Care quality following intrauterine death in Spanish hospitals: results from an online survey

Abstract

BackgroundThe objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care.MethodsA cross-sectional descriptive study using an online self-completion questionnaire. The population was defined as women who had experienced an intrauterine fetal death between sixteen weeks and birth, either through spontaneous late miscarriage/stillbirth or termination of pregnancy for medical reasons. Respondents were recruited through an online advertisement on a stillbirth charity website and social media. The analysis used Pearson’s chi-squared (p ≤ 0.05) test of independence to cross-analyse for associations between objective measures of care quality and independent variables.ResultsResponses from 796 women were analysed. Half of the women (52.9%) had postmortem contact with their baby. 30.4% left the hospital with a least one linking object or a photograph. In 35.8% of cases parents weren’t given any option to recover the body/remains. 22.9% of births ≥26 weeks gestation were by caesarean, with a significant (p < 0.001) difference between public hospitals (16.8%) and private hospitals (41.5%). 29.3% of respondents were not accompanied during the delivery. 48.0% of respondents recalled being administered sedatives at least once during the hospital stay. The autopsy rate in stillbirth cases (≥ 20 weeks) was 70.5% and 44.4% in cases of termination of pregnancy (all gestational ages). Consistent significant (p < 0.05) differences in care practices were found based on gestational age and type of hospital (public or private), but not to other variables related to socio-demographics, pregnancy history or details of the loss/death. Intrauterine deaths at earlier gestational ages received poorer quality care.ConclusionsSupportive healthcare following intrauterine death is important to women’s experiences in the hospital and beneficial to the grief process. Many care practices that are standard in other high-income countries are not routine in Spanish hospitals. Providing such care is a relatively new phenomenon in the Spanish health system, the results provide a quality benchmark and identify a number of areas where hospitals could make improvements to care practices that should have important psychosocial benefits for women and their families.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1630-z) contains supplementary material, which is available to authorized users.

‘In the hospital there are no care guidelines’: experiences and practices in perinatal loss in Spain

“…The reactions of professionals may be explained by a lack of training in attending perinatal loss, given that bereavement support care is a new phenomenon in the healthcare system in Spain (23). The complex emotions professionals experience when supporting parents after a perinatal loss (i.e.…”

“…One of the most surprising results was that, although healthcare professionals performed practices included in well‐known perinatal bereavement care guidelines 5,6, they did not attend to key aspects of care such as shared decision‐making 23,38. This lack of communication with parents was reflected in the exclusion of mothers from decisions regarding the preparation of the burial, autopsy and funeral arrangements – an exclusion which was perceived as protectiveness.…”

“…Second, the potential generalisability of our results needs to be addressed with caution because of the variability of the healthcare system in Spain (each region has its own competences and programs). Nevertheless, our research, conducted in one of the most populated regions of the country (with more than eight million inhabitants), potentially outlines a known general problem of the Spanish perinatal care system (23). Thirdly, the sample of the present study included only professionals with previous experience in attending to perinatal losses.…”

“…Finally, there are little data regarding the actual care practices, results and experiences of healthcare professional in Spanish hospitals. A recent cross-sectional study which assessed mothers that have gone through a perinatal loss indicated that in Spain, many of the standard practices that are common in other high-income countries are not integrated in the care provided (23).…”

“…Regarding perinatal loss, there are significant limitations in the Spanish healthcare system. First, there is no global and generalised care protocol for families after the death of a baby in neonatal or intensive care units 23. Second, it is not known if the practices recommended by international 24,25 and national 26,27,28 associations are implemented by healthcare professionals.…”