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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

Oxford Handbook of Midwifery (112 page)

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Assess the mother’s emotional state as part of the routine postnatal care.
The Edinburgh Postnatal Depression Scale, or other validated assessment tool, is useful in assisting the diagnosis of the condition.
If you suspect that the mother may be affected, be sensitive and
reassuring and refer to appropriate resources.
Treatment
A wide range of treatments have been suggested for postnatal depression. The treatment required will depend upon the severity of the illness and the support available for the woman. For some women the condition will resolve spontaneously, but for many the condition will become chronic and may last for the first year or longer following the birth. The
Saving Mothers’ Lives
report into maternal death
³has shown suicide to be the leading cause of maternal death in the first year after birth.
Treatments may include:
Social and emotional support
Self-help groups
Prophylactic progesterone
Oestrogen treatment
Placentophagy
Psychotropic drugs
Electro-convulsive therapy.
1. Cox J (1986).
  Postnatal Depression: A Guide for Health Professionals
  . Edinburgh: Churchill Livingstone.
2. Cooper PJ, Murray L (1998). Postnatal depression.
  British Medical Journal
  316,
  1884–6.
3. Lewis G (ed.) (2007) Confidential Enquiry into Maternal Deaths (2007).
  Saving Mothers’ Lives 2003–2005: Seventh Report of the Confidential Enquiries Into Maternal Death in the United Kingdom
  . London: CEMACH. Available from: M
  www.cemach.org.uk (accessed 25.2.11).
4. Cox JL, Holder J (eds) (1994).
  Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale
  . London: Gaskell.
  CHAPTER 21
  Disorders of the postnatal period
  516‌‌
  Bereavement care
  - This section refers to loss of a non-viable fetus, stillbirth, or neonatal death.
  - Legal definitions and requirements stated are those currently required in the UK.
  - Please check your own local policies and procedures.
  - 2 The disposal of a baby’s body is of immense importance and therapeutic value to the parents. It can be the means towards the healing of the inner hurt sustained in the death of their child. Poorly managed, it can be the foundation of severe psychological damage.
  - 2 Respect and facilitate religious customs and rituals. Time spent in getting everything right will save many years of heartache.
    Aims for the midwife
    ¹
  - To achieve optimal communication with families when their baby dies before, during, or soon after birth
    •
    To ensure parents are fully aware of, and understand, all the choices
    open to them
  - To help parents to face the reality of the situation as they grieve for their baby
  - To act as an advocate for the family, demonstrating sensitivity while maintaining professional boundaries
  - To ensure that the family’s cultural and religious traditions are respected
  - To provide families with a choice of appropriate follow-up support and counselling arrangements.
    Post-mortem examination
  - This may be legally required, in certain circumstances particularly for a neonatal death. It may also be requested by the parents.
  - Explain sensitively the reason for the post-mortem examination.
  - One of the parents will be required to sign the consent form.
  - If the parents refuse consent, their wishes must be respected, unless the death has been reported to the coroner (in Scotland the Procurator Fiscal), in which case the coroner will order the post-mortem. Try to avoid this if at all possible, as it will cause unnecessary distress.
    Practice point
    0 If the baby is to have a post-mortem, the body must be kept dry and not bathed after birth.
    The non-viable fetus
  - Definition:
    a fetus born dead before the legal age of viability, i.e. before 24 weeks’ gestation.
  - After 16 weeks’, but before 24 weeks’, gestation the parents may be given the opportunity to have their baby buried, either by the hospital making the arrangements or by the parents making their own funeral arrangements.
  - The law requires that the funeral director undertaking such a burial is given a letter signed by the qualified health care professional present at the birth.
BEREAVEMENT CARE
517
It is also possible to arrange for the hospital chaplain or a minister of the parents’ own choice to officiate. This applies to all religious faiths.
Stillbirth
Definition:
a baby who neither breathes nor shows any other sign of life after being completely expelled from its mother after 24 completed weeks’ gestation.
The Certificate of Stillbirth must be completed by the midwife present at the birth. This is given to the parents to register the stillbirth with the local Registrar of Births and Deaths, which must be done within 42 days and before the baby can be buried or cremated.
Encourage the parents to give the baby a name, as forenames cannot be added to the certificate retrospectively.
Inform your supervisor of midwives of the stillbirth.
Neonatal death
Definition:
a baby born alive, but who dies within 28 days of birth.
^{You will have completed the notification of birth in the normal way and}
the doctor certifying the baby’s death will issue the death certificate.
Both the birth and the death must be registered by the parents within 5 days. This often occurs simultaneously.
Encourage the parents to give the baby a name, as forenames cannot be added to the certificate retrospectively.
Baby’s body
Handle the baby sensitively and respectfully at all times.
Wash or bathe the baby to remove traces of blood, unless a post- mortem examination is to be carried out. Wear gloves for this procedure.
The mother or father can bathe the baby if they wish. Allow sufficient time for this to be done properly.
Dress the baby in its own clothes, disposable nappy, and bonnet, if possible.
Apply small waterproof dressings to any wounds.
Photographs
Take at least two photographs of the baby after consent gained and give one to the parents.
If they do not wish to keep the photo, seal it in an envelope and save in the mother’s notes. She may ask for it at a later date.
Encourage the parents and family to take as many photos as they wish. Have a camera and film ready for their use, if required.
Offer a professional photograph taken by the hospital photographer.
Mementos
Foot and handprints, a lock of hair, cot card, and name bracelets need to be collected for the memento folder.
Parental permission
must
be obtained before obtaining a lock of hair.
Small toys or other mementos may be kept with the baby.
CHAPTER 21
Disorders of the postnatal period
518
Religious customs and ceremonies
- Ask the parents, at the outset, about any religious customs or ceremonies they wish to be observed. They may wish to make their own arrangements or the hospital chaplain will facilitate this for them.
- The parents may appreciate a simple blessing and naming ceremony.
  Parent information booklet
- It is important that all information for parents, including helpful leaflets, booklets, support group and website addresses, and telephone numbers, should be made available in each maternity unit.
- Go through this page by page to help the parents understand the help and support available.
  The environment
- This is so important and should be as homely and non-clinical as possible.
- Each maternity unit should have a ‘quiet room’ to ensure the family is
  not disturbed.
- A door notice asking others to respect their privacy should be available for them to use at their discretion when they feel the need for privacy.
- Encourage the parents to see and cuddle the baby.
- Allow the family to be alone with the baby for as long as they wish.
- Have a Moses basket or a cot available to put the baby in when they are ready.
- Have a telephone in the room for the parents to use. The hospital switchboard may need to be informed, so that they can connect calls sensitively.
- After the baby has been taken to the mortuary, the parents may ask for it to be brought back to the ward, while the mother is in hospital, or to visit it in the mortuary viewing room.
  Transport of the baby’s body
- Inform the mortuary technician when the baby is to be collected and whether or not a post-mortem is required.
- Inform the porter when the baby is ready to be collected.
- Refer to local guidelines as the arrangements may differ slightly depending on location.
  Arranging the funeral
- In the cases of both stillbirth and neonatal death, the Registrar of Births and Deaths will issue the Certificate for Burial or Cremation once the death has been officially registered.
- The parents may wish the burial or cremation arrangements to be made by the hospital, or they may make their own arrangements. The hospital chaplain or a minister/religious leader of their own choice may officiate.
- Occasionally, parents may ask to take the baby home. This can be arranged and the undertaker will collect the baby from home for the funeral. This usually requires additional paperwork and the police may need to be informed.
  BEREAVEMENT CARE
  519
  Memorial book