Perinatal Bereavement Support Research Articles

Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death

BackgroundStillbirth and neonatal death are devastating pregnancy outcomes with long-lasting psychosocial consequences for parents and families, and wide-ranging economic impacts on health systems and society. It is essential that parents and families have access to appropriate support, yet services are often limited. Internet-based programs may provide another option of psychosocial support for parents following the death of a baby. We aim to evaluate the efficacy and acceptability of a self-guided internet-based perinatal bereavement support program “Living with Loss” (LWL) in reducing psychological distress and improving the wellbeing of parents following stillbirth or neonatal death.MethodsThis trial is a two-arm parallel group randomized controlled trial comparing the intervention arm (LWL) with a care as usual control arm (CAU). We anticipate recruiting 150 women and men across Australia who have experienced a stillbirth or neonatal death in the past 2 years. Participants randomized to the LWL group will receive the six-module internet-based program over 8 weeks including automated email notifications and reminders. Baseline, post-intervention, and 3-month follow-up assessments will be conducted to assess primary and secondary outcomes for both arms. The primary outcome will be the change in Kessler Psychological Distress Scale (K10) scores from baseline to 3-month follow-up. Secondary outcomes include perinatal grief, anxiety, depression, quality of life, program satisfaction and acceptability, and cost-effectiveness. Analysis will use intention-to-treat linear mixed models to examine psychological distress symptom scores at 3-month follow-up. Subgroup analyses by severity of symptoms at baseline will be undertaken.DiscussionThe LWL program aims to provide an evidence-based accessible and flexible support option for bereaved parents following stillbirth or neonatal death. This may be particularly useful for parents and healthcare professionals residing in rural regions where services and supports are limited. This RCT seeks to provide evidence of the efficacy, acceptability, and cost-effectiveness of the LWL program and contribute to our understanding of the role digital services may play in addressing the gap in the availability of specific bereavement support resources for parents following the death of a baby, particularly for men.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12621000631808. Registered prospectively on 27 May 2021.

Beyond Professional Competence

Health-care professionals who offer perinatal bereavement support often encountered numerous stressful events in daily practices. Secondary trauma and burnout related to psychological distress are not uncommon. Literatures suggested that further skill training enhances perceived self-competence thus lowering such traumatic impact. Nevertheless, equanimity, an emerging concept in professional development, which is characterized by a sense of unflappability and resilience in face of challenges, is an indispensable element in protecting the well-being of health-care professionals. The current study aimed to examine the role of equanimity and perceived self-competence on professional quality of life among health-care professionals. A city-wide survey study was conducted among 101 individuals who offered perinatal bereavement support at tertiary care institutions in Hong Kong. Perceived self-competence was positively associated with compassion satisfaction (β = .380, p < .001, CI = 0. 038, 0.131) and negatively correlated to burnout (β = −.439, p < .001, CI = −0.148, −0.055), in which both relationships were moderated by the level of equanimity, that is, the impact of perceived self-competence on professional quality of life was only significant among individuals with higher level of equanimity. It implied that perinatal bereavement training should integrate not only knowledge and skills but also component of equanimity training to facilitate the capacity building among frontline health-care professionals.

Combining regional expertise to form a bereavement support alliance.

Providing compassionate bereavement care for families experiencing perinatal loss is a standard of care in most healthcare organizations. In this article, we describe the development of The Alliance of Perinatal Bereavement Support Facilitators, begun over 25 years ago in Chicago by staff who identified the need to reach out to colleagues at other area institutions for advice and support in this work. This collaboration created a regional support network that has resulted in a long-lasting, active, sustainable organization of excellence focused on enhancing practice, education, and perinatal bereavement care. Alliance activities center around four main areas: education, networking/support, policy, and recognizing outstanding service to families. By continuing to draw upon the collective talent, wisdom, and expertise of its members, The Alliance still serves grieving families and provides mentoring for future interdisciplinary team members engaged in this work. The path taken to build this organization can be used by professionals in other specialties who are looking to create their own alliance infrastructure based on mutual benefit and interest.

Meeting the Challenges of Perinatal Bereavement Support Through Collaboration and Innovation

Poster Presentation Purpose for the Program To better meet the needs of the patient and families who experience perinatal loss and those of the staff providing care. Proposed Change To improve and expand the perinatal bereavement program in response to staff, patients, and community feedback. Implementation, Outcomes, and Evaluation The perinatal bereavement committee was expanded to include staff from labor and delivery, neonatal intensive care unit, mother–baby unit, genetic counseling, pastoral care, and nursing leadership. The committee identified opportunities for improvement in staff education, and the need to increase and improve processes for the respectful and individualized care of patients and infants. The existing process for burial was cost prohibitive for many families and confusing to implement. In response to these concerns, contact was made with the hospital's Foundation to identify financial resources to make this service accessible to all families who experience perinatal loss. We partnered with community resources, such as The Alexis Foundation, Linnemann Funeral Home, the HEARTS peer led support group and volunteers, to provide improved quality of care and tools. Tools include handmade blankets and hats, memory boxes individualized for gestational age, PresHand carriers for the respectful transport and handling of these infants, and brochures to assist patients and families in their journey through the grief process. Nursing management provided encouragement and financial support for the development and implementation of education for all nursing staff. Implications for Nursing Practice Collaboration within the healthcare system and the community affects the care we give our patients. Education and quality tools empower nurses to give individualized and respectful care to patients and infants. As a Magnet hospital, St. Elizabeth Healthcare continually focuses on the importance of collaboration and innovation to improve patient care and the enhancement of professional growth and development of nurses.

RETRACTED: Attitudes of midwives towards perinatal bereavement in Hong Kong

to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. a descriptive correlational survey. the obstetric and gynaecology units at two hospitals. a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. 154 out of 202 midwives (76.2% response rate) working at the two units. two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.

Perinatal bereavement support: a quantitative study

This article aims to explore Hong Kong-based midwives' attitudes towards perinatal bereavement care and identify their required support and bereavement care training needs. It is based on a study of 93 certified midwives working in an obstetrics and gynaecology unit in one of Hong Kong Island's largest public hospitals. Data were collected through a structured self-administrated questionnaire. The study measured: midwives' attitudes towards perinatal bereavement support; required support and bereavement care training needs. The main findings were that the majority of this study's sample held a positive attitude towards bereavement care and there was a significant difference in attitudes towards perinatal bereavement support in terms of demographics, practical experiences and training factors.

Attitudes of Nurses Toward Perinatal Bereavement

Nurses' attitudes toward perinatal bereavement care are explored by identifying profiles of nurses working in 2 obstetrics and gynecology units in Hong Kong. Relationships between nurses' attitudes toward bereavement supports, need for bereavement education, and hospital policy are explored. A descriptive, correlational survey design was used, and 169 nurses recruited from an obstetric and gynecology (ob-gyn) unit at 2 local public hospitals in Hong Kong completed a structured questionnaire. Attitudes toward perinatal bereavement support; required support and education needs for nurses on bereavement care. Two-step cluster analysis yielded 2 clusters. Cluster 1 consisted of 55.6% (n = 94) and cluster 2 consisted of 44.3% (n = 75) of nurses. Cluster 2 nurses were younger and had less ob-gyn experience, more junior ranking, and less education than cluster 1 nurses. Cluster 1 nurses had additional midwifery and bereavement care education, personal grieving experiences, and experience handling grieving clients. The majority held positive bereavement care attitudes, but only 29.6% (n = 50) had bereavement-related education. Attitudes toward bereavement care were positively correlated with educational needs (r(s) = 0.52) and hospital policy support (r(s) = 0.56). Hong Kong nurses emphasized the need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula. The desire of Hong Kong nurses for bereavement education highlights the universality of grief for a lost infant, regardless of cultural differences in approaching emotional topics. This study may help nurses in the United States and elsewhere gain a broader perspective in this area.

A pilot study on nurses' attitudes toward perinatal bereavement support: a cluster analysis

Aim: Nurses' attitudes towards perinatal bereavement care are explored by identifying profiles of nurses working in a Hong Kong Obstetrics and Gynaecology (OAG) unit. Relationships between nurses' attitudes towards bereavement support, need for bereavement training and hospital policy are explored. Research method: 110 nurses recruited from the OAG unit of a large Hong Kong public hospital completed a structured questionnaire. Outcome measures: Attitudes towards perinatal bereavement support; required support and training needs for nurses on bereavement care. Results: Two-step cluster analysis yielded two clusters. Cluster A consisted of 55.5% ( n=61) and cluster B consisted of 44.5% ( n=49) of nurses. Cluster A nurses were younger, had less OAG experience, more junior ranking and less education than cluster B nurses. Cluster B nurses had additional midwifery and bereavement care training, personal grieving experiences and experience handling grieving clients. The majority held positive bereavement care attitudes. Significant differences towards perinatal bereavement support were found. Only 25.5% ( n=28) had bereavement related training. Attitudes towards bereavement care were positively correlated with training needs ( r s=0.59) and hospital policy support ( r s=0.60). Conclusion: Hong Kong nurses emphasized need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula.

An expanded perinatal bereavement support committee: a community-wide resource.

While perinatal health care professionals have discussed individual methods to support bereaved parents after a perinatal death (miscarriages, stillbirths, or neonatal deaths), there needs to be a comprehensive approach to perinatal bereavement support that extends not only to bereaved family members, but to the perinatal staff and the medical and nonmedical community. To facilitate such support, a perinatal hospital bereavement support committee was established. Its functions are described, including the development of hospital bereavement protocols, educational programs for all medical and nonmedical staff, and the establishment of local support groups.

Perinatal Bereavement Support Service: Three-Year Review

Perinatal loss and grief have been recognized as a special form of loss in the last ten years. Perinatal death includes miscarriage, therapeutic abortion, stillbirth, and infant death shortly after birth. Acknowledgement of the death and support to mourn their loss by significant others promotes resolution of this bereavement. If perinatal bereavement is not resolved, one-quarter to one-third of mothers may go on to develop a clinical depression. A multidisciplinary Perinatal Support Service is in place at Women's College Hospital to provide grief counselling to the mother and her family who have experienced a stillbirth or neonatal loss. The service has a direct link to the community through the Public Health Nurse on the obstetrical service. A review of three years reveals a high rate of referral by the attending physician and obstetrical nurse.