Organisational recommendations

Background

Maternal and newborn services need to create the conditions and formal structures to support and enable healthcare professionals to provide high quality care around stillbirth and neonatal death.¹ Studies identify education, training, resources, and support as critical enablers for best practice care,^2-4 including development and implementation of local protocols and policies consistent with current evidence.

Working in perinatal loss care and supporting parents and families/whānau following a baby’s death can be intense and complex. At every stage, the actions of healthcare professionals and their timing are critical to high quality care.⁵ Healthcare professionals have a major role in supporting parents to make decisions that minimise regret and avoid missed opportunities.^6,7 Recognising and finding ways to manage the impact of perinatal death on healthcare professionals is also essential for the optimal care of parents and wellbeing of healthcare professionals.

Many countries have principles and recommendations to guide best practice care around stillbirth and neonatal death. In Australia, in addition to the Stillbirth CRE/PSANZ Guidelines,⁸ there are the Stillbirth Clinical Care Standard of the Australian Commission on Safety and Quality in Health Care⁹ and the Sands Australian Principles of Bereavement Care (Miscarriage, Stillbirth and Neonatal Death).¹⁰ Peak professional bodies in the USA,¹¹ the UK,¹² and Canada¹³ have developed guidelines for care after stillbirth. In the UK, a National Bereavement Care Pathway¹⁴ provides standards for best practice care. Common to all guidelines is the need for healthcare professionals to have access to support and resources to provide high quality care including designated bereavement rooms, opportunities for training and education, and access to self-care and emotional wellbeing support.

Acknowledging the shared responsibility between the organisation and individual healthcare professionals is critical to developing an environment that enables and supports sustainable best practice care.

Objective

The objective of this section is to support organisations in providing a service-wide approach to the provision of respectful and supportive care.

A note about terminology

This guideline uses parent-centred language that is intended to be inclusive of all affected by loss. We use the term ‘woman’ throughout the guideline to refer to the person who is pregnant and gives birth.¹⁵ We acknowledge diverse gender identities and that not all individuals who become pregnant and give birth identify as a woman. The term ‘parent’ is used to refer to expectant and bereaved mothers, fathers, and partners. It is important to recognise individuals who identify themselves as parents. However, we also acknowledge that not all individuals who experience perinatal loss consider themselves to be parents.¹⁶

This guideline uses ‘baby’ when referring to stillbirth and neonatal death because these terms are preferred by many bereaved parents. Terms such as ‘fetus’ may add to parents’ distress because this language denies personhood¹⁶ and is inconsistent with recognition of parenthood that is crucial to providing respectful and supportive care.

This guideline uses ‘healthcare professional’ to denote all those working with bereaved parents and family/whānau (see Glossary).