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.

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.