Content warning: perinatal loss.

When Gina Herrera and Daniel Pennacchi got married in the summer of 2019, they knew they wanted to start a family.

So when they learned in October that year that Herrera was pregnant, they were excited and had no reason to expect any difficulties ahead.

“We thought pregnancy happens, and then nine months later you get a baby,” Herrera said. “And for the first 12 weeks I was feeling really good.”

But in mid-December Herrera started to notice some spotting. Her doctor at the time advised temporary bed rest, and over the next couple weeks things seemed like they were getting better.

That was until the early morning hours of Jan. 8, 2020, when Herrera’s water broke, and she and her husband found themselves at Penn Medicine Princeton Medical Center facing the unimaginable.

Their baby no longer had a heartbeat.

Research Supports Evidence-Based Perinatal Bereavement Training for Nurses

In the hours that followed, Herrera and Pennacchi were cared for by longtime nurse Susan Straszynski, DNP, who has made it her mission to ensure that families suffering early pregnancy loss receive quality bereavement care to help them through one of the most devastating times of their lives.

“If there’s anything I can do to help people like Gina and Daniel through the sadness, I’m going to do it,” said Straszynski, who serves as the perinatal bereavement coordinator at Princeton Medical Center.

Perinatal loss — defined as pregnancy loss that occurs before or during birth, or neonatal death in the first month — is not uncommon in the United States.

The American College of Obstetricians and Gynecologists (ACOG) estimates that early pregnancy loss, the unexpected loss of a fetus before the 20th week of pregnancy occurs in about 10 percent of confirmed pregnancies.

Loss of a fetus after the 20th week of pregnancy is referred to as a stillbirth and occurs in 1 in 160 deliveries in the United States, according to ACOG.

A nurse for almost 30 years, Straszynski recalled the first time she cared for a family who suffered a pregnancy loss.

“I came into work one day and one of my patients was a mother who suffered a full-term pregnancy loss,” Straszynski said. “I had never treated anyone who lost a baby before, and I realized I needed to learn a lot more about caring for these families.

“It’s always been a passion of mine to help these families, and to help nurses too,” Straszynski continued. “Nurses are always worried they are going to do or say the wrong thing.”

There has been tremendous progress in perinatal loss and bereavement care since the 1970s when it was common practice at most hospitals to give mothers anesthesia, deliver their stillborn and then take the baby away.

Today, parents are normally encouraged to have time with their baby and nurses create mementoes to provide comfort to families after their loss and help them remember the baby.

However, the lack of education, training and support for nurses remain significant barriers to quality care, said Straszynski, who earned her Doctor of Nursing Practice degree in the fall of 2020.

“Nurses play a pivotal role in the care of women and families suffering a pregnancy loss,” Straszynski said. “Yet research has shown that nurses often feel unprepared and lack adequate skills and training to provide appropriate bereavement care, which can significantly impact a mother’s physical and psychological well-being.”

As part of her doctoral project, Straszynski conducted a quality improvement research project at Princeton Medical Center to determine whether providing evidence-based perinatal bereavement education to nurses, will, in turn, improve maternal satisfaction with bereavement care.

For her project, a total of 109 Maternal and Child Health nurses at Princeton Medical Center participated in the Resolve Through Sharing® online evidence-based bereavement care education program, which emphasized compassionate and sensitive care, creating memories and honoring parental relationships with the infant.

Straszynski then interviewed two sets of mothers, those who received care prior to the nurses’ education and those who received care after, and indeed found that evidence-based education for nurses can improve maternal satisfaction.

Straszynski’s research has led to ongoing education for all Maternal and Child Health nurses at Princeton Medical Center as well as the development of a comprehensive perinatal bereavement program, including a dedicated bereavement team.

Additionally, further education and training at Princeton Medical Center will include simulation and role-playing related to perinatal loss and communication skills.

Moreover, Straszynski, who will be speaking at the International Perinatal Bereavement Conference in 2022, hopes to expand the education program to include physicians and other disciplines involved in caring for families who have suffered a pregnancy loss.

She envisions the program expanding to include staff in surgical care, maternal-fetal medicine and the emergency department, often the first place families go when experiencing a pregnancy loss.

Kristyn Compitello, RN, BSN, who has participated in the training and is helping lead the expansion as part of her Master’s project, said Straszynski is a mentor who is committed to making sure all pregnancy losses are recognized no matter how early they occur.

“It’s still a loss no matter when it happens,” Compitello said.

Compitello said her goal is to be present with families and to respond to what they need, whether its bereavement boxes, photos, or guidance with planning services.

“If I can give just the slightest bit of relief or take away a little bit of pain, it is worth it,” said Compitello, who has experienced early pregnancy loss herself.

She and Straszynski stressed that even though a pregnancy may have ended in loss, the parents are still parents who had started planning, hoping and dreaming of their baby’s future from the day they found out they were expecting.

“Will it be a boy or a girl? A baseball player? A dancer? They really start to plan their baby’s life, and then it ends,” said Straszynski. “But they are still parents, just not in the way they wanted to be.”

Guardian Angels

“We were so ready to be parents,” said Herrera, who delivered a 1 lb. baby boy who she and Pennacchi named Luciano.

They held him. They dressed him. Their family visited, and they took pictures to remember him before they said goodbye.

“We wanted to do everything we could to take care of him and wanted him to be treated like any other baby would be treated,” Herrera said.

Herrera and Pennacchi participated in Straszynski’s research and said they are extremely grateful for the care they received from her and the team of doctors and nurses at Princeton Medical Center who helped guide them through the painful experience of losing their baby.

“Having the staff there at Princeton Medical Center is the only way we think we made it through the worst experience of our lives,” Herrera said. “It was as if they were guardian angels floating in and out of the room.”

At Straszynski’s suggestion, Herrera and Pennacchi joined a bereavement group hosted by the hospital and found comfort in sharing their grief with other families who experienced similar losses. Similar groups and bereavement support programs are available to families across the health system.

The group also enabled Herrera and Pennacchi to talk about Luciano and keep his memory alive.

“We knew sitting together staring at the ceiling was probably not the best way to heal,” Herrera said. “We joined the bereavement group and never stopped going.”

In January this year, Herrera and Pennacchi had their second baby, a healthy boy they named Oliver.

They brought a photo of Luciano with them to Princeton Medical Center, where they delivered, so the family could be together.

“Luciano is still part of our lives,” Herrera said. “We’re a family of four now.”