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Cited by 51Grief, Bereavement, and Mental HealthMaternal and Neonatal HealthcareGlobal Maternal and Child Health

Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic

Open access
Silverio, Sergio A., Easter, Abigail, Storey, Claire, Jurković, Davor, Sandall, Jane, on behalf of the PUDDLES Global Collaboration·2021·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-021-04292-5PMC PMC8693591
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Abstract

Background: The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic. Methods: In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents’ access to services, care, and networks of support, during the pandemic after their bereavement. Results: All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents’ experiences were notably affected by service reconfigurations. Conclusions: Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study presents preliminary UK findings from the PUDDLES collaboration on how parents who suffered late miscarriage, stillbirth, or neonatal death experienced reconfigured maternity, neonatal, and bereavement care during the COVID-19 pandemic. Parents reported reduced access to services and care that was fragmented, isolating, and often delivered impersonally or virtually.

Key findings

  • The study interviewed 24 bereaved parents: late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), and neonatal death (n = 3; all mothers).
  • Four themes were identified: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen.
  • Access to maternity, neonatal, and bereavement care services was reported as significantly reduced, with parents affected by service reconfigurations such as cancelled routine appointments, partners excluded from antenatal visits and scans, restricted NICU visiting, virtual post-mortem result meetings, and limited funeral attendance.

Methods

  • In-depth semi-structured interviews were conducted between November and December 2020 via video-call or telephone with UK parents who had suffered a late miscarriage, stillbirth, or neonatal death during the COVID-19 pandemic; mean interview time was 72 minutes.
  • Data were analysed using template analysis based on an international mapping exercise of national COVID-19 responses and maternity, neonatal, and bereavement care reconfigurations.
  • Analysis followed a six-stage template analysis process, with preliminary coding checked by the wider team, iterative checking by the PUDDLES Global Collaboration, and bracketing to reduce researcher bias; saturation was assessed on data and thematic axes.

Limitations

  • The paper states that only preliminary, descriptive, UK interview data could be presented, which may limit generalisability; demographic data were deliberately not recorded or presented to preserve confidentiality, which the authors also identify as a limitation.
  • The authors state that ongoing research will benefit from more interviews with parents bereaved through late miscarriage and neonatal death, and from cross-cultural comparisons across PUDDLES countries.
  • Evident from the text: the sample was self-selected through contact details left after an online survey or screening, was UK-only and first-wave, and was composed mostly of mothers, with only one father and one joint parent interview.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12884-021-04292-5

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    All parents in the study had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic.

    “All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic.”
    Quote in the paperSubstantial claim
  • Findingown data

    Many participants discussed how the first UK lockdown came with confusing messaging as to whether pregnant women were or were not at greater clinical risk of COVID-19.

    “Many participants discussed how the first UK lockdown came with confusing messaging as to whether pregnant women were or were not at greater clinical risk of COVID-19”
    Quote in the paperNot a substantial claim
  • Findingown data

    Restrictions on neonatal services meant parents often needed to take shifts to be with their baby.

    “Restrictions on neonatal services also meant parents would often need to take shifts to be with their baby.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Changes in maternity care were often discussed in interviews as leading women to feel alone during their pregnancy, especially when they found out their baby had died, while their partners had been confined to the carpark.

    “These changes were often discussed in interviews as leading women to feel alone during their pregnancy, especially when they found out their baby had died, whilst their partners had been confined to the carpark.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Women frequently reported detrimental effects of increased virtual care and decreased face-to-face care during the pandemic.

    “As in other research about maternity care during the pandemic [5, 6], women frequently reported the detrimental effects of increased virtual care and decreased face-to-face care.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Silverio SA, De Backer K, Easter A, von Dadelszen P, Magee LA, Sandall J. Women’s experiences of maternity service reconfiguration during the COVID-19 pandemic: a qualitative investigation. Midwifery. 2021;102(103116):1–9. https://doi.org/10.1016/j.midw.2021.103116. source

      Not checked in the free run.

    • cites [6] Jackson L, De Pascalis L, Harrold JA, Fallon V, Silverio SA. Postpartum women’s psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis. BMC Pregnancy Childbirth. 2021;21(625):1–16. https://doi.org/10.1186/s12884-021-04071-2. source

      Not checked in the free run.

  • May combine two claims. 33
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    Access to maternity, neonatal, and bereavement care services was significantly reduced during the pandemic, and parents' experiences were notably affected by service reconfigurations.

    “Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents’ experiences were notably affected by service reconfigurations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The template analysis identified four themes: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen.

    “The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Whilst fathers and partners were usually able to stay during labour, some parents experienced difficulty negotiating the presence of their preferred birthing partners, which added to the distress of starting labour knowing their baby had died.

    “Whilst fathers and partners were usually able to stay during labour, some parents experienced difficulty negotiating the presence of their preferred birthing partners, which added to the distress of starting labour knowing their baby had died”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Restrictions on movement were double-edged for many parents: lockdowns provided conditions and excuse to grieve privately, but also restricted family gatherings and access to usual support networks.

    “Restrictions on movement were double-edged for many; lockdowns providing the conditions and excuse to grieve privately, but also restricted family gatherings and access to usual support networks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Navigating grief during lockdown restrictions on social gatherings was coupled with the need to seek support, and occasionally bereaved parents were advised to stretch the rules to access support networks.

    “Navigating grief in the midst of the lockdown restrictions on social gatherings was coupled with the need to seek support, and occasionally bereaved parents were advised to stretch the rules to ensure they could still access support networks”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    While the new restrictions meant some felt trapped or dissatisfied, others used the restrictions as an excuse to not socialise when they did not want to, either during pregnancy or in their time of grief.

    “However, whilst the new restrictions meant some felt trapped or dissatisfied, others used the restrictions as an excuse to not socialise when they did not want to, either during their pregnancy, or in their time of grief”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Lockdown restrictions meant contacts were quickly minimised, so that no-one except parents were allowed to attend babies in NICU.

    “Lockdown restrictions meant contacts were quickly minimised, meaning no-one except parents were allowed to attend babies in NICU”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Analyses uncovered the idea that to keep safe meant to stay away, rendering a pattern of visits to their dying infant to perform care in shifts.

    “Analyses uncovered the idea that to keep safe meant to stay away, rendering a pattern of visits to their dying infant to perform care [38], in shifts.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Wilkinson S, Wilkinson C. Performing care: emotion work and ‘dignity work’ – a joint autoethnography of caring for our mum at the end of life. Sociol Health Illn. 2020;42(8):1888–901. https://doi.org/10.1111/1467-9566.13174. source

      Not checked in the free run.

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

    Findingnone given

    The national response to the COVID-19 pandemic was surprising to many and almost immediately halted life as they knew it.

    “The national response to the COVID-19 pandemic was surprising to many, almost immediately halting life as they knew it.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Safety precautions including personal protective equipment meant interactions between bereaved parents and healthcare professionals felt impersonal, rendering bereavement care less personable and in some cases less than adequate.

    “Safety precautions including personal protective equipment meant interactions between bereaved parents and healthcare professionals felt impersonal, rendering bereavement care less personable and in some cases less than adequate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Many restrictions were placed on daily life, meaning pregnant women and their partners often suddenly found themselves at home having to juggle pregnancy, work, other caring responsibilities, and eventually bereavement, all from their household with no ability to leave their homes.

    “Many restrictions were placed on daily life meaning pregnant and women and their partners often sudden found themselves at home having to juggle the pregnancy, work, other caring responsibilities, and eventually their bereavement, all from their household with no ability to leave their homes.”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    Limiting funeral attendees was permissible, as long as loved ones could spend time with the baby after birth.

    “Likewise, limiting funeral attendees was permissible, as long as loved ones could spend time with the baby after birth.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Restrictions on care and support available to bereaved parents after a baby died were common and included limiting attendees at funerals and religious ceremonies.

    “As with maternal and neonatal care, restrictions on the care and support available to bereaved parents after a baby died were common, and included limiting attendees at funerals and religious ceremonies [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] de Oliveira Cardoso ÉA, de Almeida de Silva BC, dos Santos JH, dos Santos Lotério L, Accoroni AG, dos Santos MA. The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families. Rev Lat Am Enfermagem. 2020;28(e3361):1–9. https://doi.org/10.1590/1518-8345.4519.3361. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Hospitals suggested video-conferencing to deliver post-mortem results, which were frequently subject to delay due to the pandemic.

    “Video-conferencing was also suggested by hospitals to deliver post-mortem results which were frequently subject to delay due to the pandemic”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Family interactions were usually conducted virtually, meaning all grief was navigated through a screen or via telephone.

    “Likewise, family interactions were usually conducted virtually, meaning all grief was navigated through a screen or via telephone”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The need for parents to take shifts in neonatal services often led to confusion and mixed messages, with one parent having to translate updates to the other as they swapped over.

    “This often led to confusion and mixed-messages, where one parent would have to ‘translate’ any updates to the other as they swapped over”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neonatal service restrictions were varied in nature but were often imposed quickly and without advance warning.

    “These restrictions were varied in nature, but were often imposed quickly and without advance warning”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Limiting birth partners to a woman's partner and visitors to neonatal units was found to be acceptable in this study, as long as updates were documented for parents to pass on accurate information.

    “Limiting birth partners to a woman’s partner and visitors to neonatal units was found to be acceptable in this study, as long as updates were documented for parents to pass on accurate information”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Maternity care changed rapidly with COVID-19 lockdown restrictions, leaving bereaved parents alone, isolated, and/or apart from their familial or fictive kin networks they would have relied on outside of pandemic circumstances.

    “Maternity care changed rapidly with COVID-19 lockdown restrictions, leaving bereaved parents alone, isolated, and/or apart from their familial or fictive kin networks they would have relied on outside of pandemic circumstances.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Parents reported seeking support in new, virtual ways (such as online counselling or support networks) which occasionally felt ineffective, especially when access to usual support networks and loved ones was not available.

    “Parents also reported seeking support in new, virtual, ways (such as on-line counselling or support networks) which occasionally felt ineffective, especially when access to usual support networks and loved ones was not available.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Participants were de-identified, and demographic data were deliberately not recorded nor presented to preserve confidentiality.

    “Participants were de-identified, and demographic data (e.g., age, educational attainment, ethnicity, geographical location, religion, etc.) were deliberately not recorded nor presented in order to preserve confidentiality of participants.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Interview schedules were developed by the lead author in discussion with the wider team and sense-checked by charitable partners and collaborative researchers rather than piloted, to avoid losing participants' data to pilot interviews.

    “Interview schedules were developed by the lead author [SAS] who has experience of undertaking interviews on sensitive topics (including pregnancy loss), in discussion with the wider team [CS, JS, AE], as well as members of the PUDDLES Global Collaboration and our charitable partners (Tommy’s, Sands, International Stillbirth Alliance).”
    • Also stated in: § Data collection · plain
      “The schedules were internally sense-checked by our charitable partners and collaborative researchers rather than piloted, to ensure participants’ data were not lost to pilot interviews, given our initial expectation of a small recruitment population.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Projections suggest rates of stillbirth are expected to double globally.

    “For perinatal women receiving maternity care, we have already seen reports of devalued care [5], poor psycho-social outcomes [6, 24], and worrying projections suggesting rates of stillbirth are expected to double globally [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Homer C, Leisher SH, Aggarwal N, Akuze J, Babona D, Blencowe H, et al. Counting stillbirths and COVID 19 – there has never been a more urgent time. Lancet Glob Health. 2021;9(1):e10–1. https://doi.org/10.1016/S2214-109X(20)30456-3. source

      Not checked in the free run.

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

    Premisecitation

    In the UK, maternity care changes during the pandemic have been consistently monitored and guidance and service provision have been frequently adapted.

    “In the UK, these changes have been consistently monitored [23] and guidance as well as service provision has been frequently adapted in an attempt to augment care [5, 21–23].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [23] Jardine J, Relph S, Magee LA, von Dadelszen P, Morris E, Ross-Davie M, et al. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG. 2021;128(5):880–9. https://doi.org/10.1111/1471-0528.16547. source

      Not checked in the free run.

    • cites [5] Silverio SA, De Backer K, Easter A, von Dadelszen P, Magee LA, Sandall J. Women’s experiences of maternity service reconfiguration during the COVID-19 pandemic: a qualitative investigation. Midwifery. 2021;102(103116):1–9. https://doi.org/10.1016/j.midw.2021.103116. source

      Not checked in the free run.

    • cites [21] Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. (2020). Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (12th Vers.). https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/.

      Not checked in the free run.

    • cites [22] Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. (2021). Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (14th Vers.). https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/.

      Not checked in the free run.

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

    Premisecitation

    Template analysis was employed using a critical perspective, arguing that realities exist independent of human activity and that situations outside participants' control may not directly determine behaviour but are recognized as important influences in understanding experience.

    “Template analysis as a method of qualitative data analysis is philosophically flexible, but has been employed in this study using a critical perspective ([29]; p.15), whereby we argue “realities which exist independent of human activity””
    • Also stated in: § Data analysis · hedged
      “and that situations outside of our participants’ control (such as the COVID-19 pandemic in the case of our study) “may not directly determine behaviour, they are nonetheless recognized as having important influences in understanding experience”.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] King N, Brooks J. Template analysis for business and management students. London: SAGE; 2017. source

      Not checked in the free run.

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

    Premisecitation

    Definitions of pregnancy losses and perinatal deaths are subject to global variation, which adds complexity when attempting to compare experiences internationally.

    “Definitions of pregnancy losses (miscarriages) and perinatal deaths (stillbirths and neonatal deaths) are subject to global variation [10], which adds complexity when attempting to compare experiences internationally.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–e108. https://doi.org/10.1016/S2214-109X(15)00275-2. source

      Not checked in the free run.

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

    Study design and conductcitation

    Researcher bias was reduced by bracketing, with personal assumptions recorded and excluded as far as possible, and all members of the PUDDLES Global Collaboration iteratively checking findings and highlighting potential bias for removal.

    “Researcher bias was reduced by a process of ‘bracketing’ [30], whereby personal assumptions were recorded and excluded as far as possible, with all members of the PUDDLES Global Collaboration iteratively checking the findings and results, whilst highlighting any sources or examples of potential bias for removal.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Gearing RE. Bracketing in research: A typology. Qual Health Res. 2004;14(10):1429–52. https://doi.org/10.1177/1049732304270394. source

      Not checked in the free run.

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

    Premisecitation

    Pregnancy loss and perinatal death can be devastating, with wide-ranging and frequently long-lasting effects on the psychological wellbeing of parents and those around them.

    “Though usually an occasion of great joy, pregnancies can be physically and emotionally turbulent when women experience complications [1], or go onto suffer a miscarriage, stillbirth, or neonatal death, the effects of which are often devastating.”
    • Also stated in: § Pregnancy loss and perinatal death · plain
      “Regardless of definition, the experience of pregnancy loss and perinatal death can be devastating, with wide-ranging and frequently long-lasting effects on the psychological wellbeing of parents and on those around them [1, 14–19]”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [1] Hall JA, Silverio SA, Barrett G, Memtsa M, Goodhart V, Bender-Atik R, et al. Women’s experiences of early pregnancy assessment unit services: a qualitative investigation. BJOG Int J Obstet Gynaecol. 2021;128(13):2116-25. https://doi.org/10.1111/1471-0528.16866. source

      Not checked in the free run.

    • cites [14] Gold KJ, Leon I, Boggs ME, Sen A. Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. J Women's Health. 2016;25(3):263–9. https://doi.org/10.1089/jwh.2015.5284. source

      Not checked in the free run.

    • cites [15] Wojcieszek AM, Shepherd E, Middleton P, Lassi ZS, Wilson T, Murphy MM, et al. Care prior to and during subsequent pregnancies following stillbirth for improving outcomes. Cochrane Database Syst Rev. 2018;12(CD012203):i–138. https://doi.org/10.1002/14651858.CD012203.pub2. source

      Not checked in the free run.

    • cites [16] Redshaw M, Henderson J. Mothers’ experience of maternity and neonatal care when babies die: a quantitative study. PLoS One. 2018;13(12):1–12. https://doi.org/10.1371/journal.pone.0208134. source

      Not checked in the free run.

    • cites [17] Volgsten H, Jansson C, Skoog Svanberg A, Darj E, Stavreus-Evers A. Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery. 2018;64:23–8. https://doi.org/10.1016/j.midw.2018.05.003. source

      Not checked in the free run.

    • cites [18] Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, et al. Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study. Am J Obstet Gynecol. 2020;222(4):e1–e22. https://doi.org/10.1016/j.ajog.2019.10.102. source

      Not checked in the free run.

    • cites [19] Obst KL, Due C, Oxlad M, Middleton P. Men’s grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model. BMC Pregnancy Childbirth. 2020;20(1):1–17. https://doi.org/10.1186/s12884-019-2677-9. source

      Not checked in the free run.

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

    Study design and conductown data

    The study received input from NIHR ARC South London PPIE meetings and from lay and expert stakeholders.

    “This programme of work has been presented to, and received input from the National Institute for Health Research Applied Research Collaboration [NIHR ARC] South London Patient and Public Involvement and Engagement [PPIE] meeting for Maternity and Perinatal Mental Health Research (July 2020; June 2021), which has a focus on co-morbidities, inequalities, and maternal ethnicity.”
    • Also stated in: § Patient and public involvement and engagement · plain
      “Throughout the course of planning and undertaking this work we have received feedback from both lay and expert stakeholders, including members of the public, those with lived experience, health and social care professionals, researchers, and policy makers.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Reports show devalued care for perinatal women receiving maternity care during the pandemic.

    “For perinatal women receiving maternity care, we have already seen reports of devalued care [5], poor psycho-social outcomes [6, 24], and worrying projections suggesting rates of stillbirth are expected to double globally [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Silverio SA, De Backer K, Easter A, von Dadelszen P, Magee LA, Sandall J. Women’s experiences of maternity service reconfiguration during the COVID-19 pandemic: a qualitative investigation. Midwifery. 2021;102(103116):1–9. https://doi.org/10.1016/j.midw.2021.103116. source

      Not checked in the free run.

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

    Study design and conductnone given

    Ethics approval for PUDDLES-UK was granted from the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Sub-Committee.

    “Ethics approval for PUDDLES-UK were sought and granted from the King’s College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Sub-Committee [ref:- HR-19/20-19455].”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Participants provided informed consent for PUDDLES.

    “Participants subsequently provided informed consent for PUDDLES (electronically signed or audio recorded).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    For perinatal women, COVID-19 has caused unprecedented challenges that can significantly impact on women's mental health.

    “For perinatal women, COVID-19 has caused “unprecedented challenges that can significantly impact on women’s mental health” ([2]; p.310).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Matvienko-Sikar K, Meedya S, Ravaldi C. Perinatal mental health during the COVID-19 pandemic. Women Birth. 2020;33(4):309–10. https://doi.org/10.1016/j.wombi.2020.04.006. source

      Not checked in the free run.

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

    Study design and conductnone given

    Preliminary coding was checked with the wider team before higher-order coding of themes was shared with the rest of the PUDDLES Global Collaboration.

    “Preliminary coding was checked with the wider team [CS, JS, AE, DJ] before higher-order coding of themes was shared with the rest of the PUDDLES Global Collaboration.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The lack of presentation of demographic data poses a limitation in the context of this study.

    “We would further add the lack of presentation of demographic data poses a limitation in the context of this study”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Template analysis follows a six-stage process and is a highly methodical approach to analysis.

    “Template analysis follows a six-stage process: 1) Re-familiarization with the Data; 2) Preliminary Coding; 3) Organization of Themes in the Template; 4) Defining the Template; 5) Application of the Final Template to the Full Dataset; and 6) Finalization of Template Definitions; thus making template analysis a highly methodical approach to analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Brooks JM, McCluskey S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qual Res Psychol. 2015;12(2):202–22. https://doi.org/10.1080/14780887.2014.955224. source

      Not checked in the free run.

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

    Premisecitation

    Template analysis maintains rigour by ensuring critical reflexivity throughout all six phases, iterative coding from stage three onwards, and accuracy checking in the final two stages.

    “Template analysis maintains rigour by ensuring critical reflexivity is engaged with throughout all six phases; as well as iterative coding is practiced from stage three onwards; and ensuring accuracy checking in the final two stages ([28]; see Fig. 3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Brooks JM, McCluskey S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qual Res Psychol. 2015;12(2):202–22. https://doi.org/10.1080/14780887.2014.955224. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Change-overs became touch-points for parents to update one another on progress and equally became points for confusion, which the authors believe is attributed to the pandemic circumstances and associated restrictions.

    “Change-overs became touch-points for parents to update one another on progress, and equally became points for confusion, something we believe is attributed to the pandemic circumstances and the associated restrictions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    During the pandemic, there has been a notable reduction of face-to-face care, with an increased reliance on virtual care, or the total removal of maternity care altogether.

    “However, during this pandemic, there has been a notable reduction of face-to-face care, with an increased reliance on virtual care, or the total removal of maternity care altogether [5, 6, 23]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Silverio SA, De Backer K, Easter A, von Dadelszen P, Magee LA, Sandall J. Women’s experiences of maternity service reconfiguration during the COVID-19 pandemic: a qualitative investigation. Midwifery. 2021;102(103116):1–9. https://doi.org/10.1016/j.midw.2021.103116. source

      Not checked in the free run.

    • cites [6] Jackson L, De Pascalis L, Harrold JA, Fallon V, Silverio SA. Postpartum women’s psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis. BMC Pregnancy Childbirth. 2021;21(625):1–16. https://doi.org/10.1186/s12884-021-04071-2. source

      Not checked in the free run.

    • cites [23] Jardine J, Relph S, Magee LA, von Dadelszen P, Morris E, Ross-Davie M, et al. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG. 2021;128(5):880–9. https://doi.org/10.1111/1471-0528.16547. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationown data

    The study has evidenced ways to better support bereaved parents through care and grief.

    “With the information found through this collaboration and our analysis, we have evidenced ways to better support bereaved parents through care and grief.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    The iterative approach to coding and quotation selection meant that when saturation was reached, transcripts could be compared to ensure the most illustrative quotations were selected.

    “The iterative approach to coding and quotation selection meant, when saturation of data and themes had been reached, transcripts could be compared to ensure the most illustrative quotations were selected and presented in the results section which follows [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] King N, Brooks J. Template analysis for business and management students. London: SAGE; 2017. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Saturation of data was assessed on two axes: data saturation and thematic saturation; both parameters were met and themes were broadly applicable across the whole dataset.

    “Saturation of data was assessed on two axes: data saturation, whereby similar data was present across many, if not all of the participants relatively early on into recruitment; and thematic saturation, whereby the final themes were well supported by data contained within the whole dataset.”
    • Also stated in: § Data analysis · hedged
      “Although this analysis is reported as preliminary, we were satisfied that both parameters were met and that themes were broadly applicable across the whole dataset.”
    Quote in the paperSubstantial claim
42 of 42

  • The paper relies on this without support.

    Parents who experience a pregnancy loss or perinatal death require particular care and support.

    “Parents who experience a pregnancy loss or perinatal death require particular care and support.”

  • The paper relies on this without support.

    Lessons from the experiences of UK parents bereaved during the first wave of the COVID-19 pandemic are transferable to ongoing and future health system shocks.

    “Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks.”

  • The paper relies on this without support.

    To the authors' knowledge, this is the only international collaboration to focus on documenting the experiences of bereaved parents after late miscarriage, stillbirth, or neonatal death during the pandemic.

    “To our knowledge, this is the only international collaboration to focus on documenting the experiences of bereaved parents after late miscarriage, stillbirth, or neonatal death, during the pandemic.”

  • The paper relies on this without support.

    This analysis provides the first insight into the implications of service reconfiguration for bereaved parents.

    “This analysis provides the first insight into the implications of service reconfiguration for bereaved parents”

  • The paper relies on this without support.

    Some pregnancy losses and perinatal deaths can be prevented with adequate care.

    “We know from previous work that some pregnancy losses and perinatal deaths can be prevented with adequate care.”
5 of 5

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?

  • Major changes in healthcare services, such as cancellation of appointments and exams, and restrictions on contact with the baby after death, further intensified women's suffering during the pandemic.

    “Major changes in healthcare services, such as the cancellation of appointments and exams (56), and restrictions on contact with the baby after death, further intensified women’s suffering during this period (57, 58).”

    From Experiences and long-term repercussions of perinatal grief in women after perinatal bereavement: a meta-ethnography (2025) · cites this paper as [57]

The citation lists haven’t been fetched yet

References 34 · Cited by 51

Research works printed but not linked: 4

  1. Tommy’s. (2021). Baby loss support. Stillbirth: your rights and benefits after stillbirth. https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/your-rights-and-benefits-after-stillbirth.
  2. Sands. (2020). National bereavement care pathway for pregnancy and baby loss. Miscarriage, ectopic pregnancy and molar pregnancy: full guidance document. https://nbcpathway.org.uk/sites/default/files/2020-02/MiscarriageFullGuidance_Jan2020.pdf.
  3. Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. (2020). Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (12th Vers.). https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/.
  4. Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. (2021). Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (14th Vers.). https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/.

Authors
Silverio, S. A., Easter, A., Storey, C., Jurković, D., Sandall, J., & on behalf of the PUDDLES Global Collaboration
Affiliations
King's College London (GB)
Corresponding author
Silverio, Sergio A.
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2021-12
Volume
21
Issue
1
Pages
840-840
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-021-04292-5
PMC
PMC8693591
OpenAlex
W4200380143
Semantic Scholar
e9018076304a11c46a847b180dbc02d96527e80f
Cited by
51
References
34
Citations by year
2026: 5 · 2025: 5 · 2024: 18 · 2023: 14 · 2022: 9
FWCI
6.99
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Liverpool John Moores University (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • ResearchSpace (University of Auckland) (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research (NIHR‐INF‐2170, NIHR200306)
  • King's College London
  • Victoria University of Wellington
  • Victoria University
  • University of Queensland
  • Tommy's
  • Faculty of Education, Victoria University of Wellington
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
perinatal bereavement, COVID-19 pandemic, late miscarriage, stillbirth, neonatal death, health care access, bereavement support, service reconfiguration, care fragmentation, social isolation, online support services, parental experiences, health system shocks
MeSH terms
Abortion, Spontaneous, Psychosocial Support Systems, Preliminary Data, COVID-19, SARS-CoV-2, Bereavement, Continuity of Patient Care, Female, United Kingdom, Grief, Health Services Accessibility, Humans, Infant, Newborn, Male, Parents, Pregnancy, Quarantine, Qualitative Research, Stillbirth, Perinatal Death

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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