Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study
Abstract
Background Most maternity units have good practice protocols, advising that after stillbirth parents should be encouraged to see and hold their dead infant. Our aim was to assess whether adherence to these protocols is associated with measurably beneficial effects on the psychological health of mother and next-born child. This study forms part of a wider case-control study of the psychological effects of stillbirth.Methods We identified 65 women in the pregnancy after stillbirth, and enrolled matched controls for 60 of them. Outcome measures included depression, anxiety, and post-traumatic-stress disorder (PTSD) in pregnancy and 1 year after the next birth, and disorganised attachment behaviour in the next-born infant. Comparison variables included seeing and holding the stillborn infant, having a funeral, and keeping mementoes.Findings Behaviours that promote contact with the stillborn infant were associated with worse outcome. Women who had held their stillborn infant were more depressed than those who only saw the infant, while those who did not see the infant were least likely to be depressed (13 of 33, 39%, vs three of 14, 21%, vs one of 17, 6%; p=0.03). Women who had seen their stillborn infant had greater anxiety (p=0.02) and higher symptoms of PTSD than those who had not (p=0.02), and their next-born infants were more likely to show disorganised attachment behaviour (18 of 43, 42%, vs one of 12, 8%, p=0 x 04). Having a funeral and keeping mementoes were not associated with further adverse outcomes, but small numbers limited interpretation.Interpretation Our findings do not support good-practice guidelines, which state that failure to see and hold the dead child could have adverse effects on parents' mourning.
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Women who hold their deceased infant have significantly higher rates of post-traumatic stress disorder, anxiety, and depression even 7 years after the event.
“It has been found that women who hold their deceased infant have significantly higher rates of post-traumatic stress disorder (PTSD), anxiety, and depression even 7 years after the event.30,31”
From Complicated grief after perinatal loss (2012) · cites this paper as [31]
A study published in 2002 showed increased maternal depression and anxiety associated with seeing and holding the deceased baby in a dose-response-like trend.
“however, a study25 published in 2002 showed increased maternal depression and anxiety associated with seeing and holding the deceased baby in a dose-response-like trend.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
Parents' mental health outcomes related to making meaning/memories were documented in 29 reports and included coping, anxiety, and depression.
“Parents’ mental health outcomes related to making meaning/memories were documented in 29 reports,17,25,53,54,58,60,63,64,69,70,76,86,89,98,103,107,110,111,116,119,121,122,127,137–139,148,149,154 and included coping, anxiety, and depression.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
A small number of studies (n=7) indicated that seeing the baby had positively influenced coping, while holding the baby did not.
“Additionally, there were a small number of studies (n=7) that indicated seeing the baby had positively influenced coping, while holding the baby did not.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
A few studies (n=5) indicated that seeing the baby was perceived negatively, or were inconclusive (n=3) in terms of influence on parents' mental health outcomes.
“A few studies (n=5) indicated that seeing the baby was perceived negatively,25,72,163,184,201 or were inconclusive (n=3)55,80,125 in terms of influence on parents’ mental health outcomes.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
The need for recognition was reported as inadequately met, which reportedly affected parents' outlook.
“This need for recognition was reported as inadequately met, which reportedly affected parents’ outlook.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
Sixty-nine reports included perinatal loss involving 1 or more babies of a twin or multiple pregnancy and indicated that additional bereavement care considerations are needed.
“Sixty-nine reports included perinatal loss involving 1 or more babies of a twin or multiple pregnancy20,25–28,33,46,47,49,53–56,58,60,61,64–66,68,72,74,76,77,79,80,82,91,100,102,103,106,107,109–116,120–122,128,131,145,150,152,154,160,161,166,169,176,179,180,182,186,188,197,200,205,209,212,214,220,223,225 indicated that additional bereavement care considerations are needed.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
Fifty-one reports identified an association between emotional and social support and mental health outcomes of coping, well-being, healing, PTSD, trauma symptoms, anxiety, depression, emotional distress, helplessness, anger, and loneliness.
“Fifty-one reports identified an association between emotional and social support, which was associated with mental health outcomes of coping, well-being, healing, PTSD, trauma symptoms, anxiety, depression, emotional distress, helplessness, anger, and loneliness.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
Fifty-nine reports indicated that parents desired shared decision-making and greatly appreciated it; however, shared decision-making was inconsistently practiced.
“Fifty-nine reports indicated that parents desired shared decision-making and greatly appreciated it; however, shared decision-making was inconsistently practiced.”
From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [25]
The guidelines for bereavement support after stillbirth that do exist require additional empirical data about what parents want or would find most meaningful and effective.
“The guidelines for bereavement support after stillbirth that do exist require additional empirical data about what parents want or would find most meaningful and effective”
From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [25]
One small study suggested that holding or even seeing one's stillborn baby was associated with higher rates of long-term depression and post-traumatic stress.
“One important but small study raised doubts about the effectiveness of such approaches in helping parents recover; results suggested that holding or even seeing one’s stillborn baby was associated with higher rates of long-term depression and post-traumatic stress [25].”
From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [25]
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- Authors
- Hughes, P., Turton, P., Hopper, E., & Evans, C.
- Affiliations
- St George's Hospital (GB)
- Rampton Hospital (GB)
- Corresponding author
- Hughes, P
- ORCID
- Hopper, E
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2002-07
- Volume
- 360
- Issue
- 9327
- Pages
- 114-118
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2133400295
- Cited by
- 375
- References
- 32
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 4 · 2023: 22 · 2022: 9 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 16 · 2017: 61 · 2016: 14 · 2015: 22 · 2014: 14 · 2013: 22 · 2012: 24
- FWCI
- 20.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- stillbirth, psychosocial care, maternal depression, maternal anxiety, post-traumatic stress disorder, disorganized attachment, good practice guidelines, bereavement, funerals
- MeSH terms
- Adult, Female, Fetal Death, Grief, Humans, Psychosocial Deprivation, Cohort Studies, Case-Control Studies, Practice Guidelines as Topic
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