Viewing the fetus following termination of pregnancy for fetal anomaly.

OBJECTIVES: To determine what evidence exists to support the practice of viewing the deceased fetus by women terminating pregnancy for fetal anomalies. DATA SOURCES: Electronic databases searched (1966-2007) were Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Dissertation Abstracts Index. STUDY SELECTION: Literature was reviewed that either directly or parenthetically dealt with the emotional effects on women of viewing the fetus post termination of pregnancy for fetal anomalies. DATA EXTRACTION: No randomized or controlled trials were found. The main conclusion of each article was noted. DATA SYNTHESIS: Topical focus is on viewing of the fetus by women following termination of pregnancy for fetal anomalies. Thematic emphasis is on the beneficial and detrimental aspects of fetal viewing assumed by obstetric nurses and physicians and by mental health practitioners. CONCLUSIONS: Despite an absence of empirical evidence, most articles concluded that viewing of the fetus by women post termination of pregnancy for fetal anomalies is beneficial and should be promoted. Concerns are expressed that health professionals may be inadvertently encouraging women and their partners to see the fetus because of their own or their institution's particular beliefs and practices. Health professionals must remain mindful of their underlying motives and stay open to respecting the decision of women who conclude that viewing is not appropriate for them.

Termination of pregnancy: a case for a change in the law.

In recent months there has been renewed public and parliamentary debate on whether the abortion law in the United Kingdom should be reformed. Parliament has debated the issue on three occasions and now the House of Commons Select Committee on Science and Technology are calling for evidence in support of their inquiry into reform of the Abortion Act 1967. The inquiry gives district nurses the opportunity to inform the debate and ensure that their voices are heard given that topics for reform include nurse-led abortions and home abortions. In this article Richard Griffith and Cassam Tengnah review the development of the law relating to abortion and highlight the areas of reform to be considered by the select committee.

Our first child was incompatible with life: understanding miscarriage as a lived experience.

Miscarriage as a medical experience is removed several times from the lived experience of a mother, partner and family. Often there is no space to grieve and mourn to facilitate that. In this article it will be shown that the lived experience of a miscarriage challenges the notion of care and loss forever. Ask a woman the memory is always there and very often the pain. It's important to let the wisdom of sadness speak and emotions to flow unhurried. Emotions need to be set free. What is less appreciated is that professional carers often feel at a loss themselves and they too need love and support. Staff and relatives are sometimes in different contexts of awareness and information about diagnosis and all aspects of care often need to be translated The experience of loss is not only related to death but to loss of hope, dreams, function and handing over care to another carer. Dealing with loss is a feature of being human, but dealing with multiple losses is sadly often a part of being a practicing nurse and midwife. It is time to really appreciate what it means to live through a miscarriage. What we need now to do is move beyond a medical experience into creating a space where a woman can feel safe and loved to grieve for all that is lost and all that could have been.

An alternative to surgery in treating ectopic pregnancy.

In an ectopic pregnancy the fertilised egg becomes implanted outside the uterus. It affects around one in every hundred pregnancies. Traditionally the condition has been managed surgically. However, in recent years many women have been treated with methotrexate therapy.

Palatable truth.

Parents can be devastated when a scan reveals their expected baby has a cleft palate. Nurses working in this specialist field can offer support and practical information to help parents cope.

Effectiveness of a nurse-led pregnancy termination clinic.

A new nurse-led service was developed for women requesting pregnancy termination. Compared with the previous service, the nurse-led clinic reduced waiting times and cost almost 40 per cent less.

Nurses' attitudes toward pregnancy termination in the labor and delivery setting.

OBJECTIVE: To examine nurses' attitudes toward pregnancy termination in the labor and delivery setting and the frequency of nurse refusal to care for patients undergoing pregnancy termination. DESIGN: Nonexperimental, descriptive study. SETTING: Six central and northern California hospitals, including Level 1, 2, and 3 facilities. PARTICIPANTS: Seventy-five labor and delivery registered nurses. METHOD: Anonymous survey with visual analog scales. RESULTS: Ninety-five percent of the nurses indicated they would agree to care for patients terminating a pregnancy because of fetal demise, 77% would care for patients terminating a fetus with anomalies that were incompatible with life, and 37% would care for patients terminating for serious but nonlethal anomalies, with a significant drop in agreement as gestation advanced. Few nurses would agree to care for patients undergoing termination for sex selection, selective reduction, or personal reasons. Nurses both accepting and refusing patient care assignments were criticized by coworkers. CONCLUSION: Clear guidelines should be established on how to handle nurse refusal to care for patients terminating pregnancy in advance. Open discussions should be encouraged between staff and management to minimize criticism.

Between professional duty and ethical confusion: midwives and selective termination of pregnancy.

This qualitative study describes midwives' experiences in relation to termination of pregnancy for fetal abnormalities, and their corresponding professional and ethical position. Thirteen midwives working in a university clinic were interviewed about their problems in this respect. The information gathered was evaluated by using qualitative content analysis. The study focused on the emotional experience of the midwives, their professional position, and ethical conflict. In this situation, midwives are faced with a conflict between the woman's right to self-determination on one hand and the right to life of the child on the other. This conflict causes a high level of emotional stress and, subsequently, professional identity problems. Although questions concerning the child's right to life are generally suppressed, the ethical principle of the woman's right to self-determination is rationalized. Although this process of rationalization seems to present a false ethical decision, it enables midwives to continue with their daily professional duties. As far as orientating midwives to the value of these women's right to self-determination is concerned, it must be assumed that they have made an ethical decision to which they have given insufficient thought. This problem is exacerbated by the fact that midwives are largely excluded from the decision-making process of the parents in question. They cannot therefore help in this process in a valuable and responsible way by providing clear information and proposing objective criteria. In relation to the tasks they are expected to fulfill, these midwives revealed that they were in a state of professional confusion.

Genetic abortion: considerations for patient care.

Women who receive abnormal prenatal diagnosis results potentially face two emotionally difficult decisions. In this article, the first decision--whether or not to terminate the pregnancy--is presented with a discussion of the factors that may influence a women's choice. Women who choose to terminate the pregnancy face a second decision when more than one type of abortion procedure is available. Two second trimester abortion procedures--dilation and evacuation and labor induction--are compared and contrasted to delineate potential advantages and disadvantages of each. The decision-making process is examined, emphasizing the individual ways in which women may weigh this information to make a fully informed decision. In addition, a number of recommendations are offered to health care providers in the role of discussing options and supporting women in their choices.

The midwife's role in pregnancy termination.

The care of women undergoing termination of pregnancy can be extremely stressful and requires considerable skills on the part of nurses involved in their psychological care. The author argues that midwives are in an ideal position to give women and their partners the emotional support they need.

Second-trimester termination of pregnancy: nursing care.

Termination of pregnancy because of fetal abnormalities is a physically and emotionally painful event. Prostaglandin E2 (PGE2) intravaginal suppositories are an effective method for inducing labor. Patient care and pain management require both knowledge and sensitivity on the part of the nurse.

PIP: Nursing management of second trimester abortion by PGE2 suppository after cervical dilatation with laminaria or Lamicel focuses on monitoring and treating side effects, managing pain, and supporting the patient emotionally. Mean abortion time by this method is 15-17 hours, within 24 hours in 80% of women. The side effects expected from PGs are nausea, vomiting, abdominal cramps, and diarrhea. Premedication with transdermal scopolamine, and ancillary methods such as giving ice chips, airing the room, keeping the patient clean are helpful. Acetaminophen is given orally or rectally for fever, headache, or chills. A beta-adrenergic tocolytic drug such as ritodrine HC1 is given if uterine contractions become tetanic, contractions 2-3 per minute or lasting longer than 6-90 seconds, detected by palpation. This drug must be used with caution in patients with asthma. Pain management in midtrimester abortion depends solely on the woman's comfort. Meperidine, morphine, epidural anesthesia with bupivacaine, lidocaine or morphine SO4, or patient-controlled anesthesia may be used. The nurse should monitor side effects such as hypotension, allergic responses, arrhythmias, and inability to void. Midtrimester abortion is often a stress-filled experience, since women may be ambivalent upon learning of fetal abnormalities. The women should be monitored after delivery to ensure that her uterus remains contracted, and assisted if surgical removal of retained products is necessary. Patients teaching for discharge, including medication to prevent lactation, is described. A care plan is suggested for assisting the family with bereavement, based on that used in case of stillbirth or neonatal deaths.