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The intense emotional and psychological consequences of pregnancy loss have been studied for decades. With the growing body of literature regarding women's experiences of pregnancy loss, there is an increased need for high quality evidence that underpins perinatal grief and bereavement support interventions. In this paper, we describe and analyze the psychometric properties of existing tools (the Perinatal Grief Scale, the Perinatal Bereavement Scale, the Perinatal Grief Intensity Scale) developed specifically to measure grief following perinatal loss. The psychometric properties of these instruments are presented along with an assessment of their trustworthiness. Of the three perinatal grief instruments, the PGS is the most well-established measure of perinatal grief. The PBS, although promising, has not been as extensively tested as the PGS. The PGIS has compared favorably with the PGS and is also a good choice for use in perinatal bereavement studies despite its shorter history of use and less extensive psychometric testing. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore culturally and linguistically diverse men's experiences of support after perinatal death, including barriers and facilitators to support and how healthcare providers, systems and policies can best support families. Background: Many groups of culturally and linguistically diverse families in Australia are at higher risk of experiencing perinatal death. Culturally sensitive bereavement services are essential; however, there has been no previous research specifically examining culturally and linguistically diverse men's experiences of support following perinatal death. Design: Individual semi‐structured interviews were completed with healthcare providers, community leaders and culturally and linguistically diverse men who had experienced a perinatal death in Australia (n = 16). Data were analysed using Thematic Analysis and COREQ guidelines were followed. Results: Men's need for support following perinatal death was associated with stigma, and shaped by culturally‐relevant religion and ritual, and connection to community and family. Significant barriers to men seeking and gaining support included challenges with self‐advocacy and navigating the woman‐centred nature of perinatal care in Australia. Conclusions: Culturally and linguistically diverse men's specific needs should be included in the development of policy and practice surrounding perinatal death. While perinatal bereavement care guidelines acknowledge the importance of culturally informed care following perinatal death, there remains a lack of culturally specific supports available, particularly for culturally and linguistically diverse men. Relevance to clinical practice: Specific recommendations from this research include increasing community liaison officers or cultural consultants in hospitals and support organisations; providing culturally and linguistically diverse support groups; adopting family‐centred and father‐inclusive language in all perinatal death support services and ensuring clear communication and targeted assistance for culturally and linguistically diverse men to self‐advocate for their baby and access to support. Patient or public contribution: This study came out of consultation with community members and member checking of results was conducted to ensure adequate representation of participants' views. [ABSTRACT FROM AUTHOR]

Introduction: Perinatal palliative care services are increasingly available globally, offering a range of clinical and psychological support services to families during pregnancy, in the neonatal period and following the death of a baby with a life‐limiting or life‐threatening condition. Little is understood about the role of children's hospice care and how it contributes to effective perinatal palliative care. Design: The study aims to answer the question "what is the role of children's hospices in the provision of perinatal palliative care and advance care planning in the United Kingdom?" Methods: An electronic survey was sent to all 54 children's hospices in the United Kingdom between May and June 2022. Results: Thirty hospices responded, representing 54% of the sector. All regions of all four counties are represented. Numbers of referrals to hospices for perinatal palliative care have increased significantly over the last 5 years. Hospices provide a range of services for families and babies, usually from the point of diagnosis or recognition of a life‐limiting or life‐threatening condition, underpinned with counseling and emotional support. Hospices worked with a range of professionals and services, most commonly fetal medicine and neonatal services. Advance care plans were an important element of effective perinatal palliative care, strengthening parent–professional and interprofessional relationships. Conclusion: Children's hospice services play an important and growing role in the perinatal care of babies and families following the diagnosis or recognition of a life‐limiting or life‐threatening condition. The family‐centered approach to care, from a broad, biopsychosocial perspective means that hospices make a unique and meaningful contribution to both the clinical and psychological needs of families. Clinical relevance: The family‐centered approach to care, from a broad, biopsychosocial perspective means that hospices make an important contribution to both the clinical needs of babies, and psychological needs of families antenatally, in the neonatal period and after death. [ABSTRACT FROM AUTHOR]

Perinatal loss (PNL) is considered the loss of any pregnancy or infant from the time of conception up until 1 year after a woman delivers. One in 4 women will experience PNL while 1 in 3 women will experience perinatal mood disorders such as anxiety, depression, and/or posttraumatic stress disorder whether they experience a healthy pregnancy and delivery or experience PNL. In this article, authors describe variable aspects to current processes of care related to PNL. The authors describe the potential value of occupational therapy in supporting mothers who are parenting after PNL and discuss how a diverse group of providers could contribute to supporting mothers and families with unmet need for services following PNL. [ABSTRACT FROM AUTHOR]

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Many researchers have demonstrated the relationship of religiosity with dimensions of mental health such as searching for meaning in life, the presence of meaning in life, and life satisfaction. Hence, this study attempts to link such aspects of religiosity with the experience of the presence and/or absence of God with the search for and presence of meaning in life and satisfaction with life among a group of Polish women who have experienced a stillbirth in the past five years. The study included 64 women who lost a baby through stillbirth after the 22nd week of gestation. All the women were born into Christian families and declared themselves to be Christians and actively practicing their faith. Women's ages ranged from 29 to 47 years. The research results showed that the experience of God's presence and absence have a positive and significant relationship with the search for meaning in life and the presence of meaning in life, as well as with the satisfaction with life in the lives of women after stillbirth. The strongest relationship was between the presence of meaning in life and life satisfaction (r =.72; p <.01), God's presence and life satisfaction (r =.66; p <.01), as well as the presence of meaning in life and the search for meaning in life (r =.57; p <.01). The structural equation model showed that the experience of God's presence and God's absence have a significant, direct impact on the search for meaning in life and the presence of meaning in life, and the satisfaction with life. These also have an indirect impact on the satisfaction with life in the lives of women who have lost a child to stillbirth. [ABSTRACT FROM AUTHOR]

Background: Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being. Research Aims: To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings. Methods: Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted. Results and Discussion: Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns. Conclusions: Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings. [ABSTRACT FROM AUTHOR]

To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation. [ABSTRACT FROM AUTHOR]

Background While perinatal mortality rates have decreased in Ireland in recent years, it is not known if this reduction was shared equally among all groups. The aim of this study is to examine inequalities in perinatal mortality by country of birth and socio-economic group in Ireland between 2004 and 2019. Methods Data for the analysis was obtained from the National Perinatal Reporting System dataset, which includes all births (including stillbirths) in Ireland. The rate and risk ratios for perinatal death were calculated for mothers' socio-economic group and country of birth for two time periods (2004–11 and 2012–19). Adjustment was made for mothers' age, marital status, parity and country of birth/socio-economic group. A total of 995 154 births and 5710 perinatal deaths were included in the analysis. Results With the exception of African born mothers, the perinatal mortality rate decreased for all groups over time; however, inequalities persisted. Relative to Irish born mothers, the risk for African born mothers increased from 1.63 to 2.00 over time. Adjusting for other variables including socio-economic status reduced but did not eliminate this elevated relative risk. Mothers who were classified as unemployed or engaged in home duties had a higher risk of a perinatal death relative to higher professional mothers, with the relative risk remaining relatively constant over time. Conclusions Reducing inequalities in health is a key objective of the Irish government. Further research is required to identify why perinatal mortality continues to be higher in some groups so that targeted action can be implemented. [ABSTRACT FROM AUTHOR]

This article reviews the literature on the experience of pregnancy for women who suffered a prior perinatal loss through miscarriage or stillbirth. Both psychological and social perspectives are considered, and findings synthesized with the first author's reflection on the psychosocial circumstances and needs of women pregnant after a loss, using her personal loss and experience as a peer providing support to this population. Clinical implications highlight the importance of acknowledging the challenges faced by those carrying a child in the very same womb that had previously seen a devastating outcome. [ABSTRACT FROM AUTHOR]

One in four American women will experience a miscarriage, stillbirth or neonatal death each time she becomes pregnant. These perinatal losses occur even more frequently in women who are immigrants from developing countries. Care of Muslim families after perinatal loss is based primarily on expert opinion as opposed to research evidence, as few, if any, studies exist on this topic. It is critically important to know what parent's preferences for care actually are, since care that is incongruent with the desires of the bereaved parents may intensify their grief. The purpose of this study was to examine the perceptions and attitudes of immigrant Arab Muslims regarding psychosocial bereavement practices common in the United States after perinatal loss and to pilot test an investigator‐developed instrument for collecting data regarding culturally relevant psychosocial bereavement practices of immigrant Arab Muslims after perinatal loss. The study employed a cross‐sectional survey design using an investigator‐developed instrument entitled the Arab Muslim Perceptions of Perinatal Loss Care (AMPPLC). The AMPPLC, available in both English and Arabic, was used to collect data on perinatal loss care from a convenience sample of 79 immigrant Arab Muslim adults (male n = 43 [54.4%]; female n = 36 [45.6%]). The study opened in June 2017 and closed in August 2019. The AMPPLC instrument demonstrated good reliability (α = 0.89) in measuring participants' responses. Responses by survey participants did not always agree with prior published literature on Muslim preferences after a loss. Optimal care for Arab Muslim immigrants involves offering all options that are typically part of Western bereavement care as well as options that may be more specifically associated with Islam. This information will enable healthcare providers to provide more culturally sensitive and compassionate care to Middle Eastern Muslim parents during this difficult and tragic experience. [ABSTRACT FROM AUTHOR]

Grief over perinatal loss is a personal experience that has a lasting impact on the life of the surviving siblings. This retrospective study is an in-depth exploration of the symbolic construction of the bond with the lost sibling employing Interpretative Phenomenological Analysis, a method to study sensitive themes. Our results have confirmed the strong social and cultural embeddedness of the grief experience. Participants of the study related perinatal loss to other major crises, conflicts, and overwhelming secrets in the lives of their families. Communication outside the family was often insensitive and stigmatizing, transforming bereaved children's stories into silenced stories. [ABSTRACT FROM AUTHOR]

Limited research has examined the grief experiences of fathers following neonatal death. Using a qualitative research design, ten fathers were interviewed, and thematic analysis resulted in three overarching themes: 'A complicated grief experience: Neonatal death is highly emotional', 'Grief is multidimensional' and 'Sense of injustice'. Overall, results showed that grief was a multidimensional experience for fathers, with expressions of grief including strong feelings of anger and guilt and the manifestation of grief in physical symptoms. In addition, the findings also indicated a sense of injustice that contributed to the disenfranchisement of grief for fathers. The results of this study contribute to developing a better understanding of the grief that fathers experience following neonatal death, and can inform improvements in healthcare practices after the death of a baby in the neonatal period, including father-specific programs and adequate provision of information. [ABSTRACT FROM AUTHOR]

To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality. [ABSTRACT FROM AUTHOR]

This study aimed to assess parents' satisfaction with received care and support when experiencing stillbirth. This was a questionnaire survey conducted at Helsinki University Hospital, Helsinki, Finland during 2016–2020. Separate questionnaires were sent to mothers and partners who had experienced an antepartum singleton stillbirth at or after 22 gestational weeks during 2016–2019. The questionnaire covered five major topics: stillbirth diagnosis, delivery, information on postmortem examinations, aftercare at the ward, and follow-up appointment. One hundred nineteen letters were sent and 57 (47.9%) of the mothers and 46 (38.7%) of their partners responded. Both mothers and their partners felt well supported during delivery. They were also satisfied with the time holding their newborn. Partners reported even higher satisfaction in this aspect with a significant within-dyad difference (p=0.049). Parents were generally pleased with the support at the ward. However, both groups were less satisfied with social worker counseling (mothers 53.7%, partners 61.0%). The majority felt that the follow-up visit was helpful. Nonetheless, a remarkable proportion felt that the follow-up visit increased their anxiousness (25.9%, 14.0%, p=0.018). Partners rated their mood higher than mothers (p=0.001). Open feedback revealed that the support received after discharge from hospital was often insufficient. Our study showed that the parents who experience stillbirth in our institution receive mostly adequate care and support during their hospital stay. However, there is room for further training of healthcare professionals and other professionals contributing in stillbirth aftercare. [ABSTRACT FROM AUTHOR]

To analyze the spatial-temporal patterns of fetal mortality according to its relationship with social vulnerability, identifying priority areas for intervention. Ecological study conducted in the state of Pernambuco, Northeast region of Brazil, from 2011 to 2018. The mean fetal mortality rate per city was calculated for the studied period. A cluster analysis was performed to select cities with homogeneous characteristics regarding fetal mortality and social vulnerability, then the Attribute Weighting Algorithm and Pearson correlation techniques were employed. In the spatial analysis it was used the local empirical Bayesian modeling and global and local Moran statistics. Twelve thousand nine hundred and twelve thousand fetal deaths were registered. The fetal mortality rate for the period was 11.44 fetal deaths per 1,000 births. The number of groups formed was 7, in which correlation was identified between fetal mortality and dimensions, highlighting the correlations between fetal mortality rate and the Index of Social Vulnerability urban infrastructure for the municipalities in group 1 and 5, the values of the correlations found were 0.478 and 0.674 respectively. The spatial analysis identified areas of higher risk for fetal mortality distributed in regions of medium, high and very high social vulnerability. The study allowed observing the existing correlations between fetal mortality and social vulnerability and identifying priority areas for intervention, with a view to reducing fetal mortality in the state. [ABSTRACT FROM AUTHOR]

The study was planned as a descriptive qualitative study to determine the emotional responses of neonatal intensive care nurses to work in the neonatal unit and to neonatal deaths. The sample of the study consisted of 7 nurses who work at the neonatal intensive care unit since data saturation was achieved. The data were collected using the "Semi-Structured In-Depth Interview Guide for Nurses". The data were analyzed using the content analysis method. Following codes were reached as a result of the study: 'happiness-sadness', 'professional satisfaction-exhaustion', 'empathy', 'responsibility-guilt', 'hope-despair' under the theme of being a nurse at neonatal unit'; 'unforgettable first loss', 'professionalism in intervention-and then: sadness, 'mature-premature difference', 'difficulty in giving hurtful news-inability to associate with death' and 'attachment-burnout' under the theme of experiencing neonatal loss.It was seen that nurses' emotions about working at neonatal intensive care unit were generally positive; however, these emotions changed to negative after neonate's relapsing and death. [ABSTRACT FROM AUTHOR]

This article explores narratives of eight mothers who experienced a stillbirth in an NHS labor ward between February, 2016, and May, 2020. Core stories were developed for each participant. Aspects of environment within core stories were compared and contrasted across participants to develop five meta-stories. Meta-stories explored the psychological safety of the labor ward, the perception of the changing status of patient for mothers of stillborn babies, the incomprehensible physical and emotional pain of stillbirth for the mothers, stillborn mothers' perceptions of worth and the impact of rooms designed for typical birthing experiences. The findings are discussed alongside limitations of the study before suggestions for future research are drawn. [ABSTRACT FROM AUTHOR]

Background: Many parents bereaved of a stillborn baby spend time with the child. In this time frame, different acts with the child in focus may occur. Some parents invite others to see the child too. Parents who suffer the loss of a newborn are vulnerable, and understanding acts and practices surrounding the dead newborn is important knowledge for caretakers. Aims: This article aims to enlighten the amount of time Danish parents spend with their stillborn in hospital settings that encourage this practice. Furthermore, it aims to transcend the mere quantitative numbers through a theoretical approach that frames the analysis and discussion of possible layers of meaning imbedded in time spent with a dead newborn. Study design: Data from a Danish cohort of bereaved parents were collected using web‐based questionnaires. These numbers were successively interpreted through an anthropological lens within the perspective of transition and ritualisation. Knowledge from existing empirical literature was also fused. Results from the cohort: Danish parents spend hours or days with their stillborn child. They feel supported in this by healthcare professionals. Mainly close relatives join the parents while admitted to the hospital to see the stillborn child, followed by other family members and friends. Conclusion: Danish parents engage to a very high degree in contact with their dead baby. The analysis points out that 'Time' and 'Others' are needed to create a socially comprehensible status for parents and child when birth brings death. In liminal space during the transition, healthcare professionals act as ritual experts, supporting parents and their relatives to ascribe social status to the dead body of the child through ritualised acts. Instead of only thinking of this period as 'memory‐making', we suggest regarding it as a time of ontological clarification as well. [ABSTRACT FROM AUTHOR]

Objectives: Women who experience stillbirth are more likely to develop post-traumatic stress disorder (PTSD), and anxious and depressive symptoms than those who deliver live healthy babies. Participants in a recent study of online yoga (OY) reported a desire for more social support, which may help reduce PTSD related to grief and aid in coping. Facebook (FB) has been used successfully to deliver support for online interventions, but little is known about its use in conjunction with OY. The purpose of this study was to examine the feasibility of a FB support group in conjunction with an 8-week OY intervention. Design: Randomized parallel feasibility trial with a 1:1 study group allocation ratio. Setting/Location: Online. Subjects: Women (N = 60) who experienced stillbirth within the past 3 years. Interventions: Participants were recruited nationally to participate and randomized into one of two groups: OY only (n = 30) or online yoga with Facebook (OYFB) (n = 30). Both groups were asked to complete 60 min of OY per week. Women in the OY group were asked to log on to a FB page at least once per week. Outcome measures: Acceptability (i.e., satisfaction) and demand (i.e., attendance), PTSD, anxiety, depressive symptoms, social support. Results: Participants were satisfied with and enjoyed OY, and 8/13 FB acceptability benchmarks were met. There were no significant differences between groups in minutes of yoga per week. Conclusions: The addition of a FB group to an OY intervention for women who have experienced stillbirth is feasible, although more research is needed to increase its efficacy. [ABSTRACT FROM AUTHOR]

Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided. [ABSTRACT FROM AUTHOR]

Introduction: Stillbirth fetal loss (SFL) is a significant cause of infant death in the US, with 23,000 reported in 2017. Negative psychological and emotional repercussions of SFL, for parents and nurses, may be mitigated by nurses' preparedness to provide bereavement support (BS). Several studies exploring BS for miscarriage-related fetal loss were found. However, studies exploring SFL BS and nurses' preparedness for providing SFL BS are sparse. The purpose of this study was to assess nurses' confidence and knowledge for providing BS to families experiencing stillbirth fetal loss. Methods: This was a cross-sectional quantitative descriptive study. Postpartum registered nurses (RN) were recruited via email, staff meetings, posted flyers, and personal invitation. RNs completed the 43-item Perinatal Bereavement Care Confidence Scale (PBCCS) and demographic information. The PBCCS has four subscales: Bereavement Support Knowledge (BSK), Bereavement Support Skills (BSS), Self-Awareness (SA), and Organizational Support (OS). Data were collected from May to July 2021 and analyzed using Pearson's correlation and one-way ANOVA. Results: The sample consisted of 48 RNs. PBCCS subscale averages were BSK = 50.85/75, BSS = 28.72/45, SA = 26.31/55, and OS = 33.79/40. Statistically significant correlations (r = .311-.386) were found between BSK and age groups, BSK and level of experience, and SA and RNs who received prior BS education. Statistically significant one-way ANOVA results showed differences in a) BSK across age groups, b) BSK across experience levels, c) total PBCCS scores and age groups, and d) total PBCCS scores and prior BS education. Discussion: Nurses' confidence in providing BS affects the psychological/emotional well-being of parents and RNs. Results suggest RNs need further BS education with assessment of actual knowledge/skills. [ABSTRACT FROM AUTHOR]

Pregnancy loss and neonatal death are recognized as distressing experiences for parents and other family members. However, no research has specifically addressed the experiences of grandfathers. This study aimed to understand grandfathers' grief experiences, and to identify supports they provide, receive, and desire following the loss of a grandchild in pregnancy or the neonatal period. Semi-structured interviews with 10 Australian grandfathers were analyzed, applying principles of thematic analysis. Three themes related to grief and three themes related to support were identified. Findings indicated that grandfathers expressed grief in a range of ways, and emotional expressiveness did not reflect the extent of their grief. Grandfathers typically provided extensive support to their child and family; however, few supports were available to help grandfathers. Recognition and validation of grandfathers' grief, early access to information, and guidance to a variety of supports including written materials, peer and professional support, is required. [ABSTRACT FROM AUTHOR]

This study explores service providers' experiences of supporting men following a miscarriage or stillbirth in Australia. In-depth, semi-structured interviews were completed with seven service providers including midwives, grief counselors and social workers. Participants highlighted that, despite the individual nature of men's grief, there is a need to recognize and address the additional expectations and responsibilities that may compound their experience. Within an environment focused on woman-centered care, participants described creative strategies and inclusive language to promote engagement of men. Further research exploring men's grief is needed to inform training and guidelines for healthcare professionals who work with bereaved families. [ABSTRACT FROM AUTHOR]

Perinatal loss poses unique challenges to grief work because of the complexity of dynamics it carries. Historically shrouded in socially and culturally based belief systems often impeding normal grief responses, the barriers to healthy processing have been surmounted in recent decades. The emergence of music therapy in partnership with social work is one such approach to addressing both anticipatory grief and bereavement of parents enduring the death of their infant prenatally. This retrospective article highlights the resourcing of popular music within a clinical music therapy approach to the curation of a perinatal bereavement event within a large hospital system in a metropolitan area. Popular music as a ubiquitous art form lends tangibility and relevance to the complicated themes of perinatal loss in a manner that invites bereft parents into a forum of acceptance and acknowledgment of a loss that for too long has remained in the shadows. [ABSTRACT FROM AUTHOR]

Parents who choose to carry a pregnancy complicated by a life-limiting congenital anomaly such as anencephaly may give birth to a live neonate and be discharged home. Very little guidance is available to health care professionals providing palliative care in the home setting to this population. This article is a secondary analysis that discusses the concerns and complications that parents experienced after bringing home a neonate with anencephaly. Each parental experience is a qualitative descriptive summary extracted from a larger study on the impact of anencephaly on parents. Parents reported feeling alone in their grief and struggled with their partners' differing style of grief. Parents' primary concerns after hospital discharge included transporting their neonate home, feeding their neonate, changing cranial defect dressings, managing pain and seizures, addressing uncertainty, and facilitating a good death. All parents received hospice services from health care professionals without perinatal bereavement training or experience. Only 1 woman received follow-up care after the death of her son. Preparing and educating health care professionals providing hospice and palliative services with perinatal bereavement training may be beneficial. Identifying and allocating local and online perinatal bereavement resources may provide parents with the tools and support necessary to facilitate healing after perinatal loss. [ABSTRACT FROM AUTHOR]

Background: For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. Validating the grief of these losses has been a challenge to Brazilian society, which is evident considering the childbirth care offered to bereaved families in maternity wards. Positively assessed care that brings physical and emotional memories about the baby has a positive impact on the bereavement process that family undergoes. Therefore, this study aims to assess the effects supportive guidelines have on mental health. They were designed to assist grieving parents and their families while undergoing perinatal loss in public maternities in Ribeirão Preto, São Paulo state, Brazil. Method: A mixed-methods (qualitative/quantitative), quasi-experimental (before/after) study. The intervention is the implementation of bereavement supportive guidelines for women who experienced a stillbirth or a neonatal death. A total of forty women will be included. Twenty participants will be assessed before and twenty will be assessed after the implementation of the guidelines. A semi-structured questionnaire and three scales will be used to assess the effects of the guidelines. Health care professionals and managers of all childbirth facilities will be invited to participate in focus group. Data will be analyzed using statistical tests, as well as thematic analysis approach. Discussion: The Perinatal Bereavement guidelines are a local adaptation of the Canadian and British corresponding guidelines. These guidelines have been developed based on the families' needs of baby memories during the bereavement process and include the following aspects: (1) Organization of care into periods, considering their respective needs along the process; (2) Creation of the Bereavement Professional figure in maternity wards; (3) Adequacy of the institutional environment; (4) Communication of the guidance; (5) Creation of baby memories. We expect that the current project generates additional evidence for improving the mental health of women and families that experience a perinatal loss. Trial registration RBR-3cpthr Plain English summary: For many couples, getting pregnant does not only mean carrying a baby, but also having a child. Most of the time, the couple has already made many plans and has expectations towards the child. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. In Brazilian culture, validating this traumatic grief is very difficult, especially when it happens too soon. The barriers can be noticed not only by the way society deals with the parents' grief, but also when we see the care the grieving families receive from the health care establishment. Creating physical and emotional memories might bring the parents satisfaction regarding the care they receive when a baby dies. These memories can be built when there is good communication throughout the care received; shared decisions; the chance to see and hold the baby, as well as collect memories; privacy and continuous care during the whole process, including when there is a new pregnancy, childbirth and postnatal period. With this in mind, among the most important factors are the training of health staff and other professionals, the preparation of the maternity ward to support bereaved families and the continuous support to the professionals involved in the bereavement. This article proposes guidelines to support the families who are experiencing stillbirth and neonatal death. It may be followed by childbirth professionals (nurses, midwives, obstetricians and employees of a maternity ward), managers, researchers, policymakers or those interested in developing specific protocols for their maternity wards. [ABSTRACT FROM AUTHOR]

PURPOSE: To develop a preliminary clinical validation the NANDA‐I nursing diagnosis "Grieving" in cases of perinatal loss. METHODS: Descriptive cross‐sectional study using the Fehring model. FINDINGS: The overall clinical validity index for the diagnosis was 0.15. Only four defining characteristics and five manifestations identified in the literature were validated. CONCLUSIONS: The variability of manifestations identified in the study participants is considered to be detrimental to the overall clinical validity index. IMPLICATIONS FOR NURSING PRACTICE: The clinical validity of the diagnosis could not be substantiated by the preliminary results of this study and, therefore, additional research is necessary to determine the ability of the diagnosis to adapt to perinatal loss situations in real contexts. Some manifestations have been proposed to NANDA‐I for inclusion as defining characteristics in the nursing diagnosis of grieving. OBJETIVO: Validar clínicamente de forma preliminar el diagnóstico enfermero NANDA‐I duelo en caso de pérdida perinatal. MÉTODOS: Estudio descriptivo transversal usando el modelo de Fehring. RESULTADOS: El índice de validez clínica global del diagnóstico fue de 0.15. Se validaron únicamente cuatro características definitorias y cinco manifestaciones identificadas en la literatura. CONCLUSIONES: Se considera que la variabilidad de las manifestaciones presentadas por los participantes actuó en detrimento del índice de validación clínica global. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: La validez clínica del diagnóstico no pudo ser corroborada por los resultados preliminares de este estudio y, por tanto, se necesita investigación adicional para terminar la capacidad de este diagnóstico para adaptarse a las situaciones de pérdidas perinatales en contexto reales. Se han propuesto a NANDA‐I algunas manifestaciones para que sean incluidas como Características Definitorias del diagnóstico enfermero Duelo. [ABSTRACT FROM AUTHOR]

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An editorial is presented on the investigation, management of perinatal death due to stillbirth. It expresses the view that women and their families should receive appropriate, respectful care. An overview of the importance of access to autopsy, placental examination and using the mother's history to direct other investigations is presented.

Emotional care is an important part of the holistic labor and should be considered when providing care to people affected by perinatal losses. To synthesize the findings from recently published scientific evidence on the emotional care needed following perinatal loss, a search in PubMed, CINAHL, SCOPUS, and Web of Science was carried out in January 2020 yielding 22 studies which met the inclusion criteria and were analyzed following Whittemore and Knafl's (2005) methodology. One category on "offering emotional care" was identified: "Aspects influencing the psychosocial well-being of women after perinatal loss," comprising eight themes: risk of complicated grief, cultural values, perinatal losses in multiple pregnancies, experience of subsequent pregnancies, need of information, contact with the deceased baby, impact on relatives, and strategies for emotional care. In conclusion, the evidence highlights the need of specific emotional grief care. [ABSTRACT FROM AUTHOR]

Objective: To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation.Design: Case-control study.Setting: 41 maternity units in the UK.Population: Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714).Methods: Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale.Main Outcome Measure: Late stillbirth.Results: Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42).Conclusions: This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth.Tweetable Abstract: Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation. [ABSTRACT FROM AUTHOR]

Objective  The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. Study Design  This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. Results  During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p  < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p  < 0.0001, respectively). A significantly (p  = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. Conclusion  The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. Key Points Less obstetrical ER attendance is observed during the pandemic. There is a parallel increase in stillbirth rate. Stillbirth cases tested negative for COVID-19. Lockdown and pandemic panic are possible causes. [ABSTRACT FROM AUTHOR]

Background: Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. Aim: Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. Methods: A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. Results: A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family‐centred accompaniment and follow‐up, parental involvement in pre‐mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. Conclusion: In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. Implications for nursing practice and policy: This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence‐based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Nurses' distress in response to the professional experience of the neonatal loss and stillbirth care is poorly addressed in nursing practice; therefore, the purpose of this study is to explore nurses' experiences of labour of a stillborn baby. A qualitative approach with ten Registered Nurses from hospital birth units in northern Taiwan was used to investigate the stillbirth care experiences of nurses. Research data analysed by interpretative phenomenological analysis (IPA) were collected from eight digital recorded sessions of group dialogues, nurses' responses and feedbacks. Three main themes extracted from data include unfolding the suffering, engrossing in stillborn parents and demonstrating compassionate actions for the stillborn baby. Unfolding the suffering includes shame, guilt and disenfranchised grief. Engrossing in stillborn parents includes perceiving the mother's suppress sadness and empathising with the father's anger. Finally, demonstrating compassionate actions includes fulfilling the parents' needs to say goodbye to their stillborn baby and saying a personal goodbye to the dead baby. The finding of this study shows that the reflective group provided the space for nurses to unfold their suffering, share their emotion, and develop practical wisdom in caring for stillborn baby and the parents. The experience of nurse group conducting the reflecting dialogues could be a expository strategy to promote the nurse to provide the compassionate care actions. [ABSTRACT FROM AUTHOR]

Maternal–fetal attachment (MFA) describes the thoughts, feelings, and behaviors of a pregnant woman toward her unborn baby. With MFA increasingly seen as an important predecessor of future outcomes, understanding the factors associated with MFA may reveal targets for treatment, potentially optimizing outcomes for mothers and infants. The primary aim of this research was to examine associations between MFA and maternal sensory and attachment patterns, when controlling for psychological distress. The secondary aim was to compare MFA and distress for women with and without previous perinatal loss. Pregnant women (N = 108) were recruited from two antenatal clinics at an Australian maternity hospital. During pregnancy, participants completed the Maternal Antenatal Attachment Scale, Adolescent/Adult Sensory Profile, Mental Health Inventory-38, and Attachment Style Questionnaire. Hierarchical linear regression models, controlling for psychological distress as the second step, were performed. Final models revealed that more favorable quality of MFA was associated with lower sensory sensitivity and higher sensory seeking. More time spent in MFA was associated with younger maternal age and higher levels of maternal sensory seeking. Women with previous perinatal loss had more distress but similar levels of MFA compared to women without loss. We provide the first evidence of links between MFA and maternal sensory patterns, and further elucidate links between adult attachment and mental health in women with and without previous perinatal loss. Consideration of maternal sensory patterns, adult attachment, and mental health status antenatally may inform new directions for services seeking to facilitate the relationship between a mother and her unborn baby. Highlights: We studied maternal–fetal attachment (MFA) among pregnant women in Australia. Favorable quality of MFA was associated with lower sensory sensitivity and higher sensory seeking. More time spent in MFA was linked with higher sensory seeking and younger maternal age. Women with previous perinatal loss had similar levels of MFA but greater distress. [ABSTRACT FROM AUTHOR]

Background and objectives: Healthcare professionals play an important role in supporting and attending to families that experience a perinatal loss. Previous research has identified the existence of obstacles that professionals may encounter during their practices. The main objective of the current research was to identify and examine the subjective experiences and practices of experienced professionals attending to perinatal loss in the hospital context in Spain. Design: Qualitative descriptive design. Setting: Three different hospitals in Spain. Participants: Sixteen professionals were interviewed, including doctors, nurses, midwives, nursing assistants, a psychologist and a funeral home manager. Methods: Individual semi‐structured interviews focusing on three areas were carried out: practices with the baby–foetus, practices with parents and interaction with the team. A thematic analysis was performed using the three main focuses of the semi‐structured interview (deductive approach) and the codes that emerged from the data (inductive approach). Results: Regarding guideline‐based care for the baby/foetus, participants made a distinction between the initial process of care for the baby and the decision‐making process with parents. Where support for families was concerned, participants identified considerable variability in the practices used and lack of organisational and care guidelines, psychological support and follow‐up. Finally, interactions with other team members were perceived as a source of support, although participants identified a significant lack of coordination. Conclusion: Participants reported variability of practices in care for the baby and parents, lack of continuity‐of‐care guidelines and the importance of support from a coordinated healthcare team. [ABSTRACT FROM AUTHOR]

Miscarriage and stillbirth are more prevalent than socially perceived and have often been discussed in nursing and medicine literature as solely a medical event to be managed, not a death to be mourned. Social silence, ambiguity surrounding the nature of what was lost, and a painful experience of having no right to mourn are common experiences faced by women with a history of miscarriage or stillbirth. While more recent psychiatry and counseling research has uncovered the extent of grief, trauma, and psychosocial impact following miscarriage and stillbirth, very few studies have sought to understand the bodily experience of living with this history. This phenomenological research study sought to understand and describe the embodied experiences of women who have had a miscarriage or stillbirth. A sample of three participants individually engaged in a movement elicitation procedure followed by a semi-structured verbal interview. Artistic inquiry methods (Hervey in Artistic inquiry in dance/movement therapy: Creative alternatives for research, Charles C Thomas, Springfield, IL, 2000) were integrated throughout the data analysis procedure (Moustakas in Phenomenological research methods, Sage Publications, Inc, Thousand Oaks, CA, 1994) to enhance the understanding of each woman's current, lived-body experience. As a result, five universal themes emerged: Momentum of new life; Stuck in emptiness; Where is my body and where am I?; We go together; and Love does not forget. These themes are supported by the extant literature and the author suggests that the results from this study may be used to inform the integration and practice of dance/movement therapy interventions in miscarriage and stillbirth bereavement counseling and future dance/movement therapy research studies. [ABSTRACT FROM AUTHOR]

After miscarrying in the hospital at eleven weeks, a patient gratefully accepts the hospital's offer to take advantage of a program for low‐income patients that provides burial for fetal remains and a memorial plaque for the gravesite. However, a hospital employee accidentally incinerates the remains, and the error is not discovered until after the ashes are discarded. Two commentaries offer opposing arguments in response to the question whether, to avoid adding to the patient's grief, it is ethically permissible for the clinicians not to disclose the error to her and to proceed with having the name put on a plaque at the burial ground. [ABSTRACT FROM AUTHOR]

Aims: The short version of the Perinatal Grief Scale (PGS) has 33 items of Likert type whose answers vary from 1 (strongly agree) to 5 (strongly disagree), and is used to assess the grief after perinatal loss and to identify women at major need of specific support. This is the first attempt to validate an Italian version of PGS. Materials and methods: The English version of PGS by Potvin et al. was translated into Italian by a professional mother tongue English translator. The survey was administered at 3 different times (translated Italian version; original English version after 10 days; and same Italian version after other 10 days) to 16 Italian/English bilingual women who had experienced a perinatal loss. The reproducibility among the three administrations and concordance were assessed using Cronbach's alpha and Cohen's kappa, respectively. Results: Considering the PGS, median score ranged from 74.5 (58.5–94.5) to 78 (64–95), with no significant difference among the three questionnaire administrations (p = 0.616). No significant difference emerged among the three administered questionnaires for subscales (p = 0.095, 0.410 and 0.410 for 'active grief' AG, 'difficulty in coping' DC and 'despair' D scores, respectively). Concordance varied from good to very good among all questionnaire administrations. Conclusions: This Italian version of the PGS can be used by clinicians to assess Italian women's responses to stillbirth and perinatal loss, as well as by researchers for research purposes. [ABSTRACT FROM AUTHOR]

Offering sensitive and compassionate clinical and bereavement care following perinatal death is the innate focus of the caring healthcare professional and facilitating informed choice around the subject of lactation following loss is an integral part of this. However, evidence suggests that there may be a deficiency in the provision of lactation advice and support following loss. Contributory factors may include a lack of awareness of lactation options following bereavement amongst midwives, as well as an absence of clarity around where the responsibility for offering lactation support and advice lies. This paper presents the literature surrounding the support of women's decision-making for lactation following perinatal death, explicating the physiology of lactation in the antenatal and postnatal periods, and exploring the challenges and opportunities for the midwife when supporting grieving mothers to decide the best option for them and their family. [ABSTRACT FROM AUTHOR]

Estimates from the World Health Organization (WHO) reveal that perinatal loss is a threat in sub-Saharan Africa. It has been established that half of all stillbirths and neonatal deaths occur around the onset of labour to delivery. Approximately 75% of these deaths occur in sub-Saharan Africa, giving the region the highest level of perinatal loss in the world. There are limited studies that have investigated the experiences of and support for women who experience perinatal loss. This article reports on a scoping review that aimed to explore and summarise the existing literature about the experiences of perinatal loss among couples in sub-Saharan Africa, and to identify the relevant support health professionals and the community give to improve the well-being of parents experiencing perinatal loss. Electronic databases were used to search comprehensively peer-reviewed articles and grey literature between 2005 and 2019. Two independent reviewers screened and analysed the selected articles through a data charting procedure. Eight articles met the inclusion criteria for the study. They were all qualitative studies: seven of them were peer-reviewed articles and one was a master's thesis. The findings were categorised under two themes: (1) emotional experiences of perinatal loss among sub-Saharan African women; and (2) support systems available for these women. The literature review highlighted the limited research and lack of literature about the emotional experiences of bereaved couples in sub-Saharan Africa. Furthermore, the literature review revealed that bereaved couples need more support to reduce psychological trauma. The study findings demonstrated the need for more research to enhance understanding of and improve the services provided to bereaved couples and their families. [ABSTRACT FROM AUTHOR]

Background: About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a "stretch and tone" control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health. Methods: Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable. Results: Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p =.036) and grief intensity (p =.009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control). Conclusions: This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial. Trial registration: ClinicalTrials.gov. NCT02925481. Registered 10–04-16. [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]

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. [ABSTRACT FROM AUTHOR]

Background: Stillbirth is a major global concern. However, most research has been con- ducted in high-income countries. Understanding of the experience and management of stillbirth in low-middle income countries is needed. Objective: This qualitative study explored health professionals' experiences of providing stillbirth care in the Lao People's Democratic Republic, a lower-middle-income country in South-East Asia. Methods: In-depth interviews were conducted with 33 health professionals (doctors, mid- wives and nurses) and thematic analysis was undertaken. Results: All participants acknowledged stillbirth as a concern, but its incidence and causes were largely undocumented and unknown. A lack of training in managing stillbirth left health professionals often ill-equipped to support mothers and provide responsive care. Social stigma surrounds stillbirth, meaning mothers found limited support or opportunities to openly express their grief. Conclusions: Better awareness of stillbirth causes could promote more positive experiences for healthcare providers and parents and more responsive healthcare. This requires improved training for healthcare professionals and awareness raising in the wider community. [ABSTRACT FROM AUTHOR]

Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals' language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed. [ABSTRACT FROM AUTHOR]