Objective: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth.
Methods:A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018. Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings.Results: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health. Conclusion: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally. K E Y W O R D S Bereavement care; Global health; Stillbirth 138 | ShakeSpeare eT aL.
| INTRODUCTIONAn estimated 2.6 million stillbirths occurred worldwide in 2015, 1 leaving a lasting and profound impact on women, families, communities, and healthcare workers. 2 The care received by women and their families immediately after a stillbirth, and in the days and months that follow, is inconsistent and often deficient. 3 The 2016 Lancet series on ending preventable stillbirths called for a "global consensus on a package of care after a death in pregnancy or childbirth… for the affected family, community, and caregiver in all settings". 4Recent systematic reviews of care after stillbirth have identified many comparable findings across low-, middle-, and high-income settings in the experiences of women, their families, and healthcare workers. 5,6 Women experience various effects of grief that may not be recognized by healthcare workers or their communities. This lack of recognition exacerbates the women's psychologic symptoms and is associated with stigma, blame, devaluation, and loss of social status. 2,3 Conversely, positive attitudes and support from healthcare workers, family, and communities can improve bereavement experience.High-quality care can moderate both immediate and long-term negative outcomes. 2 National guidelines exist in some settings to guide healthcare workers and organizations responsible for providing care to bereaved women after stillbirth. 7,8 However, evidence for best practice is limited in most settings, and particularly in low-and middle-income cou...
