4 minute read
Creating a significant new nurse specialist position for early perinatal pregnancy loss
CHRISSIE SYGROVE
Perinatal Pregnancy Loss Nurse Specialist
Pregnancy loss under any circumstances can have a significant impact on the wellbeing of women and whaanau. Irrespective of the stage of pregnancy, healthcare provided during pregnancy loss must be delivered in a respectful, responsive manner that is appropriate to the unique needs of those involved.
For more than a decade, the pregnancy loss midwife supported all CM Health women who experienced pregnancy loss after more than 20 weeks’ gestation. It recently became clear, however, that more support was needed for those women who experience pregnancy loss before the 20th week of their pregnancy. In September 2020, a new position of nurse specialist perinatal pregnancy loss was established to meet this need.
The scope of the nurse specialist’s role
The full scope of this innovative new role is still being established. In the first instance, the nurse specialist is responsible for coordinating the management of care for women experiencing either spontaneous or assisted pregnancy loss. The nurse specialist is the interface between the women accessing healthcare and those providing the relevant services; she helps coordinate care and acts as the point of contact, ensuring that women and their support people are given all appropriate information in a sensitive and timely manner.
In this new role, the nurse specialist acts as a barometer, monitoring both how well the service is meeting the needs of women and their whaanau, and whether the service is meeting the requirements of the Interim Standards for Abortion Services in New Zealand. From these observations, the nurse specialist identifies and leads best practice models of care for pregnancy loss, and works to ensure that CM Health policies and procedures reflect these.
Whether a pregnancy loss is spontaneous or planned, women and their whaanau will have their own values, beliefs and needs, which will inform the type of care they might need at any given time. An important part of the nurse specialist role is to hold space for the women, listen to and advocate for them, and help ensure that the service is operating in a way that is responsive to their particular needs and personal preferences. It is vital that service users feel respected, heard and empowered to access care that aligns with their individual needs.
Thanks are due to the Women’s Health senior team, the pregnancy loss midwife, Gynaecology Care Unit and Early Pregnancy Assessment Clinic staff, Women’s Health social workers and bereavement care staff for their work to date in the area of pregnancy loss. The nurse specialist role for early perinatal pregnancy loss is only just beginning to take shape. There will be many new learnings and we will rise to the challenge and collectively develop this service.
The Ministry of Health expects all abortion service providers to comply with the Interim Standards for Abortion Services in New Zealand from 24 March 2020.
The standards set the minimum level of service that service providers must comply with, and require all district health boards to have clear and accessible guidelines for referral of women for abortion in the second and third trimester of their pregnancies. All district health boards must also provide women with written information on the abortion process for the first trimester, and access to admission for an abortion should be possible at any time during the second or third
trimester, provided the criteria in the legislation are met.
At CM Health, we continue to improve our process for all women wishing to access abortion through our DHB at whatever gestation. The process aims to continue a service to women in line with the new requirements of the Act and in particularly in relation to local delivery and minimisation of delay for women in accessing the service, including through direct self-referral.
Areas for improvement
Care provision for miscarrying women requires continuous review and improvement. Currently some women who are miscarrying present to the Emergency Department when they could be managed more appropriately as outpatients. We are working to develop improved systems and processes to capture information for all women experiencing pregnancy loss. To progress this, we are also investigating whether Badgernet could be used to manage follow-up appointments and plan care pathways for these women. Better data capture will also help us understand our population and guide opportunities to improve care.
More education for staff is also required around pregnancy loss, including which investigations are appropriate for which women, provision of contraception counselling, and building confidence in caring for women who lose a baby after the first trimester. New strategies and solutions we plan to develop include: • streamlining and standardising patient contact and support processes
• making it easier for women to navigate access to all services
• creating and updating patient pamphlets for all pregnancy loss to ensure the information is appropriate, up to date and readily available • updating and reviewing procedures and guidelines in all areas of gynaecology services
• using Badgernet to store all pregnancy data in one place and ensure data collection is robust and accurate • providing ongoing education and support all staff involved in pregnancy loss
• assisting with long-acting reversible contraception consultations before women go home • working with the GP liaison team to develop robust, clear referral pathways
• assisting with electronic lead maternity carer and GP notifications • ensuring follow-up appointments for the second trimester pregnancy loss clinics are made at the correct times.
