In today’s issue

👋 Special announcement and survey
🔗 The best links I found this week
📖 Deep dive: Part 1 of 3: Preparing your patient for the first 24hrs after a stillbirth discharge
🩷 Self-care moment: Book recommendation

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🔗 My Favorite Finds This Week

🏠 First Day Home Guide Star Legacy Foundation's comprehensive guide for families on what to expect during the first day home after hospital discharge following stillbirth. (Star Legacy Foundation)

🧊 Cooling Myths debunked Resolve Through Sharing's evidence-based guide debunks common cooling misconceptions after perinatal death, emphasizing that quality bereavement care depends on relationships, not equipment. Essential reading for any L&D nurse. (Resolve Through Sharing)

📷 Declining photos How to respond to a patient who isn’t intersted in photos of their stillborn baby (Forget Me Not on Instagram)

📖 Deep Dive

Part 1 of 3: Preparing your patient for the first 24hrs after being discharged

Note: This deep dive will be a three-part series about supporting pregnancy loss patients and families after hospital care.

For many parents, leaving the hospital without their baby after a stillbirth is when the grief reaaally starts to kick in.

As L&D nurses, your support doesn't end at discharge. In fact, the first 24 hours at home may be where families need your preparation and guidance most. Research shows that women who experienced stillbirth were 1.47 times more likely to be readmitted within 6 weeks compared to women with live births. Nearly 68% of women who experienced stillbirth are being discharged in under 2 days (compared to just 31% of women with live births).

The Preparation Before Discharge: Permission and Timing

Do’s to: Gauging Readiness for Information

1. ✅ Ask permission - "I wanted to find a good time to walk through what you might experience in your first day at home, is now a good time for that?"

2. ✅ Assess their state of mind - Watch for signs of overwhelm or emotional shutdown. If you notice either, consider saying: "We don't have to talk about all of this right now. I can write down key points for you to look at when you're ready."

3. ✅ Create a comfortable environment - Ensure privacy, minimize interruptions, and sit at eye level rather than standing over them.

4. ✅ Be prepared to repeat gently - "I know this is a lot to take in. I'm happy to go over anything again later or tomorrow."

5. ✅ Offer written materials - "I'll provide all of this in writing too, so you don't need to remember everything now."

Physical Recovery Preparation

Parents need clear information about what to expect physically after leaving the hospital. Many are unaware that their bodies won't recognize the baby has died, and they'll experience typical postpartum symptoms including heavy bleeding, cramping, and breast milk production.

Key discussion points before discharge:

1. Breast changes and milk production
   Explain that milk typically comes in 1-3 days after birth. Discuss options for:

   • Medication (dopamine agonists) to suppress milk production

   • Non-medication management techniques including ice packs with cloth covers, well-fitting supportive bras, and pain relief medication

   • The option of milk donation if desired

2. Vaginal recovery or C-section care
   Provide detailed instructions on caring for stitches, managing pain, and identifying signs of infection. For C-section recovery, ensure they understand wound care and activity restrictions.

3. Postpartum bleeding expectations
   Explain that lochia will be heavy for about 2 weeks, then lighter until around 6 weeks after birth. Discuss when bleeding patterns warrant medical attention (filling a large pad in 1-2 hours or passing clots larger than a £2/quarter coin).

Emotional Preparation: The First 24 Hours

Warn families about emotional waves that will hit when they arrive home. Studies indicate that the first few days may involve irregular sleeping and eating patterns. Encourage them to rest whenever possible and accept help from others.

Discussion points:

1. The empty nursery
   Rather than making assumptions, approach this sensitive topic with care: "Would it be helpful if I talked with a family member or friend about the nursery and baby items at home? Some parents find it comforting to have these items put away before they return home, while others prefer to handle this themselves. What feels right for you?"

This conversation is best held with the mother directly if she's receptive, or with a support person with her permission. Respect that different mothers will have different preferences for how they want to handle the physical reminders of their baby.

2. Sleep disruption preparation
   Many bereaved parents report that waking up is particularly difficult. Research indicates that sleep disruption in the first 24 hours correlates with increased risk of complicated grief and PTSD symptoms. Some centers now provide short-term sleep aids and relaxation techniques as part of discharge planning.

3. Grief manifestation education
   Help parents understand they may experience feelings of shock, devastation, numbness, anger, guilt, and depression. Some may want isolation while others need family nearby.

Practical Support: Equipping Families for the First Day Home

Memory Making and Documentation

Remind parents to bring home any keepsakes (photos, blankets, footprints, handprints) from the hospital. As one forum commenter advised: "You may not feel like it now but you'll wish you did later."

Communication Planning

1. Prepare parents for awkward silence and avoidance
   Let them know that many people will be uncomfortable and may avoid mentioning their baby or loss entirely. This silence can feel like their baby has been forgotten or doesn't matter. Discuss strategies for addressing this:

   • Preparing simple responses like "Yes, it's hard. We're taking it day by day."

   • Giving close friends/family permission to talk about the baby

   • Understanding that others' discomfort comes from not wanting to cause more pain

2. Help parents craft their announcement strategy

   • Do they want to tell people individually or have a designated person share the news?

   • Would they prefer text communication over phone calls in the first 24 hours?

   • Should they prepare a brief statement to share as needed?

Support System Activation

Discuss the importance of having a support system in place. Help them identify who can help with meals, household tasks, or just be present. Studies show that verbal instructions alone are retained at less than 20% after emotional trauma. Providing written, specific self-care instructions with visual aids significantly improves adherence and reduces complications.

Best Practices Summary

Before discharge, consider implementing this checklist:

1. Medical preparation 🩺

   • Review written instructions for physical recovery

   • Discuss medication for milk suppression options

   • Provide warning signs that require medical attention

   • Schedule follow-up appointment

2. Emotional preparation 💛

   • Discuss what the first night might feel like

   • Provide grounding techniques for overwhelming moments

   • Connect to peer support options

3. Home preparation 🏡

   • Discuss nursery and baby items management

   • Identify key support person for first 24 hours

   • Create contact plan with healthcare team

Specific instruction on managing afterpains, breast discomfort, and perineal pain significantly reduces these incidents. With 11 days being the median time to readmission, but many women being readmitted even earlier, the first 24 hours represents a critical intervention window for preventing complications and supporting families.

Remember

Your preparation of these families for the first 24 hours at home can significantly impact their grief journey. By providing comprehensive education on physical recovery, emotional expectations, and practical support strategies, you help create a foundation for healing during one of life's most difficult transitions.

This list is not exhaustive, but provides a good outline to help gently educate your patient as they begin their grief journey. Research shows that parents who receive proactive contact from healthcare providers within 24 hours of discharge have better psychological outcomes, so consider implementing a next-day call protocol as part of your standard care.

🩷 Self-care moment

Finding Your Ikigai (100% joy)

I'm halfway through this book and can't stop thinking about you all. As bereavement nurses, you embody ikigai - where your skills, compassion, livelihood, and the world's needs perfectly intersect. When the emotional weight feels heavy, remember: your presence during families' darkest moments creates ripples of healing. That's not just nursing—that's purpose.

source: García, H., & Miralles, F. (2017). Ikigai: The Japanese Secret to a Long and Happy Life. Penguin Books.

👎 I didn’t learn anything new

👍 Good information

💯 Very valuable