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

Approach to care

All maternal and newborn services should establish and foster a commitment to delivering best practice care around stillbirth and neonatal death. Services can support staff providing perinatal loss care by establishing and maintaining systems and practical resources, and through ongoing training.17 Support strategies should be documented in organisational polices,18 which are implemented, evaluated and updated as required.19

A multidisciplinary team is integral to caring for parents and families/whānau when a baby dies. This team may include medical, nursing, midwifery, and social work care professionals as well as peer supporters, volunteers, and community members. Cultural, religious, and spiritual variation around practices relating to childbirth, death and dying require flexibility and individualised approaches.20 Poor coordination of care and lack of healthcare professional knowledge or skill in managing care or in interactions with parents can exacerbate family/whānau trauma and add to healthcare professional stress. Lack of a single point of contact is commonly reported by parents and adds to frustration and feelings of distress. Parents value continuity of carer because of the comfort of a familiar face and knowing they will not need to repeat their story.21

A dedicated and appropriate space is essential for provision of best practice care. A recognisable marker that designates pregnancy or newborn loss should be used to identify designated bereavement spaces, medical records or any other item that is appropriate and accepted by parents.22 All staff (both clinical and nonclinical, including volunteers) should be aware of this marker/identifier to ensure sensitive care and support.  

“The hospital I was at also had signs on the door with a teddy bear and a tear…[staff] know to be sensitive.”16

All major maternity hospitals should develop specialist bereavement support services with staff trained in perinatal loss care.5 These staff have an important role in the ongoing training and support of all healthcare professionals who have contact with bereaved parents. Smaller facilities or those located in rural or remote areas should ensure protocols are in place for care after perinatal loss and in subsequent pregnancies that include working with larger centres with appropriate expertise. This may include the use of telehealth. For some Aboriginal people and Torres Strait Islander communities, telehealth consultations may include important people in the community such as Elders or Traditional Healers. Better collaborative care at the interface between hospital and community is also essential to addressing the ongoing support needs of bereaved parents.

Consensus-based recommendation 8.1

Each maternal and newborn service should establish and support a multidisciplinary team approach across the continuum of care to meet the physical, social, and emotional, cultural, religious, and spiritual needs of bereaved parents and family/whānau.

  • Ensure processes are established for cultural support services including interpreters.
  • Use a recognisable marker that designates perinatal loss in all physical spaces where bereaved parents are cared for, to ensure all clinical and non-clinical staff are aware of loss.

Consensus-based recommendation 8.2

Ensure a coordinated and informed approach to care across the continuum through a dedicated role within the service, ideally a bereavement midwife, to be a known point of contact (that is, contact details of a named healthcare professional) for bereaved parents and family/whānau.

  • This requires appropriate rostering of staff to provide high quality care.

Consensus-based recommendation 8.3

Maternal and newborn services should have established protocols in place to access appropriate expertise where not available locally for all aspects of care around the time of a perinatal death and in subsequent pregnancies (such as team-to-team or telehealth consultations).

  • This is particularly important to ensure families/whānau who live in regional or remote areas have access to appropriate clinical, social, and emotional supports.

Consensus-based recommendation 8.4

Ensure culturally and linguistically appropriate information and resources are available in multiple formats (print, audio, digital) and languages for bereaved parents and family/whānau.

Evidence-based recommendation 8.5

Evidence quality: Moderate confidence

Ensure a designated private and safe place is available for bereaved parents and family/whānau whose baby has died or is receiving palliative care. This includes capacity and resources to support:

  • parents to spend time with and create memories with their baby including mementos and other keepsakes
  • family/whānau members and other support people to gather
  • cultural, religious, and/or spiritual rituals or ceremonies. 

Maternal and newborn services should have processes in place to ensure all parents have access to memory making opportunities such a bereavement photographs and videos, hand and footprints, casts/moulds of hands and feet. Parents also value the opportunity to spend time with their baby in natural environments or settings. All services should have established processes to facilitate commemorative rituals.

Parents will need to make “memories of a lifetime” in a very limited span of time.8

Some parents may be apprehensive about creating mementos and may choose not to take these home with them. It is crucial that all services have processes in place for the storage of mementos in case the families wish to collect these in the future.

In Australia, Red Nose’s Treasured Babies Program and Angel Gowns Australia provide bereaved families with gifts of handmade clothing and Angel boxes for their baby. Miracle Babies Foundation provides memory boxes for newborn loss. Bears of Hope, Possum Portraits, and Huggable Hearts also support bereaved families with mementos and keepsakes for lasting memories. In Aotearoa New Zealand, Baby Loss NZ, Sands New Zealand, and A Star is Born provide memory making services.

Consensus-based recommendation 8.6

Establish a local process for storing mementos for parents who initially choose not to take them, including how to store securely and label appropriately in medical records for future access.

Evidence-based recommendation 8.7

Evidence quality: Moderate confidence

Establish relationships and partnerships with parent support organisations to ensure appropriate commemorative rituals are available to parents, such as an annual remembrance service for parents whose babies have died.

Organisational recommendations
Education and training for healthcare professionals
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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