Abstract
BackgroundThe objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care.MethodsA cross-sectional descriptive study using an online self-completion questionnaire. The population was defined as women who had experienced an intrauterine fetal death between sixteen weeks and birth, either through spontaneous late miscarriage/stillbirth or termination of pregnancy for medical reasons. Respondents were recruited through an online advertisement on a stillbirth charity website and social media. The analysis used Pearson’s chi-squared (p ≤ 0.05) test of independence to cross-analyse for associations between objective measures of care quality and independent variables.ResultsResponses from 796 women were analysed. Half of the women (52.9%) had postmortem contact with their baby. 30.4% left the hospital with a least one linking object or a photograph. In 35.8% of cases parents weren’t given any option to recover the body/remains. 22.9% of births ≥26 weeks gestation were by caesarean, with a significant (p < 0.001) difference between public hospitals (16.8%) and private hospitals (41.5%). 29.3% of respondents were not accompanied during the delivery. 48.0% of respondents recalled being administered sedatives at least once during the hospital stay. The autopsy rate in stillbirth cases (≥ 20 weeks) was 70.5% and 44.4% in cases of termination of pregnancy (all gestational ages). Consistent significant (p < 0.05) differences in care practices were found based on gestational age and type of hospital (public or private), but not to other variables related to socio-demographics, pregnancy history or details of the loss/death. Intrauterine deaths at earlier gestational ages received poorer quality care.ConclusionsSupportive healthcare following intrauterine death is important to women’s experiences in the hospital and beneficial to the grief process. Many care practices that are standard in other high-income countries are not routine in Spanish hospitals. Providing such care is a relatively new phenomenon in the Spanish health system, the results provide a quality benchmark and identify a number of areas where hospitals could make improvements to care practices that should have important psychosocial benefits for women and their families.
Highlights
The objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care
Despite disagreement about how active a role Health professional (HP) should take in promoting postmortem contact [13, 14], key aspects of care related to ritual, include: supporting parents to see, hold and interact with their baby, regardless of gestational age or condition; helping them to keep objects related to the baby or birth; and providing options and support for a respectful disposition [1, 15,16,17]
Population The population was defined as women who experienced a spontaneous intrauterine death or termination of pregnancy for medical reasons between 16 weeks gestation and up to and including intrapartum death, within the Spanish healthcare system
Summary
The objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care. Despite the inherent sadness of their situation, when they receive meaningful support in a caring environment, many women and their partners have positive memories of the birth and their time in the hospital [8, 9]. Over the last few decades, care practices have developed to encompass specific bereavement support actions focused on psychosocial care, which complement medical/ technical aspects of care related to the management of the birth and the death of the baby. The provision of meaningful care stresses the development of an empathetic and trusting relationship between healthcare professionals (HPs) and bereaved women, their partners and other family members [10]. Despite disagreement about how active a role HPs should take in promoting postmortem contact [13, 14], key aspects of care related to ritual, include: supporting parents to see, hold and interact with their baby, regardless of gestational age or condition; helping them to keep objects related to the baby or birth; and providing options and support for a respectful disposition [1, 15,16,17]
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