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Fernández-Basanta S, Coronado C, Movilla-Fernández MJ. Encountering the health and social environment after a pregnancy loss: A grounded theory study from male perspective. Midwifery 2024; 137:104107. [PMID: 39003933 DOI: 10.1016/j.midw.2024.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
AIM To develop an empirical model that explores and explains the social process of the encounters of men who suffered pregnancy loss with health and social environments. METHODS A constructivist grounded theory method was performed, whereby 23 couples were interviewed using a semi-structured interview. Men that suffered pregnancy loss were analysed iteratively, with line-by-line and incident-to-incident coding, focused coding and axial coding, until data saturation and the emergence of theory. RESULTS The theory Behind bars that hide and mask them illustrates the social process of the encounters of men who suffered pregnancy loss with the health and social environment. Social taboo and gender stereotypes could repress, marginalize, and hide men's feelings. This transposed into the healthcare setting, which focused on the physical aspects of the woman, and lacked an emotional approach, follow-up, and sensitivity. Men reported a lack of recognition or family and social support. CONCLUSION Many men report not feeling involved in the care process after pregnancy loss, in addition to the prioritisation of medicalised care, which can be explained by a medical paternalism approach. These results provide a basis to reflect and plan the inclusion of men for the provision of comprehensive and couple-centred care. IMPLICATIONS FOR PRACTICE Communication strategies and emotional management, self-reflection of health professionals, theoretical-practical content with a gender perspective in the training of nurses and midwives, involvement of the organisation and leadership, and further research is required.
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Affiliation(s)
- Sara Fernández-Basanta
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Ferrol Industrial Campus, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain.
| | - Carmen Coronado
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Ferrol Industrial Campus, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Ferrol Industrial Campus, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain
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Adams MA, Bevan C, Booker M, Hartley J, Heazell AE, Montgomery E, Sanford N, Treadwell M, Sandall J. Strengthening open disclosure in maternity services in the English NHS: the DISCERN realist evaluation study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-159. [PMID: 39185618 DOI: 10.3310/ytdf8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. Objectives To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. Design A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. Setting National recruitment (study phases 1 and 3); three English maternity services (study phase 2). Participants We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. Results The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Limitations Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. Conclusions We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study's findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. Study registration This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Mary Ann Adams
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Charlotte Bevan
- The Stillbirth and Neonatal Death Charity (SANDS), London, UK
| | | | - Julie Hartley
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | | | - Elsa Montgomery
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
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Geusens F, Bogaerts A, Skalkidou A. 'I had to Educate Myself': A thematic analysis of online stillbirth stories to improve obstetric care. BJOG 2024; 131:1120-1128. [PMID: 38221506 DOI: 10.1111/1471-0528.17750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To examine which met and unmet needs are discussed in stillbirth stories shared on YouTube with the aim to improve obstetric care. DESIGN Inductive thematic analysis of 19 English-language stillbirth stories uploaded to YouTube. SETTING Online setting, YouTube video content. SAMPLE Women who experienced stillbirth and shared a video on YouTube talking about their experience. METHODS We conducted a thorough textual reading of the transcripts following Braun and Clarke's guidelines for thematic analysis. MAIN OUTCOME MEASURES Codes were developed and grouped into themes. RESULTS Although some women actively used their birth videos to call out shortcomings in their care, most others used their platform for other purposes such as destigmatisation, awareness and support, and rather unintentionally provided insight into their met and unmet needs. When analysing their birth stories, three major themes emerged: choice and decision-making, education and information, and behaviour of healthcare providers. CONCLUSIONS This study demonstrates the value of birth stories in research. We identified three major opportunities for improvement of obstetric care: being provided with options and being able to make choices in the decision-making process are clearly valued, but there are some caveats: women and other childbearing individuals need timely and continuous information, and more attention is needed for emotional intelligence training of healthcare providers.
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Affiliation(s)
- Femke Geusens
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Roberts LR, Nick JM, Sarpy NL, Peters J, Tamares S. Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review. JBI Evid Synth 2024:02174543-990000000-00324. [PMID: 38932508 DOI: 10.11124/jbies-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE 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. INTRODUCTION 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. INCLUSION CRITERIA 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Nancy L Sarpy
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Judith Peters
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Shanalee Tamares
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
- Del Webb Library, Loma Linda University, Loma Linda, CA, USA
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Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study. Aust N Z J Obstet Gynaecol 2024; 64:133-140. [PMID: 37833833 DOI: 10.1111/ajo.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Evidence to guide intrapartum care when an unborn baby has died is limited. AIMS To explore parents' experiences of care during labour of an antepartum stillbirth. MATERIALS AND METHODS Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. FINDINGS 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. CONCLUSIONS 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.
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Affiliation(s)
- Jane Warland
- UniSA Clinical and Health Sciences, UniSA, Adelaide, South Australia, Australia
| | - Danielle Pollock
- Evidence-Based Healthcare Research Division, JBI, Adelaide, South Australia, Australia
| | | | - Dell Horey
- Faculty of Science Agriculture Business and Law, University of New England, Armidale, New South Wales, Australia
| | - Frances Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
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Challacombe FL, Suchomelova Z, Zampieri C, Hall M, Curran C, Shennan A, Story L. Preterm premature rupture of the membranes (PPROM): a study of patient experiences and support needs. J Reprod Infant Psychol 2024:1-18. [PMID: 38361489 DOI: 10.1080/02646838.2024.2314179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Preterm prelabour rupture of membranes (PPROM) is a common obstetric condition but outcomes can vary depending on gestation. Significant maternal and foetal complications occur including preterm birth, infection, abruption, cord prolapse, pulmonary hypoplasia and even death. Although the need for psychological support is recognised it is unclear how much is actually offered to women and their families. This study aimed to survey the views of women and their families who have undergone PPROM in order to understand the care and psychological burden these families face. METHODS An online survey was conducted, recruiting women via social media with collaboration from the patient advocacy support group Little Heartbeats. Responses were collated where fields were binary or mean and standard deviations calculated. Framework analysis was used to identify and analyse themes in free text responses. RESULTS 180PPROM pregnancies were described from 177 respondents. Although carewas variable and respondents were from across the world there werecommon themes. Five themes were highlighted which were: a lack ofbalanced information regarding the condition, support in decisionmaking and support with the process, specific psychological supportand ongoing psychological consequences of PPROM. CONCLUSION This survey highlights areas in which care needs to be improved for women with PPROM. Previous studies have shown that providing good care during the antenatal period reduces long-term psychological morbidity for the whole family. The need for support, with regard both to information provided to women and their families and their psychological support needs to be addressed urgently.
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Affiliation(s)
- Fiona L Challacombe
- Section of Women's Mental Health, HSPR, Institute of Psychology and Psychiatry and Neurosciences, King's College London, London, UK
| | - Zuzana Suchomelova
- Institute of Psychology and Psychiatry and Neurosciences, King's College London, London, UK
| | - Carla Zampieri
- Department of Women and Children's Health, King's College London, London, UK
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, UK
| | - Ciara Curran
- Littleheartbeats, Preterm Prelabour Rupture of the Membranes Patient Support Group, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, UK
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Persson M, Hildingsson I, Hultcrantz M, Kärrman Fredriksson M, Peira N, Silverstein RA, Sveen J, Berterö C. Care and support when a baby is stillborn: A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries. PLoS One 2023; 18:e0289617. [PMID: 37582089 PMCID: PMC10427022 DOI: 10.1371/journal.pone.0289617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/22/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Approximately 2 million babies are stillborn annually worldwide, most in low- and middle-income countries. Present review studies of the parental and healthcare providers' experiences of stillbirth often include a variety of settings, which may skew the findings as the available resources can vary considerably. In high-income countries, the prevalence of stillbirth is low, and support programs are often initiated immediately when a baby with no signs of life is detected. There is limited knowledge about what matters to parents, siblings, and healthcare providers when a baby is stillborn in high-income countries. OBJECTIVES This systematic review and interpretive meta-synthesis aim to identify important aspects of care and support for parents, siblings, and healthcare professionals in high-income countries from the diagnosis of stillbirth throughout the birth and postpartum period. METHODS A systematic review and qualitative meta-synthesis were conducted to gain a deeper and broader understanding of the available knowledge about treatment and support when stillbirth occurred. Relevant papers were identified by systematically searching international electronic databases and citation tracking. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol, including qualitative and quantitative study approaches, was registered on PROSPERO (CRD42022306655). RESULTS Sixteen studies were identified and included in the qualitative meta-synthesis. Experiences of care and support were interpreted and identified as four fusions. First, Personification is of central importance and stresses the need to acknowledge the baby as a unique person. The parents became parents even though their baby was born dead: The staff should also be recognised as the individuals they are with their personal histories. Second, the personification is reinforced by a respectful attitude where the parents are confirmed in their grief; the baby is treated the same way a live baby would be. Healthcare professionals need enough time to process their experiences before caring for other families giving birth. Third, Existential issues about life and death become intensely tangible for everyone involved, and they often feel lonely and vulnerable. Healthcare professionals also reflect on the thin line between life and death and often question their performance, especially when lacking collegial and organisational support. Finally, the fusion Stigmatisation focused on how parents, siblings, and healthcare professionals experienced stigma expressed as a sense of loneliness, vulnerability, and being deviant and marginalised when a baby died before or during birth. GRADE CERQual ratings for the four fusions ranged from moderate to high confidence. CONCLUSIONS The profound experiences synthesised in the fusions of this meta-synthesis showed the complex impacts the birth of a baby with no signs of life had on everyone involved. These fusions can be addressed and supported by applying person-centred care to all individuals involved. Hence, grief may be facilitated for parents and siblings, and healthcare professionals may be provided with good conditions in their professional practice. Furthermore, continuing education and support to healthcare professionals may facilitate them to provide compassionate care and support to affected parents and siblings. The fusions should also be considered when implementing national recommendations, guidelines, and clinical practice.
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Affiliation(s)
| | - Ingegerd Hildingsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Maja Kärrman Fredriksson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Nathalie Peira
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Rebecca A. Silverstein
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Josefin Sveen
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Carina Berterö
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Tataj-Puzyna U, Heland-Kurzak K, Sys D, Szlendak B, Ryś M, Krauze M, Baranowska B. The Experiences of Midwives Who Attend Births by Women with Life-Limiting Fetal Conditions (LLFC): A Phenomenological Research Study. Healthcare (Basel) 2023; 11:healthcare11111540. [PMID: 37297680 DOI: 10.3390/healthcare11111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Providing care to a woman after a Life-Limiting Fetal Conditions (LLFC) diagnosis is a difficult experience for midwives. This study's aim is to describe the experience of midwives assisting in births following an LLFC diagnosis. It is a qualitative study using Interpretative Phenomenological Analysis (IPA). Semi-structured in-depth interviews were conducted with 15 midwives with experience in caring for women giving birth following an LLFC diagnosis. The data was analyzed through coding using the MAXQDA tool. The main theme emerging from the experience of midwives concerned difficulty in interacting with the woman giving birth. The analysis singled out four subthemes containing the most significant issues arising from the experience of midwives in caring for a woman giving birth to a lethally ill child: in relation with the woman giving birth; in relation with the child and the family; in relation with oneself; and in relation with the workplace. Midwives should have access not only to solid knowledge about this question, but also to courses developing skills in dealing with difficult situations, in coping with stress, in expressing compassion and, most importantly, in communicating with women and their families in such difficult circumstances.
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Affiliation(s)
- Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland
| | - Krystyna Heland-Kurzak
- Department of Social Pedagogy, The Maria Grzegorzewska University, 02-353 Warsaw, Poland
| | - Dorota Sys
- Department of Medical Statistics, School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Beata Szlendak
- Foundation for Supporting Midwives, 00-112 Warsaw, Poland
| | - Maria Ryś
- Institute of Psychology, Department of Christian Philosophy, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland
| | - Magdalena Krauze
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-581 Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland
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Adams M, Hartley J, Sanford N, Heazell AE, Iedema R, Bevan C, Booker M, Treadwell M, Sandall J. Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence. BMC Health Serv Res 2023; 23:285. [PMID: 36973796 PMCID: PMC10041808 DOI: 10.1186/s12913-023-09033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts. METHODS Realist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified. RESULTS After realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated. CONCLUSIONS This is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.
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Affiliation(s)
- Mary Adams
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Julie Hartley
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, UK
| | | | - Rick Iedema
- School of Life Sciences and Medicine, King's College London, London, UK
| | - Charlotte Bevan
- The Stillbirth and Neonatal Death Charity (SANDS), London, UK
| | | | | | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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10
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Jones EE, Crawley R, Brierley-Jones L, Kenny C. Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation. J Reprod Infant Psychol 2023; 41:93-109. [PMID: 34510967 DOI: 10.1080/02646838.2021.1972951] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.
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Affiliation(s)
- Emma E Jones
- School of Psychology, University of Sunderland, Sunderland, UK
| | | | | | - Catherine Kenny
- School of Psychology, University of Sunderland, Sunderland, UK
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11
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Actis Danna V, Lavender T, Laisser R, Chimwaza A, Chisuse I, Kasengele CT, Kimaro D, Kuzenza FD, Lyangenda K, Mwamadi M, Shayo H, Tuwele K, Wakasiaka S, Bedwell C. Exploring the impact of healthcare workers communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia. A grounded theory study. Women Birth 2023; 36:e25-e35. [PMID: 35440427 PMCID: PMC9880556 DOI: 10.1016/j.wombi.2022.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Communication and interaction with healthcare workers at the time of stillbirth remain in parents' long-term memories and impact on emotional and psychological well-being. Cultural attitudes and norms influence how stillbirth is acknowledged and discussed in society. There is limited evidence on how women from sub-Saharan Africa became aware of the death of their babies. This research explored how women perceived the approach adopted by healthcare workers when the news of their stillbirth was disclosed to them. METHODS Grounded theory study. Women (n = 33) who had birthed a stillborn baby in the preceding 12 months were purposively sampled and participated in in-depth interviews (9 in Zambia, 16 in Tanzania and 8 in Malawi). Informed consent was gained from all participants. Data were analysed via a coding process using constant comparative analysis. FINDINGS Women sacrificed individualized and personal grieving strategies to conform and behave according to what was expected within their community. An overarching theme of cultural conformity overrides personal grief incorporated four sub-themes: perceiving something was wrong, the unexpected outcome, experience contrasting emotions, bonding with the baby. DISCUSSION AND CONCLUSIONS Most participants embarked on a negative 'emotion work' to adapt and suppress emotions and grief due to cultural expectations. Inability to voice the trauma of losing a baby may lead to perinatal mental health issues and needs addressing. Maternity healthcare workers should encourage women to express their feelings and grief. Appropriate training in perinatal bereavement care including good communication, appropriate attitudes and provision of meaningful information to grieving women is recommended.
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Affiliation(s)
- Valentina Actis Danna
- Centre for Childbirth, Women’s and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK,Correspondence to: Centre for Childbirth, Women’s and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK Pembroke Place, Liverpool L3 5QA UK.
| | - Tina Lavender
- Centre for Childbirth, Women’s and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK
| | - Rose Laisser
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | | | - Debora Kimaro
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Flora D. Kuzenza
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Milcah Mwamadi
- NIHR Global Health Group Community Engagement and Involvement (CEI) Group, Blantyre, Malawi
| | - Happiness Shayo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Khuzuet Tuwele
- University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | - Sabina Wakasiaka
- College of Health Science, School of Nursing, University of Nairobi, Nairobi, Kenya
| | - Carol Bedwell
- Centre for Childbirth, Women’s and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, UK
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12
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Smith DM, Thomas S, Stephens L, Mills TA, Hughes C, Beaumont J, Heazell AEP. Women's experiences of a pregnancy whilst attending a specialist antenatal service for pregnancies after stillbirth or neonatal death: a qualitative interview study. J Psychosom Obstet Gynaecol 2022; 43:557-562. [PMID: 35853021 DOI: 10.1080/0167482x.2022.2098712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women's experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.Results: All women expressed a heightened "awareness of risk". Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a "quiet, unspoken subject" causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them "expecting the worst and hoping for the best" in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.Conclusion: Women's experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued.
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Affiliation(s)
- Debbie M Smith
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Suzanne Thomas
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise Stephens
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tracey A Mills
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Christine Hughes
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanna Beaumont
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Alexander E P Heazell
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
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13
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Helps Ä, O'Donoghue K, O'Connell O, Leitao S. Bereaved parents involvement in maternity hospital perinatal death review processes: 'Nobody even thought to ask us anything'. Health Expect 2022; 26:183-198. [PMID: 36335583 PMCID: PMC9854318 DOI: 10.1111/hex.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The death of a baby is devastating for parents, families and staff involved. Involving bereaved parents in their baby's care and in the maternity hospital perinatal death review can help parents manage their bereavement and plan for the future. In Ireland, bereaved parents generally have not been involved in this review process. The aim of our study was to assess parents' perception of how they may be appropriately involved in the maternity hospital perinatal death review in ways that benefit them and the review process itself. METHODS Bereaved parents (n = 20) in Ireland were invited to take part in semistructured interviews. Thematic analysis was carried out on the interview transcripts. RESULTS Four main themes were identified based on the participants' views and opinions on how they experienced the review process and how they feel this process may be improved. The themes reflect the journey of the parents through the different stages of the review process: Throughout process; On leaving the hospital; Interaction with the hospital 'waiting in limbo'; Review itself. Identified subthemes highlighted essential aspects of this process and care provided to parents. For the parents, open, honest communication with staff, as well as having a key hospital contact was essential. Parents wished to provide feedback on their experience and wanted to be included in the review of their baby's death, in a way that was sensitive to their needs and the hospital's schedule. CONCLUSION A respectful, flexible system that allows bereaved parents' involvement in their baby's perinatal death review and is tailored to their needs is essential. A collaborative process between staff and parents can highlight clinical areas in need of change, enhance lessons learned, improve bereavement services and may prevent future perinatal deaths. PUBLIC CONTRIBUTION Bereaved parents were interviewed for this study.
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Affiliation(s)
- Änne Helps
- Department of Obstetrics and Gynaecology, Pregnancy Loss Research GroupUniversity College CorkCorkIreland,Department of Obstetrics and Gynaecology, INFANT Research CentreUniversity College CorkCorkIreland,Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre (NPEC)University College CorkCorkIreland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Pregnancy Loss Research GroupUniversity College CorkCorkIreland,Department of Obstetrics and Gynaecology, INFANT Research CentreUniversity College CorkCorkIreland
| | - Orla O'Connell
- Department of Obstetrics and Gynaecology, Pregnancy Loss Research GroupUniversity College CorkCorkIreland
| | - Sara Leitao
- Department of Obstetrics and Gynaecology, Pregnancy Loss Research GroupUniversity College CorkCorkIreland,Department of Obstetrics and Gynaecology, National Perinatal Epidemiology Centre (NPEC)University College CorkCorkIreland
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14
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Cassidy PR. Beyond emotional support: predictors of satisfaction and perceived care quality following the death of a baby during pregnancy. J Perinat Med 2022; 50:832-843. [PMID: 35468664 DOI: 10.1515/jpm-2021-0489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/27/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. METHODS A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). RESULTS Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. CONCLUSIONS The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.
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Affiliation(s)
- Paul Richard Cassidy
- Complutense University of Madrid, Umamanita (Stillbirth and Neonatal Death Charity), Carrer Major 3, 17133, Girona, Spain
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15
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Leinweber J, Fontein-Kuipers Y, Karlsdottir SI, Ekström-Bergström A, Nilsson C, Stramrood C, Thomson G. Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper. Birth 2022; 50:362-383. [PMID: 35790019 DOI: 10.1111/birt.12666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research. AIM To formulate an inclusive woman-centered definition of a positive childbirth experience. METHODS A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42). RESULTS The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman's psychosocial well-being." CONCLUSIONS This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.
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Affiliation(s)
- Julia Leinweber
- Institute of Midwifery, Charité-University Medicine Berlin, Berlin, Germany
| | - Yvonne Fontein-Kuipers
- School of Midwifery, Health and Social Work, University College Antwerp, Antwerp, Belgium.,Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK
| | | | - Anette Ekström-Bergström
- Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Claire Stramrood
- Department of Obstetrics and Gynaecology, OLVG Hospital, Amsterdam, The Netherlands
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
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16
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Kothari A, Bruxner G, Callaway L, Dulhunty JM. "It's a lot of pain you've got to hide": a qualitative study of the journey of fathers facing traumatic pregnancy and childbirth. BMC Pregnancy Childbirth 2022; 22:434. [PMID: 35610624 PMCID: PMC9128289 DOI: 10.1186/s12884-022-04738-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to explore the emotional and behavioural responses and coping strategies of fathers or expectant fathers who faced a significant traumatic event during a partner's pregnancy, labour, or the postpartum period. METHODS This prospective qualitative study of 24 fathers was conducted at a public teaching hospital in Brisbane, Australia. 'Traumatic pregnancy' was defined as a pregnancy complicated by life-threatening or severe risk to the mother and the fetus, termination of pregnancy, intrauterine fetal death or stillbirth. Semi-structured interviews of participants were conducted 3-4 months after the traumatic event. An initial qualitative analysis with automatic coding was performed using Leximancer and later followed by a six-phase manual thematic analysis. RESULTS A pregnancy-related traumatic event had significant mental and physical impacts on fathers. Participants' reactions and coping strategies were varied and influenced by their background history, pre-existing vulnerabilities, and the gap between expectation and reality. Most fathers described a fluctuating state between their needs 'not being met' and 'being met'. These needs were conceptualised using Maslow's hierarchy and Calman's gap theory to construct a composite thematic model to depict the universal requirements of men facing a traumatic pregnancy or childbirth. CONCLUSIONS A greater understanding of the needs of men and gaps in their care is urgently needed. A targeted effort is required to make maternity services father-inclusive. This approach may assist in preventing long term consequences on fathers, partners, and their children.
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Affiliation(s)
- A. Kothari
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland 4020 Australia
- The University of Queensland, St Lucia, Queensland 4067 Australia
| | - G. Bruxner
- Metro North Mental Health Service, Butterfield St, Herston, Queensland 4029 Australia
| | - L. Callaway
- The University of Queensland, St Lucia, Queensland 4067 Australia
- The Royal Brisbane and Women’s Hospital, Herston, Queensland 4006 Australia
| | - J. M. Dulhunty
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland 4020 Australia
- The University of Queensland, St Lucia, Queensland 4067 Australia
- The Royal Brisbane and Women’s Hospital, Herston, Queensland 4006 Australia
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17
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Aggarwal N, Moatti Z. "Getting it right when it goes wrong - Effective bereavement care requires training of the whole maternity team". Best Pract Res Clin Obstet Gynaecol 2021; 80:92-104. [PMID: 34866003 DOI: 10.1016/j.bpobgyn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Stillbirth or neonatal death is one of the most traumatic and distressing life experiences with negative psychosocial effects. Perinatal grief is natural and understandable, and, if not recognized and well supported, may lead to long-term harmful effects. Harm may also be caused to the other surviving siblings, families, and next generation. This can be helped by effective bereavement care. Bereavement care is an area of enormous needs, relatively untraveled road. Though the loss cannot be undone, but a negative impact can be minimized by compassionate supportive care. This chapter will focus on the need of a trained team for effective bereavement care. Principles of evidence-based best practices from the literature will be reviewed and translated into key practice implications. An emphasis is laid on a structured training involving the whole team. We hope this will help in day-to-day situation handling so as to prevent the harm associated with unaddressed grief. Areas of gap with the further need of research are highlighted.
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Affiliation(s)
- Neelam Aggarwal
- Department of Obstetrics. & Gynecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Zoe Moatti
- Department of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel Rd, London, E1 1FR, United Kingdom
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18
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Christou A, Alam A, Hofiani SMS, Mubasher A, Rasooly MH, Rashidi MK, Raynes-Greenow C. 'I should have seen her face at least once': parent's and healthcare providers' experiences and practices of care after stillbirth in Kabul province, Afghanistan. J Perinatol 2021; 41:2182-2195. [PMID: 33408332 DOI: 10.1038/s41372-020-00907-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to explore bereaved parents' and healthcare providers experiences of care after stillbirth. STUDY DESIGN Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants in Kabul province, Afghanistan between October and November 2017. RESULTS Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying disclosing the stillbirth were recurring concerns. There was a disconnect between parents' desires and healthcare provider's perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as profound regret. Health providers' reported hospitals were not equipped to separate women who had a stillbirth and acknowledged that psychological support would be beneficial. However, the absence of trained personnel and resource constraints prevented provision of such support. CONCLUSION Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.
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Affiliation(s)
- Aliki Christou
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Mohammad Hafiz Rasooly
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | | | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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19
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Horey D, Boyle FM, Cassidy J, Cassidy PR, Erwich JJHM, Gold KJ, Gross MM, Heazell AEP, Leisher SH, Murphy M, Ravaldi C, Siassakos D, Storey C, Vannacci A, Wojcieszek A, Flenady V. Parents' experiences of care offered after stillbirth: An international online survey of high and middle-income countries. Birth 2021; 48:366-374. [PMID: 33738843 DOI: 10.1111/birt.12546] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high-level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high-income and middle-income countries. METHODS An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high-income and middle-income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high-income and middle-income countries. RESULTS Over three thousand parents (3041) with a self-reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high-income countries (HICs) compared with women in middle-income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR = 4.8, 95% CI 4.0-5.9). The widespread occurrence of all nine practices was reported only for The Netherlands. CONCLUSIONS Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision-making, and follow-up care.
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Affiliation(s)
- Dell Horey
- College of Science, Health and Engineering, La Trobe University, Bundoora, Vic., Australia
| | - Frances M Boyle
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | | | | | | | | | - Mechthild M Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Alexander E P Heazell
- Faculty of Biological, Obstetrics, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medical and Health, University of Manchester, Manchester, UK
| | | | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claudia Ravaldi
- PeaRL Perinatal Research Laboratory, University of Florence, Prato, Italy
| | | | | | - Alfredo Vannacci
- Pharmacology and Toxicology, PeaRL Perinatal Research Laboratory, University of Florence, Firenze, Italy
| | - Aleena Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, South Brisbane, QLD, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, South Brisbane, QLD, Australia
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20
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Leitao S, Helps A, Cotter R, O'Donoghue K. Development and evaluation of TEARDROP - a perinatal bereavement care training programme for healthcare professionals. Midwifery 2021; 98:102978. [PMID: 33743511 DOI: 10.1016/j.midw.2021.102978] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
Appropriate perinatal bereavement care can benefit bereaved parents and reduce further distress. Poor training can impact healthcare professionals (HCPs) at a personal and professional-level. HCPs have reported poor preparation to care for bereaved parents. High-quality perinatal bereavement care training is essential. This study describes the TEARDROP workshop for perinatal bereavement care training, an evaluation of its pilot and first workshop, and the teaching methods applied. The TEARDROP workshop was created in line with the Irish National Bereavement Standards, and based on the SCORPIO model of teaching, offering a participant-centred teaching. Both pilot session and workshop were held in a tertiary maternity hospital. Paper-based anonymous questionnaires were used to evaluate these sessions. Overall, participants were highly satisfied with the workshop. The level of information and quality of teaching in the pilot and workshop scored very high. Most participants stated not being adequately prepared to communicate or care for bereaved parents. The pre-workshop evaluation showed that only 8% of participants received prior training on discussing post-mortems with bereaved parents. Participants (100%) would recommend the workshop be available nationally and would recommend it to a colleague. To our knowledge this is one of few participant-centred perinatal bereavement care training for maternity staff in Ireland. The workshop has been well received and results highlighted the relevance and importance of the TEARDROP programme for HCPs. Adequate training for all maternity staff is essential and TEARDROP has the potential to impact on the quality of bereavement care provided in Irish maternity units.
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Affiliation(s)
- Sara Leitao
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Aenne Helps
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Ireland
| | - Riona Cotter
- Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Cork University Maternity Hospital, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group (PLRG), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Ireland; Cork University Maternity Hospital, Cork, Ireland
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21
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Jørgensen ML, Prinds C, Mørk S, Hvidtjørn D. Stillbirth - transitions and rituals when birth brings death: Data from a danish national cohort seen through an anthropological lens. Scand J Caring Sci 2021; 36:100-108. [PMID: 33576029 DOI: 10.1111/scs.12967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many parents bereaved of a stillborn baby spend time with the child. In this time frame, different acts with the child in focus may occur. Some parents invite others to see the child too. Parents who suffer the loss of a newborn are vulnerable, and understanding acts and practices surrounding the dead newborn is important knowledge for caretakers. AIMS This article aims to enlighten the amount of time Danish parents spend with their stillborn in hospital settings that encourage this practice. Furthermore, it aims to transcend the mere quantitative numbers through a theoretical approach that frames the analysis and discussion of possible layers of meaning imbedded in time spent with a dead newborn. STUDY DESIGN Data from a Danish cohort of bereaved parents were collected using web-based questionnaires. These numbers were successively interpreted through an anthropological lens within the perspective of transition and ritualisation. Knowledge from existing empirical literature was also fused. RESULTS FROM THE COHORT Danish parents spend hours or days with their stillborn child. They feel supported in this by healthcare professionals. Mainly close relatives join the parents while admitted to the hospital to see the stillborn child, followed by other family members and friends. CONCLUSION Danish parents engage to a very high degree in contact with their dead baby. The analysis points out that 'Time' and 'Others' are needed to create a socially comprehensible status for parents and child when birth brings death. In liminal space during the transition, healthcare professionals act as ritual experts, supporting parents and their relatives to ascribe social status to the dead body of the child through ritualised acts. Instead of only thinking of this period as 'memory-making', we suggest regarding it as a time of ontological clarification as well.
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Affiliation(s)
| | | | - Sofie Mørk
- University of Southern Denmark, Odense, Denmark
| | - Dorte Hvidtjørn
- Unit for Perinatal Loss: Aarhus University Hospital, Aarhus N, Denmark.,University of Southern Denmark, Odense, Denmark
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Das MK, Arora NK, Gaikwad H, Chellani H, Debata P, Rasaily R, Meena KR, Kaur G, Malik P, Joshi S, Kumari M. Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents: A qualitative study. PLoS One 2021; 16:e0240270. [PMID: 33503017 PMCID: PMC7840017 DOI: 10.1371/journal.pone.0240270] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Grief following stillbirth and child death are one of the most traumatic experience for parents with psychosomatic, social and economic impacts. The grief profile, severity and its impacts in Indian context are not well documented. This study documented the grief and coping experiences of the Indian parents following stillbirth and child death. METHODS This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother's grief severity after 6-9 months of loss. RESULTS The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn't express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5-20 days and mothers took 2-6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6-9 months. CONCLUSIONS Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.
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Affiliation(s)
| | | | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Reeta Rasaily
- Division of Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
| | - K. R. Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | | | | | - Shipra Joshi
- The INCLEN Trust International, New Delhi, India
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Obst KL, Oxlad M, Due C, Middleton P. Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample. BMC Pregnancy Childbirth 2021; 21:29. [PMID: 33413199 PMCID: PMC7792062 DOI: 10.1186/s12884-020-03514-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. Methods Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style. Results Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. Conclusions Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03514-6.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia.
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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Fuller D, Kuberska K. Outside the (memory) box: how unpredictable objects disrupt the discourse of bereavement in narratives of pregnancy loss. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/13576275.2020.1783221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Danielle Fuller
- Department of English and Film Studies, University of Alberta, Edmonton, Canada
| | - Karolina Kuberska
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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McKelvin G, Thomson G, Downe S. The childbirth experience: A systematic review of predictors and outcomes. Women Birth 2020; 34:407-416. [PMID: 33039281 DOI: 10.1016/j.wombi.2020.09.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Birth is often viewed as a pathological event, consequently, there has been an increase in literature focusing on predictors, experience and implications of traumatic childbirth and childbirth-related posttraumatic stress. However, to fully understand childbirth experiences a salutogenic perspective is required. This enables an understanding of what facilitates a positive childbirth experience besides what places women at risk of experiencing traumatic childbirth. OBJECTIVE To identify the psychosocial factors that could contribute to or be influenced by women's subjective accounts of childbirth. METHOD An in-depth literature search across four databases was undertaken. Quality appraisal based on internal and external validity was conducted and a combined numerical summary and categorical description were undertaken. FINDINGS Nineteen papers were included in the review and the variables grouped into three categories. The variables relate to 'Measures of labour and birth experience' (discussing the impact of events and perceptions during labour and birth). The second category discusses how 'support and relationships' can potentially shape the birth experience or be altered by it and finally, 'Psychological variables: influence and impact' is examined extensively. DISCUSSION The results of the review highlight significant contradictory evidence of what influences birth experiences. The findings confirm the dearth of available literature concerning positive birth experiences and most variables identified were pathogenic. This review suggests that such factors for PTSD may differ from those that influence birth experiences and should be examined separately. An enhanced understanding of the range of experiences is required to support women's rights in achieving a positive birth.
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Affiliation(s)
| | - Gillian Thomson
- School of Community Health and Midwifery, University of Central Lancashire, UK
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, UK
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The Perinatal Loss Care Educational Programme and its Evaluation. Zdr Varst 2020; 59:1-7. [PMID: 32952697 PMCID: PMC7478081 DOI: 10.2478/sjph-2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Working with bereaved parents is an immense challenge for professionals in the field of perinatal care and requires a high level of knowledge and skill. This article aims to evaluate the effectiveness of the Perinatal Loss Care blended educational programme. Methods An evaluative assessment was carried out using a scored questionnaire to gather pre- and post-programme data. Participants were medical and healthcare professionals (n=200) who participated in the programme voluntarily (the Medical Professional/Motivated group and the Others group) or were selected by their employer and for whom attendance was mandatory (the Medical Professional/Non/Motivated group). Results Participants’ perception of their own knowledge and understanding of perinatal bereavement care was significantly higher on completion of the educational programme, proving its effectivity. There was a statistically significant effect on overall score in individual groups of respondents, as well as the whole set (p<0.001), with post-intervention scores higher than pre-intervention scores. No statistically significant differences in overall score were detected before participation in the educational programme in individual groups (p=0.204). Participants from the Medical Professional/Non/Motivated group achieved lower post-intervention scores to a significantly greater extent (p<0.05) and more often perceived the educational programme as being “very difficult” (χ2=20.66, df=6, P<0.01) compared to other groups. Conclusions The educational programme was assessed as effective. Care of bereaved parents has its specifics and healthcare professionals should possess a basic knowledge of how to provide sensitive care during this time.
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Helps Ä, O'Donoghue K, O'Byrne L, Greene R, Leitao S. Impact of bereavement care and pregnancy loss services on families: Findings and recommendations from Irish inquiry reports. Midwifery 2020; 91:102841. [PMID: 32956983 DOI: 10.1016/j.midw.2020.102841] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pregnancy loss and the death of their baby can be overwhelming for families, especially when the loss is unexpected. The standard of bereavement care families receive around the time of pregnancy or early infant loss can have a significant impact on their psychological recovery. At times external inquiries are carried out to identify issues in the maternity care provided and make recommendations to improve its' standard. OBJECTIVE This study aims to describe the impact of bereavement care provided to families around the time of pregnancy and/or early infant loss as stated in ten published inquiry reports related to Irish maternity services. METHODS Using thematic analysis, issues with care encountered by bereaved parents as outlined in the reports were identified. These focussed around five main themes (communication, healthcare staff skills, maternity unit environment, post-mortem/coronial process, local incident reviews). FINDINGS Bereavement care, as described by families in the ten reports, was not consistently individualised or respectful, resulting in additional feelings of anger and upset. Problems with clear communication of complex issues, in a manner that is understandable to bereaved families, were identified in several reports. Recommendations from the inquiry reports included that experienced and skilled staff should always be available to provide immediate support to bereaved families as appropriate, and assist families in understanding and processing information around the time of their loss. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Consistent, individualised bereavement care facilitates a seamless transition for bereaved families from diagnosis through the hospital stay to discharge and follow-up, allowing them to focus on their baby, their bereavement and their family's wellbeing. The process of consent for a perinatal post-mortem and associated concerns have evolved over the timeframe of the ten inquiries. We reflect further on this and the impacts of the other issues highlighted, as well as discussing possible improvements to address them as described in the scientific literature.
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Affiliation(s)
- Änne Helps
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Laura O'Byrne
- Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork University Maternity Hospital, 5th floor, Wilton, Cork, Ireland
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Garcia R, Ali N, Griffiths M, Randhawa G. A qualitative study exploring the experiences of bereavement after stillbirth in pakistani, bangladeshi and white british mothers living in luton, UK. Midwifery 2020; 91:102833. [PMID: 32898720 DOI: 10.1016/j.midw.2020.102833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/07/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
AIM This study aims to explore the experiences of bereavement after stillbirth of Pakistani, Bangladeshi and White British mothers in a town with multi-ethnic populations in England. PARTICIPANTS A purposive sample of Pakistani, Bangladeshi and White British mothers aged over 16 (at time of infant birth), who suffered a stillbirth in the preceding 6-24 months and residing in a specified postcode area were invited to take part in the study, by an identified gatekeeper (audit midwife) from the local National Health Service Trust, in addition to local bereavement charities. DESIGN Qualitative methods using face-to-face semi-structured interviews were undertaken, recorded and transcribed verbatim. Using framework analysis, several themes were identified. FINDINGS There were three main themes identified from the data; 1. knowledge and information of pregnancy and perinatal mortality; 2. attitudes and perceptions to pregnancy and perinatal mortality and 3. experiences with maternity care. The findings revealed mostly similarities in the bereavement experiences of the Pakistani, Bangladeshi and White British mothers. A few cultural and religious differences were identified. CONCLUSIONS This study found important similarities in bereavement experiences of Pakistani, Bangladeshi and White British mothers and highlights considerations for policy makers and maternity services in how the timing of bereavement after care is provided, including advice surrounding the infant post-mortem. 209.
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Affiliation(s)
- Rebecca Garcia
- Faculty of Health, Education and Languages, The Open University, Walton Hall, Milton Keynes, MK7 6AA.
| | - Nasreen Ali
- The Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE.
| | - Malcolm Griffiths
- Luton &Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ.
| | - Gurch Randhawa
- The Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE.
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Power S, Meaney S, Cotter R, O'Donoghue K. Education priorities for voluntary organisations supporting parents experiencing perinatal loss: a Delphi survey. Int J Palliat Nurs 2020; 26:156-166. [DOI: 10.12968/ijpn.2020.26.4.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: There is a reliance on voluntary organisations in healthcare. Education is necessary to keep up-to-date with best practice. The authors' aim was to identify education priorities of voluntary organisations that support parents who experience pregnancy/perinatal loss, to inform the development of an education day. Method: A modified Delphi study was undertaken to identify education needs. There were two Delphi rounds, inclusive of free text, where voluntary group experts reflected on responses in order to develop a consensus among the group. Results: There were 12 responses to Round One and seven responses to Round Two. From a list of 10 subjects, Round One identified 64 sub-topics, which were then determined as essential, desirable or not relevant in Round Two. The final 55 sub-topics were included in the education day. Conclusion: This study identified educational needs of voluntary organisations. A standardised approach was necessary to develop an education day that is responsive to their learning needs.
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Affiliation(s)
- Stacey Power
- Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, Cork, Republic of Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork
| | - Riona Cotter
- Health Service Executive, Cork University Maternity Hospital
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital
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Abstract
BACKGROUND Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.
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Farrales LL, Cacciatore J, Jonas-Simpson C, Dharamsi S, Ascher J, Klein MC. What bereaved parents want health care providers to know when their babies are stillborn: a community-based participatory study. BMC Psychol 2020; 8:18. [PMID: 32066494 PMCID: PMC7027220 DOI: 10.1186/s40359-020-0385-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Bereaved parents experience higher rates of depressive and post-traumatic stress symptoms after the stillbirth of a baby than after live-birth. Yet, these effects remain underreported in the literature and, consequently, insufficiently addressed in health provider education and practice. We conducted a participatory based study to explore the experiences of grieving parents during their interaction with health care providers during and after the stillbirth of a baby. Methods This community-based participatory study utilized four focus groups comprised of twenty-seven bereaved parents (44% fathers). Bereaved parents conceptualized the study, participating at all stages of research, analyses, and drafting. Data were reduced into a main theme and subthemes, then broad-based member checked to ensure fidelity and nuances within themes. Results The major theme that emerged centered on provider acknowledgement of the baby as an irreplaceable individual. Subthemes reflected 1) acknowledgement of parenthood and grief, 2) recognition of the traumatic nature of stillbirth, and 3) acknowledgement of enduring grief coupled with access to support. It was important that providers realized how grief was experienced within health care and social support systems, concretized by their desire for long-term, specialized support. Conclusions Both mothers and fathers feel that acknowledgement of their baby as an individual, their parenthood, and their enduring traumatic grief by healthcare providers are key elements required in the process of initiating immediate and ongoing care after the stillbirth of a baby.
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Affiliation(s)
- Lynn L Farrales
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, Canada.,International Stillbirth Alliance, Bristol, UK
| | - Joanne Cacciatore
- Arizona State University West, 4701 W Thunderbird Road, Glendale, AZ, USA.
| | | | - Shafik Dharamsi
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,College of Health Sciences, Peter De Wetter Distinguished Professor of Health Sciences, The University of Texas at El Paso, El Paso, USA
| | - Jaime Ascher
- Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, Canada
| | - Michael C Klein
- Emeritus Professor Family Practice & Pediatrics, Department of Family Practice, University of British Columbia, Vancouver, Canada.,Senior Scientist Emeritus, BC Children's Hospital Research Institute, Vancouver, Canada
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Camacho-Ávila M, Fernández-Sola C, Jiménez-López FR, Granero-Molina J, Fernández-Medina IM, Martínez-Artero L, Hernández-Padilla JM. Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study. BMC Pregnancy Childbirth 2019; 19:512. [PMID: 31856748 PMCID: PMC6923983 DOI: 10.1186/s12884-019-2666-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background Perinatal grief is a process that affects families in biological, psychological, social and spiritual terms. It is estimated that every year there are 2.7 million perinatal deaths worldwide and 4.43 deaths for every 1000 births in Spain. The aim of this study is to describe and understand the experiences and perceptions of parents who have suffered a perinatal death. Methods A qualitative study based on Gadamer’s hermeneutic phenomenology. The study was conducted in two hospitals in the South of Spain. Thirteen mothers and eight fathers who had suffered a perinatal death in the 5 years prior to the study participated in this study. In-depth interviews were carried out for data collection. Inductive analysis was used to find themes based on the data. Results Eight sub-themes emerged, and they were grouped into three main themes: ‘Perceiving the threat and anticipating the baby’s death: “Something is going wrong in my pregnancy”’; ‘Emotional outpouring: the shock of losing a baby and the pain of giving birth to a stillborn baby’; “We have had a baby”: The need to give an identity to the baby and legitimise grief’. Conclusion The grief suffered after a perinatal death begins with the anticipation of the death, which relates to the mother’s medical history, symptoms and premonitions. The confirmation of the death leads to emotional shock, characterised by pain and suffering. The chance to take part in mourning rituals and give the baby the identity of a deceased baby may help in the grieving and bereavement process. Having empathy for the parents and notifying them of the death straightaway can help ease the pain. Midwives can help in the grieving process by facilitating the farewell rituals, accompanying the family, helping in honouring the memory of the baby, and supporting parents in giving the deceased infant an identity that makes them a family member.
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Affiliation(s)
| | - Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine, Universidad de Almería, Carretera de Sacramento, 04120, Almería, Spain. .,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile.
| | - Francisca Rosa Jiménez-López
- Department of Nursing Science, Physiotherapy and Medicine, Universidad de Almería, Carretera de Sacramento, 04120, Almería, Spain
| | - José Granero-Molina
- Department of Nursing Science, Physiotherapy and Medicine, Universidad de Almería, Carretera de Sacramento, 04120, Almería, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | | | | | - José Manuel Hernández-Padilla
- Department of Nursing Science, Physiotherapy and Medicine, Universidad de Almería, Carretera de Sacramento, 04120, Almería, Spain.,Department of Adult, Child and Midwifery School of Health & Education, Middlesex University, London, UK
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Alvarenga WDA, de Montigny F, Zeghiche S, Polita NB, Verdon C, Nascimento LC. Understanding the spirituality of parents following stillbirth: A qualitative meta-synthesis. DEATH STUDIES 2019; 45:420-436. [PMID: 31403372 DOI: 10.1080/07481187.2019.1648336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This meta-synthesis aims to synthesize qualitative evidence from primary studies to better understand the experience of the spirituality of parents and its relationship to adapting following stillbirth. Five electronic databases were systematically searched and the quality of 21 eligible studies was critically appraised. A thematic synthesis revealed two analytical themes: (1) Spiritual suffering following stillbirth; (2) Moving through spirituality to adapt to the loss, each encompassing four descriptive themes. The findings can inform a more culturally and spiritually sensitive approach to care, taking into account the parents' beliefs, folk customs, religion, values, and spiritual needs.
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Affiliation(s)
| | - Francine de Montigny
- Département des Sciences Infirmières, Universite du Quebec en Outaouais, Gatineau, Quebec, Canada
| | - Sabrina Zeghiche
- Département des Sciences Infirmières, Universite du Quebec en Outaouais, Gatineau, Quebec, Canada
| | - Naiara Barros Polita
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Chantal Verdon
- Département des Sciences Infirmières, Universite du Quebec en Outaouais, St-Jérôme, Quebec, Canada
| | - Lucila Castanheira Nascimento
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Martínez-Serrano P, Pedraz-Marcos A, Solís-Muñoz M, Palmar-Santos AM. The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study. Midwifery 2019; 77:37-44. [PMID: 31254962 DOI: 10.1016/j.midw.2019.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
AIM To explore the experience of both the mothers and the fathers regarding the care received during delivery in cases of stillbirth. DESIGN A hermeneutic phenomenological study based on semi-structured interviews with eleven mothers and fathers who experienced stillbirth. PARTICIPANTS A purposive sample was recruited in Hospital XXX of XX and through a local pregnancy loss support organization. METHODS Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis. FINDINGS Four main categories identified: 1) denial of grief, 2) the life and death paradox, 3) guilt, and 4) go through and overcome the loss. The parents manifested a lack of recognition of their loss and their parenthood. Although the midwife was the highest valued professional, not all the experiences were positive and the parents would have appreciated being accompanied by trained people with good communication skills. They also referred to in-hospital logistic barriers that complicated the process, as well as the fact that these births occurred in the same place where healthy deliveries were attended. CONCLUSION Findings highlight the importance of tailoring support systems according to mothers' and fathers' needs. Promoting social and institutional recognition of this kind of loss and training healthcare professionals in the accompaniment of this type of mourning is useful to plan comprehensive care to facilitate the initiation and subsequent evolution of healthy mourning.
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Affiliation(s)
- Paloma Martínez-Serrano
- Obstetric and Ginecology Service, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2. 28222 Majadahonda (Madrid), Madrid, Spain.
| | - Azucena Pedraz-Marcos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
| | - Montserrat Solís-Muñoz
- Nursing and Healthcare, Research Area, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2, Majadahonda (Madrid) 28222, Spain.
| | - Ana María Palmar-Santos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
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Murphy S. “I'd failed to produce a baby and I'd failed to notice when the baby was in distress”: The social construction of bereaved motherhood. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2018; 71:12-18. [PMID: 30640134 DOI: 10.1016/j.midw.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE As advances in prenatal diagnosis increasingly enable detection of life-limiting conditions, end-of-life care may start before birth. Termination of these pregnancies may have been default management, but in the Republic of Ireland, where termination is not a legal option, skilled experience in caring for mothers who continue their pregnancies has developed. This study examines the lived experience of four such mothers. METHOD A qualitative study was designed using interpretive phenomenological analysis, which examined the maternal experience of continuing pregnancy with a prenatal diagnosis of anencephaly. Four mothers participated in semi-structured interviews on their experience of pregnancy and delivery of a baby with anencephaly. RESULTS A profoundly emotional journey represented an adaptive grieving process, which culminated in rich experiences of transformative growth for all the parents. The parents' relationship with their caregivers facilitated this process and the development of a meaningful parenting relationship with their babies. This positive finding coexists alongside a parallel experience of ongoing deep sense of loss and sadness. CONCLUSION Perinatal palliative care for those with a prenatal lethal diagnosis is a positive life experience for some mothers. The role of relationship with healthcare professionals is vital to the process and consideration must be given to a comprehensive multi-disciplinary team approach.
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Redshaw M, Henderson J. Care associated with stillbirth for the most disadvantaged women: A multi-method study of care in England. Birth 2018; 45:275-285. [PMID: 29436049 PMCID: PMC6099371 DOI: 10.1111/birt.12335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most research on women experiencing stillbirth relies on online user group surveys or qualitative interviews. The objective of this study was to investigate the experience of women who are at a higher risk of stillbirth, living in areas of greatest deprivation, and are commonly not well represented. METHODS This study used birth and death registrations in 2012-2013 to identify a sample of mothers whose babies had died as a result of stillbirth. These women were sent a survey 6-9 months after the stillbirth. We undertook descriptive analysis of quantitative data and used binary logistic regression with the Index of Multiple Deprivation as a measure of disadvantage. We used thematic analysis to describe free text responses. RESULTS The survey response rate was 30% (N = 473). Ethnic minority, younger age, and single parenthood were associated with disadvantage. Women residents in the most deprived areas perceived care more negatively: during labor they were significantly less likely to be spoken to by medical staff so they could understand (73% compared with 90%, adjusted odds ratio [aOR] 0.33 [95% confidence interval {CI} 0.18-0.65]), or treated with respect by midwives (79% compared with 90%, aOR 0.41 [95% CI 0.22-0.77]). The qualitative themes identified were: "Difficulty in accessing care," "More could have been done," "Ineffective communication," and "Cared for and not cared for" which support the quantitative findings. CONCLUSION Women living in the most deprived areas reported poorer experiences of care compared with more advantaged women. All women need compassionate and sensitive care around the time of a stillbirth.
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Affiliation(s)
- Maggie Redshaw
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Jane Henderson
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Ravaldi C, Levi M, Angeli E, Romeo G, Biffino M, Bonaiuti R, Vannacci A. Stillbirth and perinatal care: Are professionals trained to address parents’ needs? Midwifery 2018; 64:53-59. [DOI: 10.1016/j.midw.2018.05.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 12/30/2022]
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Martínez-Serrano P, Palmar-Santos AM, Solís-Muñoz M, Álvarez-Plaza C, Pedraz-Marcos A. Midwives' experience of delivery care in late foetal death: A qualitative study. Midwifery 2018; 66:127-133. [PMID: 30170265 DOI: 10.1016/j.midw.2018.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/03/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
AIM To explore the experiences of midwives regarding the attention given during labour in late foetal death. DESIGN Qualitative research using a hermeneutic-interpretative phenomenological approach was carried out. Data were collected through focus groups, audio-recorded, transcribed verbatim, and analyzed using the van Manen approach. SETTING AND PARTICIPANTS Three focus group with a purposive sample of 18 midwives from 10 public hospitals and 1 primary health centre in Madrid, Spain were conducted. FINDINGS Two main themes were identified: Professionals for Life Not Death; and Organizing the Work Without Guidelines. Midwives felt there is a lack of social awareness related to the possibility of antepartum death that keeps the mourning hidden and affects the midwives´ practice during the late foetal death process. Midwives recognize difficulties in coping with a process that ends in death: organizations are not prepared for these events (not suitable rooms), there is lack of training to cope with them, and lack of continuity in the attention received by the parents when they are discharged. CONCLUSION Midwives need to be trained in mourning and communication skills to guarantee good practice when attending late foetal death. Intervention guidelines and support mechanisms are required, not only for the parents, but also for the healthcare professionals.
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Affiliation(s)
- Paloma Martínez-Serrano
- Obstetric and Ginecology Service, Puerta de Hierro Majadahonda University Hospital, C/Joaquín Rodrigo, 2, 28222 Majadahonda (Madrid), Spain.
| | - Ana María Palmar-Santos
- Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, no 4, 28029 Madrid, Spain.
| | - Montserrat Solís-Muñoz
- Nursing and Healthcare, Research Area, Puerta de Hierro Majadahonda University Hospital, C/Joaquín Rodrigo 2, 28222 Majadahonda (Madrid), Spain.
| | - Consuelo Álvarez-Plaza
- Facultad de Ciencias Políticas y Sociología, Campus de Somosaguas 28223, Pozuelo de Alarcón (Madrid), Spain.
| | - Azucena Pedraz-Marcos
- Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo, no 4, 28029 Madrid, Spain.
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Due C, Obst K, Riggs DW, Collins C. Australian heterosexual women’s experiences of healthcare provision following a pregnancy loss. Women Birth 2018; 31:331-338. [DOI: 10.1016/j.wombi.2017.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/01/2022]
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Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives. Midwifery 2018; 66:1-9. [PMID: 30075300 DOI: 10.1016/j.midw.2018.06.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/22/2022]
Abstract
AIMS To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death. BACKGROUND The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice. DESIGN A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation. METHODS Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires. RESULTS Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p < .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p < .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p < .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p < .000, partial eta squared = 0.458] in relation to providing bereavement support were also found. CONCLUSION Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.
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A mixed methods sequential explanatory study of the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. Midwifery 2018; 64:69-76. [PMID: 29966879 DOI: 10.1016/j.midw.2018.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents. AIM OF THE STUDY To explore within an Irish context, the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. DESIGN A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups. METHODS A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability. RESULTS The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives' confidence were identified as the midwives' awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work. CONCLUSION Improving midwives' bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.
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Cullen S, Coughlan B, McMahon A, Casey B, Power S, Brosnan M. Parents' experiences of clinical care during second trimester miscarriage. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.5.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Cullen
- Clinical midwife specialist in bereavement, National Maternity Hospital, Dublin
| | - Barbara Coughlan
- Assistant professor/lecturers, School of Nursing, Midwifery and Health Systems, University College Dublin
| | - Anne McMahon
- Assistant professor/lecturers, School of Nursing, Midwifery and Health Systems, University College Dublin
| | - Brenda Casey
- Clinical midwife specialist in bereavement, National Maternity Hospital, Dublin
| | - Sheila Power
- Midwife/psychoanalytic psychotherapist in private practice, Dublin
| | - Mary Brosnan
- Director of Nursing and Midwifery, National Maternity Hospital, Dublin
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Hennegan JM, Henderson J, Redshaw M. Is partners' mental health and well-being affected by holding the baby after stillbirth? Mothers' accounts from a national survey. J Reprod Infant Psychol 2018. [PMID: 29517345 PMCID: PMC5974507 DOI: 10.1080/02646838.2018.1424325] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: This study aimed to assess the effects on partners’ health and well-being of holding a stillborn baby. Background: Findings from quantitative and qualitative studies have produced inconsistent results concerning the effects of holding a stillborn baby on parents. Methods: Secondary analyses were conducted on postal questionnaire data relating to 455 partners of women who had a stillbirth. Women answered questions about their partners’ behaviour, perceptions of care, mental health and well-being at three and nine months after the stillbirth. Demographic, clinical and care characteristics were compared between partners who, according to the mothers, did and did not hold their baby. Sub-group analyses assessed hypothesised moderating effects. Results: Mothers reported that most partners saw (92%) and held (82%) their stillborn baby. However, partners born outside the UK were less likely to have held their baby. Higher gestational age, shorter time interval between antepartum death and delivery, and mother’s holding the baby all predicted a higher rate of partner’s holding. There was a consistent negative effect of holding the baby across mental health and well-being outcomes, although after adjustment only higher odds of depression (OR 2.72, 95% CI 1.35–5.50) and post-traumatic stress type symptoms (OR 1.95, 95% CI 1.01–3.78) at 3 months were significantly associated with having held the baby following stillbirth. Conclusions: This study is the first to assess the impact of holding the baby on partners’ mental health and well-being. The prevalence of depression and anxiety were high, and the negative effects of holding the baby were significant 3 months later.
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Affiliation(s)
- Julie M Hennegan
- a Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health , University of Oxford , Oxford , UK
| | - Jane Henderson
- a Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health , University of Oxford , Oxford , UK
| | - Maggie Redshaw
- a Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health , University of Oxford , Oxford , UK
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Nuzum D, Meaney S, O’Donoghue K. The impact of stillbirth on bereaved parents: A qualitative study. PLoS One 2018; 13:e0191635. [PMID: 29364937 PMCID: PMC5783401 DOI: 10.1371/journal.pone.0191635] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 12/22/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose To explore the lived experiences and personal impact of stillbirth on bereaved parents. Methods Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. Results Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. Conclusions The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.
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Affiliation(s)
- Daniel Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- * E-mail:
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O’Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Brierley-Jones L, Crawley R, Jones E, Gordon I, Knight J, Hinshaw K. Supporting parents through stillbirth: A qualitative study exploring the views of health professionals and health care staff in three hospitals in England. Eur J Obstet Gynecol Reprod Biol 2018; 222:45-51. [PMID: 29353132 DOI: 10.1016/j.ejogrb.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the views of a range of hospital based health professionals and health care staff involved in the management of stillbirth. STUDY DESIGN A qualitative pilot study informed by grounded theory conducted in three hospital trusts in the North East of England. In total, 21 consultant obstetricians, 3 trainees (including 1 senior trainee), 29 midwives, 3 midwife sonographers and 4 chaplains took part in six focus groups and two semi-structured interviews. RESULTS Two different approaches in stillbirth management could be detected in our study. One approach emphasised the existing evidence-base and patient directed choice whilst the other emphasised tradition and profession-directed care. These differences were particularly apparent in choices over mode of delivery, and the location of women as well as the time interval between diagnosis of an IUD and delivery. The existence of these two approaches was underscored by a lack of high quality evidence. CONCLUSION Robust, high quality evidence is needed regarding the longer term psychological and emotional sequelae of different modes of delivery and varying time intervals and locations of women between diagnosis and delivery in stillbirth. If the competing discourses demonstrated here are found elsewhere then such need to be considered in any future policy development, evidence implementation and training programmes.
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Affiliation(s)
- Lyn Brierley-Jones
- Department of Sociology, Wentworth College, University of York, Heslington, York, YO10 5DD, United Kingdom.
| | - Rosalind Crawley
- School of Psychology, Faculty of Health Sciences and Well-being, Shackleton House, Sunderland, SR1 3SD, United Kingdom
| | - Emma Jones
- School of Psychology, Faculty of Health Sciences and Well-being, Shackleton House, Sunderland, SR1 3SD, United Kingdom
| | - Isabel Gordon
- Nursing, Health and Wellbeing, Sciences Complex, Wharncliffe Street, Sunderland, SR1 3SD, United Kingdom
| | - Joanne Knight
- Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom
| | - Kim Hinshaw
- Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom
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Cassidy PR. Care quality following intrauterine death in Spanish hospitals: results from an online survey. BMC Pregnancy Childbirth 2018; 18:22. [PMID: 29321000 PMCID: PMC5763533 DOI: 10.1186/s12884-017-1630-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND 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. METHODS A 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. RESULTS Responses 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. CONCLUSIONS Supportive 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.
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Affiliation(s)
- Paul Richard Cassidy
- Universidad Complutense de Madrid, Facultad de Ciencia Política y Sociología, Somosaguas, Pozuelo de Alarcon, 28223, Madrid, Spain.
- Umamanita (Stillbirth Charity), C/ Hierbabuena 15, Esc B, 4 Izq, 28039, Madrid, Spain.
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Campbell HE, Kurinczuk JJ, Heazell A, Leal J, Rivero-Arias O. Healthcare and wider societal implications of stillbirth: a population-based cost-of-illness study. BJOG 2017; 125:108-117. [PMID: 29034559 PMCID: PMC5767761 DOI: 10.1111/1471-0528.14972] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 12/05/2022]
Abstract
Objective To extend previous work and estimate health and social care costs, litigation costs, funeral‐related costs, and productivity losses associated with stillbirth in the UK. Design A population‐based cost‐of‐illness study using a synthesis of secondary data. Setting The National Health Service (NHS) and wider society in the UK. Population Stillbirths occurring within a 12‐month period and subsequent events occurring over the following 2 years. Methods Costs were estimated using published data on events, resource use, and unit costs. Main outcome measures Mean health and social care costs, litigation costs, funeral‐related costs, and productivity costs for 2 years, reported for a single stillbirth and at a national level. Results Mean health and social care costs per stillbirth were £4191. Additionally, funeral‐related costs were £559, and workplace absence (parents and healthcare professionals) was estimated to cost £3829 per stillbirth. For the UK, the annual health and social care costs were estimated at £13.6 million, and total productivity losses amounted to £706.1 million (98% of this cost was attributable to the loss of the life of the baby). The figures for total productivity losses were sensitive to the perspective adopted about the loss of life of the baby. Conclusion This work expands the current intelligence on the costs of stillbirth beyond the health service to costs for parents and society, and yet these additional findings must still be regarded as conservative estimates of the true economic costs. Tweetable abstract The costs of stillbirth are significant, affecting the health service, parents, professionals, and society. Plain Language Summary The costs of stillbirth are significant, affecting the health service, parents, professionals, and society.
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Affiliation(s)
- H E Campbell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - O Rivero-Arias
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gandino G, Di Fini G, Bernaudo A, Paltrinieri M, Castiglioni M, Veglia F. The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals' reactions. J Health Psychol 2017; 25:640-651. [PMID: 28854811 DOI: 10.1177/1359105317727841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals' language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed.
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Affiliation(s)
| | | | | | | | - Marco Castiglioni
- Riccardo Massa Department of Human Sciences and Education, University of Milano-Bicocca, Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin, Italy
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50
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Bond D, Raynes-Greenow C, Gordon A. Bereaved parents' experience of care and follow-up after stillbirth in Sydney hospitals. Aust N Z J Obstet Gynaecol 2017; 58:185-191. [PMID: 28776636 DOI: 10.1111/ajo.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite stillbirth being identified as one of the most traumatic events a woman can experience, there is a lack of evidence on which to inform best practice in hospital and follow-up care. AIMS The aim of this study was to identify which strategies are most valued by parents regarding care following stillbirth in order to improve the support and management of grieving families. METHOD Mixed methods questionnaires were sent to bereaved participants of the Sydney Stillbirth Study. Questionnaires included a combination of fixed and open-ended responses regarding two critical areas: the participant's hospital stay and their follow-up care. We analysed the qualitative data using thematic analysis. RESULTS Of the 103 women who experienced a stillbirth, 36 responded to the questionnaire. Responders were more likely to have private obstetric care (odds ratio (OR) 4.7, 95% CI 1.7-12.7) and be tertiary educated (OR 6.2, 95% CI 2.3-16.8). Three key themes relating to hospital management of stillbirth were identified: the emotional response to grief, the educational importance of being guided through the grief process, and the environmental aspects of adequate time and appropriate physical space. Families preferred not to be seen in an antenatal setting for follow-up. CONCLUSIONS Simple key components of care including a sensitive and respectful approach, offering guidance as to creating memories, and arranging follow-up care in a quiet and private environment are valued by families experiencing a stillbirth. Incorporating these into practice is achievable and could benefit both families and caregivers.
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Affiliation(s)
- Diana Bond
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy/Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- RPA Newborn Care, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, Obstetrics, Gynaecology and Neonatology, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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