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Cited by 15Grief, Bereavement, and Mental HealthGlobal Maternal and Child HealthMaternal and Neonatal Healthcare

Exploring the impact of healthcare workers communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia. A grounded theory study

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Actis Danna, Valentina, Lavender, Tina, Laisser, Rose, Chimwaza, Angela, Chisuse, Isabella, Kasengele, Chowa Tembo, Kimaro, Debora, Kuzenza, Flora D. +6 more·2023·Women and Birth
DOI 10.1016/j.wombi.2022.04.006PMC PMC9880556
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Abstract

BACKGROUND: Communication and interaction with healthcare workers at the time of stillbirth remain in parents' long-term memories and impact on emotional and psychological well-being. Cultural attitudes and norms influence how stillbirth is acknowledged and discussed in society. There is limited evidence on how women from sub-Saharan Africa became aware of the death of their babies. This research explored how women perceived the approach adopted by healthcare workers when the news of their stillbirth was disclosed to them. METHODS: Grounded theory study. Women (n = 33) who had birthed a stillborn baby in the preceding 12 months were purposively sampled and participated in in-depth interviews (9 in Zambia, 16 in Tanzania and 8 in Malawi). Informed consent was gained from all participants. Data were analysed via a coding process using constant comparative analysis. FINDINGS: Women sacrificed individualized and personal grieving strategies to conform and behave according to what was expected within their community. An overarching theme of cultural conformity overrides personal grief incorporated four sub-themes: perceiving something was wrong, the unexpected outcome, experience contrasting emotions, bonding with the baby. DISCUSSION AND CONCLUSIONS: Most participants embarked on a negative 'emotion work' to adapt and suppress emotions and grief due to cultural expectations. Inability to voice the trauma of losing a baby may lead to perinatal mental health issues and needs addressing. Maternity healthcare workers should encourage women to express their feelings and grief. Appropriate training in perinatal bereavement care including good communication, appropriate attitudes and provision of meaningful information to grieving women is recommended.

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  • When mothers or parents were not involved in aftercare or rituals for the deceased baby, depression and anxiety were reported.

    “When mothers or parents were not involved in aftercare or rituals for the deceased baby, depression and anxiety were reported.103,104,138,143”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [104]

    The Discussion (page unavailable) says women may be denied attendance at the baby’s burial and discouraged from seeing or holding the baby. The Implications for practice section (page unavailable) warns that unaddressed, hidden grief may increase psychological ill-health, including depression and anxiety. It does not report depression and anxiety specifically among mothers or parents excluded from aftercare or rituals; that connection is more definite than the paper supports. (LLM, conf=0.85)

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Research works printed but not linked: 6

  1. [8]Institute of Medicine (US) Committee for the Study of Health Consequences of the Stress of Bereavement. Bereavement: Reactions, Consequences, and Care. In: Osterweis M SF, Green M, editor. CHAPTER 3, Adults' Reactions to Bereavement 1984. 25032459
  2. [16]Harter L.M., Japp P.M., Beck C.S. (Eds.), Narratives, Health, and Healing: Communication Theory, Research, and Practice 2005, Lawrence Erlbaum Associates Publishers.
  3. [26]Glaser B.G. Theoretical sensitivity 1978 Sociology Press Mill Valley, Calif
  4. [46]Hochschild A.R. The Managed Heart: Commercialization of Human Feeling, Twentieth Anniversary Edition, With a New Afterword second ed. 2003 University of California Press,
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  6. [56]Klass D. Silverman P.R. Nickman S.L. Continuing Bonds: New Understandings of Grief 1996 Taylor & Francis Philadelphia, PA, US 361 (xxi, p)

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Authors
Actis Danna, V., Lavender, T., Laisser, R., Chimwaza, A., Chisuse, I., Kasengele, C. T., Kimaro, D., Kuzenza, F. D., Lyangenda, K., Mwamadi, M., Shayo, H., Tuwele, K., Wakasiaka, S., & Bedwell, C.
Affiliations
  • Liverpool School of Tropical Medicine (GB)
  • Catholic University of Health and Allied Sciences (TZ)
  • Kamuzu University of Health Sciences (MW)
  • Ministry of Health (ZM)
  • University Teaching Hospital (ZM)
  • University of Nairobi (KE)
ORCID
Venue
Women and Birth
Publisher
Elsevier BV
Published
2023-02
Volume
36
Issue
1
Pages
e25-e35
ISSN
1871-5192 (ISSN-L)
DOI
10.1016/j.wombi.2022.04.006
PMC
PMC9880556
OpenAlex
W4223919095
Cited by
15
References
47
Citations by year
2026: 5 · 2025: 4 · 2024: 3 · 2023: 3
FWCI
2.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Women and Birth (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
Funders
National Institute for Health Research (16/137/53)
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 › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
stillbirth, grief, cultural conformity, perinatal bereavement, perinatal mental health, emotional labor, maternal psychological well-being, obstetric care, sub-Saharan Africa
MeSH terms
Bereavement, Communication, Female, Grief, Health Personnel, Humans, Malawi, Parents, Pregnancy, Tanzania, Zambia, Stillbirth, Grounded Theory

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