Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the international stillbirth alliance

Abstract

Stillbirth remains a global health challenge which is greatly affected by social and economic inequality, particularly the availability and quality of maternity care. The International Stillbirth Alliance (ISA) exists to raise awareness of stillbirth and to promote global collaboration in the prevention of stillbirth and provision of appropriate care for parents whose baby is stillborn. The focus of this ISA conference was to share experiences to improve bereavement support and clinical care. These issues, relevant throughout the globe, are not discrete but closely interrelated, with both similarities and differences depending on the specific country and cultural context. Counting stillbirths and understanding the causes of stillbirth are essential not only for providing optimal care and support to parents whose babies die, but also for reducing the future burden of stillbirth. This summary highlights novel work from obstetricians, midwives, psychologists, parents and peer support organizations that was presented at the ISA meeting. It covers topics including the bereavement process, peer support for parents, support and training for staff, evidence for clinical care, and the need for accurate data on stillbirths and perinatal audits. Representatives from the maternity services of the region presented their outcome data and shared their experiences of clinical and bereavement care. Data and developments in practice within stillbirth and bereavement care must be widely disseminated and acted upon by those responsible for maternity care provision, both to prevent stillbirths and to provide high-quality care when they do occur.

Defining disrespect and abuse of newborns: a review of the evidence and an expanded typology of respectful maternity care

“…All patients, including infants who may have been exposed to HIV or other infectious diseases, need medical care that protects both them and their providers. Families with pregnancy or infant loss may also require additional support from the health system; this may include additional training of staff, more resources for pathology laboratories and audit systems, development of networks of peer support for families, and additional monitoring and counselling in subsequent pregnancies [12]. While cultural contexts vary, these basic principles should guide the provision of competent, supportive and dignified care for all patients [13].…”

“…blood draws, injections) [25, 26]Poor rapport between patients and providersWomen blamed for poor neonatal outcomes, small infant, female newborn [2]Unnecessary separation of mother/parent/caregiver and newborn [31]Non-consented treatment of newborn [31]Lack of breastfeeding, thermal care or other postpartum support [15]Health system conditions and constraintsNot enough providers for mother and newborn [2]Providers with no/limited skills for newborn care [19, 32]Unavailable or insufficient equipment for newborn care [2]Room cold or dirty (e.g. exposure to bacteria) [33]Newborn left alone or unattended [1]Added category: Legal accountabilityNo birth/death registration [35]Poor governance of health system/no legal recourse for malpractice [19]Added category: Bereavement and posthumous careNo/inappropriate bereavement options offered [12]No options for autopsies/verbal autopsies [18]Deleted category: Sexual abuse No evidence for newborns …”

Preventing stillbirths: Better data to inform interventions in Australia

“…Parents may regret their decision about autopsy as a result of poor communication or inadequate information [143]. A study found that 52% of bereaved parents reported a poor understanding of events surrounding the stillbirth and 71% were dissatisfied with information they were given [144]. Twice as many parents who declined an autopsy later regretted their decision compared to those who agreed to an autopsy (34.4% versus 17.4%) [134].…”

“…However, there is limited understanding about how the interactions between health care providers and parents impact on parent's perception of care and the decision making process about investigation into the cause of death [144].…”

“…It has been estimated that for Indigenous Australian women, the population attributable fraction may be as high as 20%, reflecting the higher maternal smoking rates [32]. There is evidence to support stillbirth risk reduction with smoking cessation during pregnancy [62,63], as well 144 as high level evidence for the effectiveness of smoking cessation interventions for pregnant women. However, smoking cessation rates have been consistently lower for…”