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Cited by 98Grief, Bereavement, and Mental HealthGlobal Maternal and Child HealthPalliative Care and End-of-Life Issues

Stillbirth and perinatal care: Are professionals trained to address parents’ needs?

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Ravaldi, Claudia, Levi, Miriam, Angeli, Elena, Romeo, Gianpaolo, Biffino, Marco, Bonaiuti, Roberto, Vannacci, Alfredo·2018·Midwifery
DOI 10.1016/j.midw.2018.05.008
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Abstract

Objective To assess current practices of health care providers (HCPs) caring for women experiencing a stillbirth and to explore their needs for training to better support bereaved families.Design Nationwide cross-sectional survey. The main outcome measures were the evaluation of HCPs cognition, emotions and behaviours with regard to the care of women with a stillbirth care, as well as their compliance with international guidelines.Participants 750 HCPs, in 11 Italian hospitals, were administered a multiple-choice questionnaire.Findings The response rate was 89.9%; the majority (94.1%) were female, with a mean age of 37.6 (SD = 10.4) years. Midwives were the most represented (72.8%). Half of the respondents recommended immediate birth; only 55% routinely bathed and dressed stillborn babies for their parents to see, while 44.4% of HCPs immediately took the babies away without allowing parents to properly say goodbye to them. More than half felt inadequate and some even reported having failed to provide support to the family when caring for a woman with stillbirth in the past. The need for professional training courses was expressed by 90.2%, and three-quarters had never previously attended a course on perinatal bereavement care. When answers by Italian HCPs are systematically evaluated with reference to international guidelines, the results were very poor with only 27.9% of respondents reported having created memories of the baby and less than 3% complied with all recommendations in the areas of respect for baby and parents, appropriate birth options, and aftercare.Key conclusions There is a substantial gap between the standards of care defined by international guidelines and the practices currently in place in Italy. Italian HCPs feel an urgent need to be offered professional training courses to better meet the needs of grieving families.Implication for practice Perinatal HCPs should be aware of their pivotal role in helping bereaved parents after stillbirth and perinatal loss, and seek appropriate training.

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  • Globally, there is inconsistent development and application of international bereavement care guidelines, which may increase the risk of untoward outcomes for parents.

    “International guidelines provide additional recommendations for bereavement care, although globally, there is inconsistent development and application of the guidelines,31 which may increase the risk of untoward outcomes for parents.”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [31]

    The Introduction (page not supplied) says that approaches to stillbirth differ among countries and that many healthcare providers ignore available international guidelines. The Abstract reports a gap between guideline standards and practice in Italy, while the Introduction says care providers’ attitudes can impair parents’ wellbeing. The paper does not establish inconsistent development of guidelines globally or show that guideline gaps themselves increase adverse outcomes for parents. (LLM, conf=0.84)

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  • Health care providers cite feeling underprepared to provide adequate care to bereaved parents and needing formalized training in perinatal bereavement care.

    “Additionally, health care providers cite feeling underprepared to provide adequate care to bereaved parents and needing formalized training in perinatal bereavement care (5, 11, 14–16).”

    From Parent hospital experiences following stillbirth (2026) · cites this paper as [16]

  • Key characteristics of international bereavement care guidelines include using simple language and compassionate caring expressions, enabling parents to spend time with their baby, providing information about autopsy, respecting culture and religion, and arranging postnatal follow-up care.

    “Key characteristics of the guidelines include using simple language and compassionate caring expressions (eg, referring to baby rather than fetus), enabling parents to spend time with their baby, providing information about autopsy, respecting culture and religion, and arranging postnatal follow-up care.20,29,31”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [31]

  • The care a woman receives during perinatal bereavement has a significant impact on her experience and long-term recovery.

    “The care a woman receives during this time is known to have a significant impact on her experience and long-term recovery (Ravaldi et al., 2018; Boyle et al., 2020).”

    From Stranger in a mask” midwives’ experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: a qualitative descriptive study (2022) · cites this paper as Ravaldi et al., 2018

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Authors
Ravaldi, C., Levi, M., Angeli, E., Romeo, G., Biffino, M., Bonaiuti, R., & Vannacci, A.
Affiliations
  • Regione Toscana (IT)
  • University of Florence (IT)
Corresponding author
Vannacci, Alfredo
ORCID
Venue
Midwifery
Publisher
Elsevier BV
Published
2018-09
Volume
64
Pages
53-59
ISSN
0266-6138 (ISSN-L)
DOI
10.1016/j.midw.2018.05.008
OpenAlex
W2806041598
Cited by
98
References
40
Citations by year
2026: 5 · 2025: 18 · 2024: 16 · 2023: 11 · 2022: 17 · 2021: 13 · 2020: 11 · 2019: 5 · 2018: 2
FWCI
9.09
Type
journal article
Language
en
Open access
Licence
Locations
  • Midwifery (publishedVersion)
  • PubMed (publishedVersion)
  • Florence Research (University of Florence) (submittedVersion, other-oa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
stillbirth, perinatal bereavement, perinatal care, health professions education, professional competence, guideline adherence, midwives, follow-up care, Italy
MeSH terms
Adult, Clinical Competence, Cross-Sectional Studies, Education, Female, Grief, Humans, Italy, Middle Aged, Midwifery, Parents, Pregnancy, Surveys and Questionnaires, Social Support, Perinatal Care, Stillbirth

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