Towards the end of last year there were a series of National Care Bereavement Pathways published to guide healthcare professionals in supporting families through pregnancy and baby loss. This was a collaborative project lead by Sands along with several core partners and had the support of the Department of health and the All Party Parliamentary Group on Baby Loss
The aim is to improve bereavement care for parents who have suffered loss and to set an ideal, evidence-based standard of care for healthcare professionals to aim for and to reduce variability amongst different hospitals.
There were five documents produced, each specific to the different types of loss parents may experience:
I took an in-depth review of the guidance for Miscarriage, Ectopic Pregnancy and Molar Pregnancy as this was most relevant to my personal history and where I think I may encounter the most patients as a GP.
The Guidance starts with some initial care standards that are encouraged such as ensuring that care is parent-led and that all parents should be informed about and, if requested, referred for emotional and/or special mental health support. There should be allocated bereavement rooms and attempts should be made to maintain continuity of care. Parents should also be offered the opportunity to make memories.
The pathway is then split into 6 distinct sections:
I will just highlight some aspects of this pathway that I felt were really key:
Delivering Difficult News
- Follow woman’s/couple’s of use of terminology and language. Often using overtly medical terms (such as ‘products’ instead of ‘baby’ for example) can be a common source of additional grief.
- Offering a scan picture as this can help with memory making
Labour and Birth
- If a woman opts for medical management of miscarriage at home, then clinicians should explain honestly about what can be expected and offer adequate analgesia
- For late miscarriage (14 weeks to 23+6 days) she should be offered an appropriate environment
- Offering a Pregnancy Loss Form and for this to be added to notes to help alert staff in future pregnancies.
- There are many suggestions on how to help the woman/couple make memories, the appropriateness of which will depend on diagnosis and condition of baby. But ideas include:
- Seeing and/or holding their baby in a suitable container if needed
- A memory box
- A copy of the scan image
- Taking the baby out of the hospital environment
- Hand and footprints
- Also the pathway suggests that a ‘certificate of loss’ or ‘certificate of birth’ can be administered from the hospital (**NOTE** This is not the same as a birth certificate which can legally only be administered for a birth after 24 weeks gestation i.e. live birth/stillbirth). However the certificate of loss may help the woman/couple communicate what has happened to employers and also justify the impact of events that have occurred.
- Allowing adequate time to discuss post-mortem if needed – a minimum of one hour is recommended
- Symptom management – bleeding, pain, lactation
- Inform GP (with consent) – also partner’s GP if they consent too
- Give details of national support organisations
- Perhaps one of the most important lines for me as a doctor and for fellow healthcare practitioners is ‘to be aware that statistical probabilities
may not provide comfort’. People don’t want to hear that ‘miscarriage is common’ or that ‘1 in 4 pregnancies will end in miscarriage’. It doesn’t help a grieving heart
- Antenatal Care suggestions include:
- additional scans
- emotional support
- referral to a different unit if possible
- To discuss and acknowledge events/stages that may be difficult for the woman/couple
- To acknowledge the mixed emotions at birth and to show understanding and empathy
- I love that a guideline includes staff care!
- This of the guidance part encourages staff to look after their own mental/emotional health and training needs
The guideline ends with a long list of great charities and organisations that are working towards a shared goal of improving care following pregnancy and baby loss and their contact details.
This guideline is a MUST READ if you work in Primary Care (yes – you GP’s! We are often the first people that see women and couples following a miscarriage) and obviously if you work in a Obstetrics and Gynaecology hospital unit. It really feels as though there has been careful consideration of parents throughout this guideline with the primary aim of improving overall care.
Have you read this or the other guidelines? Do you think you received the level of care outlined in the documents? Let me know your thoughts.