There is trauma all round’: a qualitative study of health workers’ experiences of caring for parents after stillbirth in Kenya and Uganda
Open accessAbstract
BACKGROUND: Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents' needs. However, very few studies have explored health worker's experiences in these settings. AIM: To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda. METHODS: Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse-midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen's reflexive approach. RESULTS: Three main themes summarised participants' experiences: 'In the mud and you learn to swim in it' reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in 'It's bad, it's a sad experience'. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks 'how are you doing?'. CONCLUSION: Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes.
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Nurses and midwives described feelings of fear and self-blame, as bereavement care was often perceived as conflicting with the traditional life-affirming focus of midwifery practice.
“Several studies (Fernández-Basanta et al., 2021; Shen et al., 2022; Mills et al., 2023) described feelings of fear and self-blame among nurses and midwives, as bereavement care was often perceived as conflicting with the traditional life-affirming focus of midwifery practice (Fernández-Basanta et al., 2021).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
Some professionals questioned whether different clinical decisions could have prevented death, leading to rumination and emotional distress, with some describing demoralisation and consideration of leaving the profession.
“Some professionals questioned whether different clinical decisions could have prevented death, leading to rumination and emotional distress, with some practitioners describing feelings of demoralisation and even consideration of leaving the profession (Mills et al., 2023).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
The sample size in included studies ranged from 7 to 61 participants.
“The sample size in the included studies ranged from 7 (Obst and Due, 2019) to 61 participants (Mills et al., 2023).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
In low-resource settings like Kenya and Uganda, midwives and doctors sometimes faced aggressive or violent reactions from bereaved families, leading to trauma and fear for personal safety.
“Mills et al. (2023) reported that in low-resource settings, like Kenya and Uganda, midwives and doctors sometimes faced aggressive or violent reactions from bereaved families, leading to trauma and fear for personal safety.”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
A significant challenge in bereavement care was communication; nurses and midwives felt pressure from families when delivering bad news, answering emotionally charged questions, and offering continuous information to parents and families.
“However, a significant challenge highlighted was communication; nurses and midwives felt pressure from families when delivering bad news, answering emotionally charged questions, and offering continuous information to parents and families (Mills et al., 2023; Xie et al., 2025b).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
Nurses and midwives emphasised the need to be emotionally present, respectful, and communicative even when no words could offer comfort.
“Many emphasised the need to be emotionally present, respectful, and communicative, even when no words could offer comfort(Mills et al., 2023).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
Such fears can hinder open communication and emotional expression, essential components of compassionate care.
“Such fears can hinder open communication and emotional expression, essential components of compassionate care (Mills et al., 2023).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as Mills et al., 2023
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- Authors
- Mills, T. A., Ayebare, E., Mweteise, J., Nabisere, A., Mukhwana, R., Nendela, A., Omoni, G., Wakasiaka, S., & Lavender, T.
- Affiliations
- University of Liverpool (GB)
- Makerere University (UG)
- University of Nairobi (KE)
- Liverpool School of Tropical Medicine (GB)
- Corresponding author
- Mills, Tracey A.
- Venue
- Women and Birth
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 36
- Issue
- 1
- Pages
- 56-62
- ISSN
- 1871-5192 (ISSN-L)
- PMC
- PMC9880557
- OpenAlex
- W4220997931
- Cited by
- 22
- References
- 30
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 5 · 2023: 1 · 2022: 1
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Women and Birth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- Greater South Information System
- Funders
- Government of the United Kingdom
- National Institute for Health and Care Research (16/137/53)
- Department of Health and Social Care (16/137/53)
- Wellbeing of Women (IFA 200)
- H2020 European Research Council
- 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 and Oncologic Care
- Keywords
- stillbirth, bereavement support, health worker experiences, midwives, compassionate care, grief, organizational culture, psychological distress, low- and middle-income countries, Kenya, Uganda, sub-Saharan Africa
- MeSH terms
- Female, Grief, Humans, Kenya, Parents, Pregnancy, Uganda, Qualitative Research, Stillbirth
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