Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study.

Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.

The public awareness of stillbirth: an Irish population study.

OBJECTIVE: To evaluate the general population's awareness of stillbirth. DESIGN: A cross-sectional telephone population survey. SETTING: A nationally representative sample of the Irish adult population. SAMPLE: In all, 999 members of the Irish population were selected by random digit dialling. METHODS: Data were analysed using descriptive and inferential statistics. Binary logistic regression was used to assess the odds of identifying risk factors for stillbirth. MAIN OUTCOME MEASURES: Public knowledge of incidence, risk factors, causes and social awareness about stillbirth. RESULTS: Only a minority, 17%, of respondents correctly identified the incidence of stillbirth. Men and those aged over 45 years were more likely to say they did not know when a stillbirth occurs. Over half, 56% of respondents were unable to identify any stillbirth risk factors. Half of respondents, 53%, believed that the cause of stillbirth was due to a problem with the baby, 39% a problem with the mother, while 31% believed stillbirth occurred as a result of the care provided to the mother. The majority, 79%, believed that all stillbirths should be medically investigated, although women were more likely to suggest this (82% versus 76.4%; P = 0.043). Stillbirth had been represented in traditional and online media for 75% of respondents and 54% said they personally knew someone who had a stillbirth. CONCLUSIONS: There is a lack of public knowledge concerning the incidence, risk factors and causes of stillbirth. Improved public health initiatives and antenatal education are warranted to increase awareness of stillbirth risk factors and to improve care and monitoring during pregnancy. FUNDING: No funding was granted for this study. TWEETABLE ABSTRACT: Irish population study shows low public awareness of stillbirth incidence, risk factors and causes. PLAIN LANGUAGE SUMMARY: This study aimed to find out what the general public know about the risk factors associated with stillbirth and whether stillbirth can be prevented. Many stillbirth risk factors can be identified and when they are, healthcare professionals can monitor pregnancy and hopefully reduce the possibility of a baby dying before birth. A sample of 999 people from the Irish population was surveyed by a professional telephone polling company for this study. The results of this study found that most people did not know how common stillbirth was and also believed that only a minority could be prevented. Most people were not able to identify any risk factors that can lead to stillbirth. Most people knew someone who had had a stillbirth and likewise most people believed that all stillbirths should be investigated to find a cause. It is possible that some people do not know the difference between stillbirth and miscarriage and this question was not asked in this study. Six people did not complete the interview as the topic of stillbirth was too sensitive. It is possible that these people had experienced a stillbirth themselves and so their results are not included. This study highlights the importance of increasing public awareness about stillbirth by providing clear information to women and their partners that there are risk factors associated with stillbirth that can be identified and monitored. The results of this study suggest that these risk factors could be highlighted in antenatal preparation classes and public health campaigns.

Communication skills in Obstetrics: what can we learn from bereaved parents?

Communicating bad news in obstetrics is challenging. This study explores the impact of how bad news was communicated to parents following a diagnosis of stillbirth. Qualitative in-depth interviews were conducted with 12 mothers and 5 fathers, bereaved following stillbirth at a tertiary maternity hospital where the perinatal mortality rate is 5.2/1000. Data were analysed using Interpretative Phenomenological Analysis. How the diagnosis of stillbirth was communicated had a profound and lasting impact on parents. Dominant superordinate themes were Language used, Sensitivity and Diversionary techniques. Parents recalled in detail where and how bad news was broken and language used. Diversionary techniques created a sense of mistrust especially when parents felt information was being withheld. Bereaved parents valued privacy at the time of diagnosis of stillbirth.This study highlights the importance of language, sensitivity and environment where clinicians can learn from the experiences of bereaved parents who value open, sensitive and honest communication. The results of this study highlight the importance of patient-focused communication training for clinicians.

The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study.

OBJECTIVE: To explore the personal and professional impact of stillbirth on consultant obstetrician gynaecologists. DESIGN: Semi-structured in-depth qualitative interviews. SETTING: A tertiary university maternity hospital in Ireland with a birth rate of c. 9000 per annum and a stillbirth rate of 4.6/1000. SAMPLE: Purposive sample of eight consultant obstetrician gynaecologists (50% of consultant obstetrician gynaecologists in the hospital). METHODS: Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis. (IPA) IPA is a methodology for exploring human experience and its meaning for the individual. MAIN OUTCOME MEASURES: The lived experiences, personal feelings and professional impact of stillbirth on consultant obstetrician gynaecologists. RESULTS: Stillbirth was identified as amongst the most difficult experiences for consultants. Two superordinate themes emerged: the human response to stillbirth and the weight of responsibility. The human response to stillbirth was characterised by the personal impact of stillbirth for consultants and, in turn, how that shapes the care they provide. The weight of professional responsibility was characterised by the sense of professional burden and the possibility of a medico-legal challenge-mostly for those who are primarily gynaecologists resulting in the question 'what have I missed?'. CONCLUSIONS: Despite the impact of stillbirth, no consultant has received formal training in perinatal bereavement care. This study highlights a gap in training and the significant impact of stillbirth on obstetricians, professionally and personally. The provision of support, ongoing education, bereavement training and self-care is recommended. Medico-legal concerns following stillbirth potentially impact on care, warranting further research.