, Lindsay Gibb, of solicitors Irwin Mitchell in Birmingham. 'He wanted us to tell him that it was no one's fault, that it was just one of those things, so to learn that it was avoidable was very difficult for him.'

The hospital's first blunder was to send the boy's mother home after hospital staff had failed to induce the birth. An expert witness who gave evidence for the family said that, given the late stage of her labour, she should definitely have been kept in until the baby arrived, if necessary by Caesarean section.

Later, when she was back in hospital again, the child became distressed while he was being delivered and suffered a sudden loss of air to his brain when meconium, the result of his first bowel movement, seeped into his lungs.

Usually, when maternity staff realise that is occurring, they suck out the meconium. But when the anxious personnel attending the woman sought advice by phone from a neonatologist, a specialist in dealing with newborn babies, the doctor seems to have failed to appreciate how serious the situation was. Her guidance meant nothing was done to tackle the baby's oxygen starvation and respiratory collapse. More

Stillbirth Support Symposium

First Candle (SIDS Alliance) is pleased to announce that it will host its inaugural Stillbirth Support & Advocacy Symposium October 22-23, 2007.

Set to coincide with a meeting of the Stillbirth Collaborative Research Network, the symposium will offer stillbirth parents an opportunity to hear from leading stillbirth researchers and meet with representatives on Capitol Hill. Additionally, we will launch a National Stillbirth Peer Support Network, providing training to peer advocates who will offer support to bereaved families in their communities.

As space is limited, First Candle is asking interested individuals to complete a pre-registration application on the First Candle web site at www.firstcandle.org. It is their goal to select a geographically diverse, ambitious group of participants that will help us gain the momentum needed to push this important agenda forward.

Deborah Boyd
Executive Director
First Candle/SIDS Alliance
Phone: 1-800-221-7437