Caring for Families Coping With Perinatal Loss

doi:10.1111/j.1552-6909.2008.00290.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 37, Issue 6, November–December 2008, Pages 631-639

https://doi.org/10.1111/j.1552-6909.2008.00290.x Get rights and content

ABSTRACT

Objective

To describe support needs and comfort level of labor nurses caring for families experiencing perinatal loss.

Design

Qualitative descriptive study.

Setting

A western hospital birthing unit.

Participants

Ten labor nurses.

Method

Participants completed online surveys and follow-up interviews; data saturation was reached. Content analysis produced themes and recommendations related to providing perinatal bereavement care. Participants reviewed and confirmed accuracy of the results.

Results

Nurses are generally comfortable but find it difficult to provide perinatal bereavement care. Strategies for coping include focusing on needed care, talking to nursing peers, and spending time with their own family members. Nurses take turns providing care depending on “who is best able to handle it that day” and prefer not to be assigned a laboring patient in addition to the grieving parents. Developing clinical expertise is necessary to gain the comfort level and the skills necessary to care for these vulnerable families. Orientation experiences and nursing staff debriefing would help. Needed education includes grief training, communication techniques, and guidelines for the extensive paperwork.

Conclusions

Initial and ongoing education of nurses about perinatal bereavement care is needed. Effective strategies for coping during and after providing care would support nurses in meeting the emotional challenge of providing high quality perinatal bereavement care.

Section snippets

Background Information on Perinatal Loss

The Centers for Disease Control and Prevention (2008) report the latest available fetal death rates from 2003: 6.4 per 1,000 (over 20 weeks), 3.2 per 1,000 (over 28 weeks), and 6.9 per 1,000 for perinatal (over 28 weeks and up to 7 days old). Because many early fetal losses (miscarriages) are handled on an outpatient basis, the birthing unit nurses confront these three aspects of perinatal loss most often.

The existing literature on perinatal bereavement focuses primarily on the experiences of

Background Information on the Hospital and Current Bereavement Practices

The location for this study was a western hospital with a birth rate of about 200 per month. Although nurses whose primary practice is with newborns or postpartum women also interact with bereaved families present in this birth center, this study focused on nurses whose practice focuses on women during labor and birth. There are 35 nurses on the labor staff. A perinatal loss program called “Helping Understand Grief Through Support” has been in place for about 20 years. The goal of the program

Purpose and Research Questions

The need to learn about nurses' experience of providing perinatal bereavement care was identified by the coordinator of the perinatal loss program, who noted that some nurses seem more comfortable and more effective in providing such care than other nurses, potentially leading to differences in quality of care for families. She wanted to know what factors might influence this variation in comfort among the nurses and what might be done to facilitate the development of nurses' skills. She

Limitations and Further Research

This was a qualitative study with the goal of describing the perspectives of one group of labor nurses about providing perinatal bereavement care, thus the results cannot be generalized to other groups of nurses. A sample size of 10 is appropriate for an introductory qualitative study of this nature; however, the variability of the sample should be examined. Because 6 of the nurses who participated work exclusively on the night shift, and another rotates to nights, the perinatal loss program

Implications

If the nurses in this study are typical of other labor nurses, most would not consider leaving the unit because of the challenge of bereavement care. These participants clearly indicated, however, that more education about perinatal loss and enhanced peer support for coping with the emotional stress of such care are needed and important. The nurses stated that caring for patients who have a perinatal loss made them feel sad, and although they felt they were making a positive difference for

Acknowledgment

Supported by the North Colorado Medical Center Foundation.

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Cited by (59)

Women's Length of Stay in a Danish Specialized Unit for Perinatally Bereaved Parents
2021, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
To describe the clinical characteristics of women admitted to a specialized unit for bereaved parents and to identify the characteristics of women who stayed more than 2 days.
A population-based descriptive study.
A midwifery-led specialized unit for bereaved parents at Aarhus University Hospital, Denmark.
Women with miscarriage (>14 weeks), missed abortion (>14 weeks), termination of pregnancy (>14 weeks), stillbirth, or death of their neonate during the first 48 hours after birth.
We collected information from the electronic health care records for women admitted to the unit from January 2012 through December 2018, including parity, type of loss, gestational age, mode and duration of birth, pain relief, and duration of stay.
From January 1, 2012. to December 31, 2018, 579 women were admitted to the unit. Hospitalization varied from 1 day to 1 week. More women with a loss after 22 gestational weeks stayed for more than 2 days. In multivariate analyses, the hazard ratio (HR) of staying longer than 2 days was 1.3 times greater for primiparous women than for multiparous women (HR = 1.3, 95% confidence interval [1.0, 1.7]) and 2.4 times greater for women with near-term loss compared to women with perinatal loss before gestational week 22 (HR = 2.4, 95% confidence interval [1.7, 3.6]).
Providing unlimited stay at a specialized unit for perinatal loss resulted in variation in length of stay. Primiparous women and women who lost neonates or fetuses closer to term gestation were more likely to stay in the unit for up to 8 days. This may indicate a need for individual support not available in standard care.
Responding to catastrophe: A case study of learning from perinatal death in midwifery practice
2020, Women and Birth
Perinatal death has far reaching emotional effects for all involved in this devastating event. The opportunity for learning as a result of this catastrophe, however, remains unexplored.
To explore midwives’ experiences of caring through, and learning from, perinatal death, to better inform the effective planning and delivery of education that optimises both midwifery and self-care.
A naturalistic interpretive multiple case study design. Seventeen midwives, located in Australia, participated in an online group activity hosted as a blog, followed by telephonic focus groups and in-depth email interviews.
Thematic data analysis revealed seven major themes: Grappling with the reality of perinatal death; Struggling with personal and professional heartache; Seeking the space to grieve as a professional; Being with the woman and her family; Finding a new purpose; Strengthened through support; and Developing the courage to care.
The initial turmoil and impact of loss reflected the catastrophic nature of perinatal death. Midwives uncovered a journey to acceptance and learning, realising a determination to enhance expertise and discovering value in experiential knowledge. Insecurity regarding competence and confidence to manage perinatal death and bereavement care was highlighted. However, sharing their stories revealed professional fulfilment, personal strength, and solidarity amongst midwives who have endured similar experiences.
A coordinated approach to support and the dissemination of experiential knowledge and learning could be developed within an online model of narrative sharing and discussion. Debriefing, support and sharing of expertise in this way may foster engagement within and beyond the workplace.
Development, validation and reliability testing of ‘Perinatal Bereavement Care Confidence Scale (PBCCS)’
2020, Women and Birth
Equipping midwives and nurses with confidence to provide bereavement care to parents who have experienced a perinatal loss is vital and impacts on the efficacy of the care received by grieving parents. In education and clinical practice environments there are shortages of bereavement care questionnaires specifically designed to measure midwives’ and nurses’ confidence and psychosocial factors that impact on their confidence to provide bereavement care.
The purpose of the study was to develop a valid and reliable perinatal bereavement care confidence scale (PBCCS).
The PBCCS was developed in 4 phases. Phase 1: Questionnaire development, 44 questions were formulated from the literature. Phase 2: Face and content validation of the PBCCS by an Expert Panel. Phase 3: A pilot study was conducted and included 10 cognitive pre-testing interviews and test-retest reliability assessment with a cohort of 26 midwives. Phase 4: Construct validity was assessed using factor analysis with 277 midwives and nurses. In order to avoid confusion with terminologies, the term midwife was used for both nurses and midwives who provided care to bereaved parents and participated in the study. Internal consistency reliability measurement was assessed with Cronbach’s alpha. Ethical approval of the study was obtained from four maternity hospitals in Ireland.
The PBCCS has 43 items. Bereavement care knowledge (15 items, 3 sub-scales). Bereavement care skills (9 items, 2 sub-scales). Self-awareness (8 items, 2 sub-scales). Organisational support (11 items, 2 subscales). The internal consistency reliabilities ranged from 0.753 to 0.871 except for one subscale 0.663.
The PBCCS is a valid and reliable tool with good psychometric properties which can be used to measure midwives’ confidence and the psychosocial factors thatimpact on their confidence to provide bereavement care.
Midwives’ experience of delivery care in late foetal death: A qualitative study
2018, Midwifery
Citation Excerpt :
In this respect, very few studies have considered the experience of midwives faced with late foetal death as the reference professional. There are some studies that describe how labour nurses find it difficult to provide perinatal bereavement care to families experiencing a loss (Roehrs et al., 2008; Hutti et al., 2016). In a systematic review of parents’ experiences with health providers during a perinatal loss, nurses were identified as being more emotionally supportive than physicians, but a lack of training in bereavement support was detected in both, nurses and physicians (Gold, 2007).
To explore the experiences of midwives regarding the attention given during labour in late foetal death.
Qualitative research using a hermeneutic-interpretative phenomenological approach was carried out. Data were collected through focus groups, audio-recorded, transcribed verbatim, and analyzed using the van Manen approach.
Three focus group with a purposive sample of 18 midwives from 10 public hospitals and 1 primary health centre in Madrid, Spain were conducted.
Two main themes were identified: Professionals for Life Not Death; and Organizing the Work Without Guidelines. Midwives felt there is a lack of social awareness related to the possibility of antepartum death that keeps the mourning hidden and affects the midwives´ practice during the late foetal death process. Midwives recognize difficulties in coping with a process that ends in death: organizations are not prepared for these events (not suitable rooms), there is lack of training to cope with them, and lack of continuity in the attention received by the parents when they are discharged.
Midwives need to be trained in mourning and communication skills to guarantee good practice when attending late foetal death. Intervention guidelines and support mechanisms are required, not only for the parents, but also for the healthcare professionals.
A mixed methods sequential explanatory study of the psychosocial factors that impact on midwives’ confidence to provide bereavement support to parents who have experienced a perinatal loss.
2018, Midwifery
Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents.
To explore within an Irish context, the psychosocial factors that impact on midwives’ confidence to provide bereavement support to parents who have experienced a perinatal loss.
A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups.
A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability.
The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives’ confidence were identified as the midwives’ awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work.
Improving midwives’ bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.
Building confidence in neonatal bereavement: The use of simulation as an innovative educational approach
2017, Journal of Neonatal Nursing
Citation Excerpt :
The conversation developed into a thoughtful examination of the nurses and midwives they had watched in these situations and the students were probed about their perspective of their professional role in bereavement. This stimulated further intrigue by the learners concerning whether bereavement was a rewarding or a challenging aspect of the job, as both notions have been highlighted in the literature (Roehrs et al., 2008). There was an analysis of offloading post these events, as nurses and midwives may talk to their family; their colleagues and an emphasis on the importance of debrief, to maintain a healthy work ethic.
Neonatal death is an unfortunate, yet recurrent incidence. Care of the dying infant is recognised as a care event that both paediatric nurses and midwives will encounter during their professional life. Thus students should be exposed to such subject matter during their training; however, a curriculums review identified gaps in local pre-registration infant bereavement education. It is recognised, though, that it can be difficult to participate in and develop crucial skills in neonatal bereavement, whilst learning in clinical practice.
A contemporary simulated educational approach was developed, to examine management and coping strategies, for student paediatric nurses and midwives. These students were able to learn interprofessionally, from a combined teaching approach by expert neonatal nurses and the simulation faculty. An assessment of learning showed that a large percentage of participants felt the session enhanced their practice.
This innovative Neonatal Simulated Bereavement Session was the first of its nature in the Northwest of England and has been shared at conference with the Northwest Neonatal Simulation Network, which leads on infant simulation in the region.

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ResearchCaring for Families Coping With Perinatal Loss

ABSTRACT

Objective

Design

Setting

Participants

Method

Results

Conclusions

Section snippets

Background Information on Perinatal Loss

Background Information on the Hospital and Current Bereavement Practices

Purpose and Research Questions

Limitations and Further Research

Implications

Acknowledgment

Journal of Obstetric, Gynecological & Neonatal Nursing

Journal of Obstetric, Gynecological & Neonatal Nurses

“I cried … I had to …”

Evidence Based Midwifery

From novice to expert: Excellence and power in clinical nursing practice

Who cares? Offering emotion work as a “gift” in the nursing labour process

Journal of Advanced Nursing

Infant, fetal and perinatal mortality rates

Perinatal bereavement

Journal of Perinatal and Neonatal Nursing

The influence of perinatal loss of anxiety in multigravidas

Journal of Obstetric, Gynecological & Neonatal Nursing

The American tradition in qualitative research

Effects of an educational bereavement program on health care professionals' perceptions of perinatal loss

Journal of Continuing Education in Nursing

Predictors of maternal grief in the year after a newborn death

Illness, Crisis and Loss

Research
Caring for Families Coping With Perinatal Loss