Centre for Academic Women's Health, Chilterns, Women's Health, Southmead Hospital, University of Bristol, Westbury on Trym, Bristol, UK.
International Stillbirth Alliance, Bristol, UK.
BJOG. 2018 Jan;125(2):160-170. doi: 10.1111/1471-0528.14765. Epub 2017 Jul 31.
To understand challenges in care after stillbirth and provide tailored solutions.
Multi-centre case study.
Three maternity hospitals.
Parents with a stillborn baby, maternity staff.
Thematic analysis of parent interviews and staff focus groups and service provision investigation.
1 Themes; 2 Triangulation matrix; 3 Recommendations.
Twenty-one women, 14 partners, and 22 staff participated. Service Provision: Care for parents after stillbirth varies excessively; there are misconceptions; post-mortem does not delay follow-up.
Women 'do not feel right' before stillbirth; their management is haphazard and should be standardised.
Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well-designed bereavement space is critical. Birth: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies. Post-mortem: Parents are influenced by discussions with staff. Staff should 'sow seeds', clarify its respectful nature, delineate its purpose, and explain the timescale.
FOLLOW-UP: It is not standardised; parents wish to see their multi-professional team.
There is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision-making. Every bereaved parent is entitled to good, respectful care.
Care too varied & interactions often insensitive after stillbirth; national pathway & training urgently needed PLAIN LANGUAGE SUMMARY: Why and how was the study carried out? Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care. At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty-five parents of 21 babies agreed to participate. Twenty-two 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 as sensitive as they would have liked because staff did not have appropriate training. Some 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 action was taken. 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 were several reasons why parents asked for a caesarean birth that staff had not considered. Staff influenced parents' decisions about post-mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination. 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. What are the limitations of the work? The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally. What is the implication for parents? Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single parent is treated respectfully and participates in decision making.
了解胎儿死亡后护理的挑战并提供针对性的解决方案。
多中心案例研究。
三家产科医院。
死产婴儿的父母，产科工作人员。
对父母访谈和工作人员焦点小组以及服务提供情况的专题分析。
1 个主题；2 个三角矩阵；3 项建议。
21 名妇女、14 名伴侣和 22 名工作人员参与了研究。服务提供：父母死产婴儿后的护理差异过大；存在误解；尸检不会延迟后续随访。
女性在死产前“感觉不舒服”；他们的管理杂乱无章，应该标准化。
胎儿死亡对父母来说是紧急情况，但对工作人员来说并不总是紧急情况；沟通可能看起来冷淡；精心设计的丧葬空间至关重要。分娩：工作人员将优先事项转移到母亲和未来，但对父母来说，他们的孩子仍然是孩子；父母对工作人员推荐阴道分娩为正常分娩感到不舒服；父母要求剖腹产有几个原因；更好的护理涉及清晰的沟通、正常的行为和应对策略的讨论。
父母受与工作人员讨论的影响。工作人员应该“播种”，澄清其尊重性质，划定其目的，并解释时间尺度。
它没有标准化；父母希望见到他们的多专业团队。
胎儿死亡后护理存在不可接受的差异，工作人员与悲痛欲绝的父母之间存在敏感的互动。了解父母的需求，包括他们为什么要求剖腹产，将有助于共同决策。每个失去孩子的父母都有权获得良好、尊重的护理。
胎儿死亡后护理差异过大，工作人员与悲痛欲绝的父母互动往往不敏感；迫切需要国家途径和培训。
为什么和如何进行这项研究？之前的研究表明，改善胎儿死亡后的护理对家庭很重要。我们调查了悲痛欲绝的父母和产科工作人员的意见，以寻找改善护理的方法。2013 年，在三家医院，所有经历过胎儿死亡的女性都被邀请参加访谈，她们的伴侣也参加了访谈。21 名婴儿的 35 名父母同意参与。22 名产科医生和助产士参加了焦点小组讨论。主要发现是什么？护理通常不如应有的那么好，而且可能存在差异。与父母的沟通并不总是像他们希望的那样敏感，因为工作人员没有接受适当的培训。一些女性报告说，在去医院之前她们“感觉不舒服”。一旦她们到达医院，就没有标准的方法来提供护理。有时在确认婴儿死亡并采取行动之前会有很长的延迟。一旦确认婴儿死亡，工作人员就会专注于母亲的需求，但父母的首要任务仍然是他们的孩子。父母要求剖腹产有几个工作人员没有考虑到的原因。工作人员向父母解释尸检的尊重性质和目的，这对父母有帮助。出院后，没有关于如何提供后续护理的一致计划。父母希望获得更多关于下次医院预约的信息。这项工作有哪些局限性？接受访谈的父母依赖于他们对护理细节的记忆，这些细节发生在一段时间之前。在工作人员小组讨论中，由于有资深医生在场，初级医生可能不会坦率地发言。需要进一步研究以了解和改善全球范围内的护理。这对父母意味着什么？每个失去孩子的父母都有权获得尽可能好的护理，但有些父母没有得到好的护理。父母和工作人员提出了一些建议，这些建议可以帮助制定如何在胎儿死亡后提供护理的流程。这些建议还可以为工作人员培训提供信息，以便每个父母都能得到尊重并参与决策。
