An analysis of parents experiences and the caregivers role following the birth of a stillborn child

Abstract

The objective of this thesis was to describe and analyse parents experiences of hospital care and to describe caregivers role and attitudes to the management of stillbirth. To accomplish the overall aim, three studies were conducted. The prospective, quantitative study compared 22 couples experiences of bonding with their stillborn child, and of hospital care and evaluated their well-being three months after the event. The retrospective qualitative study comprising 57 interviews and representing 31 stillborn children demonstrated the parents experience of the caregivers support four to six years after the stillbirth.The physicians roles, attitudes and advice were investigated in a nationwide study comprising 594 physicians.

The findings indicated that all but one couple in the prospective study and most of the parents in the retrospective study hold the baby.This was also in line with what 94% of the physicians with significantly more female physicians (p=.008), considered to be important for the parents' grieving process. The prospective and retrospective studies showed that the parents need the support of the caregivers in both facing and separating from the baby. Most of the parents in the prospective study thought the amount of time they held the baby was too short. When holding the baby, the fathers in the prospective study stated that they had strong feelings of warmth, pride, tenderness and grief to the same extent as the mothers.

Having mementos such as a photo of the baby and the need to look at the photo was reported more often by the mothers (p=<.0001) and was also considered by the physicians to be an urgent thing to encourage the parents to do (92%). If the labour had to be induced, most of the mothers wanted and 40% of the physicians agreed the induction to be started within 24 hours, while 30% of the physicians thought the issue lacked significance. The physicians (73%) considered the diagnosis important from a medical point of view in order to be able to give a correct explanation of why the child had died, and most of the parents also thought it was essential from a psychological point of view to better understand why the child was born dead. Significantly more male than female physicians prescribed tranquillisers for the mother (p=.001).

Most parents are sick-listed, but the female physicians extend the mothers sick-leave to a greater extent than the males (p=.020).Three months after the event, there were significant differences within the couples in the prospective study in that no father and all but five mothers were still on sickleave (p=.004).The women also scored a significantly higher negative well-being (p=<.0001), a lower positive wellbeing (p=.010) and a lower general well-being (p=.001) than the fathers three months after the event.

The most frequent approach to a subsequent pregnancy expressed by the majority of the physicians was to support the couples (59%). Six qualities summarising the transitional process of stillbirth were found in the interview study: Support in chaos, Support in the meeting with and separation from the baby, Support in bereavement, Explanation of the stillbirth, Organisation of the care and Understanding the nature of grief.

The results of the present thesis contribute to the understanding of the factors related to the transitional process following the birth of a stillborn child.Taking these factors into account when planning psychosocial guidance for the couples may improve the counselling for the bereaved parents.