3. Grief and childbearing experience. The loss of a pregnancy or a newborn, or the birth of a physiologically compromised child (preterm, congenital disorder) is a crisis situation. The unexpected outcome can cause the parent(s) to suffer a sense of loss of self-esteem, self-concept, positive body image, feelings of worth.
1. Assessment:
   1. Response to loss of the "fantasy child"/real child.
      1. Behavioral - anger, hostility, depression, disinterest in activities of daily living, withdrawal.
      2. Biophysical - somatic complaints (stomach pain, malaise, anorexia, nausea).
      3. Cognitive - feelings of guilt.
   2. Knowledge/understanding/perception of situation.
   3. Coping abilities, mechanisms.
   4. Support system.
2. Analysis/nursing diagnosis:
   1. Ineffective family coping: compromised related to psychological stress related to fear for infant, guilt feelings, impact on self-image.
   2. Ineffective individual coping related to anxiety, stress.
   3. Ineffective family coping: disabling related to disturbance in intrafamily relations secondary to individual coping deficits, recriminations.
   4. Altered parenting related to lack of effective bonding secondary to emotional separation from infant, feelings of guilt.
   5. Dysfunctional grieving related to guilt feelings, impact of loss on self-concept.
   6. Disturbance in body image, self-esteem, role performance related to perceived failure to complete gestational task, produce perfect, healthy infant; associated with sleep deprivation.
   7. Social isolation related to severe coping deficit, dysfunctional grieving, disturbance in self-esteem.
3. Nursing care plan/implementation:
   1. Goal: emotional support.
      1. Provide privacy; encourage open expression/verbalization of feelings, fears, concerns, perceptions.
      2. Crisis intervention techniques.
   2. Goal: facilitate bonding, effective coping, or anticipatory grieving processes.
      1. Encourage contact and participation in care of premature or compromised infant.
      2. Keep informed of infant’s status.
      3. Provide realistic data.
   3. Goal: health teaching.
      1. Clarify misperceptions, as appropriate.
      2. Discuss, demonstrate infant care techniques (e.g., feeding infant who has cleft lip or palate).
      3. Refer to appropriate community resources.
4. Evaluation/outcome criteria:
   1. Woman verbalizes recognition and acceptance of diagnosis.
   2. Woman verbalizes understanding of relevant information regarding treatment, prognosis.
   3. Woman makes informed decision regarding infant care.
   4. Woman demonstrates comfort and increasing participation in care of neonate.
   5. Woman shows evidence of bonding (eye contact, cuddles, calls infant by name).