Exploring the lived experience of women, families and health care professionals of care and support following perinatal death in south-western Nigeria : a hermeneutic phenomenological study

Introduction: Perinatal death has a significant impact on the physical, emotional and mental health of women. This requires adequate bereavement care to limit the impact in the short and long term and on the quality of life. Women and families in sub-Saharan Africa and South Asian countries are most affected as they carry the highest burden of perinatal death. The experience of care and support in these countries has not been explored. Thus, there is a lack of understanding of the care and support received by women, and provided by healthcare professionals in South-Western Nigeria, one of the regions with the highest rate of perinatal death globally. Aim: The aims of this thesis were (i) to identify, synthesise and critically reinterpret the findings of existing literature on the care and support following perinatal death in high burden settings, and to reveal gaps and new understanding, (ii) to explore the lived-experience of women and families of care and support following perinatal death in South-Western Nigeria and (iii) to explore the lived experience of health care professionals who provide care and support following perinatal death in South-Western Nigeria. Methods: A metaethnographic metasynthesis was undertaken in synthesising and critically reinterpreting existing studies on womens care and support following perinatal death in high burden settings. Qualitative hermeneutic phenomenological studies using semi-structured interviews were conducted in exploring the lived experience of women, families and health care professionals of care and support following perinatal death. Results: Perinatal death is not appropriately acknowledged, thus care and support in high burden settings is inadequate. Women are not adequately supported whilst in hospital and receive no follow-up care from health care professionals in the community following discharge. Nurses endeavour to provide support as far as is possible within the hospital but this is determined by their practice as there is no recognised guideline for bereavement care following perinatal death in South-Western Nigeria. Thus, there is a lack of consistency in care and support. Nonetheless, nurses recognise the need for post-discharge follow-up and provide this within their own leisure time, outside of their role. Conclusion: Overall, bereavement care following perinatal death is limited in South-Western Nigeria; rather nurses provide care and support based on their own practice. There is a need for further research into and a development of sufficient bereavement care in Nigeria for women who experience perinatal death. In addition, the experience of other health care professionals and family members including partners of care and support also requires further research.