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

Breaking bad news

Care around loss - parent resources

A baby’s condition, diagnosis and prognosis is often complex and uncertain.¹⁰ How news is communicated to parents has immediate and lasting effects on parents’ experiences of care and wellbeing.^11-15 Communication when confirming the baby’s death or life-limiting prognosis, and during labour and birth care, should always be respectful, honest, and free from distractions.

There are many ways of breaking bad news.
No way is good, but some are better.¹⁸

No parent is prepared for the news of the death, or possible death, of their baby and intense shock and grief are to be expected.²⁵

The attitudes and communication skills of healthcare professionals, the timing of the communication, and the physical surroundings in which the news is delivered are all important.^10,16,17 A coordinated multidisciplinary approach may be the most effective way to ensure parents receive accurate and consistent information, with diagnosis shared as soon as confirmed.^18,19 Signs of a problem may first be discovered by sonographers or other healthcare professionals who may not be empowered or authorised to communicate their observations to parents.^12,20,21 The Parent-centred communication in obstetric ultrasound guideline developed by the Australasian Society for Ultrasound in Medicine (ASUM) provides recommendations and support to sonographers to improve care of expectant parents.

For breaking news about the death of an unborn baby, guidelines on perinatal loss care recommend using sensitive language, selecting appropriate and understandable messages, and ensuring enough time is given for parents to absorb that information.

When breaking news about a life-limiting diagnosis for an unborn baby, the timing, amount, and quality of information provided to parents has implications for their wellbeing and understanding of the situation. Balanced and accurate information about all available options should be presented to parents. Parents may face much uncertainty, and ultimately must decide whether to continue the pregnancy. Parents who choose to continue the pregnancy should have immediate access to perinatal palliative care (see Section 4: Perinatal palliative care).

Through the Unexpected is an Australian charity providing information and social and emotional resources to expectant parents and families faced with an antenatal diagnosis of an anomaly in their baby.

Consensus-based recommendation 3.1

The option of ultrasound should always be available and used to diagnose death or other conditions in an unborn baby. A second opinion should be considered where appropriate.

Ensure sonographers are considered as part of the multidisciplinary team and are aware of the clinical context and receive relevant information when caring for parents in the context of perinatal loss.
Advise parents that there may be periods of silence during procedures such as scanning.
Adverse findings should be communicated by an experienced and empathic healthcare professional.

Consensus-based recommendation 3.2

Prior to breaking bad news, ensure that you are well-placed to answer parents’ questions by gathering relevant information and consulting with colleagues, where needed. If you are uncertain of an answer or information is unavailable, assure parents’ that you will seek the information they need.

Consensus-based recommendation 3.3

When breaking bad news:

communicate the news in a safe and private space to both parents together; if this is not possible, communicate to the woman first, before others
use thoughtful and clear communication and sensitive terminology when referring to the baby (for example ask parents if they have a name for the baby and ask permission to call the baby by name)
acknowledge parents’ distress, feelings, and concerns
assure parents that everything possible is being done to ascertain the baby’s condition and offer to stay for support or to answer questions
inform parents of expected time delays between investigations and results and keep parents updated.

Consensus-based recommendation 3.4

Do not leave parents on their own without information. If a woman has attended alone, offer to contact her partner or other support person, and ensure that she is supported by a healthcare professional and not left alone until that person arrives.

Consensus-based recommendation 3.5

Advise parents of the possibility of passive movement of the unborn baby following diagnosis of death. If parents report movements after the scan, offer support and a repeat scan.

Perinatal loss care

Care planning and decision making