# A nurse is caring for a 28-year-old woman who delivered a stillborn infant at 36 weeks gestation due to placental abruption. She and her partner are in the postpartum unit, and the mother is asking repeatedly, 'Why did this happen? What did I do wrong?' The partner appears withdrawn and has not spoken since the delivery. Both parents declined to hold the baby initially but are now asking questions about what the baby looked like. What is the most appropriate nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543185 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is caring for a 28-year-old woman who delivered a stillborn infant at 36 weeks gestation due to placental abruption. She and her partner are in the postpartum unit, and the mother is asking repeatedly, 'Why did this happen? What did I do wrong?' The partner appears withdrawn and has not spoken since the delivery. Both parents declined to hold the baby initially but are now asking questions about what the baby looked like. What is the most appropriate nursing intervention? A 28-year-old woman delivered a stillborn infant at 36 weeks gestation due to placental abruption. She and her partner are in the postpartum unit, and the mother is asking repeatedly, "Why did this happen? What did I do wrong?" The partner appears withdrawn and has not spoken since the delivery. Both parents declined to hold the baby initially but are now asking questions about what the baby looked like. ## 보기 1. Provide detailed medical explanations about the cause of stillbirth and risk factors 2. Reassure the parents that stillbirth was not their fault and encourage them to focus on future pregnancies. 3. Acknowledge their pain, provide honest information within your scope, and offer memory-making opport **✔ 정답** 4. Suggest they speak with the physician about the medical details and focus on physical recovery **정답: 3** ## 해설 The most appropriate intervention acknowledges pain, provides honest information within scope, and offers memory-making opportunities. Other options are either too detailed, dismissive, or incomplete. ## 심화 해설 Therapeutic Communication and Grief Support in Perinatal Loss When parents experience a stillbirth, their immediate reactions often include shock, disbelief, and an intense search for meaning. The mother's repeated questions—"Why did this happen? What did I do wrong?"—are a hallmark of the acute grief phase, driven by a profound sense of guilt and a need to construct a narrative around the loss. Simultaneously, the partner's withdrawn silence represents another common, yet distinct, grief expression. The evolving request from both parents to know what the baby looked like signals a shift from initial avoidance toward engagement, which is a critical therapeutic window. The most appropriate nursing intervention is to acknowledge their pain, provide honest information within your scope, and offer memory-making opportunities. Why This Approach is Correct This intervention aligns directly with stage-based bereavement support, which is structured around the parent's evolving needs rather than a rigid timeline. The umbrella review by Chen et al. synthesizes evidence that effective support must be tailored to the grief trajectory [1]. In the initial disorganization and searching phase, parents are not ready for detailed medical causation or reassurance about the future. They require validation of their emotional chaos and gentle, factual answers to their immediate, concrete questions. By answering their questions about the baby's appearance honestly and within your professional scope, you help them begin to build a tangible memory, which is foundational for processing the loss. Offering memory-making opportunities is a high-level, evidence-based intervention. Creating memories—such as seeing, holding, or receiving mementos of the baby—provides a bridge between the abstract shock of loss and the concrete reality of the baby's existence. This practice is strongly supported by the qualitative systematic review by Gao et al., which highlights that nurses and midwives play a key role in facilitating these tangible connections, even when parents initially decline [2]. The parents' shift from declining to hold the baby to asking questions is a direct cue that they are moving toward this need. Your role is to create a safe, non-judgmental space for them to explore these options at their own pace, without pressure. Analysis of Incorrect Options - **Option 1:** Providing detailed medical explanations about the cause of stillbirth and risk factors is premature and outside the nurse's primary scope at this moment. While the question "Why?" is being asked, it is an expression of emotional pain, not a request for a pathophysiology lecture on placental abruption. Delivering complex medical information during the acute shock phase overwhelms parents who are cognitively and emotionally unable to process it. This task belongs to the physician later, in a planned follow-up conversation. The network meta-analysis by Huang et al. emphasizes that early interventions should focus on emotional processing, not cognitive restructuring . - **Option 2:** Reassuring the parents that the stillbirth was not their fault and encouraging them to focus on future pregnancies is a dismissive and harmful non-therapeutic response. While the reassurance is factually true, it invalidates their current, all-consuming grief and the profound attachment to this specific baby. The phrase "focus on future pregnancies" is particularly damaging as it implies this baby is replaceable. The compassion-focused therapy (CFT) model, evaluated by Hunter et al., is specifically designed to reduce the self-criticism and shame that underlie the mother's "What did I do wrong?" question, but this is done through compassionate validation, not premature reassurance . - **Option 4:** Suggesting they speak with the physician and focus on physical recovery deflects the parents' immediate psychological needs and fragments their care. While physician consultation is important later, and physical recovery is a nursing responsibility, referring all emotional questions away from yourself abandons the parents at their most vulnerable point. The systematic review by Gao et al. found that a primary barrier to effective bereavement care is nurses feeling underprepared, which can lead to avoidance behaviors [2]. The therapeutic action is to stay present with the parents' pain, using your therapeutic presence as the core intervention. Clinical Integration and Underlying Mechanisms The parents' contrasting grief responses—the mother's externalizing guilt and the partner's internalizing withdrawal—illustrate the dyadic nature of perinatal loss. A compassionate, non-judgmental approach that meets each parent where they are is essential. The CFT framework is particularly relevant here, as it targets the self-criticism and shame that are central to perinatal grief . By acknowledging their pain without trying to fix it, you model self-compassion and begin to de-escalate the mother's guilt-driven thought loop. For the withdrawn partner, your calm, inclusive presence and gentle, factual answers provide a safe pathway to re-engage without the pressure of direct emotional confrontation. The act of describing the baby—mentioning features like hair color or a calm expression—transforms the baby from a traumatic concept into a real, loved family member, which is the cornerstone of healthy grieving and the creation of a lasting, positive memory [1, 2]. References (research sources) - [1]Stage-based bereavement support for parents after stillbirth: an umbrella review.Research articleChen LL, Tsai CH, Yang CL. (2026) · DOI: 10.1080/02646838.2026.2675706 - [2]Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review.Meta-analysis/systematic reviewGao H, Iwunze CJ, An X, Zhou T, Curtin M. (2026) · DOI: 10.1016/j.ijnsa.2026.100538 ## 임상 시나리오 Clinical Practice Guide: Supporting Parents After Stillbirth When a stillbirth occurs, nursing care must shift from obstetric management to bereavement support. The immediate postpartum period is a critical time to validate grief, provide honest information, and facilitate memory-making based on the parents' evolving cues. 1. Therapeutic Communication in Acute Grief - **Validate, Don't Reassure Prematurely:** Acknowledge pain with statements like, "This is a devastating loss. I am here with you." Avoid platitudes such as "It was for the best" or "You can try again," which invalidate the current loss. - **Answer Concrete Questions Honestly:** When parents ask what the baby looked like, provide simple, truthful descriptions (hair color, weight, features). Use the baby's name if given, and stay within your scope of practice; defer medical causation questions to the provider but offer to be present during that conversation. - **Normalize Diverse Grief Responses:** Explain that the mother's repeated questioning and the partner's withdrawal are both normal. Avoid pushing the withdrawn partner to talk; instead, offer presence and periodic, gentle check-ins. 2. Facilitating Memory-Making - **Offer Options Without Pressure:** Present memory-making as a choice: "Some parents find it helpful to see or hold their baby. We can do that whenever you feel ready, or not at all. Would you like me to describe your baby to you?" - **Create Tangible Keepsakes:** Collect a lock of hair, handprints/footprints, hospital ID bands, and photographs. Place these in a memory box. Even if parents initially decline, create and store these items; they may request them weeks or months later. - **Support Sibling and Family Involvement:** If there are siblings, offer them the opportunity to see the baby or create a drawing to include in the memory box, guided by the parents' wishes. 3. Interdisciplinary Care and Follow-Up - **Coordinate with Spiritual Care and Social Work:** Offer chaplain services for blessing or baptism rituals. Engage social work to provide resources on funeral arrangements and perinatal loss support groups. - **Prepare for Discharge:** Provide written information about grief reactions, lactation suppression if applicable, and community resources. Schedule a follow-up appointment with the obstetric provider to review autopsy or pathology results in a supportive setting. - **Staff Debriefing:** Participate in or request a team debriefing after a stillbirth event to process the emotional impact on caregivers and ensure consistent, compassionate care. ## 핵심 개념 - **Perinatal Bereavement Support** — A stage-based, individualized approach to care that validates parents' grief, provides honest information, and facilitates memory-making to support the grieving trajectory after the loss of a baby. - **Memory-Making** — Nursing interventions such as offering to describe the baby, facilitating viewing or holding, and creating keepsakes (footprints, locks of hair) that help parents construct a tangible narrative and validate their baby's existence. - **Acute Grief Phase** — The initial period of shock, disbelief, and intense searching for meaning following a loss, often marked by guilt and chaotic emotions, where validation and concrete answers are prioritized over medical details. - **Placental Abruption** — The premature separation of the placenta from the uterine wall, a leading cause of stillbirth, which often occurs suddenly and can intensify maternal feelings of guilt and shock. - **Therapeutic Window** — A critical moment in care when a patient's or family's expressed need signals readiness to engage, such as the parents' shift from declining contact to asking about the baby's appearance. ## 같은 주제 문제 - [A nurse is caring for a couple who experienced a stillbirth at 36 weeks gestation. The mot…](https://mymerci.kr/pages/nclex_q.php?qn_id=543184) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._