Infertility is experienced by 48.5 million couples globally and leads to excess stress and psychological issues such as depression, hopelessness, isolation, and anxiety (Güneri et al., 2019; Swanson & Braverman, 2021). In the past 40 years, significant research and practice guidelines have been developed to address the holistic needs of the family experiencing infertility. Menning, an infertility nurse, first recognized the role of grief and vulnerability in infertile couples back in the 1970s and brought attention back to the patient with emotional support, patient-centered care, and teaching (Patel et al., 2018). Women who have been trying and finally are pregnant show more anxiety than those who are pregnant for the first time (Patel et al., 2018). Infertility has an impact on emotional, financial, and social health as well as physical health. Changes in relationships are reported, and less often, these are positive changes.
It is important for pediatric surgical nurses to have knowledge about infertility. We care for the children of families who have navigated the challenges of fertility. Families may present with higher anxiety, increased stress, and fear. Children of infertile couples are at a higher risk for developing intellectual disabilities, autism, and psychosis (Kasman et al., 2020). We play a role in assisting parents and caregivers to express their fear and to provide reassurance during all aspects of care of their child.
Loss of pregnancy or a newborn is a highly personal grief (Eckenrode et al., 2021). A live baby born after a family has experienced a miscarriage, neonatal loss, or stillbirth is often called a rainbow baby (Smith et al., 2018). Family and friends expect them to be happy because they are now pregnant again. However, they do not stop grieving for their previous loss and now have heightened states of fear and hypervigilance in the next pregnancy.
It is a common misconception that couples will overcome the grief and psychological effects of the previous loss once they have a new and healthy infant. Mothers may feel guilt, fear that her previous infant will be forgotten, and experience unusual amounts of anxiety. All of this can interfere with bonding and nurturing of the new baby. As these families present for care in pediatrics, there may be unprocessed grief and trauma. As that child grows, any illness or need for surgery may result in an overreactive family. Families may become unusually stressed if their rainbow baby becomes ill later, especially if a healthy birth and early childhood occurred. Pediatric surgical nurses are in a position to recognize the possible effect of the mother's obstetrical history and reassure and educate the family. Pediatric nurses should inquire about the infant loss if this is discovered and, if this child was named, say the name out loud.
For those who have had multiple attempts and years of infertility, their reaction to a health issue in their child may include more disbelief than expected. This is their miracle child, and to them, they cannot fathom the unfairness. They may have ridden the waves of hope and dismay every month as they battled infertility, and the perceived unfairness of more suffering and anxiety is not easily accepted. When a nurse assessing a child for pediatric surgery notices a great deal of disbelief that their child is unwell, an inquiry about reproductive history might help explain the reaction.
The experience of infertility permeates life for many years and influences all levels of health, including psychological, physical, and social. High anxiety and maladaptive patterns of behavior remain part of coping even if ineffective. In a time of stress, such as a sick child needing surgery, parents will revert to previous behaviors and patterns, even if maladaptive.
RESOURCES FOR FAMILIES AND PEDIATRIC NURSES
For grieving families, Nationalshare.org has vast resources, online groups, and links to local groups and grief professionals who might be able to help. Postpartum Support International offers a helpline and online support group for pregnancy and infant loss. For families struggling with infertility, Resolve.org is an excellent source of support, education, and advocacy. Resolve also has links to local and online support groups and mental health professionals. There are numerous online blogs to help parents feel supported in their journey as well as more formal support groups, both locally and online.
Parents' previous reproductive histories are not part of intake for our pediatric patients. The child in a pediatric surgical nurse's care may be the product of the 10th pregnancy to a family who kept trying for their only child or might be the result of a twin pregnancy where the twin died. There might be clues that this family has experienced previous loss that will guide a pediatric nurse to ask more questions, deepen assessment, and seek holistic care of this family. Be aware of both the hypervigilant mother and the one in disbelief about the health challenges their child is facing. Consider that parents may not have discussed previous losses with their child and do not want to talk in the child's presence.
Many different pathways can lead to healing, and the role of the pediatric surgical nurse may just be listening and supporting the family's story and experience. Finding a private place to allow the family to tell their story and giving that time freely may be the biggest challenge for a nurse. Ask about other stressors and grief they have experienced. Recognize the uniqueness of their experience. Recognize cultural value systems involved and ask about their beliefs about the loss and their healing to date. In the past, families were encouraged to sever bonds with those who died, but current trends in grief counseling support a continued bond. Aid parents in identifying needed resources and connect them to available support groups or counselors. Extending support and providing a place to share encourages a sense of safety for families and their children.
Pediatric surgical nurses can provide support through education, active listening, and encouragement. They can engage in supportive conversation, connecting individuals and families to needed healing resources.
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Kasman A. M., Zhang C. A., Luke B., Eisenberg M. L. (2020). Association between infertility and mental health of offspring in the United States: A population based cohort study. Human Fertility
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Smith T., Davidson W., Roberson K. (2018). Permission to love: Celebrating your rainbow baby after a reproductive loss. International Journal of Childbirth Education
, 33(4), 46–48.
Swanson A., Braverman A. M. (2021). Psychological components of infertility. Family Court Review: An Interdisciplinary Journal
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