Limits...
The Role of Healthcare Professionals in Encouraging Parents to See and Hold Their Stillborn Baby: A Meta-Synthesis of Qualitative Studies.

Kingdon C, O'Donnell E, Givens J, Turner M - PLoS ONE (2015)

Bottom Line: Where clinical guidelines exist some recommend that professionals do not encourage parental contact.We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation.Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.

View Article: PubMed Central - PubMed

Affiliation: School of Health, University of Central Lancashire, Preston, Lancashire, United Kingdom.

ABSTRACT

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences?

Methods/findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20 weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation.

Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.

No MeSH data available.


Related in: MedlinePlus

Process of article selection with inclusion and exclusion criteria.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4495992&req=5

pone.0130059.g001: Process of article selection with inclusion and exclusion criteria.

Mentions: Papers that included only maternal and/or paternal viewpoints were included, in accordance with the research question. All other family viewpoints were therefore excluded. No geographical criteria was placed on the search, or lower date restriction, as it has been shown that women’s memories of birth are generally accurate in following years and any memory lapses or confusion that can occur tend to be minor[44]. There is no standardised definition of stillbirth[4]. In the UK, stillbirth is defined by the Births and Deaths Registration Act 1953 section 41[45] (amended by the Stillbirth Definition Act 1992[46] as being: “a baby which has issued forth from its mother after the 24thweek of pregnancy and which did not at any time breathe or show any other signs of life”. In Australia, stillbirth is defined as the death of a baby after 20 weeks in-utero until immediately before birth[47]. The World Health Organisation does not recognise a stillbirth until 28 weeks gestation[4]. Consequently we imposed the lower gestational limit of 20 completed weeks in utero. This encompasses the lower gestational limits referred to in current guidance. Articles reporting early miscarriages or termination of pregnancy for non-medical reasons were also excluded. Papers reporting miscarriage and/or termination of pregnancy that included data on stillbirth (>20 weeks gestation) reported separately were not excluded if they met all other inclusion criteria. Two papers fulfilled this criteria The full list of exclusion and inclusion criteria is shown in Fig 1 Process of article selection with inclusion and exclusion criteria.


The Role of Healthcare Professionals in Encouraging Parents to See and Hold Their Stillborn Baby: A Meta-Synthesis of Qualitative Studies.

Kingdon C, O'Donnell E, Givens J, Turner M - PLoS ONE (2015)

Process of article selection with inclusion and exclusion criteria.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495992&req=5

pone.0130059.g001: Process of article selection with inclusion and exclusion criteria.
Mentions: Papers that included only maternal and/or paternal viewpoints were included, in accordance with the research question. All other family viewpoints were therefore excluded. No geographical criteria was placed on the search, or lower date restriction, as it has been shown that women’s memories of birth are generally accurate in following years and any memory lapses or confusion that can occur tend to be minor[44]. There is no standardised definition of stillbirth[4]. In the UK, stillbirth is defined by the Births and Deaths Registration Act 1953 section 41[45] (amended by the Stillbirth Definition Act 1992[46] as being: “a baby which has issued forth from its mother after the 24thweek of pregnancy and which did not at any time breathe or show any other signs of life”. In Australia, stillbirth is defined as the death of a baby after 20 weeks in-utero until immediately before birth[47]. The World Health Organisation does not recognise a stillbirth until 28 weeks gestation[4]. Consequently we imposed the lower gestational limit of 20 completed weeks in utero. This encompasses the lower gestational limits referred to in current guidance. Articles reporting early miscarriages or termination of pregnancy for non-medical reasons were also excluded. Papers reporting miscarriage and/or termination of pregnancy that included data on stillbirth (>20 weeks gestation) reported separately were not excluded if they met all other inclusion criteria. Two papers fulfilled this criteria The full list of exclusion and inclusion criteria is shown in Fig 1 Process of article selection with inclusion and exclusion criteria.

Bottom Line: Where clinical guidelines exist some recommend that professionals do not encourage parental contact.We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation.Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.

View Article: PubMed Central - PubMed

Affiliation: School of Health, University of Central Lancashire, Preston, Lancashire, United Kingdom.

ABSTRACT

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences?

Methods/findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20 weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation.

Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.

No MeSH data available.


Related in: MedlinePlus