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Providing meaningful care for families experiencing stillbirth: a meta-synthesis of qualitative evidence

Journal of Perinatology volume 36, pages 3–9 (2016)Cite this article

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Abstract

Objective:

The objective of this study was to explore the meaningfulness of non-pharmacological care experienced by families throughout the experience of stillbirth from diagnosis onwards.

Study Design:

A comprehensive systematic review was conducted. Multiple sources were searched for relevant studies including gray literature. Studies were included if they reported the experiences of families with the care they received throughout the experience of stillbirth, from diagnosis onwards. Studies were assessed for methodological quality prior to inclusion. Qualitative findings were extracted from included studies and pooled using a meta-aggregative approach. This paper reports the results of one meta-synthesis from the systematic review.

Results:

Ten qualitative studies of moderate to high quality informed this meta-synthesis. The meta-aggregative synthesis included 69 findings that informed the development of 10 categories and one final, synthesized finding. Emerging themes that underpinned the meaningfulness of care provided to parents experiencing stillbirth included: information provision, the need for emotional support and appropriate maternity ward environments and systems.

Conclusion:

The results of this meta-synthesis revealed the elements of care that were experienced as meaningful from the perspective of parents who had experienced stillbirth. Exploration of these elements has provided important detail to underpin a growing understanding of how parents experience care and what may help or hinder parents’ experience of distress, anxiety and grief throughout the experience of stillbirth.

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References

  1. Li Z, McNally L, Hilder L, Sullivan E . Australia’s Mothers and Babies 2009. AIHW National Perinatal Epidemiology and Statistics Unit: : Sydney, SA, Australia, 2011.

    Google Scholar 

  2. Stillbirth Foundation Australia. About stillbirth. 2013 (cited 14 August 2014). Available at: http://www.stillbirthfoundation.org.au/about-stillbirth/. (date last accessed 1 April 2015).

  3. Adeyemi A, Mosaku K, Ajenifuja O, Fatoye F, Makinde N, Ola B . Depressive symptoms in a sample of women following perinatal loss. J Natl Med Assoc 2008; 100 (12): 1463–1468.

    Article  Google Scholar 

  4. McCreight BS . A grief ignored: narratives of pregnancy loss from a male perspective. Sociol Health Illn 2004; 26 (3): 326–350.

    Article  Google Scholar 

  5. Kelley MC, Trinidad SB . Silent loss and the clinical encounter: parents' and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy Childb 2012; 12: 137.

    Article  Google Scholar 

  6. Corbet-Owen C, Kruger L-M . The health system and emotional care: validating the many meanings of spontaneous pregnancy loss. Fam Syst Health 2001; 19 (4): 411–427.

    Article  Google Scholar 

  7. Pullen S, Golden MA, Cacciatore J . 'I'll never forget those cold words as long as I live": parent perceptions of death notification for stillbirth. J Soc Work End Life Palliat Care 2012; 8 (4): 339–355.

    Article  Google Scholar 

  8. Rådestad I, Malm MC, Lindgren H, Pettersson K, Larsson LL . Being alone in silence—mothers' experiences upon confirmation of their baby's death in utero. Midwifery 2013; 30: e91–e95.

    Article  Google Scholar 

  9. Trulsson O, Rådestad I . The silent child—mothers' experiences before, during, and after stillbirth. Birth (Berkeley, CA) 2004; 31 (3): 189–195.

    Article  Google Scholar 

  10. Yamazaki A . Living with stillborn babies as family members: Japanese women who experienced intrauterine fetal death after 28 weeks gestation. Health Care Women Int 2010; 31 (10): 921–937.

    Article  Google Scholar 

  11. Lee C . 'She was a person, she was here': the experience of late pregnancy loss in Australia. J Reprod Infant Psychol 2012; 30 (1): 62–76.

    Article  Google Scholar 

  12. Dyson L, While A . Research study. The 'long shadow' of perinatal bereavement. Br J Community Nurs 1998; 3 (9): 432–439.

    Article  Google Scholar 

  13. Sanchez NA . Mothers' perceptions of benefits of perinatal loss support offered at a major university hospital. J Perinat Educ 2001; 10 (2): 23–30.

    Article  CAS  Google Scholar 

  14. O'Neill B . A father's grief: dealing with stillbirth. Nurs forum 1998; 33 (4): 33–37.

    Article  CAS  Google Scholar 

  15. Downe S, Schmidt E, Kingdon C, Heazell A . Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study. BMJ Open 2013; 3: e002237.

    Article  Google Scholar 

  16. Say L, Donner A, Gulmezoglu AM, Taljaard M, Piaggio G . The prevalence of stillbirths: a systematic review. Reprod Health 2006; 3: 1.

    Article  Google Scholar 

  17. Cacciatore J . Psychological effects of stillbirth. Semin Fetal Neonatal Med 2013; 18 (2): 76–82.

    Article  Google Scholar 

  18. Malm MC, Rådestad I, Erlandsson K, Lindgren H . Waiting in no-man's-land—mothers' experiences before the induction of labour after their baby has died in utero. Sex Reprod Healthc 2011; 2 (2): 51–55.

    Article  Google Scholar 

  19. Bruce SJ . Reactions of nurses and mothers to stillbirths. Nurs Outlook 1962; 10: 88–91.

    CAS  PubMed  Google Scholar 

  20. Johnson JM . Stillbirth—a personal experience. Am J Nurs 1972; 72 (9): 1595.

    CAS  PubMed  Google Scholar 

  21. Lewis E . Mourning by the family after a stillbirth or neonatal death. Arch of Dis Child 1979; 54 (4): 303–306.

    Article  CAS  Google Scholar 

  22. Koopmans L, Wilson T, Cacciatore J, Flenady V . Support for mothers, fathers and families after perinatal death. Cochrane Database Syst Rev 2013; 6: CD000452.

    Google Scholar 

  23. Peters MDJ, Riitano D, Lisy K, Jordan Z, Aromataris E . Providing care for families who have experienced stillbirth: a comprehensive systematic review. 15 October 2014 (cited 26 March 2015). Available at: http://www.stillbirthfoundation.org.au/provision-of-effective-and-appropriate-care-for-families-who-have-experienced-stillbirth/. (date last accessed 1 April 2015).

  24. Peters MDJ, Riitano D, Lisy K, Jordan Z, Pearson A, Aromataris E . Provision of effective, meaningful and appropriate care for families who have experienced stillbirth: a comprehensive systematic review protocol. JBI Database Syst Rev Impl Reps 2014; 12 (11): 141–156.

    Article  Google Scholar 

  25. Pearson A, Wiechula R, Court A, Lockwood C . The JBI model of evidence-based healthcare. Int J Evid Based Healthc 2005; 3 (25): 207–215.

    PubMed  Google Scholar 

  26. World Health Organization. Stillbirths. Maternal, newborn, child and adolescent health [online] 2015 (cited 26 March 2015). Available at: http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/. (date last accessed 1 April 2015).

  27. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C . Group atGR. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childb 2010; 10 (Suppl 1): S1.

    Article  Google Scholar 

  28. The Joanna Briggs Institute. Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). 2014 (cited 27 October 2014). Available at: http://joannabriggs.org/sumari.html. (date last accessed 1 April 2015).

  29. Hannes K, Lockwood C, Pearson A . A comparative analysis of three online appraisal instruments' ability to assess validity in qualitative research. Qual Health Res 2010; 20 (12): 1736–1743.

    Article  Google Scholar 

  30. Porritt K, Gomersall J, Lockwood C . JBI's Systematic reviews: study selection and critical appraisal. Am J Nurs 2014; 114 (6): 47–52.

    Article  Google Scholar 

  31. Munn Z, Tufunaru C, Aromataris E . Data extraction and synthesis. Am J Nurs 2014; 114 (7): 49–54.

    Article  Google Scholar 

  32. Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A . Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol 2014; 14 (1): 108.

    Article  Google Scholar 

  33. The Joanna Briggs Institute Joanna Briggs Institute Reviewers' Manual: 2014 Edition 2014 Edition edn. The Joanna Briggs Institute: : Adelaide, SA, USA, 2014.

  34. Hannes K, Lockwood C . Pragmatism as the philosophical foundation for the Joanna Briggs meta‐aggregative approach to qualitative evidence synthesis. J Adv Nurs 2011; 67 (7): 1632–1642.

    Article  Google Scholar 

  35. Pearson A, Robertson-Malt S, Rittenmeyer L . Synthesizing Qualitative Evidence. Lippincott Williams & Wilkins: : Philadelphia, PA, USA, 2011.

    Google Scholar 

  36. Saflund K, Sjögren B, Wredling R . The role of caregivers after a stillbirth: views and experiences of parents. Birth (Berkeley, CA) 2004; 31 (2): 132–137.

    Article  Google Scholar 

  37. Nicol MT, Tompkins JR, Campbell NA, Syme GJ . Maternal grieving response after perinatal death. MJA 1986; 144 (6): 287–289.

    CAS  PubMed  Google Scholar 

  38. LaRoche C, Lalinec-Michaud M, Engelsmann F, Fuller N, Copp M, McQuade-Soldatos L et al. Grief reactions to perinatal death-a follow-up study. Can J Psychiatry Rev Can Psychiatrie 1984; 29 (1): 14–19.

    Article  CAS  Google Scholar 

  39. Cacciatore J, Erlandsson K, Rådestad I . Fatherhood and suffering: a qualitative exploration of Swedish men's experiences of care after the death of a baby. Int J AdHoc Networking Systems 2013; 50 (5): 664–670.

    CAS  Google Scholar 

  40. Peters MDJ, Lisy K, Riitano D, Jordan Z, Aromataris E . Caring for families experiencing stillbirth: evidence-based guidance for midwives and maternity care providers. Women Birth (in press).

  41. Cacciatore J, Bushfield S . Stillbirth: the mother's experience and implications for improving care. J Soc Work End Life Palliat Care 2007; 3 (3): 59–79.

    Article  Google Scholar 

  42. Clauss DK . Psychological distress following miscarriage and stillbirth: an examination of grief, depression and anxiety in relation to gestational length, women’s attributions, perception of care and provision of information. PhD thesis, Drexel University, 2009.

  43. Warland J, O’Leary J, McCutcheon H . Born after infant loss: the experiences of subsequent children. Midwifery 2011; 27 (5): 628–633.

    Article  Google Scholar 

  44. O'Leary J, Warland J . Untold stories of infant loss: the importance of contact with the baby for bereaved parents. J Fam Nurs 2013; 19 (3): 324–347.

    Article  Google Scholar 

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Acknowledgements

We acknowledge the financial support of the Stillbirth Foundation Australia for the conduct of this research. We also acknowledge the input of the members of the expert reference group: Mrs Glenise Coulthard, Ms Philippa Middleton, Professor Ben Mol, Professor Alan Pearson, Dr Anne Sved Williams, Professor Susan Walker, Dr Jane Warland and Mrs Emma Wotherspoon.

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Authors and Affiliations

  1. The Joanna Briggs Institute, Faculty of Health Science, The University of Adelaide, Adelaide, SA, Australia

    M D J Peters, K Lisy, D Riitano, Z Jordan & E Aromataris

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  1. M D J Peters
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  2. K Lisy
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Correspondence to M D J Peters.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Peters, M., Lisy, K., Riitano, D. et al. Providing meaningful care for families experiencing stillbirth: a meta-synthesis of qualitative evidence. J Perinatol 36, 3–9 (2016). https://doi.org/10.1038/jp.2015.97

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