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ABSTRACT Background Objectives Search Strategy and Selection Criteria Data Collection and Analysis Main Results Conclusions Ninety‐eight percent of neonatal deaths worldwide occur in low‐ and middle‐income countries (LMICs), yet there is little bereavement care guidance available for these settings.To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs.Four databases were searched for peer‐reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting.Data were collected by two independent reviewers, collated through line‐by‐line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven‐step meta‐ethnography approach to create first‐, second‐ and third‐order themes.Seven first‐order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third‐order themes arose: The individual, the healthcare setting and the community/context.Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high‐quality, bereavement care guidelines suitable for use in LMIC settings. [ABSTRACT FROM AUTHOR]

Objective: Parent engagement in perinatal mortality review meetings following stillbirth may benefit parents and improve patient safety. We investigated perinatal mortality review meeting practices, including the extent of parent engagement, based on self‐reports from healthcare professionals from maternity care facilities in six high‐income countries. Design: Cross‐sectional online survey. Setting: Australia, Canada, Ireland, New Zealand, UK and USA. Population: A total of 1104 healthcare professionals, comprising mainly obstetricians, gynaecologists, midwives and nurses. Methods: Data were drawn from responses to a survey covering stillbirth‐related topics. Open‐ and closed‐items that focused on 'Data quality on causes of stillbirth' were analysed. Main outcome measures: Healthcare professionals' self‐reported practices around perinatal mortality review meetings following stillbirth. Results: Most clinicians (81.0%) were aware of regular audit meetings to review stillbirth at their maternity facility, although this was true for only 35.5% of US respondents. For the 854 respondents whose facility held regular meetings, less than a third (31.1%) reported some form of parent engagement, and this was usually in the form of one‐way post‐meeting feedback. Across all six countries, only 17.1% of respondents described an explicit approach where parents provided input, received feedback and were represented at meetings. Conclusions: We found no established practice of involving parents in the perinatal mortality review process in six high‐income countries. Parent engagement may hold the key to important lessons for stillbirth prevention and care. Further understanding of approaches, barriers and enablers is warranted. Parent engagement in mortality review after stillbirth is rare, based on data from six countries. We need to understand the barriers. Parent engagement in mortality review after stillbirth is rare, based on data from six countries. We need to understand the barriers. [ABSTRACT FROM AUTHOR]

Objective: To explore the healthcare experiences of parents whose baby died either before, during or shortly after birth between 20+0 and 23+6  weeks of gestation in order to identify practical ways to improve healthcare provision.Design: Qualitative interview study.Setting: England through two parent support organisations and four NHS Trusts.Sample: A purposive sample of parents.Methods: Thematic analysis of semi-structured in-depth narrative interviews.Main Outcome Measures: Parents' healthcare experiences.Results: The key overarching theme to emerge from interviews with 38 parents was the importance of the terminology used to refer to the death of their baby. Parents who were told they were 'losing a baby' rather than 'having a miscarriage' were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby. Appropriate terminology validated their loss, and impacted on parents' health and wellbeing immediately following bereavement and in the longer term.Conclusion: For parents experiencing the death of their baby at the margins between miscarriage, stillbirth and neonatal death, ensuring the use of appropriate terminology that reflects parents' preferences is vital. This helps to validate their loss and prepare them for the experiences of labour and birth. Reflecting parents' language preferences combined with compassionate bereavement care is likely to have a positive impact on parents' experiences and improve longer-term outcomes.Tweetable Abstract: Describing baby loss shortly before 24 weeks of gestation as a 'miscarriage' does not prepare parents for labour and birth, seeing their baby and making memories. [ABSTRACT FROM AUTHOR]

Background: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.Objective: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.Search Strategy: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.Selection Criteria: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.Data Collection and Analysis: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).Main Results: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.Conclusions: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.Tweetable Abstract: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]