Please cite this paper as: Heazell A, McLaughlin M, Schmidt E, Cox P, Flenady V, Khong T, Downe S. A difficult conversation? The views and experiences of parents and professionals on the consent process for perinatal postmortem after stillbirth. BJOG 2012;119:987–997. Objective  To describe the experiences, knowledge and views of both parents and professionals regarding the consent process for perinatal postmortem. Design  Internet‐based survey. Setting  Obstetricians, midwives and perinatal pathologists currently working in the UK. Parents who have experienced a stillbirth in the UK in the previous 10 years. Sample  Obstetricians, midwives and perinatal pathologists registered with their professional bodies. Parents who accessed the Sands website or online forum. Methods  Online self‐completion questionnaire with both fixed‐choice and open‐ended questions. Results  Responses were analysed from 2256 midwives, 354 obstetricians, 21 perinatal pathologists and 460 parents. The most common reason for parents to request postmortem examination was to find a cause for their baby’s death; the prevention of stillbirths in others also ranked highly. Perinatal pathologists possessed greatest knowledge of the procedure and efficacy of postmortem, but were unlikely to meet bereaved parents. The majority of professionals and parents ranked emotional distress and a lengthy wait for results as barriers to consent. The majority of staff ranked workload, negative publicity, religion and cultural issues as important barriers, whereas most parents did not. Almost twice as many parents who declined postmortem examination later regretted their decision compared with those who accepted the offer (34.4 versus 17.4%). Conclusion  Emotional, practical and psychosocial issues can act as real or perceived barriers for staff and bereaved parents. Education is required for midwives and obstetricians, to increase their knowledge to ensure accurate counselling, with due regard for the highly individual responses of bereaved parents. The contribution of perinatal pathologists to staff education and parental decision‐making would be invaluable.

Background Stillbirth affects 1 in 200 pregnancies in the UK. There are few guidelines to guide the investigation of stillbirth, but postmortem (PM) is considered the gold-standard investigation, fi nding new information in 40-60% of cases. However, rates of PM have fallen from 54.7% in 2000 to 45.0% in 2007. The reasons for this decrease are unknown, but acceptance of PM after stillbirth may be infl uenced by counselling by obstetricians. Methods To describe the knowledge, practice and attitudes of obstetricians regarding PM a link to a validated questionnaire was sent to 1136 obstetricians on the Royal College of Obstetricians and Gynaecologists database. In the absence of an email, a paper questionnaire was sent. Results 493 (44%) practitioners responded. Of these, 365 were in relevant clinical practice. Obstetricians were all involved in counselling parents for PM, 84.1% were always present with only 1.7% rarely seeing parents after stillbirth. 13% of obstetricians had never received training in counselling for PM and a further 11% were dissatisfi ed with the training they had received. 50% of obstetricians counselling parents had never seen a PM. Knowledge of the PM procedure was variable with as few as 45% of respondents identifying correct responses. Importantly, 36.5% of obstetricians signifi cantly underestimated the diagnostic value of PM. Conclusions Obstetricians are essential in counselling parents after stillbirth. A signifi cant proportion have received inadequate training, which is evident in lack of knowledge of the value and procedure of PM examination. Increased education for obstetricians may help increase PM uptake.

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