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Cited by 222Grief, Bereavement, and Mental HealthMaternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal Healthcare

Support after perinatal death: a study of support and counselling after perinatal bereavement

Open access
Forrest, G C, Standish, E, Baum, J D·1982·BMJ
DOI 10.1136/bmj.285.6353.1475
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Abstract

After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling.

Integrity signals

Registry

Crossref · 10.1136/bmj.285.6353.1475

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 2 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The counselling was required for only six to eight weeks by 75% of the mothers seen.

    “The counselling was required for only six to eight weeks by 75% of the mothers seen, which suggests that the medical social workers attached to maternity units could undertake this task.”
    Quote in the paperSubstantial claim
  • Findingown data

    At six months, five of 16 supported group compared with 12 of 19 contrast group scored 7+ on either the Leeds anxiety scale or on both the anxiety and depression scales (p = 0.06).

    “At six months, five of the 16 supported group compared with 12 of the 19 contrast group scored 7 + on either the Leeds anxiety scale or on both the anxiety and depression scales (p = 006).”
    Quote in the paperNot a substantial claim
  • Findingown data

    All the mothers reported becoming more protective towards their children.

    “All the mothers reported becoming more protective towards their children.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The incidence of pregnancies in the supported group and the contrast group was similar at both six and 14 months.

    “The incidence of pregnancies in the supported group and the contrast group was similar at both six and 14 months despite the fact that the women in the supported group had been advised to wait until they thought that they had recovered from the loss of the baby.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    The women in the contrast group seemed to cope better psychologically with their next pregnancy if they had waited more than six months before conceiving.

    “The women in the contrast group seemed to cope better psychologically with their next pregnancy if they had waited more than six months before conceiving.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Findingown data

    The children's grief reactions were mostly brief, except where the mothers remained severely depressed and anxious for many months.

    “The children's grief reactions were mostly brief, except where the mothers remained severely depressed and anxious for many months.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Half of the women in both groups who had had scores of 12+ at six months were now scoring below 11: one of the 12 supported women compared with four of the 18 in the contrast group remained ill.

    “Half of the women in both groups who had had scores of 12+ at six months were now scoring below 11: one of the 12 supported women compared with four of the 18 in the contrast group remained ill.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    By 14 months, seven (three supported and four contrast) of the 35 women interviewed had new babies, aged between 4 weeks and 6 months.

    “By 14 months seven (three supported and four contrast) of the 35 women interviewed had new babies, aged between 4 weeks and 6 months.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Infertility, low social class, previous psychiatric illness, children under 14 at home, caesarean section, stillbirth, and no previous bereavement were not found to be statistically significant associations with high GHQ scores at six months in the contrast group.

    “Infertility, low social class, previous psychiatric illness, children under 14 at home, caesarean section, stillbirth, and no previous bereavement were not found to be statistically significant.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-two of the 35 women interviewed had other children at home.

    “Twenty-two of the 35 women interviewed had other children at home.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Half the women interviewed stated that the loss of the baby had improved their relations with their husbands; the other half stated that their relations had been unaffected by the bereavement.

    “Half the women interviewed stated that the loss of the baby had improved their relations with their husbands; the other half stated that their relations had been unaffected by the bereavement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Leeds scales showed a similar fall in anxiety or anxiety plus depression, and again there was no significant difference between the supported and contrast groups.

    “The Leeds scales showed a similar fall in anxiety or anxiety plus depression.Again there was no significant difference between the supported and contrast groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Parents greatly valued early contact with their own general practitioner and with the community midwife who had provided antenatal care.

    “Parents greatly valued early contact with their own general practitioner (before they left hospital if possible; other- wise as soon as they got home) and also with the community midwife who had provided antenatal care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Half of the contrast women showed appreciable symptoms of depression and anxiety at six months and 20% at 14 months (GHQ); in other words, 80% of them had recovered from their grief by 14 months.

    “Half of these women showed appreciable symptoms of depression and anxiety at six months and 20% at 14 months (general health questionnaire).In other words, 80% of them had recovered from their grief by 14 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At six months, two of 16 supported mothers compared with 10 of 19 contrast mothers scored 12+ on the general health questionnaire, indicating a lower rate of psychiatric disorder in the supported group (p < 0.01, Fisher's exact test).

    “At six months, two of the 16 supported mothers compared with 10 of the 19 contrast mothers scored 12+ on the general health questionnaire, indicating a lower rate of psychiatric disorder in the supported group (p < 0-01, Fisher's exact test).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The two high-scoring supported fathers had recovered at 14 months; the two fathers in the contrast group remained high scorers.

    “The two high-scoring supported fathers had recovered at 14 months: the two fathers in the contrast group remained high scorers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    All the parents interviewed had found it difficult to give consent for a necropsy but did so in the hope that the information provided would help to clarify what had gone wrong.

    “All the parents interviewed had found it difficult to give consent for a necropsy but did so in the hope that the information provided would help to clarify what had gone wrong.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    By six months, 16 (32%) of the 49 women in the study had become pregnant, including three who miscarried later.

    “By six months, 16 (32%) of the 49 women in the study had become pregnant, including three who miscarried later.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The only statistically significant associations with a high GHQ score at six months in the contrast group were social isolation (p < 0.04) and poor relations (low intimacy) with husband (p < 0.02).

    “The only statistically significant associations with a high score were social isolation (p < 0 04) and poor relations (low intimacy) with husband (p < 002).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Five of the women with new babies were considered to be relating normally to their babies, but two (one supported, one contrast) were experiencing negative feelings and seemed unresponsive to the baby during interview.

    “Five of the women were considered to be relating normally to their babies, but two (one supported, one contrast) were experiencing negative feelings and seemed unresponsive to the baby during interview.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Immediately after the death or stillbirth of their baby, the mothers were randomly allocated either to a group that received planned support and counselling or to a contrast group that received routine hospital care.

    “Immediately after the death or still- birth of their baby, the mothers were randomly allocated either to a group that received planned support and counselling or to a contrast group that received routine hospital care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was a randomised trial carried out in the John Radcliffe Maternity Hospital in Oxford.

    “The study was a randomised trial carried out in the John Radcliffe Maternity Hospital in Oxford.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    Our results are similar to Raphael's and indicate the need for further research to identify those women, and their husbands, most at risk for prolonged bereavement reactions.

    “But our results are similar to Raphael's and indicate the need for further research to identify those women, and their husbands, most at risk for prolonged bereavement reactions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Raphael

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The evaluation was carried out by a trained interviewer who did not know to which group the family had been allocated.

    “The evalua- tion took place in the parents' home and was carried out by a trained interviewer who did not know to which group the family had been allocated.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Sixteen of the supported group and 19 of the contrast group were interviewed at six months (compliance rate 70%).

    “Sixteen of the supported group and 19 of the contrast group were interviewed at six months (compliance rate 70%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The result of the necropsy was seen to be important to parents; they expected the results to be discussed with them when they returned to the hospital.

    “The result of the necropsy was seen, therefore, to be important to them; they expected the results to be discussed with them when they returned to the hospital.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    The assessment of these sorts of factors retrospectively is not satisfactory, as a mother's account of her friends' and her husband's behaviour is likely to be influenced by her state of mind.

    “The assessment of these sorts of factors retrospectively is not satisfactory, as a mother's account of her friends' and her husband's behaviour is likely to be influenced by her state of mind.”
    Quote in the paperNot a substantial claim
22 of 22

  • The authors state this as an assumption.

    The contrast group may be taken to represent the natural history of bereavement reactions after stillbirth or early neonatal death.

    “Nevertheless, the contrast group may be taken to repre- sent the natural history of bereavement reactions after stillbirth or early neonatal death.”

  • The paper relies on this without support.

    Training programmes emphasise the technical rather than the psychological aspects of management.

    “All too often, training pro- grammes emphasise the technical rather than the psychological aspects of management.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Parents are more likely to develop prolonged psychological problems if professional support is not given.

    “parents are more likely to develop prolonged psychological problems if professional support is not given [13].”

    From Systematic review to understand and improve care after stillbirth: a review of parents’ and healthcare professionals’ experiences (2016) · cites this paper as [13]

    The Abstract reports more psychiatric symptoms at six months among mothers receiving routine care than among mothers offered counselling. But the Fathers section reports no significant difference between groups at six months, and the Abstract reports no significant difference among mothers at 14 months. The claim therefore extends a six-month finding in mothers to parents generally and to prolonged problems without a time limit. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Only a few randomized controlled studies have been carried out for women after prenatal loss, and most have been limited by being aimed at outcomes of depression and psychiatric disorder rather than grief itself.

    “Only a few randomized controlled studies have been carried out for women after prenatal loss, and most of these have been limited by being aimed at outcomes of depression and psychiatric disorder rather than grief itself.61-63”

    From Complicated grief after perinatal loss (2012) · cites this paper as [63]

    The Method describes a randomized trial after stillbirth or neonatal death, and the Evaluation section says it used scales for psychiatric disorder, depression, and anxiety. But it also used interviews about bereavement symptoms, and the Discussion addresses recovery from grief. This paper alone cannot establish that only a few such trials existed or that most focused on psychiatric outcomes rather than grief. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Photographs of the deceased baby are frequently reported.

    “Photographs of the deceased baby are frequently reported.63,66,107,111,114,121,128,178,181,187,188,223”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [66]

  • Only 2 RCTs resulted from the searches, one in 1982 and the other in 2015.

    “Only 2 RCTs resulted from our searches, one in 198266 and the other in 2015.67”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [66]

  • Other specific recommendations found in older literature are no longer practiced, such as announcing the loss on the ward and suggesting to hold someone else's newborn.

    “Other specific recommendations also found in older literature are no longer practiced (eg, announcing the loss on the ward, suggestion to hold someone else’s newborn).”

    From Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review (2024) · cites this paper as [66]

    The Method section describes encouraging parents to hold their own deceased baby and allowing mothers a choice of ward; it does not recommend announcing the loss on the ward or holding someone else’s newborn. Searches for both practices found no matching passage, and this 1982 paper does not address whether they are practiced today. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Pregnancy percentages use the wrong denominator

    Minor

    The stated percentages match a denominator of 50, not the stated 49 women. In particular, 28 of 49 is 57.1%, not 56%; 16 of 49 would round to 33%, not 32%.

    Reported 56 · recomputed 57.142857

1 of 1

Cites

Flagged first, then by citations

2 of the 17 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Lewis E. Reactions to stillbirth. In: Psychosomatic medicine in obstetrics and gynaecology. 3rd International Congress, Basel. London: Karger, 1971: 323-5.
  2. Am3J Obstet Gynecol 1970;108:73-7.
  3. Standish E. The loss of a baby. Lancet 1982;i:611-2.

Cited by

Sorted by citations

Related

Authors
Forrest, G. C., Standish, E., & Baum, J. D.
Affiliations
John Radcliffe Hospital (GB)
Venue
BMJ
Publisher
BMJ
Published
1982-11-20
Volume
285
Issue
6353
Pages
1475-1479
ISSN
  • 0007-1447 (ISSN-L)
  • 1468-5833
DOI
10.1136/bmj.285.6353.1475
OpenAlex
W2003832274
Semantic Scholar
595d72d9da18496e3af774b2bb47515b9efb0a73
Cited by
221
References
17
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 1 · 2016: 8 · 2015: 10 · 2014: 7 · 2013: 5 · 2012: 8
FWCI
5.28
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
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 › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
perinatal death, perinatal bereavement, grief counseling, postpartum depression, social isolation, marital intimacy, maternal mental health
MeSH terms
Adolescent, Adult, Mental Disorders, Counseling, Family, Female, Fetal Death, Grief, Humans, Infant Mortality, Infant, Newborn, Interpersonal Relations, Male, Middle Aged, Pregnancy, Professional-Family Relations, Psychiatric Status Rating Scales, Risk, Stress, Psychological

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