All bereaved parents are entitled to good care after stillbirth: a mixed-methods multicentre study (INSIGHT)

D Siassakos, S Jackson, K Gleeson, C Chebsey, A Ellis, C Storey
  • BJOG An International Journal of Obstetrics & Gynaecology, July 2017, Wiley
  • DOI: 10.1111/1471-0528.14765

All bereaved parents are entitled to good care after stillbirth: INSIGHT

What is it about?

Why this study No health system can be proud of the care it provides when babies continue dying before or after birth yet go unnoticed, and when their parents’ needs are not acknowledged. How was the study carried out? We investigated the experiences of bereaved parents, and examined their actual care, to find ways to improve it. All women and their partners who experienced a stillbirth in three UK hospitals in 2013 were invited to an interview. 35 parents of 21 babies agreed to participate. 22 obstetricians and midwives took part in focus group discussions. What were the main findings? • Care was often not as good as it should and could be. Communication with parents was not always sensitive, because staff did not have appropriate training. • Women reported they did not ‘feel right’ before going to hospital. • Once they arrived there was no standard approach to how care was given. • Sometimes there were long delays before the death of the baby was confirmed, and before action was taken. For example, a couple who attended the hospital overnight were sent home to wait for the next day before the death of the baby was eventually confirmed. • After it had been confirmed that the baby had died, staff focussed on the mothers’ needs but the parents’ priorities were still with their baby. • There was wide variation in decision making, with a common characteristic being decisions made for parents instead of with parents, for example if they asked for a caesarean birth. Staff were not aware of the different reasons why bereaved parents ask for a caesarean birth. • For many parents, the fear of vaginal birth of a stillborn baby might be the result of inadequate preparation for such a situation, a scenario so different to the livebirth they had planned. • There was inconsistent discussion of the post-mortem examination of the baby, because of lack of training for staff how to approach such discussions with parents. • After discharge from hospital, there was no consistent plan for how follow-up care would be given. Parents would have liked more information about their next hospital appointment

Why is it important?

There are several examples of excellent communication and parent-centred care, but also several instances where parents’ needs are ignored, care is delayed, interactions with caregivers are clumsy and inappropriate, and decision-making is one-sided. Better care will only become possible if parents are involved in initiatives to understand and address any problems, but also in recognising and rewarding excellent care. Every bereaved parent is entitled to respectful care. Moreover, every member of maternity staff is entitled to training and support, so that they can in turn support parents effectively.

Perspectives

Dr Dimitrios Siassakos
University College London

We must listen to every voice. The INSIGHT study team collected information to understand and improve the journey for parents, at last.

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http://dx.doi.org/10.1111/1471-0528.14765

The following have contributed to this page: Dr Dimitrios Siassakos

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