Daniel Nuzum

Stillbirths: economic and psychosocial consequences.

Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.

The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study

To explore the personal and professional impact of stillbirth on consultant obstetrician gynaecologists.

The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed methods study

Background The death of a baby is recognised as one of the most difficult bereavements with life-long impact for parents. How bereaved parents are cared for influences their grief journey. Optimal holistic care is provided when the physical, emotional, spiritual and social needs of parents are attended to. This study reviewed how spiritual care is provided to bereaved parents following stillbirth in maternity units in Ireland and the impact of stillbirth on healthcare chaplains. Methods This was a mixed methods study using semistructured qualitative interviews with hospital chaplains in Irish maternity units. Quantitative data about the provision of services to bereaved parents were collated from the interviews. Qualitative data were analysed thematically to identify key themes. Results 20 chaplains from 17 units participated in the study (85% of Irish maternity units). 12 chaplains (60%) are formally accredited chaplains; only one has received specialist training in perinatal bereavement care. 11 chaplains (55%) provide follow-up bereavement care. Seven chaplains (35%) did not feel part of the multidisciplinary team. The main themes that emerged were the impact of stillbirth, suffering and the challenge to faith creating inner conflict and doubt. Conclusions The provision of spiritual care following stillbirth in Ireland is diverse. Spiritual care in this specialised area by chaplains who are not professionally trained and accredited potentially impacts quality and depth of care. Chaplains experience considerable impact and challenge to personal faith and belief as they provide care. Recommendations are made for ongoing education and greater support for chaplains.

The Spiritual and Theological Challenges of Stillbirth for Bereaved Parents

Stillbirth is recognized as one of the most challenging experiences of bereavement raising significant spiritual and theological questions. Semi-structured qualitative interviews were conducted with bereaved parents cared for in a tertiary maternity hospital to explore the spiritual impact of stillbirth. Data were analysed using interpretative phenomenological analysis. Stillbirth was identified as an immensely challenging spiritual and personal experience with enduring impact for parents. The superordinate themes to emerge were searching for meaning, maintaining hope and questioning core beliefs. Most parents reported that their spiritual needs were not adequately addressed while in hospital. The faith of all parents was challenged with only one parent experiencing a stronger faith following stillbirth. This study reveals the depth of spiritual struggle for parents bereaved following stillbirth with a recommendation that spiritual care is provided as part of comprehensive perinatal bereavement care in the obstetric setting.

The Spiritual and Theological Issues Raised by Stillbirth for Healthcare Chaplains

The death of a baby is one of the most challenging bereavements for parents and healthcare professionals. This study explores the spiritual and theological issues raised for healthcare chaplains as they minister with parents following perinatal bereavement. Chaplains from 85% of maternity units in the Republic of Ireland participated in this study. Suffering, doubt and presence were the main theological themes raised for chaplains following perinatal death. The process of theological reflection is recommended as a sustaining and necessary tool in perinatal healthcare ministry.

The public awareness of stillbirth: an Irish population study

To evaluate the general populations awareness of stillbirth.

The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study

Stillbirth remains among the most challenging areas in obstetric practice. The objectives of this study were to explore the impact of stillbirth on the faith of obstetricians. Semi-structured in-depth qualitative interviews were conducted with obstetricians focusing on the impact of stillbirth on their faith. Data were analyzed using interpretative phenomenological analysis. Stillbirth was identified as one of the most difficult experiences, and most consultants were unable to engage with their personal beliefs when dealing with death at work. The major study themes were conflict of personal faith and incongruence between personal faith and professional practice. This study highlights a gap in how obstetricians see their own faith and feeling able to respond to the faith needs of bereaved parents. Participating obstetricians did not demonstrate that spirituality was an integrated part of their professional life.

The impact of stillbirth on bereaved parents: A qualitative study

Purpose To explore the lived experiences and personal impact of stillbirth on bereaved parents. Methods Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. Results Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. Conclusions The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.

Stillbirth and Suffering in Ireland: A Theological Reflection from Healthcare Chaplaincy

Stillbirth is a devastating experience for parents who in a short period of time move from the excitement and expectancy of new life in pregnancy to the depth of heart-rending grief in the experience of bereavement. Semi-structured in-depth qualitative interviews were conducted with parents bereaved through stillbirth who were cared for at an Irish tertiary maternity hospital. The data were analyzed using Interpretative Phenomenological Analysis prior to theological reflection using Greens Theological Spiral. This theological reflection explores the experience of suffering/ theodicy and providence as expressed by bereaved parents in the study as a focus for new insights to develop spiritual care by maternity healthcare chaplains. Theological engagement, pastoral tenderness and empathic presence are identified as key attributes for spiritual care by healthcare chaplains following stillbirth.

PA.05 The spiritual impact of stillbirth on bereaved parents: a qualitative study

Objective Stillbirth is recognised as one of the most difficult bereavements for parents with life-lasting impact. This study explores the spiritual impact of stillbirth on parents who were cared for in an Irish tertiary maternity hospital (8,500 births per annum) where the stillbirth rate is 4.6/1000. Study design Semi-structured qualitative interviews lasting 31–104 min were conducted with 12 mothers and 5 fathers bereaved following stillbirth. The participants were purposively sampled from each of the years 2008, 2010 and 2013. The data were analysed using Interpretative Phenomenological Analysis. Results Stillbirth had a profound and enduring impact on each of the parents interviewed. The data revealed five main themes: Searching for Meaning, Maintaining Hope, Relationships, Importance of Personhood and Protective Care. Most parents felt their spiritual needs were not addressed adequately while in hospital. Those who were prepared for the possible death of their baby found it easier to find meaning in their loss. Most parents revealed that they struggled spiritually. All parents continue to experience close connection and enduring bonds with their baby. Conclusion The impact of perinatal death and bereavement is considerable. This study, the first of its kind in Ireland, reveals the lived experience of spiritual wrestling and impact following stillbirth. How parents are cared for as they prepare for the death of their baby is remembered in close detail: often revisited by parents as they seek to understand their loss. These findings highlight the need for consistent and sensitive care from all who care for parents following stillbirth.