A beautiful ribbon, a journal and precious baby bonnet represent the compassionate efforts of a group of four neonatal intensive care unit (NICU) nurses at UC San Diego Health who came together nearly 17 years ago to support families who experienced a loss during pregnancy or postpartum.
While a loss like this is rare, the team of nurses developed a bereavement committee rooted in compassionate care and support for families.
“We become close to the patients we care for and their loved ones. When there is a loss, it can be traumatic for the families,” said Nicole Dominguez, RN, clinical nurse at UC San Diego Health. “We wanted to find a way to support our patients on a very personal level and help them navigate the extremely difficult and profound life event. Some families may only be with their baby for a short time, but we wanted to give them lasting memories that would help them through the grieving process.”
Over the years, the committee has expanded to a multidisciplinary group of physicians, nurses, leadership and staff from labor and delivery, neonatal intensive care unit (NICU), postpartum, social work, respiratory therapy, midwifery and lactation, along with family members who have previously lost a child.
The team meets bimonthly to coordinate and determine the best approach to serve families, each with a different need.
“In our meetings, we review policies and case studies for improvement opportunities, but most importantly, we listen to each other to ensure both staff and families feel supported, seen, heard and cared for,” said Kendra Everly, supervisor of social work at UC San Diego Health.
At UC San Diego Health, a team of five social workers serve the labor and delivery and NICU units at Hillcrest Medical Center and Jacobs Medical Center in La Jolla.
In the event of a loss, social workers connect with parents at the bedside, at times holding their hands or just sitting with them and listening to concerns. Each parent is provided with information on bereavement classes, group events for other grieving parents, such as grief counseling, yoga, meditation and additional support options.
After parents return home facing an unexpected reality, a social worker will check-in on them with a phone call just to see how they are doing and if there’s anything they may need.
“Oftentimes, parents are in shock initially, but we are there for them in whatever capacity that they need or want us to be,” said Everly.
Support is also provided from chaplains with Spiritual Care Services who offer companionship, tailored rituals, blessings and prayer for each family that requests it. The chaplains also collaborate with community clergy, helping them to understand how a loss may impact a family's spiritual well-being and resilience as they enter back into the community and their daily life.
One result of the bereavement committee was the creation of a “Comfort Cart,” which provides different memory-making opportunities for parents while they are still in the hospital. Photo credit: Leslie Aquinde
“When facing an unexpected loss, many people draw on their spiritual, religious and cultural beliefs for support and strength,” said Allison Kestenbaum, supervisor of spiritual care services at UC San Diego Health. “It’s our hope that in offering this that the families experience comfort, hope and guidance in processing their experience, as well as love and legacy for their lost child.”
One result of the bereavement committee was the creation of a “Comfort Cart,” donated by the Chadwick Family in honor of their daughter Reagan. Some families may choose to take part in the offerings of this cart, which provides different memory-making opportunities for parents while they are still in the hospital.
The cart also provides parents respite from stress they may be experiencing with items such as essential oils and lotions, to journaling notebooks to write down special moments, and molds to make handprints or footprints. These moments give parents the chance to exhale in a time where catching their breath may seem impossible.
The committee also organizes memory boxes for each family, which are filled with a variety of items, including a ribbon cut to the baby’s length and a note attached saying, “I love you beyond measure.”
“We always will do our best to create these special moments for the families while they are here with us in the hospital,” said Dominguez. “Our team represents the few people that had connections with the parents and knew their baby. It’s a bond that we will share forever and we will always continue to be there for our patients.”
Program offers a guiding light during the unexpected
When a parent goes through such a loss at UC San Diego Health, each person is also provided information on how the body changes after a delivery, including the production of breast milk, a detail often overlooked.
“During this time, the parent does not necessarily think about how their body will continue in the production of breast milk, and that is where our team comes in to help,” said Christina Toedtman, RN, clinical nurse and lactation consultant at UC San Diego Health. “Our team educates patients on the changes in their body — to know that what they are experiencing is normal; we also provide information on when the milk will come in and how to manage such a change.”
According to Toedtman, many patients are not aware of the options available to them in addressing their milk production and many do not own a breast pump yet due to the timing of their delivery and loss.
“This is why the Cherry Blossom Program was formed,” said Toedtman.
In many cultures, the blossoms of a cherry tree are a unique representation of the fragility of life as the flowers themselves are some of the most beautiful, but only live for a short time.
Inspired by this symbolism and developed by a team with the UC Health Milk Bank, the Cherry Blossom Family Program provides education on how a new parent can manage breast milk production and suppression after experiencing a loss.
“After a loss, we meet with the patient for our regular lactation consult to discuss options and symptoms, but no decisions are made that day,” said Toedtman. “Our team’s purpose is to provide education so the patient can make a choice that is best for their body and their family.”
"From the bedside in the hospital to home, it is such an honor to witness how our teams continue to expand upon the support available for our grieving patients who become family."
— Nicole Dominguez, RN, clinical nurse at UC San Diego Health
In 2024, the UC Health Milk Bank team organized the creation of a new mural, a blooming cherry blossom tree that spans 10 feet tall and 40 feet wide, as part of the Cherry Blossom Family Program to honor parents and memorialize their beloved babies. Photo credit: UC San Diego Health
Each patient is provided with a free breast pump, supplies and options on what they can do with the milk they produce.
“Many moms feel this immediate loss of control, but by providing them with this education we empower them and give them some control back,” said Toedtman. “Many choose to suppress their milk, but some choose to pump and donate their milk to help others.”
The Cherry Blossom Family Program — funded by the Mia Risa Foundation in honor of their daughter Mia — is offered to patients both in the labor and delivery unit and NICU. The breast pumps, storage bags and additional equipment for the pump are provided in a special bag in which patients are also offered a ceramic, heart-shaped stone for tactile comfort.
The program itself is available to anyone across the country and also provides support to anyone who contacts the UC Health Milk Bank considering donation after a perinatal loss. The breast pumps and bags are available to be overnighted to any family across the country.
How a 10-foot mural of a blooming cherry blossom tree is honoring families and memories
In 2024, the UC Health Milk Bank team organized the creation of a new mural, a blooming cherry blossom tree, as part of the Cherry Blossom Family Program to honor parents and memorialize their beloved babies.
The mural spans 10 feet tall and 40 feet wide and is proudly displayed at the entrance of the milk bank itself. It is decorated with beautiful ceramic cherry blossoms, many of which adorn the name of a baby who passed away. Taking part in the mural is open to all who have donated their breast milk after experiencing a loss, regardless of where they delivered.
“For some, donating milk after loss can be a time for healing and a time to connect with your child. It can also be a time to save the lives of other babies,” said Stephanie Lehman, PhD, donor program manager at the UC Health Milk Bank. “For those who choose to donate, we walk them through the process to make their experience as meaningful as possible and we are grateful to be a part of their grief journey.”
From the bereavement committee and additional support provided in the hospitals at UC San Diego Health, to the Cherry Blossom Program in place for when parents go home, all of these efforts are done with one thing in mind: the parents and their babies.
“From the bedside in the hospital to home, it is such an honor to witness how our teams continue to expand upon the support available for our grieving patients who become family,” said Dominguez.