In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: The ATTEND Model: Transforming Bereavement Care Through Mindful Attunement
🩷 Self-care moment: How to protect yourself after supporting a stillborn

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🔗 The Best Resources I Found This Week

🏠 First 24 Hours at Home: Part 1 of 3
This deep dive outlines essential L&D nurse guidance for preparing families for the first 24 hours after discharge. (Forget Me Not)

📖 “Bearing the Unbearable” Quotes
The best quotes from Joanne Cacciatore’s book. (Good Reads)

📊 Stillbirth Disparities Snapshot
1 in 177 U.S. pregnancies ends in stillbirth and underscores racial and regional disparities, such as a 1 in 100 risk for Black families compared to 1 in 223 for white families, plus elevated risks for women over 45, smokers, and multiple gestations. (Counting the Kicks)

Today’s newsletter is sponsored by: Caring Cradle®

Caring Cradle® A Cooling Cradle for Infant Demise

A Caring Cradle® is a cooling bassinet that is designed to allow families more time with their infant that has died. The cradle comes assembled and is ready for use 30 minutes after being plugged in. With the gel mat properly cooled, it allows families to hold their baby and have that extra time they wouldn’t normally have to create memories.

📖 Deep Dive

The ATTEND Model: Transforming Bereavement Care Through Mindful Attunement

At our latest bereavement training event, we were fortunate to have Dr. Joanne Cacciatore as our keynote speaker. As the creator of the groundbreaking ATTEND model and author of 52 published articles (and counting!), Dr. Cacciatore briefly introduced this framework during her presentation. Many of you expressed interest in learning more about this approach, so I'm excited to dive deeper into this revolutionary model that's transforming bereavement care across hospitals and healthcare settings nationwide.

What is the ATTEND Framework?

The ATTEND model represents a paradigm shift in bereavement care, moving away from standardized protocols toward a mindfulness-based approach that honors each family's unique grief journey. This evidence-based framework consists of six interconnected components:

Attunement
Trust
Therapeutic touch
Egalitarianism
Nuance
Death education

At its foundation lies attunement–the cornerstone that enables healthcare providers to remain fully present with grieving families during their most vulnerable moments. This isn't simply about being physically present; it's about cultivating a deep awareness that allows providers to respond with empathy rather than react from their own discomfort.

The Current Crisis in Bereavement Care

The statistics paint a sobering picture of the scope of this challenge.

Despite these numbers, research reveals significant gaps in hospital bereavement care. Only one-third of hospitals provide staff with protected time for perinatal bereavement care, and just six out of 17 bereavement topics are routinely offered by at least two-thirds of hospitals. Even more concerning, only half of hospitals address risks for mental health issues following loss, and fewer than 55% discuss the impact on fathers or partners.

The Evidence Behind Mindful Attunement

Recent neuroimaging studies demonstrate that mindfulness-based bereavement care produces measurable changes in brain connectivity patterns. Researchers found that mindfulness-based cognitive therapy (MBCT) enhanced cognitive control networks while reducing activity in the default mode network–the brain region associated with rumination and self-referential thinking.

In one landmark study of the ATTEND model, 42 traumatically bereaved individuals showed statistically significant improvements across multiple measures. Participants experienced:

• Large effect size reduction in trauma symptoms (Cohen's d = 0.92)

• Medium effect size reduction in anxiety and depression (Cohen's d = 0.70)

• 36% of participants saw scores drop below clinical thresholds for psychopathology

These improvements occurred regardless of time since loss, with some participants entering treatment up to 7 years post-loss.

Practical Application: What Attunement Looks Like for L&D Nurses

Attunement in practice involves specific contemplative practices that providers can integrate into their daily routine. The three-minute breathing space (3MBS) exemplifies this approach:

1. Before entering the room: Take three focused breaths, feeling the rise and fall of your chest

2. Walking to the door: Remember that behind it waits a human being who is suffering and believes you can help

3. Approaching the family: Set the intention to be mindful, present, and compassionate

4. Reflective Presence: During interactions, maintain open posture, gentle eye contact, and silence when needed to mirror the family’s emotions without rushing or offering premature solutions.

5. Mindful Communication: Use soft tone, simple language, and confirm understanding by reflecting back families’ words.

6. Neutral Touch Points: Offer a gentle hand on the shoulder or place a hand over the parents’ hands to convey support when invitations to touch are present.

7. Collaborative Care Planning: Invite parents to choose whether to hold, photograph, or name their baby and involve them in small rituals (e.g., planting a tree, light a candle) to honor personal and cultural preferences.

8. Avoid Checklists: Use flexible guidelines rather than rigid bereavement checklists to honor each family’s timing, privacy needs, and emotional readiness.

9. Debriefing Sessions: Schedule group debriefs within 72 hours of a stillbirth to reflect on emotions, share experiences, and receive peer support.

10. Mindfulness and Self-Compassion: Integrate daily 10–15 minute meditation or quiet time and brief nature breaks between assignments to replenish emotional reserves.

This isn't about perfection - it's about presence. When a mother asks "Why did my baby die?" an attuned provider doesn't rush to fill the silence with explanations. Instead, they sit with the weight of that question, allowing the mother to feel truly heard in her anguish.

🩷 Self-care moment

Caring for families through stillbirth is deeply meaningful yet emotionally taxing. To sustain your well-being and presence, consider integrating these evidence-based self-care practices into your routine:

1. Mindful Breathing Breaks
Take three focused breaths between patient encounters to reset your attention and release tension. Short mindfulness interventions, like an 8-week Mindfulness-Based Stress Reduction program, have been shown to decrease nurse burnout and enhance self-compassion and resilience1.

2. Nature Micro-Escapes
Step outside for a 10–15 minute nature break during your shift. Even brief exposure to green spaces can lower cortisol levels, reduce emotional exhaustion, and improve mood among nurses2.

3. Debrief and Peer Support
Within 72 hours of a stillbirth, convene a structured debrief with colleagues. Interdisciplinary debriefs reduce feelings of isolation, foster shared coping strategies, and can mitigate burnout3.

4. Daily Self-Compassion Ritual
Practice a one-minute self-compassion exercise: place your hand over your heart, acknowledge the difficulty of your work, and offer yourself kind words. Mindfulness training significantly increases self-compassion and emotional well-being in nurses.

5. Scheduled Gratitude Check-Ins
At the end of each shift, jot down one thing that went well or one act of kindness you witnessed. Gratitude exercises boost positive affect and resilience in high-stress healthcare settings.