'An emotional emergency': Cleveland Clinic Mercy offers perinatal loss education

CANTON − In her 36 years as a maternity nurse at Cleveland Clinic Mercy Hospital, Linda Heitger has seen thousands of babies born to happy and excited families.

But there also are times when pregnancy doesn't have a happy ending.

At Mercy, Heitger has been the go-to person for perinatal-loss education since the 1990s. The 44-year nurse has worked to equip staff to help patients navigate miscarriage, stillbirth or newborn death.

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"Nobody talks about losses in an obstetrics unit," she said. "It's a happy place. We don't get miscarriages on our floor. We only have people who have had a loss at 20 weeks or over and if they're like 15 or 20 weeks and they need to be induced. We take those patients."

Heitger said that according to her statistics, about 6.1% of births at Mercy end up as a perinatal loss.

"There are probably many women who do not need to come to the hospital because they are seeing their private provider," she said. "Or they have not had any issues that needed medical care."

Course fit a need for families, staff

Heitger said perinatal-loss education was developed in the mid-1980s by two nurses on staff at Gundersen Lutheran Hospital in Wisconsin. She has taken classes at Gundersen Lutheran under a curriculum known as RTS, or Resolving to Share, which trains providers how to train their peers in perinatal care.

"It's the gold standard," she said. "They created this program, and it's all around the world."

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Heitger said that prior to perinatal-loss education, women and families were left to deal with the losses on their own.

"In the 1700s and 1800s, women delivered at home; they might have a midwife from the neighborhood," she said. "When people would know that they were going to have a loss, their families and churches and everybody would help them. Moms would hold their babies. And then when people started coming into hospitals in the 1940 and '50s, it was believed that a mom shouldn't hold her baby who died. It was taken right away, and that's when women started having more psychiatric issues."

Heitger said Mercy also works in concert with other perinatal-loss organizations including God's Tiny Angels, a Massillon-based support group, Brooks' Bereavement Bears, Forget Me Not Baskets of Wooster, Call If You Need Anything, a grief-support group aimed at family and friends, and the Pregnancy Loss And Infant Death Alliance, which serves as a network connecting and promoting various groups and programs.

Heitger also is a member of the Stark County Health Department's Fetal, infant and Maternal Loss Board.

Heitger said that after a loss, families have control over arrangements. Hospitals are required by law to store fetal tissue 20 weeks or more in their morgues. At Mercy, families have the option of allowing the hospital to arrange for cremation of fetal tissue, which is then interred at Calvary Cemetery beneath a common marker.

Heitger said Mercy also offers a Naming and Memorial Service guide. She's also reached out to local funeral homes to see what they do to accommodate families. Most, she said, provide some services free of charge. For others, a foundation, created by a couple who had a still born child, offers scholarships to cover the costs of medical and burial expenses.

Charlotte Forsythe, Mercy's manager of maternity services, said another goal is to educate by providing information and material for extended families and friends, particularly after a loss.

"People say things and they truly don't mean to say them, but it does hurt," she said. "It's the first time that many of our patients have ever dealt with a loss."

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Heitger said families are the ones who ultimately decide how they respond to a pregnancy loss.

"Both RTS and PLAIDA do mission statements; that helps us take care of everybody," Heitger said. "It's all about patient-centered care; what do moms and dads want, what can they handle. I had a couple one time, and she was a nurse. Her baby had died in utero. When she did deliver, she didn't want her husband to see the baby, didn't want the grandparents to see the baby − nothing. But by the time they went home − I had held the baby for them − they decided they wanted to see the baby's foot, and then they went to the leg, and eventually they saw the whole baby and held the baby, and the grandparents came in and it was really awesome to see that. I think it helps with the grief process."

Lessons help staff say right right things, listen

Heitger and Forsythe say perinatal-loss education is beneficial for all hospital staff, from chaplains to technicians and even secretaries − anyone who might cross paths with a patient. Mercy recently added M-Power, a curriculum to help providers serve expectant women who may have undergone a prior sexual or previous birth-related trauma.

Forsythe said educating their staff is all about increasing awareness, along with "compassion, empathy and understanding" because losing a child can be a traumatic experience.

"It's life-changing and it's super-important and we're pretty passionate about it," she said. "Linda empowers them to become ambassadors, so they can know what to expect. It's really good to give nurses the tools. This is a whole other type of grief; it's an emotional emergency. It's super-important to give our nurses, even our front desk people what they need. It's just an awareness, to give them what they need."

Forsythe said the training is important because while most nurses might have experience with adults dying, working with families experiencing perinatal loss is completely different.

"This is a whole other type of grief," she said.

Forsythe noted that with recent changes in abortion law, there likely will be more need for such education.

Reach Charita at 330-580-8313 or charita.goshay@cantonrep.com. On Twitter: @cgoshayREP.

On Twitter: @cgoshayREP

This article originally appeared on The Repository: Mercy nurse spearheads perinatal loss education for patients and staff