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

Perinatal loss care

Background

The death of a baby is a devastating pregnancy outcome with long-lasting social and emotional consequences for parents and families, and wide-ranging economic impacts on health systems and society.1,2 The quality of care that parents and family/whānau receive around the time their baby dies is a major contributor to immediate and long-term wellbeing, including into subsequent pregnancies.3,4

Healthcare professionals can support parents by offering opportunities to connect with their baby. Recognising parenthood is a core goal of care and requires actions by healthcare professionals that validate a baby’s existence and support the creation of lasting memories.4-6 These actions are highly valued by many parents and enable them to get to know their baby, to engage in parenting activities, and to collect tangible mementos of their baby.

This guideline acknowledges all parents and family/whānau who have experienced the death of a baby during pregnancy or soon after birth including early pregnancy loss. Implementation of these recommendations for perinatal loss care will ensure high quality consistent care for all parents and family/whānau who are cared for in maternal or newborn settings, regardless of when (during pregnancy or soon after birth) or where (location of maternal or newborn health service) their baby dies.

Objective

The overarching objective of this section is to assist frontline healthcare professionals to provide the best possible care for parents and family/whānau faced with the death of a baby before or soon after birth. Specifically, this section aims to help healthcare professionals:

  • provide parents and family/whānau with care and support to meet their individual needs
  • support parent-centred decision making and care planning
  • strengthen coordinated care and referral pathways across all sectors of health and community services.

The evidence synthesis of this section includes care of parents who have experienced stillbirth or neonatal death including stillbirths and neonatal deaths following termination of pregnancy.

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.7 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.8 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 personhood9 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).

Section 2 references
Breaking bad news
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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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