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Care Around Stillbirth and Neonatal Death (CASaND) Clinical Practice Guideline

Care in subsequent pregnancies

Background

Parents with a history of stillbirth or neonatal death may be at increased risk of stillbirth and other complications in subsequent pregnancies, including preterm birth, low birth weight, placental abruption, pre-eclampsia, and gestational diabetes.1,2 In this context, parents face social and emotional challenges, including increased risk of distress, anxiety and depression, and delayed attachment.3,4 There may be mixed emotions and conflict between the desire for another baby and fear of adverse outcomes.4-6

The grief associated with the death of a baby is enduring.12

Parents need continued respectful and supportive perinatal loss care from the time a baby dies through to a subsequent pregnancy.4,7,8 Many parents will become pregnant within 12 months of the death of their baby.9,10  

Objective

Providing best practice care for parents and families/whānau in pregnancies following stillbirth or neonatal death includes:

  • meeting parents’ medical, social, and emotional needs, and providing pathways to specialised care
  • parent-centred decision making and care planning, including preconception counselling, pregnancy management, and consideration of timing of birth
  • coordinated care across health and community services
  • culturally safe and responsive care
  • supporting wellbeing of parents, including referral to support.

A note about terminology

This guideline uses parent-centred language that is inclusive of all individuals. Throughout this guideline, we use the term ‘woman’ to refer to the person who is pregnant and gives birth. We acknowledge diverse gender identities and that not all individuals who become pregnant and give birth will identify as a woman. The term ‘parent’ is used to refer to expectant and bereaved mothers, fathers, and partners. However, we also acknowledge that not all individuals who experience perinatal loss consider themselves to be parents. This guideline uses ‘baby’ when referring to stillbirth, neonatal death, or termination of pregnancy for medical reasons, because this is preferred by many bereaved parents and validates the magnitude of the loss experienced. This guideline uses ‘healthcare professional’ to denote all those working with bereaved parents and family/whānau.

Section 4 references
Approach to care  
Stillbirth Logo
Western Pacific Regional Office of the International Stillbirth Alliance
Coordinating Centre, Stillbirth and Neonatal Death Alliance, Perinatal Society of Australia and New Zealand

Level 3, Aubigny Place
Mater Research Institute
Raymond Terrace,
South Brisbane QLD 4101
The University of Queensland Faculty of Medicine

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