A public maternity hospital in the south zone of the city of Rio de Janeiro has become a reference in providing care to bereaved families after the death of a baby during pregnancy, birth or in the first days of life. This October, the month that, for the first time, focuses on gestational, neonatal and child mourning in Brazil, the Maternity School of the Federal University of Rio de Janeiro opened its doors to present how it welcomes patients and how its practices have been evolving for at least 15 years, despite the challenges.
In August of this year, the policy of humanization of maternal and parental griefwhich determines respectful care that helps in the recovery of people who have gone through this trauma. The policy brings a series of determinations to public and private maternity hospitals, including the possibility for families to have a last moment with the child, take photos or receive records such as fingerprints and say goodbye. The possibility of recording the baby’s name on the death certificate was also determined, and if it is in the family’s interest, bury or cremate it.
In the UFRJ maternity ward, this moment of farewell takes place in a different place, called “morge”, which is often not open to families in the units. There, simple moments happen, but full of affection, said psychologist Paula Zanuto.
“This week, a farewell took place that moved the entire team. A father and a grandmother came to say goodbye to a baby who was born full-term, I think at 38 weeks, but only lived for one day”, revealed the psychologist.
“The father and the grandmother came very careful, very loving with the baby’s body, the father put on the clothes, put on the glove, the sock, very careful, the grandmother saying ‘be careful so he doesn’t feel cold’, even though the baby was dead. The grandmother still rocked a little on her shoulder, wrapped in the blanket. The father put the strap of our heart [de pano] around the baby’s arm and at the height of the real heart. It was a beautiful scene, everyone held back crying, they faced a difficult loss together”, described Paula to highlight the importance of the morge.
Souvenir given to parents of babies at the moment of farewell, at the UFRJ Maternity School – Photo: Tomaz Silva/Agência Brasil
The maternity ward set aside a special place for that moment, with stickers decorating the walls, blankets full of animals, swaddles and newborn clothes, in case the family didn’t have any. Another difference were the little cloth hearts, produced by volunteers and donated to families as souvenirs.
“We offer a pair. One unit stays with the mother or father and the other we pack with the baby”, explained Daniela Porto Faus, head of the Psychosocial Care Unit and clinical psychologist at the unit.
“We really favor this moment of farewell, whether in the obstetric center or in the ICU. We respect the family’s time, we are very careful”, added Daniela, giving an example of another very sensitive protocol: “when the baby in the ICU is very serious and we know there will be a bad outcome, we already offer [que ele vá para] the lap so that this baby can die there close to the mother”.
According to the head of the Care Management Division, Andrea Marinho Barbosa, responsible for implementing the policy, there is the intention to expand morge so that families have more space for the practice, considered important for mourning.
“Our big problem today is the physical structure. The place in the morge, where the bodies are kept, is a little small to receive the whole family to say goodbye to the baby”, he said.
In addition to this space, mothers, in the infirmary bed or in the Intensive Care Unit (ICU), have as much time as they need to say goodbye. In the ICU, the team prepares a kind of screen, to guarantee privacy at the moment.
“They are extremely grateful, they are very grateful, they feel welcomed, right?”, revealed Andrea, adding that the same happens with the possibility of putting their name on the certificate.
“Some [mães] They already asked for it before, but as there was nothing formalized, we didn’t put it in, it was stillborn, now, the vast majority ask to put the name chosen by the parents”, he said.
For at least 15 years, the maternity hospital has put measures in place to ensure more respect and acceptance for families in this situation. The first of these was the installation of the Finitude Infirmary, where these mothers go. The maternity hospital observed that the coexistence of those bereaved with other mothers of children born alive or breastfeeding caused psychological suffering for the postpartum women and led to the separation.
“We respect family time, we are very careful”, explains the head of the psychosocial care unit, Daniela Porto Faus, at the UFRJ Maternity School. Photo: Tomaz Silva/Agência Brasil
Many other health units are faced with overcrowding and a lack of physical space to carry out separation, but, according to the new policy, the measure is mandatory. THE Law 15,139 it also ensures that women who have had pregnancy losses can investigate the reason for death, as well as specific follow-up in new pregnancies.
Another determination of the law is the psychological care after discharge. The UFRJ maternity ward offers in-person and telephone care, but recognizes limitations, such as the difficulty for mothers to return to the unit, and the limitations of the teams themselves, a problem identified as a policy bottleneck.
“We are still unable to provide this service. [em casa]we only offer it in our unit and remotely, but we want to form partnerships with other units, so that people do not have to travel here”, said the head of the Care Management Division, Andrea Marinho Barbosa.
The new law allows partnerships between health units and third sector organizations, which should be an option.
Music therapy
Other provisions of the grief humanization policy at the UFRJ maternity school, which are an example, include music therapy for patients and health teams, which, according to Andrea, is “for them to take away some of that burden”, with the support of the team’s own psychologists and social workers.
Room where family members say goodbye to babies, at the UFRJ Maternity School – Photo: Tomaz Silva/Agência Brasil
The law recommends the inclusion of discussion about maternal grief in the training of health professionals, which also makes it opportune for technicians, doctors and nurses to share experiences.
The implementation of the policy, even stipulated by law, requires a change of mentality, according to the unit’s director, Penélope Saldanha, who recalls the process to guarantee the presence of a companion at birth this year.
“Initially, everyone thought it wouldn’t be possible, that the maternity wards wouldn’t accommodate it, that it wouldn’t fit in the surgical center. Here, we asked the companions to prioritize someone female, to ensure the privacy of the women in labor. It took a while longer for us to recognize that women wanted their partner to participate in the birth, and then it was up to us to adapt and ensure that right.”
The UFRJ maternity ward, which is a reference for six basic health units in the city of Rio de Janeiro, also provides prenatal care for high-risk pregnant women, and receives, from all over the state, pregnant women diagnosed with gestational trophoblastic disease, a type of tumor that can progress to placental cancer, in addition to providing emergency births.
