In Today’s Issue:

🔗 The best links I found this week
📖 Deep dive: Part 2 of 3: What Moms should Expect The First Week After A Stillborn
🩷 Self-care moment: Supporting a Colleague After a Stillbirth Case

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🔗 My Favorite Finds This Week

🗺️ State Laws on Fetal Burial
An interactive map showing fetal burial and cremation laws across the U.S., offering clarity on what’s required in each state. (LawAtlas)

📖 Book for Mothers
When Skies Are Gray is a heartfelt read for grieving mothers. “Your pain is real... And it’s okay to feel that love; it’s a mother’s love, and like lullabies, a mother’s love never dies.” (Amazon)

🕊️ Planning a Memorial
A thoughtful step-by-step guide for families organizing a memorial or funeral for a stillborn baby. (Cake)

💰 Stillbirth Funeral Costs
A helpful breakdown of typical funeral expenses and tips for navigating financial options. (Cake)

📚 Children’s Book Titles for Grief
A curated list of children’s books to help siblings understand and process the loss of a baby. (M.E.N.D.)

📖 Deep Dive

Part 2 of 3: The First Week After A Stillborn Patient is Discharged

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

Last week, we discussed the first 24 hours after a stillbirth, focusing on the initial shock parents experience when leaving the hospital without their baby. This week, we’re breaking down everything parents experience in the first week following their loss and how you, as a provider, can prepare them for it.

Remember, you're the only one outside of the mother and her support person who knows what happened in the hospital. Therefore, you can relate with them on a level no one else can.

Research indicates that "a period of two to four years seems to be about average for parents, but five or more years of grief is not uncommon" (Guidelines for Health Care Professionals Supporting Families Experiencing a Perinatal Loss, p. 470). Your compassionate care during this first critical week can help establish a foundation for healthy grieving.

In order to understand how to support families, let's dive into a common timeline of events parents and families experience during the first week after they are discharged from the hospital.

Events During the First Week at Home

Logistical Expectations

Official Documentation
In the first few days, parents are asked to handle difficult paperwork such as signing the death certificate, registering the stillbirth, and, in some cases, receiving a birth certificate.

Funeral Planning
Decisions about burial or cremation, type of service, and funeral home arrangements must be made quickly, often while navigating intense grief.

Financial Considerations
Funeral costs can vary significantly—basic services often range from $900 to $1,500, while traditional funerals may exceed $3,000. Parents may need to explore payment options and seek out financial assistance programs.

Communication Decisions
Sharing the news of a stillbirth is deeply personal and emotionally complex. Parents face difficult choices, such as whether to share photos, how to talk about the loss with friends and family, and what language to use when describing their baby’s birth and death.

Employment Considerations
It’s often necessary to contact employers soon after the loss to discuss maternity or paternity leave options, even while still processing the immediate aftermath.

Medical Follow-Up
Medical teams may offer autopsies or genetic testing, and a postpartum checkup is typically scheduled about six weeks after delivery. Parents may also need to review test results or meet with specialists to understand possible causes of the stillbirth.

Breast Milk Decisions
Lactation can occur even after stillbirth, and parents may need to decide whether to suppress milk production or explore donation options.

Home & Work Matters
Parents often need to make emotional decisions about the nursery, cancel baby-related appointments, and arrange for time off from work.

Physical Recovery Planning
The body still undergoes postpartum recovery, requiring pain management, gradual physical activity, and regular check-ins with healthcare providers.

Support System
Many find comfort in connecting with bereavement support groups, grief counseling, or trusted friends who offer practical help.

Emotional Expectations

Initial Emotional Response
Shock, numbness, and disbelief are common in the first week, with many describing the experience as surreal or dreamlike.

Grief & Identity
Parents may feel lost, unsure of how to describe themselves or their role, and grieve both their baby and the future they imagined.

Mental Load
Grief often clouds thinking, making it difficult to focus, make decisions, or process information.

Guilt & Self-Blame
It’s common for parents to question medical care, replay events, or feel responsible, even when they did everything they could.

Fear & Anxiety
Anxiety about future pregnancies, others' reactions, or forgetting their baby can be overwhelming and isolating.

Relationship Strain
Grief often affects partners differently, which can lead to emotional disconnection or tension in the relationship.

Social Isolation
Many parents withdraw from social situations, especially around babies or pregnant women, and may feel misunderstood by others.

Self-Care Struggles
Basic routines like eating, sleeping, and hygiene can feel impossible in early grief, and self-compassion becomes a critical survival tool.

Physical Expectations

Postpartum Bleeding
Heavy vaginal bleeding and clotting are normal after stillbirth and can last for several weeks.

Breast Changes
Breast engorgement, leaking, and milk production are physical reminders of loss and may require management or suppression.

Uterine Contractions
As the uterus returns to its pre-pregnancy size, cramping and after-pains are common and sometimes painful.

Perineal Discomfort
Healing from a vaginal delivery or episiotomy can include swelling, soreness, and tenderness for a week or more.

Hormonal Shifts
Postpartum hormone drops can trigger night sweats, mood swings, and physical changes like hair loss.

Sleep Disruptions
Grief, physical discomfort, and anxiety often interfere with sleep, contributing to deep fatigue.

Digestive Issues
Many parents experience appetite changes, constipation, or stomach upset related to medication or stress.

Weakened Immunity
Stress and sleep loss can compromise the immune system, increasing vulnerability to illness and postpartum depression.

How can the nurse prepare their patients for the week ahead?

Before parents leave the hospital, there are several critical discussions nurses should initiate that will significantly affect their experience during the first week:

✅ Discuss burial vs. cremation options: Parents need to understand the differences between these choices, including costs, religious considerations, and the impact on memorial planning. This fundamental decision affects many subsequent choices.

🤔 Consider autopsy options (if appropriate): Discussing whether an autopsy might provide peace of mind or answers about the cause of death is important. This medical investigation can sometimes offer closure, but parents need support in determining if it's the right decision for their situation.

🤔 Provide information about breast milk options and donation: Many mothers don't realize they can donate breast milk after loss. Others may want information about milk suppression methods to ease physical discomfort. Explain that milk typically comes in 1-3 days after birth. Discuss options for medication to suppress milk production and non-medication management techniques that include ice packs with cloth covers, well-fitting supportive bras, and pain relief medication.

✅ Create memory-making opportunities for the funeral - Offer photography, make hand/footprint, memory boxes, and collect locks of hair, fingernail clippings, weighted teddy bear, or other mementos.

✅ Discuss birth certificate and death certificate processes - Explain the paperwork they'll need to complete, and the timeline for receiving these documents. This will vary by state.

✅ Provide realistic expectations about physical and emotional recovery - The postpartum physical experience continues alongside grief, which can be overwhelming and confusing.

Follow-up Care the First Week

One of the most meaningful interventions you can provide is sending a personal letter or card to the family during this critical first week. Many nurses experience uncertainty about what to write, but the simple act of reaching out can be profoundly supportive.

As one nurse beautifully expressed:

Another approach comes from a CRNA who always writes: "Thank you for letting us love you and your family through this time."

Other thoughtful messages shared by nurses include:

• "Thank you for allowing me to walk through this with you"

• "I wish we had met during better circumstances but it was a pleasure to meet you and to care for you. I'll be thinking of you and your family"

• "I'll be remembering [baby's name] along with you"

• "It was a privilege caring for you and your baby"

The Pregnancy Loss and Infant Death Alliance (PLIDA) emphasizes that acknowledging the baby by name and validating the parents' experience can be particularly healing.

🩷 Self-care moment

Supporting a Colleague After a Stillbirth Case

As healthcare professionals who regularly support families through loss, we sometimes forget that our colleagues need care too. Nurses who provide bereavement care can experience "secondary trauma" or "compassion fatigue" that affects their emotional wellbeing.

One Simple Step: The Cup of Tea Approach

When you notice a colleague has just finished caring for a stillbirth patient, invite them for a cup of tea (or coffee) in a quiet space. This simple act accomplishes several important things:

1. It provides a brief but intentional pause in their day

2. It acknowledges the emotional weight of what they've just experienced

3. It creates an opportunity for them to process their feelings if they choose to

4. It validates that what they did was important and difficult

You don't need to force conversation or ask probing questions. Simply sitting in supportive silence can be just as healing as talking. What matters most is that they aren't left to immediately jump back into routine care without acknowledgment of the emotional labor they've just performed.

👎 I didn’t learn anything new

👍 Good information

💯 Very valuable