Perinatal palliative care: Integration in a United States nurse midwifery education program

Midwives' support for parents following stillbirth: How they practise and resources they need from a phenomenological perspective

AIM

To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth.

DESIGN

Qualitative study based on Gadamer's hermeneutic phenomenology.

METHODS

This study was conducted with midwives (n = 18) at the birth unit of a third-level public hospital in Jaén (Spain) in 2023. Personal semi-structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming.

RESULTS

Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided.

CONCLUSIONS

Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system. WHAT PROBLEM DID THE STUDY ADDRESS?: The midwives´ experiences in cases which end with the delivery of a stillborn. WHAT WERE THE MAIN FINDINGS?: Each action of the midwife is as important as the availability of resources to offer the most appropriate care. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: In each woman who receives the care of a midwife who attends the birth of a stillborn.

REPORTING METHOD

COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

The Role of Midwives in US Perinatal Palliative Care: A Scoping Review

INTRODUCTION

Perinatal palliative care (PPC) is a rapidly growing and essential reproductive health care option for pregnant persons with a diagnosed life-limiting fetal condition who continue their pregnancy. The provision of PPC is within the scope of basic midwifery competencies, and midwives are well-positioned to make unique and valuable contributions to interprofessional PPC teams. However, little is known about midwives' past or current involvement in PPC in the United States.

METHODS

This scoping review of the literature investigated what is known about the role of midwives in PPC in the United States. Multiple databases of published literature were used for this review: PubMed, CINAHL, Embase, Web of Science, ProQuest, Google Scholar, and relevant citations from identified studies. All types of English language publications addressing midwives' involvement in PPC in the United States were included, without any limitations on publication date.

RESULTS

The role and contributions of midwives in PPC is not well represented in existing literature. Of the 259 results identified, 7 publications met criteria for inclusion. These included 5 case reports, one quantitative research article, and one conference abstract. Midwives are involved in PPC through the provision of direct clinical care (including antepartum, intrapartum, postpartum, neonatal, bereavement, postmortem, and follow-up care) and care planning and coordination as part of an interprofessional team.

DISCUSSION

Despite midwives being uniquely positioned to provide holistic, family-centered, and person-centered care in situations of pregnancy with life-limiting fetal conditions, there is limited literature about their involvement in PPC in the United States. PPC should be incorporated into midwifery education and training programs. Midwives should play a central role in shaping future research and policies to ensure the accessibility and quality of PPC.

Perinatal death witnessed by midwifery students during clinical practice and their coping methods: A qualitative study

OBJECTIVE

The aim of this study was to determine the perinatal death experience of midwifery students during clinical practice and their coping methods.

DESIGN

A qualitative, descriptive, phenomenological design was used.

SETTINGS

The study was conducted with midwifery students.

PARTICIPANTS

The study was conducted with 14 midwifery students at a state university in northern Turkey between April and July 2023.

METHODS

Perinatal death experiences that students witnessed during clinical practice and their coping methods were analyzed using the individual in-depth interview technique. Data were analyzed using the thematic analysis method. The results obtained from the study were reported according to the COREQ criteria.

FINDINGS

As a result of the analysis, four main themes: (1) the perception of the concept of death, (2) the first encounter with death, (3) methods of coping with death, and (4) students' suggestions were elicited from the data. Students who witnessed perinatal death were affected by this situation, experienced negative emotions, and resorted to different methods to cope with their negative feelings about death.

CONCLUSIONS

Midwifery students who witnessed perinatal death were negatively affected emotionally and professionally; therefore, education and policy-oriented regulations are needed to cope with perinatal death.

Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss

INTRODUCTION

Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth.

PROCESS

A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation.

OUTCOMES

Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82).

DISCUSSION

Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.

Life-limiting fetal conditions: Are Australian student midwives prepared? A mixed-methods survey

AIM

To document current teaching methods, curriculum, and perceived educational preparation related to the teaching of life-limiting fetal conditions, termination, and perinatal palliative care to Australian student midwives.

BACKGROUND

Australian women receiving a diagnosis of a life-limiting fetal condition are generally offered a choice between termination of pregnancy and perinatal palliative care. Midwives are often involved with caring for these women. What Australian student midwives are being taught about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during their entry-to-practice program is unknown.

DESIGN

This study utilised a mixed-methods descriptive approach for data collection and analysis.

METHODS

Academic Leads of all Australian entry-to-practice midwifery programs received a questionnaire exploring topics taught, teaching time, teacher role, and perceived effectiveness of student preparation. Data was analysed statistically and thematically.

RESULTS

Twelve of 24 Academic Leads responded (50%); only five stated their programs taught all three areas. More respondents taught about termination of pregnancy (10/12) than perinatal palliative care (7/12). On average 5.8 ( ± 2.8) total hours was spent teaching about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during the entire midwifery program, with a range of 1 - 10 h. The free-text data identified three central themes: lack of value within the curriculum; disconnect between the university and the placement hospital; and preparation for practice. Most (10/12) Academic Leads did not believe student midwives are prepared to care for affected families.

CONCLUSIONS

Entry-to-practice midwifery programs vary considerably in their education surrounding life-limiting fetal conditions, however teaching hours overall were low and most Academic leads did not feel (or know if) their students were adequately prepared. Further research is required to determine if early career midwives find their university education in life-limiting fetal conditions adequate preparation for practice, and to then remediate identified deficiencies.

Experience of undergraduate midwifery students faced with perinatal death in clinical practice: A qualitative study

BACKGROUND

Student midwives often encounter perinatal loss including stillbirth and neonatal death as part of their clinical training. There has been limited research on how student midwives cope with perinatal death.

OBJECTIVE

To explore the experiences of undergraduate midwifery students facing perinatal death during their internships.

DESIGN

Qualitative research design based on interpretive phenomenological approach and COREQ-guided reporting.

SETTING

Tertiary maternal and child care center or general hospital.

PARTICIPANTS

Undergraduate midwifery students from a medical university in Guangzhou, China.

METHODS

Study participants were recruited through purposive sampling. Semi-structured in-depth interviews were conducted between October 2020 and March 2021 with 12 midwifery students. Transcripts of the interviews were analyzed using Diekelmann's interpretive method.

RESULTS

Four themes were identified from the data: unavoidable anxiety and avoidance response; overwhelming fear and taboos related to death; self-blame and emotional inhibition; and ethical conflict and reflection on practice.

CONCLUSIONS

Undergraduate midwifery students believed they were ill-prepared to care for women who experienced perinatal loss, consciously endured their own negative emotions such as anxiety and fear, and hoped for improved bereavement and stillbirth care in future clinical practice. Students valued support from the bereavement midwife and identified effective strategies that would help them cope with their feelings. It is recommended that adequate education and emotional support be provided to midwifery students, who should be encouraged to provide appropriate care to grieving families.