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.

Objective To review quality of care in births planned in midwifery‐led settings, resulting in an intrapartum‐related perinatal death. Design Confidential enquiry. Setting England, Scotland and Wales. Sample Intrapartum stillbirths and intrapartum‐related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013–16 (freestanding midwifery units and home births). Methods Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics. Results Sixty‐four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review. Conclusions These confidential enquiry findings do not address the overall safety of midwifery‐led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations. Tweetable abstract Confidential enquiry of intrapartum‐related baby deaths highlights areas where care in midwifery‐led settings can be made even safer.

Nurse‐led prostate assessment clinics (PACs) have been shown to be both cost‐effective and reduce the workload of urologists. We set out to determine how closely guidelines were adhered to in our PAC and whether the outcomes of these clinics, as determined by set protocols, were producing effective management strategies. The notes of 100 consecutive patients who attended the PAC at a single institution were retrospectively analysed. The presenting symptoms, examination findings, investigations performed and their results were documented, and the consultation outcome was recorded. In particular, we assessed whether the guidelines for investigations and management were followed and whether there were any changes in these following consultant review. Of the 100 patients (mean age 67 years), 79 were referred from primary care. The most common presenting symptoms were frequency and nocturia. Ninety‐two per cent of patients were appropriately assigned to the PAC. Eighty‐two per cent had a complete assessment according to the clinic guidelines. Patient management was appropriate and based on clinic guidelines in 81%. Following consultant review, 78% had no change in their management, while 26% were discharged. Nurse‐led PACs are fit for purpose. Guidelines for assessment and management are closely followed with minimal changes to treatment at consultant review.

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