The loss of a pregnancy or baby is described by Gardner (1999) and Saflund et al (2004) as a ‘life crisis’, and is traumatic for both parents and health professionals. Death is an unexpected outcome of pregnancy (Charles and Kavanagh, 2009). Stillbirths are consistently the largest contributor to perinatal mortality in the UK (Gardosi, 2004), occurring in approximately 1 in 200 births and a rate of 5.2 per 1000 live births (Royal College of Obstetricians and Gynaecologists (RCOG), 2010). On a worldwide scale, there are 4 million sudden intrauterine deaths each year (Cacciatore et al, 2009), yet the cause of most stillbirths remains unknown and a third occur when the fetus has reached full term (Daniel, 2007). The management of care following perinatal loss needs to be sensitively arranged. Parents should be warned of any gross abnormality or suspected maceration, and discussions should take place about how the baby may look at delivery (Liu, 2007; Medforth et al, 2009). The care that parents receive around the time of the intrauterine death or stillbirth cannot remove the pain of their grief, but inadequate care can make the situation worse (Schott and Henley, 2009). Midwives need to be adequately prepared within mandatory training for this and appropriate support should be available from the supervisor of midwives as required. Birth should take place away from the main delivery suite in a quiet and calm atmosphere, and needs to be gentle and slow due to fragility of fetal skin (Charles and Kavanagh, 2009). Liu (2007) adds that appropriate analgesia according to maternal wishes should be administered and that caesarean section should only be considered in emergencies and where mechanical difficulties present. Immediate care post delivery should revolve around supporting the parents and encouraging them to hold and spend time with their baby (Medforth et al, 2009). Trulsson and Radestad (2004) found that no woman regretted seeing her baby and all were grateful for the encouragement given by staff to do so. The parents and family may wish to bath and dress the baby, and to have the baby weighed and measured, as with a live birth (Medforth et al, 2009). The obstetric registrar or consultant should see the baby and issue a stillbirth certificate, with the services of the hospital chaplain offered to ensure that the woman and her family have the spiritual support they require (Medforth et al, 2009). By supporting the couple at the meeting and farewell with the baby and by helping to create memories, caregivers diminish the risk of long-term psychological problems (Radestad et al, 1996; Radestad et al, 1997). All appropriate persons should be informed of the intrauterine death or stillbirth (GP, health visitor, community midwife) to avoid unnecessary upset and the woman should be put in touch with a bereavement midwife if there is one available (Liu, 2007; Medforth et al, 2009). Perinatal loss is a difficult part of maternity care but how the care is implemented is greatly important for women and their families. Some antenatal practices, such as auscultating the fetal heart and fetal movement monitoring, can be helpful in assessing fetal wellbeing, however they may not prevent perinatal loss. Care should be given in a sensitive manner while being truthful with the parents. Women need to be adequately supported in making informed choices about the care that they receive after diagnosis, through their labour and postnatally. These choices will be difficult for women and their families so it is important that practitioners give them the time they need to think about and formulate their decisions. The impact of the care that women receive through perinatal loss may affect their relationship and perception of any further pregnancies, so appropriate care is important to their health in the future. BJM
Read full abstract
Jul 1, 2013
Tracey Barnfather 
Open Access