Tuesday, February 24, 2009

ACOG Issues New Guidelines on Managing Stillbirth

Yesterday, ACOG released new guidelines on managing stillbirth.

Overall, it's a generally solid, informative, although very clinically-driven, piece that gives a run-down of the known stats and evidence currently available.

What really struck me was the section on Management. Stillbirth is universally devastating for new mothers and families. They've spent at least 5 months (since stillbirth is deemed to occur after 20 weeks) pregnant feeling this child grow inside them and anticipating its birth, only to have their worst fears realized.

In token appreciation to this great loss, the ACOG guidelines state:

After a stillbirth, sensitivity to the family's emotional state is important. Parents should be given the opportunity to hold their baby and perform cultural or religious activities, such as baptism.

In response to this tragedy and its overwhelming impact on the mental and emotional health of their patients, clinicians are advised in a brief, single sentence to be sensitive to the family's emotional state.

The other 3.5 paragraphs are devoted on how to get a family to agree to an autopsy or get their consent for a number of additional tests if they can't be talked into a full autopsy, citing this reasoning:

"Parents want answers when they have a stillbirth, so clinicians should not be afraid to request an autopsy. Without a thorough evaluation it will be difficult to counsel women on their risk of having another stillbirth," said Dr. Fretts.

While I agree in principle, in practice, far too many families are so emotionally blindsided, they can't see the benefit of the autopsy or testing at the time. Perhaps its due to the lip service physicians are instructed to pay to the family's emotional state, wrapped up in a single sentence with a few token activities thrown in.

Perhaps the guidelines could read, "families should be allowed to hold their babies for as long as they like, call whatever family members they wish to come support them, dress the baby and take pictures, as needed. Families should be moved to a location off the maternity floor to avoid painful contact with other families experiencing the joy of their new babies if they so wish".

It would seem to me that by truly showing empathy to the emotional needs of the family, it would be easier to broach painful topics such as autopsy and post-mortem testing.


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