Perinatal Bereavement Research Articles

A Phenomenological Study of Clinical Stillbirth Management for Grieving Mothers

For any expectant mother, the worst possible outcome of pregnancy is for the baby to die. The experience can lead to various forms of physical and psychosocial morbidity. The purpose of this study was to gain in-depth understanding of the experiences of mothers who suffered stillbirth with a view to improving the clinical management of stillbirth. Semi-structured qualitative interviews were conducted with ten women who had experienced stillbirths within one year prior to the interview. The interviews were recorded and transcribed verbatim. The data were analyzed using Smith’s interpretative phenomenological analysis (IPA) model and ATLAS.ti 8 software. Healthcare professionals identified three main themes: clinical management for stillbirth and bereaved mothers across various roles; public hospitals; and the Jordanian Ministry of Health Policies and Guidelines. The study findings underscore the devastating impact of insensitive and poor-quality care on bereaved mothers, highlighting how it exacerbates their grief and sorrow. These findings emphasize the need for training healthcare providers in perinatal loss and bereavement care, as well as the importance of adopting new policies and guidelines to improve the quality of care provided to bereaved mothers.

Providing emotional care for early pregnancy loss: development and evaluation of a new training module for healthcare providers

BackgroundMiscarriage is a common life event that frequently causes significant grief and distress. The emotional impact of miscarriage has been shown to be strongly influenced by patients’ and partners’ experiences interacting with healthcare providers during the miscarriage diagnosis and treatment: positive experiences are associated with reduced perinatal grief, whereas negative interactions can aggravate the traumatic impact of the loss. Unfortunately, healthcare providers frequently report feeling ill-equipped and unprepared to provide adequate emotional care for miscarriage. As such, there is an urgent need for effective training material to support healthcare providers in this important care. MethodHere, we report a quasi-experimental study evaluating the effectiveness of a new training module that we recently developed to empower healthcare providers when providing emotional care for miscarriage. ResultsUsing the previously-validated Perinatal Bereavement Care Confidence Scale, we show that this module is highly effective, achieving significant increases in healthcare providers’ knowledge, bereavement support skills, and awareness after completing training. Importantly, the module was effective for each of five different staff roles (anaesthetists, midwives, nurses, obstetricians and receptionists) and for both junior and more experienced staff. Furthermore, at six-week follow-up, HCPs reported using many of the module's recommendations in their ongoing practice. ConclusionAltogether, this new training module is therefore an important step towards empowering healthcare providers (in all roles) in providing essential emotional care for this common and frequently highly-distressing life event.

Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: a qualitative study

BackgroundWomen who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic’s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported.MethodsIn-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women’s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic.ResultsAll women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal.ConclusionsThese findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.

Navigating the Complexities of Perinatal Loss with Expressive Arts Therapy

Perinatal loss, encompassing miscarriage, stillbirth, and abortion, is a complex and multifaceted experience that presents significant challenges for those affected. Despite the growing emphasis on grieving rituals and proactive involvement with affected families, the mental health treatment field has only recently begun to explore the potential benefits of expressive arts therapy in supporting individuals and families through the bereavement process. This paper reviews research suggesting that expressive arts therapy, a holistic approach that utilizes various creative modalities, can facilitate emotional expression, self-awareness, and healing in the context of perinatal loss. By providing a non-verbal means of emotional expression,fostering a sense of community, and promoting empowerment, expressive arts therapy can help navigate the complexities of perinatal bereavement, ultimately promoting healing and strengthening the parent-child bond, even in the face of tragedy.

Undergraduate midwifery students' experiential learning of perinatal bereavement care: A qualitative analysis

BackgroundIt is widely acknowledged that midwives are essential in providing care for mothers experiencing perinatal death. However, midwifery students lack the knowledge and skills needed to deal with perinatal death, and. There is limited research on perinatal bereavement care training for midwifery students. AimTo investigate undergraduate midwifery students' experiential learning of perinatal bereavement care and serve as a reference for future perinatal bereavement care teaching and training. DesignQualitative descriptive design. SettingUniversity in Guangzhou, China. ParticipantsUndergraduate midwifery students at a university in Guangzhou, China. MethodThis research was conducted at a university in Guangzhou, China. The participants were recruited using purposeful sampling. Semi-structured, in-depth interviews were conducted with 11 midwifery students who participated in perinatal bereavement care training from May to June 2023. The Colalizzi 7-step data analysis method was used for data analysis. ResultsFrom the data, five themes emerged: 1) immersive experience of perinatal bereavement care, 2) formation of perspectives on perinatal bereavement care, 3) clarification of the service boundaries and internalization of the professional service spirit, 4) emotional impact and coping strategies, and 5)) factors influencing practice optimization. ConclusionsExperiential learning is an effective teaching strategy. However, participants continued to feel unprepared to provide perinatal bereavement care. Implementing relevant training, disseminating perinatal bereavement care knowledge and skills, and enhancing the ability of midwifery students to manage and cope with the psychological impact of perinatal death are important.

Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review.

The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers.

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

Multidisciplinary Simulation Improves Resident Comfort With Perinatal Bereavement Care [ID 2683378

INTRODUCTION: Physicians have difficulty delivering bad news because of discomfort and lack of appropriate education. We introduce an initiative to enhance trainee comfort in delivering the diagnosis of intrauterine fetal demise (IUFD) through multidisciplinary simulation training. METHODS: Twelve obstetrics and gynecology residents participated in perinatal bereavement training with a palliative care specialist utilizing the SPIKES framework, followed by an immersive simulation of an IUFD case and debrief with multidisciplinary physicians. Pre- and post-training surveys were administered. This study was approved by the IRB. RESULTS: Participants were equally distributed in training year (58% female, 33% male). 92% had previously delivered the diagnosis of IUFD, yet 50% had no previous bereavement training, and of those with training, most (84%) had less than 2 hours. Wilcoxon signed-ranks tests showed statistically significant increase in comfort level of delivering bad news (Z=66; P=.003), delivering a diagnosis of fetal demise (Z=64; P=.005), and having the skills and foundation to deliver the news of a fetal demise (Z=28; P=.017). Qualitative responses identified acquisition of verbal and nonverbal skills such as direct patient communication, using the word death, and sitting down at the patient’s eye level prior to delivering the news. Most described the experience as real, immersive, and a safe learning environment. One hundred percent would recommend the course to others. CONCLUSION: Perinatal bereavement education in obstetrics and gynecology residency training is lacking. Multidisciplinary, immersive simulation training significantly increased residents’ comfort and perceived preparedness in delivering the diagnosis of fetal demise.

Reflective evaluations of perinatal bereavement care provision in the US and UK: An exploratory qualitative comparative study

There is increased recognition of the need to improve standards of perinatal bereavementcare, due to its frequency and potential sequelae. As part of a Fulbright Scholar award, United States (US) and United Kingdom (UK) researchers collaborated to explore similarities and differences in perinatal bereavement care between two nations. Using an explorative qualitative comparative method, key categories within perinatal bereavement provision were identified and analysed. Themed findings include: (1) Differences in definitions of miscarriage and stillbirth impact care pathways; (2) For the experiencer grief is the same regardless of legal lines drawn; (3) The meaning of loss is personal and ‘fetal personhood’ needs to be acknowledged during care; (4) Appropriate psychological care is required whether miscarriage or stillbirth is experienced. We conclude that perinatal bereavement care should include screening for Postnatal Depression (PND) and Post-Traumatic-Stress-Disorder (PTSD), and support should be equally available to all women who experience perinatal bereavement, irrespective of type of loss. Acknowledging that cultures react to loss in different ways, we recommend that strategies are developed to build human resilience. For example, Compassionate-Mind-Training (CMT), which helps people copewith trauma through cultivating compassion and teaching self-care strategies to buildresilience, reduce self-criticism, and decrease threat-based emotions.

Perinatal Bereavement Photography: A Mixed-Methods Study on Posttraumatic Growth in Parents

Perinatal death is a devastating loss for parents, often exacerbated by the lack of social support. There is accumulating evidence that perinatal bereavement photography is a valuable memory-making tool to support parents experiencing perinatal loss. However, very few studies have examined posttraumatic growth (PTG) concerning perinatal loss and bereavement photography. This mixed-methods study aims to investigate predictors of PTG for parents using bereavement photography. The sample consisted of 489 parents in Australia and New Zealand using professional perinatal bereavement photography. Quantitative data were gathered through an anonymous online survey. Qualitative data were gathered from 36 parents through recorded semistructured interviews. Quantitative results indicate that engagement with and sharing photographs within a supportive environment and having a spiritual orientation were significant predictors of PTG. The overarching theme of Meaning making was constructed through reflexive thematic analysis of qualitative interview data. Participants reported bereavement photography as humanizing the loss of their baby and wanting their baby's death to have meaning through legacy making and parents having increased compassion for other parents. Bereavement photos provide a tangible means for parental grief to be validated and facilitates ongoing meaning making from the loss.

Measuring EQ-5D-5L utility values in parents who have experienced perinatal death

BackgroundPolicymakers use clinical and cost-effectiveness evidence to support decisions about health service commissioning. In England, the National Institute for Health and Care Excellence (NICE) recommend that in cost-effectiveness analyses “effectiveness” is measured as quality-adjusted life years (QALYs), derived from health utility values. The impact of perinatal death (stillbirth/neonatal death) on parents’ health utility is currently unknown. This knowledge would improve the robustness of cost-effectiveness evidence for policymakers.ObjectiveThis study aimed to estimate the impact of perinatal death on parents’ health utility.MethodsAn online survey conducted with mothers and fathers in England who experienced a perinatal death. Participants reported how long ago their baby died and whether they/their partner subsequently became pregnant again. They were asked to rate their health on the EQ-5D-5L instrument (generic health measure). EQ-5D-5L responses were used to calculate health utility values. These were compared with age-matched values for the general population to estimate a utility shortfall (i.e. health loss) associated with perinatal death.ResultsThere were 256 survey respondents with a median age of 40 years (IQR 26–40). Median time since death was 27 months (IQR 8–71). The mean utility value of the sample was 0.774 (95% CI 0.752–0.796). Utility values in the sample were 13% lower than general population values (p < 0.05). Over 10 years, this equated to a loss of 1.1 QALYs. This reduction in health utility was driven by anxiety and depression.ConclusionsPerinatal death has important and long-lasting health impacts on parents. Mental health support following perinatal bereavement is especially important.

A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build.

The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered. A consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy. The synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, & Practice. The evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis

BackgroundA lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives.MethodsA descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit.ResultsOrganisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion.ConclusionsThis study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

"You Are in the Middle of a Road, a Road With No End": Experiences of Women Who Underwent Medical Termination of Their Pregnancies: A Phenomenologıcal Study.

This article focused on the experiences of women who underwent medical termination of their pregnancies. The study adopted a qualitative phenomenological research design with a sample of 20 pregnant women. Data were collected between April and June 2022 using a personal information form and a semistructured individual interview. The qualitative data were analyzed into 4 categories: "psychosocial impacts," "impacts on functionality," "coping," and "expectations." These categories comprised 8 themes and 24 subthemes. Nurses play a crucial role in adopting family-centered approaches to offer holistic care. They should prioritize providing physical care throughout the medical termination, while also assessing the psychological impact of fetal loss. Perinatal palliative care and bereavement counseling should be integrated into care practices.

Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital-a Qualitative Study.

This study aimed to investigate the understanding and experiences of mothers who have suffered perinatal loss regarding their needs after being discharged from the hospital. Data were collected through semi-structured face-to-face and telephone interviews using purposive sampling with maximum diversity. The sample included 15 mothers and 6 midwives who had experienced fetal loss and perinatal bereavement. The interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyze the data. Sampling was conducted from July 2022 to March 2023, continuing until data saturation was reached. The study identified 2 main categories of needs for mothers who have experienced perinatal loss: continuous healthcare (including the Comprehensive Mother Tracking System, provision of psychological welfare, and educational needs) and provision of a support network, including "spouse and family support" and "peer and colleague support." The primary theme of this study was "Deliberating Care for Grieving Mothers." The study results indicate that mothers who experience perinatal loss require continuity of care after being discharged. Psychological screening and counseling support are essential for both parents. Considering the significant impact of spousal, familial, and community support on an individual's life, it is crucial to prepare the community to comprehend and embrace grieving parents.

Healthcare professionals' needs when providing perinatal bereavement care: A qualitative study.

Caring for and supporting bereaved parents with fetal loss requires preparation, training, and attention to a set of needs of health workers to provide optimal services. This is although it has been less addressed in the educational curriculum and in-service training. This study aims to investigate the experiences of Iranian healthcare professionals regarding the needs related to the care of bereaved parents with perinatal loss. This research was a qualitative study conducted in Shahroud City, Iran, to explore healthcare professionals' needs from June 2021 to December 2022. Semi-structured in-depth interviews on purposive sample of 14 participants were conducted. The participants were care providers who worked in OB-GYN ward, general midwifery clinics, and a private office. The interviews were recorded verbatim, transcribed, and analyzed using an inductive content analysis. MAXQDA software version 10 was used for data analysis. Granheim and Lundman's approach was used to analyze the data. Two major themes, four categories, and nine subcategories emerged. The themes included the "existence of protective laws and policies" and "skill and training needs." Protective laws and policies included "Government Rules and guidelines" and "organizational Rules protecting the individual." Skills and training needs consisted of two categories: "communication skills" and "Self-Care needs." Educational policies, development of guidelines for the care of bereaved mothers based on culture, training programs for dealing with bereaved parents, providing self-care programs for employees, and improving the physical and emotional conditions of the workplace were among the needs expressed by the participants. Meeting the needs of healthcare professionals is effective in job satisfaction, feeling of value, and high quality of services for bereaved parents.

Assessment of Knowledge, Attitude and Factors Associated with Perinatal Bereavement Care among the Nurses in Madhya Pradesh, Central India

Perinatal bereavement care encompasses holistic support and services offered by healthcare professionals, addressing physical, psychological, emotional, and spiritual needs of bereaved parents which are most often ignored in clinical settings. This hospital-based descriptive study aimed to assess knowledge, attitudes, and associated factors regarding perinatal bereavement care among nursing personnel in a tertiary care hospital in central India. A total of 207 nursing personnel selected through non-probability convenient sampling participated in the study. Data were collected using a structured questionnaire with a 5-point Likert scale and dichotomous scale. The study revealed that 78.3 percent of nursing personnel possessed average knowledge, while 73.4 percent exhibited a positive attitude towards perinatal bereavement care. Several influencing factors were identified, including personal perinatal grieving experiences, a history of other grieving experiences, existing hospital policies, regular training and Continuing Nursing Education, as well as traditional beliefs and values. Further, a positive correlation between the knowledge and attitude of nursing personnel regarding perinatal bereavement care came to light. Significant associations were observed between knowledge scores, attitudes, and demographic variables such as age, total work experience, years of experience in maternity wards, personal loss experiences, and past experience in handling grieving parents among nursing personnel. The study underscores the importance of perinatal bereavement care in providing support to grieving parents and emphasises the need for nursing personnel to possess both knowledge and a compassionate attitude in this regard. The study recommends the establishment of Standard Operating Procedures for Perinatal Bereavement Care within the hospital and the implementation of regular Continuing Nursing Education and training programmes to create a supportive environment.

Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study.

Evidence to guide intrapartum care when an unborn baby has died is limited. To explore parents' experiences of care during labour of an antepartum stillbirth. Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub-themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub-themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available.

Nurses’ Knowledge, Attitudes, and Practices regarding perinatal bereavement care in Malaysia: A Cross-sectional Study

Background: Perinatal bereavement occurs when a parent experiences the loss of a baby during pregnancy or shortly after birth. Coping with this loss can be incredibly challenging and emotionally taxing for the parents involved. They often have complex and intense emotional and psychosocial needs to navigate during this difficult time. Objective: This study aimed to investigate nurses’ knowledge, attitudes, and practices regarding perinatal bereavement care (PBC) and its correlation with their selected sociodemographic factors. Methods: In 2021, a cross-sectional descriptive study was conducted utilising a structured questionnaire for data collection. A total of 182 nurses were sampled conveniently, comprising 45 registered nurses, 124 registered midwives, and 13 community nurses. The data was subjected to descriptive statistical analysis using IBM SPSS Version 28.0. Results: The finding shows that 67% had a poor understanding of perinatal bereavement. However, the majority (85.2%) had positive attitudes towards providing care for those affected by perinatal bereavement, and 58.8% displayed favourable care behaviour. The results also indicated that nurses who had experience working with grieving parents had a higher level of knowledge regarding perinatal bereavement care (p&lt;0.005). Additionally, the study found that nurses who had been working in the field for longer had more positive attitudes toward bereavement care (p&lt;0.05). Furthermore, the practices of perinatal bereavement care were found to be related to work designation and qualifications (p&lt;0.05). Conclusion: It is recommended that perinatal bereavement care education be included in undergraduate healthcare education, postgraduate education, and Continuing Professional Education (CPE) workshops. Evidence-based policies and protocols on perinatal bereavement care are also recommended to support parents and family members during their experience of bereavement.

Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study

BackgroundResearch highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students.MethodsEducational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis.Results96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss.ConclusionsThe educational intervention increased student nurses’ perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.