Pregnancy loss and death of a baby: the new Sands Guidelines 2007

Abstract

The third edition of the Sands (Stillbirth and Neonatal Death Charity) Guidelines will be published in June 2007. This article discusses some of the issues that are covered. These are: The current debate about whether parents should see and hold their baby following a stillbirth or late miscarriage and the principle of choice. The increased risk of perinatal mortality in some minority ethnic groups and the need to provide culturally sensitive care and professional interpreters. The importance of recognizing and meeting the needs of bereaved fathers. The Human Tissue Authority Codes of Practice and asking for consent for post mortem examination. The experience of women having a mid-trimester miscarriage and whether they should be cared for in a gynaecology ward or a labour ward.

Experiences and needs of Nigerian women after stillbirth

“…Practices that have been advocated to help recovery include seeing and holding the stillborn infant; obtaining photographs and other mementoes of the infant; options for labor and delivery; options for funeral and memorial services; and autopsy [7]. These practices are widely promoted by parent support groups [5], even though the scientific benefit of some of these practices has been questioned [8].…”

“…Women who lose an infant but survive are considered fortunate, and are therefore encouraged to put the loss behind them and to be grateful to God for sparing their lives. Most of the guidelines for care after stillbirth reflect Anglo-American sociocultural perspectives [5][6][7]. It would be inappropriate to import these practices into an African setting in view of the powerful effects of cultural conditioning and social norms on the way that people express grief [13].…”

An exploration of the prevalence and patterns of care for women presenting with mid-trimester loss

“…Our findings showed the referral services offered by the hospital, including Clinical Midwife Specialists in Bereavement, Chaplain and Social Workers were used by the participants. These services provide added support and memorial services for parents experiencing such losses, which literature has shown is invaluable in limiting the psychological and emotional impact miscarriage evokes [17,28,29]. Current literature recommends follow-up appointments for women following miscarriage [20,21] and women themselves have voiced a desire for such follow-up care [30].…”

“…Recommendations from the HSE [1] advise that women admitted with a second trimester loss should ideally be cared for in ''a ward where there are no women with uncomplicated pregnancies or healthy babies''. Although this decision is usually based on gestation, it should be a matter of informed choice by the woman [17]. Options for the clinical management of women presenting with MTL are expectant management, medical management or surgical management.…”

The experience of parents who lose a baby of a multiple birth during the neonatal period – A literature review

“…Bryan (2002) concludes that the repercussions of losing a single triplet are as great as those following the loss of a single-born infant, and it would therefore be wholly unfair for others, including HCP, to label any one's grief greater, or lesser than another'. Bereaved multiple birth parents are unlikely to resolve their grief (Worden, 2009) as every event in the life of the surviving infant, for example: first Christmas, birthdays and reaching developmental milestones, is likely to act as a reminder of loss (Schott et al 2007). Long term support is therefore crucial.…”