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OBJECTIVE: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth.METHODS: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018 Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings.RESULTS: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health.CONCLUSION: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally.

The growing need for compassionate bereavement education for all involved in caring for women and their families has been highlighted in recent studies (Heazell et al. 2016, O’Connell et al. 2016, Burden et al. 2016). Staff have identified training and education as key priorities for them in caring for bereaved families (McNamara et al. 2017, O’Connell et al. 2016; Gandino et al. 2017; Agwu Kalu et al, 2018; Doherty et al, 2018a, b). The groundwork for this paper was based upon the Report of the Work-stream on Education and Staff Support under the Chair of Prof. Mary Higgins and presented at the Bereavement Forum, April 2018. This work-stream collated data on the current curriculum on perinatal bereavement education at five out of the six Higher Education Institutions offering bereavement education delivered to medical and midwifery students in Ireland.

Background: Despite advances in maternity care, 2.6 million babies die at or before their birth each year across the globe. The majority of couples will proceed to a pregnancy after loss, often within a very short timeframe of their index loss. However, little is known about how couples, as a unit, negotiate the experience of pregnancy after loss. Aim: To understand how couples, as a dyad, make sense of a pregnancy after stillbirth. Method: The experiences of eight heterosexual couples, who were pregnant again in the immediate pregnancy after stillbirth, was explored using Interpretive Phenomenological Analysis (IPA). Data were collected by joint, semi-structured, face-to-face interviews with a convenience sample. Interviews were audiotaped, transcribed verbatim and analysed using IPA principles. To ensure both the individual and dyadic experiences were explored an additional layer of data analysis was performed. Findings: Two superordinate themes emerged from the data ‘Hoping for a born alive baby’ and ‘Journey of Loss. The first theme, ‘Hoping for a born alive baby’ was the aim of all of the couples in a pregnancy after stillbirth. The processes of negotiated decision-making and lived experience of a subsequent pregnancy were explored. Couples made sense of their experiences of pregnancy after loss via the lens of the death of their babies. In the second theme, ‘Journey of Loss’, couples spoke about the unexpected death of their babies, their experiences at the time of loss and in its aftermath, and the impact that these events had on them as a couple. Conclusion and Implications: Perinatal loss and pregnancy after loss are common occurrences in maternity services. The original findings of this study adds to the understanding of pregnancy after loss, from a couples’ perspective and will assist in the provision of appropriate support services for couples both at the time of loss and in the pregnancy that follows. How couples negotiate the experiences of loss and subsequent pregnancy will help to inform policy and improve services for future couples pregnant after stillbirth.

Margaret Murphy, a member of the Scientific Advisory Committee of the International Stillbirth Alliance, shares her experience working on this call for global action with Deirdre Munro: Despite advances in maternity care, babies still die around the time of their birth. There are an estimated 2.6 million stillbirths annually across the globe, of which 98% occur in low-income and middle- income countries. A high number of these deaths are preventable, with half of all stillbirths (1.3 million) occurring during labour and birth. Most result from preventable conditions such as maternal infections (most commonly syphilis and malaria), non-communicable diseases and obstetric complications. In high income countries stillbirth occurring during labour is a rare event with 90% of deaths occurring antenatally. Many stillbirths are preventable with high quality antenatal and intrapartum care.

A handbook for parents-to-be attending the Preparation for Birth and Parenthood Education programme at Cork University Maternity Hospital.

It is estimated that 15 million babies annually are born too soon, which is before 37 completed weeks of gestation and that this number is rising (1). Complications of preterm birth are the leading cause of death among children less than 5 years of age and this accounted for nearly one million preventable deaths in 2013 (1). The United Nations Millennium Development Goal (MDG) 4 targeted a two-thirds’ reduction of under five deaths by 2015 and recommended interventions to prevent preterm birth and to improve survival for preterm newborns (2). While infant and maternal mortality rates have witnessed some improvements, the burden of mortality and morbidity in the perinatal period remains a major concern (3). This is due in part to the high number of births per year, the young age of the maternal and infant population harmed by adverse perinatal events and the long-term sequelae of adverse pregnancy events such as very preterm birth or severe hypoxia (4).

With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who die having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem.

Teachers can have a profound effect on us all, both good and bad. In this paper the effect two individual midwives had on my evolution as a midwife will be examined. They were very different: one was formal and the other informal. The classroom was the setting for one, the clinical area for the other. Each had her own unique style and way of looking at the world. One was very different from the other in manner and in approach. However they each shared a philosophy of women centred, normal birth which they espoused in all aspects of their working lives.

Healthcare professionals are encountering more andmore women with cardiac conditions contemplating pregnancyor when pregnant than ever before. Advances insurgical treatment of congenital cardiac anomalies meanmany more women are now reaching childbearing age andcontemplating pregnancy than would hitherto have beenseen.Due to the fact that Irish figures have not been availablethus far on the effects of cardiac disease on pregnancy andvice versa, we have come to rely on statistics from our nearestneighbour the UK. The Centre for Maternal and ChildEnquiries (CMACE) is an independent charity. Its missionis to improve the health of mothers, babies and children bycarrying out confidential enquiries and other related workon a UK wide basis and widely disseminating the results. Itproduces a report every three years into maternal fatalitiesin the previous three-year period. The most recent reportwas published in 2007, reflecting the deaths that occurredin 2002-2005. In the most recent CMACE triennial reportinto maternal mortality (2002-2005) for the first time cardiacdisease was found to be the leading cause of maternaldeath among women in the UK, with a maternal mortalityrate for heart disease of 2.27 per 100,000 maternities.

Pregnancy after prenatal or infant loss can be a lonely and frightening time, but through stories of both pain and healing, the authors show how to navigate the exciting but choppy waters of a subsequent pregnancy. The loss of a pregnancy or newborn infant changes the meaning of pregnancy, birth, and parenting forever. Increased parental fear and anxiety, and continuing grief for the deceased baby, can impact subsequent pregnancies in unexpected ways. Parents who are unsupported in pregnancy after loss are may be more at risk of experiencing anxiety, depression, Post-Traumatic Stress Disorder, and difficulty in attaching to a new baby. Different Baby Different Story explores the range of emotions, thoughts, and physical experiences of parents who have gone on to subsequent pregnancies. Including stories from mothers, fathers, other children, and extended family members, this poignant and moving work will help readers through their own feelings and give voice to those who may have felt unheard or unsupported in the past. With practical advice on self-advocacy, the book helps expectant parents gain insights as to how others learned to work with health care professionals, mental health professionals, and their own families and friends and coworkers. For expectant mothers, their partners, their families and their friends, this work supports the range of experiences and encourages readers on a path to healing.