A M Wojcieszek1,2, F M Boyle2,3, J M Belizán2,4, J Cassidy2,5, P Cassidy2,5, Jjhm Erwich2,6, L Farrales2,7,8, M M Gross2,9,10, Aep Heazell2,11,12, S H Leisher1,2, T Mills13, M Murphy2,14, K Pettersson2,15, C Ravaldi2,16, J Ruidiaz2,17, D Siassakos2,18, R M Silver2,19, C Storey2, A Vannacci2,16,20, P Middleton2,21, D Ellwood2,22, V Flenady1,2. 1. Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia. 2. International Stillbirth Alliance, Bristol, UK. 3. School of Public Health, The University of Queensland, Brisbane, Qld, Australia. 4. Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. 5. Umamanita, Girona, Spain. 6. Department of Obstetrics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands. 7. University of British Columbia, Vancouver, BC, Canada. 8. Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, BC, Canada. 9. Hannover Medical School, Hannover, Germany. 10. Zurich University of Applied Sciences, Institute for Midwifery, Winterthur, Switzerland. 11. Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK. 12. St Mary's Hospital, Central Manchester University Hospitals, NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. 13. School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK. 14. School of Nursing and Midwifery, University College Cork, Cork, Ireland. 15. Karolinska University Hospital, Stockholm, Sweden. 16. CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy. 17. Era en Abril, Buenos Aires, Argentina. 18. Academic Centre for Women's Health, University of Bristol, Bristol & Southmead Hospital, Bristol, UK. 19. University of Utah Health Sciences Center, Salt Lake City, UT, USA. 20. Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy. 21. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia. 22. Griffith University and Gold Coast University Hospital, Gold Coast, Qld, Australia.
Abstract
OBJECTIVE: To assess the frequency of additional care, and parents' perceptions of quality, respectful care, in pregnancies subsequent to stillbirth. DESIGN: Multi-language web-based survey. SETTING: International. POPULATION: A total of 2716 parents, from 40 high- and middle-income countries. METHODS: Data were obtained from a broader survey of parents' experiences following stillbirth. Data were analysed using descriptive statistics and stratified by geographic region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. MAIN OUTCOME MEASURES: Frequency of additional care, and perceptions of quality, respectful care. RESULTS: The majority (66%) of parents conceived their subsequent pregnancy within 1 year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographic regions. Care addressing psychosocial needs was less frequently provided, such as additional visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared with parents whose stillbirth occurred at ≤ 29 weeks of gestation, parents whose stillbirth occurred at ≥ 30 weeks of gestation were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making. CONCLUSIONS: Greater attention is required to providing thoughtful, empathic and collaborative care in all pregnancies following stillbirth. Specific education and training for health professionals is needed. TWEETABLE ABSTRACT: More support for providing quality care in pregnancies after stillbirth is needed. PLAIN LANGUAGE SUMMARY: Study rationale and design More than two million babies are stillborn every year. Most parents will conceive again soon after having a stillborn baby. These parents are more likely to have another stillborn baby in the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died.
OBJECTIVE: To assess the frequency of additional care, and parents' perceptions of quality, respectful care, in pregnancies subsequent to stillbirth. DESIGN: Multi-language web-based survey. SETTING: International. POPULATION: A total of 2716 parents, from 40 high- and middle-income countries. METHODS: Data were obtained from a broader survey of parents' experiences following stillbirth. Data were analysed using descriptive statistics and stratified by geographic region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. MAIN OUTCOME MEASURES: Frequency of additional care, and perceptions of quality, respectful care. RESULTS: The majority (66%) of parents conceived their subsequent pregnancy within 1 year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographic regions. Care addressing psychosocial needs was less frequently provided, such as additional visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared with parents whose stillbirth occurred at ≤ 29 weeks of gestation, parents whose stillbirth occurred at ≥ 30 weeks of gestation were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making. CONCLUSIONS: Greater attention is required to providing thoughtful, empathic and collaborative care in all pregnancies following stillbirth. Specific education and training for health professionals is needed. TWEETABLE ABSTRACT: More support for providing quality care in pregnancies after stillbirth is needed. PLAIN LANGUAGE SUMMARY: Study rationale and design More than two million babies are stillborn every year. Most parents will conceive again soon after having a stillborn baby. These parents are more likely to have another stillborn baby in the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died.
Authors: Aleena M Wojcieszek; Emily Shepherd; Philippa Middleton; Zohra S Lassi; Trish Wilson; Margaret M Murphy; Alexander Ep Heazell; David A Ellwood; Robert M Silver; Vicki Flenady Journal: Cochrane Database Syst Rev Date: 2018-12-17
Authors: Aleena M Wojcieszek; Alexander Ep Heazell; Philippa Middleton; David Ellwood; Robert M Silver; Vicki Flenady Journal: BMJ Open Date: 2019-06-22 Impact factor: 2.692
Authors: Tracey A Mills; Stephen A Roberts; Elizabeth Camacho; Alexander E P Heazell; Rachael N Massey; Cathie Melvin; Rachel Newport; Debbie M Smith; Claire O Storey; Wendy Taylor; Tina Lavender Journal: BMC Pregnancy Childbirth Date: 2022-08-10 Impact factor: 3.105