Women’s Experiences of a Specialist Antenatal Service for Pregnancies After a Stillbirth or Neonatal Death: A Qualitative Interview Study and Social Return on Investment Analysis

Abstract

Background Pregnancy after the death of a baby is associated with a series of emotional and psychological challenges for pregnant women and their families. Specialist antenatal services have been proposed to address the increased biomedical and psychological risks in pregnancies after perinatal death. This study aimed to explore the pregnancy and postnatal experiences of women in a pregnancy after a perinatal death who were attending a specialist antenatal service and to evaluate the economic impact of the service.Methods To explore women’s views and experiences of care during their pregnancy this study used face-to-face semi-structured interviews following a topic guide comprising of four sections (history leading to care pathway, their experience of coping with new pregnancy after loss, support and advice for others). Following inductive thematic analysis, a deductive approach was taken to map themes to Stroebe and Schutt’s Dual Process Model of Grief.A Social Return on Investment (SROI) analysis informed by contributions from a subgroup of women and staff participants. Information was obtained from focus groups discussions, questionnaires and interviews. The SROI was reported as the ratio of the value generated by the clinic and the costs of providing the service.Results Thematic analysis of interviews (n=20) described how perinatal death was a quiet, unspoken subject and that navigating subsequent pregnancies relied on expecting the worst and hoping for the best. Mapping these themes onto the Dual Process Model of Grief found being pregnant complicated the grieving process, as increased awareness of the risk of stillbirth drew parents’ focus back to loss. Attendance at a specialist service was valued; SROI analysis found that for £1 invested, £6.10 of value was generated, mostly relating to the birth of a live baby, reduced negative psychological symptoms and fewer focussed contacts with health professionals.Conclusions Specialist antenatal care in pregnancies after perinatal death was viewed favourably by parents. Women’s experiences can be used to synthesise and develop models of care that aim to meet their needs but comparative studies are required to determine whether these models are superior to routine high-risk care and to identify which components are most valued.