How to use the guideline

The guideline is presented in eight sections:

• Section 1: Introduction
• Section 2: Approach to care
• Section 3: Perinatal loss care
• Section 4: Perinatal palliative care
• Section 5: Care in subsequent pregnancies
• Section 6: Investigations for perinatal death
• Section 7: Perinatal mortality audit and classification
• Section 8: Organisational recommendations

Resources are provided to assist healthcare professionals implement the recommendations including resources for parents and families/whānau.

Implementation and review

Refer to Implementation and dissemination plan (Appendix 1E). The guideline and all supporting documents and resources will be available as a web-based tool and as a printable text document (PDF) from the Stillbirth CRE website (https://stillbirthcre.org.au/) so that they are accessible to healthcare professionals and the broader community.

NHMRC approval of recommendations is valid for five years. However, evidence will be reviewed three years after publication to evaluate whether all or part of the guideline should be updated. In Australia, the National Stillbirth Action and Implementation Plan²⁷ highlights the need for all families/whānau who experience stillbirth to receive personalised, respectful, supportive and holistic clinical and community care.

A co-designed national care pathway is currently under development by the Stillbirth CRE to ensure best practice care around stillbirth and neonatal death is provided across the continuum of care and different settings. In Aotearoa New Zealand, a national perinatal bereavement pathway is under development with key stakeholders including governmental and non-governmental organisations to ensure high-quality, appropriate, and equitable care for all.

The Australian Commission on Safety and Quality in Health Care (the Commission) released the Stillbirth Clinical Care Standard (the Standard) in November 2022. The Standard aims to reduce variation in the prevention and investigation of stillbirth, and to support best practice in bereavement care after any perinatal loss. This Standard provides maternal and newborn services with a robust tool to help with implementation of the guideline.

Resource implications associated with implementation of the recommendations

This clinical practice guideline was produced to support the delivery of appropriate care after stillbirth or neonatal death, based on the best evidence available at the time of development. Healthcare professionals are advised to use clinical discretion and consider the circumstances of the individual patient and their family when applying recommendations from the guideline. In some settings, resources to support best practice care may not be as readily available as in others. In these situations we hope these guidelines may be used as an advocacy tool for services to use in planning care provision for families who experience stillbirth or neonatal deaths. By acknowledging and addressing resource implications we aim to contribute to the sustainable and equitable implementation of clinical recommendations to improve care for families.

In a survey of maternity services, we identified variation in implementation of recommendations of the previous guidelines³⁷ in Australia. Services in rural and remote regions and non-tertiary centres were less likely to report optimal care practices. As many of the recommendations in this update are similar in terms of respectful supportive care with a strengthening of the focus on culturally appropriate care, education of healthcare professionals and continuity of care there is likely to be variation in resource requirements for implementing or upscaling based on type and place of service. See also the Implementation and dissemination plan (Appendix 1E).

Recommendations

This edition of the guideline contains two types of recommendations — evidence-based and consensus-based. Both provide best practice, respectful and culturally responsive care to parents and families/whānau around stillbirth and neonatal death. The methodology and recommendation process are detailed in the technical reports for each section.

See Executive summary (Appendix 1D) for summary of recommendations.