Quiz 5: Key considerations in perinatal palliative care

Please choose the one, most correct answer to each question or statement.

1. Part of the continuum of care includes which of the following:
   • Cutting any contact with the family to let them get on with their lives
   • Supporting the family in the bereavement period
   • Putting the mother on sleeping tablets for a month
   • Referring the family to a psychiatrist
2. What is the effect of perinatal loss on a family who wanted their baby?
   • It is a loss of all the hopes, dreams and the future imagined for the baby, the parents and their family
   • There will always be complicated grieving patterns with a perinatal loss
   • The gestational age of the baby will have an influence on how parents grieve as they will not mourn a miscarriage
   • The effect will be much less than when an adult dies
3. What is bereavement?
   • The period experienced before the death of a child
   • What only a mother can experience after losing her baby
   • It is a 6-month period after a loss of a baby
   • A period of time during which the person is grieving and mourning a loss
4. Initial grief reactions following the death of a baby will include:
   • A broad range of emotions including shock, numbness, disbelief, crying and denial
   • Their reactions will be less than with a child because they don’t yet know their baby
   • The parents will always show anger because their baby could not be saved
   • Parents will not show any emotion as they have not yet bonded with their baby
5. How can you support parents after the death of their baby?
   • Suggest it is best that they don’t see their baby and go home as soon as possible
   • Take over planning and making decisions for the family to relieve the pressure
   • Encourage the grandparents to take over running the home for a few weeks
   • Give them the time and space to react while still being present and available to support them and to answer any questions they may have
6. Informal types of bereavement support such as giving sympathy cards, sending letters, emails or text messages, phone calls, and attendance at funerals and memorial services are:
   • Ongoing support that can be provided by the hospital staff
   • The support that only the extended family needs to provide
   • Written orders given to the social worker to carry out
   • Only provided by church support groups
7. What is complicated grief?
   • Grief that affects both parents and siblings
   • Grief that occurs for more than a few weeks after the loss
   • Bereavement accompanied by extreme symptoms of separation distress and functional impairment
   • Grief that only occurs after losing two or more babies
8. What risk factors may result in an increased likelihood of complicated grief?
   • Having more than 5 children
   • Having no money for therapy
   • The mother’s religious beliefs
   • Lack of social support and termination of a pregnancy for severe fetal anomalies
9. What aspects about the mother do we need to consider after the death of her baby?
   • Her emotional wellbeing as well as her post-partum physical recovery including suppression of lactation
   • Only her physical wellbeing as that is the most important
   • Only her emotional wellbeing as physical recovery will be fast
   • She will recover both her emotional and physical wellbeing by falling pregnant as soon as possible
10. What lactation advice must you give the mother if her baby dies?
    • She needs to be told to bind her breasts tightly to suppress lactation
    • She will not need any advice as her milk will not come in if her baby has died
    • She should be asked whether she would like to express and donate her milk to a milk bank or allow her milk to slowly stop
    • She must be told not to drink anything for a few hours after her baby has died in order that her breasts not leak
11. Referral to a primary health clinic or primary treating doctor should initially be made:
    • Via a phone call
    • Via a hand-delivered referral letter
    • Only if the family are grieving
    • If it appears that the mother is suicidal
12. The referral letter should:
    • Be posted to the primary healthcare nurse to do the follow up
    • Give the history of the pregnancy and birth, neonatal care provided and the follow-up plan of ongoing care
    • Be given to the parents to take to their doctor when doing a postnatal follow-up visit
    • Give a brief reason for the referral
13. If a surviving twin is in the nursery, what can be used on the cot to indicate that this baby was one of twins?
    • The name of both the twins
    • A symbol such as a butterfly
    • Nothing as it is not important to show that this baby is a surviving twin
    • The parents’ names
14. What do you need to understand about the siblings of the baby who has died?
    • That they do not have the capacity to understand what is happening and will not grieve
    • They are likely to misbehave when they are included in any memory-making activities
    • They need to be protected from the truth as it will upset them
    • That they are an integral part of the family and are often referred to as the ‘forgotten mourners’
15. The role of the genetic counsellor is to:
    • Advise the family not to have more children
    • Tell the family about the genetic condition and discuss the risk of the problem reoccurring in a future pregnancy
    • Suggest that the mother immediately be sterilised
    • Suggest that the siblings all may have the same genetic condition
16. How can you deal with your own grief when a baby dies?
    • Do not show any emotion and rather pretend that everything is alright
    • Take time off immediately after the death
    • It is important to use both organisational and personal strategies to cope with your grief
    • Go for a run
17. True self-care is:
    • The discipline to care for your mind, body and spirit, building the life you want to live
    • Spending your time taking care of others
    • Only needed by those who are not spiritual
    • Only taking care of your physical wellbeing
18. Self-care includes the following:
    • Taking all your sick leave due to you
    • Making sure boundaries are in place
    • Taking longer lunch breaks than you are allowed
    • Buying a new car
19. Which of the following is an important barrier to self-care?
    • Being female
    • A low salary
    • Not being religious
    • Lack of time for yourself both at work and at home
20. You are crossing professional boundaries when you:
    • Allow your own grief to limit the support you can provide for the family
    • Assist the family by giving their dead baby a bath
    • Offer to call the family when the baby has died
    • Hold the parent’s hand while the baby is dying