A stillbirth was given to me today: professional pressures, conflict and perceived roles
Doreen Kenworthy, Mavis Kirkham in Midwives Coping with Loss and Grief, 2019
The allocation of a midwife to a woman presenting with a known stillbirth should be one to which prior thought and consideration has been given, but this was not felt to be a consistent practice. Some respondents considered providing care to a mother with an impending stillbirth to be a heavy professional burden. Many factors limit the professional development of a midwife with regard to stillbirth. Midwives may avoid the care of women with stillbirths not because of previous negative experiences but from feelings of inadequacy and perceived lack of capabilities resulting from a lack of experience. The idea that approaching an anticipated stillbirth constructively rather than negatively could help to engender a positive birthing experience was found in Sophie’s reflective narrative. The completion of stillbirth documentation seemed to weigh heavily on some of the midwives interviewed. J. M. Gardner identifies that following a stillbirth midwives endeavour to provide the mother with mementos and keepsakes.
Stained glass windows: stillbirth memories and their impact on midwives
Doreen Kenworthy, Mavis Kirkham in Midwives Coping with Loss and Grief, 2019
Many of the memories of stillbirths were recounted by the midwives in the form of pictures. Midwives are taught the importance of recording events in detail: time, place, individuals present, conversations and instructions given, and outcomes. The triggers and associations that evoked the lasting memories of the midwives varied considerably. Mementos that midwives give to mothers of stillborn babies are given in the hope that they will help the mother reconcile her ideas about what might have been with reality. Sonia and Lesley’s accounts are linked together, in that they identified with mothers of stillborn babies who were themselves midwives. The midwives had differing opinions as to whether their home was an acceptable place to discuss the ramifications of the tragic events to which they were party. Experience informed one midwife that the use of visualisation, solitude, privacy and appropriate music was effective in helping her to cope with stressful situations.
Listen to me, for we all need a degree of closure
Doreen Kenworthy, Mavis Kirkham in Midwives Coping with Loss and Grief, 2019
Some stillbirths may render the midwife professionally saddened but require no closure other than the midwife recognising that all health professionals concerned acted appropriately. In achieving closure on loss, bereaved individuals are often able to identify, on reflection, the precise time when they found that they could continue with their lives, both psychologically and socially. The individual’s ability to articulate feelings, anxieties, and fears are cited in bereavement studies as making a significant contribution to achieving a state of acceptable closure or resolution around death and loss. In the opinion of four out of the five midwives, knowing that new babies are anticipated served to aid them in finding closure on the previous stillbirth. Most of the midwives interviewed felt that they needed to talk of the reasons why the stillbirth events impacted on them in such a way as to cause emotional and physical distress.
Predictors of stillbirth among HIV-infected Tanzanian women
Published in Acta Obstetricia et Gynecologica Scandinavica, 2009
Roland Kupka, Tarik Kassaye, Elmar Saathoff, Ellen Hertzmark, Gernard I. Msamanga, Wafaie W. Fawzi
Objective. To determine maternal risk factors for stillbirth among pregnant HIV-infected women in sub-Saharan Africa. Design. Prospective cohort study nested within a micronutrient trial. At enrollment, maternal sociodemographic, obstetric, immunologic, clinical, and nutritional variables were measured. Women were followed through monthly clinic visits until delivery. Multivariate predictors of stillbirth were identified in Poisson regression models. Setting. Antenatal clinic in a tertiary care hospital in urban Dar es Salaam, Tanzania. Population. N=1,078 women enrolled between 12 and 27 weeks of gestation. Main outcome measures. Stillbirth (delivery of dead baby ≥ 28 weeks’ gestation), fresh stillbirth, and macerated stillbirth. Results. Among 1,017 singleton pregnancies, there were 49 stillbirths, yielding a stillbirth risk of 50.0 per 1,000 deliveries (95% Confidence Interval(CI) = 37.2, 65.6). Of stillbirths with known type, 53.7% were fresh and 46.3% macerated. In multivariate analyses, baseline measures of late (≥ 21 weeks’ gestation) study entry (Relative Risk (RR) = 2.13, 95% CI = 1.17, 3.87), CD3 count ≥ 1,179 cells/ml (RR = 2.15, 95% CI = 1.16, 4.01), stillbirth history (RR = 3.53, 95% CI = 1.30, 9.59), primiparity (RR = 3.65, 95% CI = 1.83, 7.29), and syphilis infection (RR = 2.06, 95% CI = 1.09, 3.88) predicted increased stillbirth risk. Late study entry, illiteracy, stillbirth history, primiparity, CD3 count ≥ 1,179 cells/ml, gonorrhea infection, and previous hospitalization predicted increased risk of fresh stillbirth, while living alone and syphilis infection predicted increased risk of macerated stillbirth. Conclusions. Applying antenatal screening and preventive tools for the socioeconomic, obstetric, immunologic, and clinical risk factors identified may assist in reducing the high incidence of stillbirth among HIV-infected women in urban sub-Saharan Africa.
Can post-mortem examination of the placenta help determine the cause of stillbirth?
Published in Journal of Obstetrics and Gynaecology, 2009
A. E. P. Heazell, E. A. Martindale
Summary Some cases of stillbirth are associated with placental abnormality; recent classification systems have included some features of placental pathology. This study aimed to determine whether placental investigations assist in determining the cause of stillbirth. A total of 71 consecutive cases of stillbirth were reviewed. Placental investigations were undertaken in 54% of cases. Women who had placental asssessment were significantly less likely to have an unexplained stillbirth (OR = 0.17; 95% CI 0.04–0.70). In 47% of cases, the findings of placental investigation were included in the classification of stillbirth. In 16% of cases the classification was determined primarily by placental examination. Some placental abnormalities found were associated with clinical causes of stillbirth, such as placental infarction and IUGR or leukocyte infiltration and chorioamnionitis (p < 0.05). We conclude that assessment of the placenta can aid classification of stillbirth and recommend that histological analysis of placental tissue be offered in all cases of stillbirth, even when full infant post-mortem is declined.
The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries
Published in Acta Obstetricia et Gynecologica Scandinavica, 2007
Robert L. Goldenberg, Elizabeth M. McClure, Carla M. Bann
Background. The objective of this study was to explore the relationship between intrapartum and antepartum stillbirths and various measures of obstetric care in developing and developed countries. Methods. For 51 countries, we obtained data about intrapartum and antepartum stillbirth rates and obstetric care measures from the World Health Organisation (WHO) and other sources. Using piecewise regression techniques, the relationships between the intrapartum and antepartum stillbirth rates and the various measures of obstetric care were determined. Results. Developed countries had lower total stillbirth rates (6.0 versus 21.3/1,000 births, p=0.0002) as well as a lower fraction of stillbirths that were intrapartum (0.16 versus 0.31, p=0.0019). Developed country antepartum stillbirth rates were 5.2 versus 14.0/1,000 in developing countries (p=0.0002). The highest antepartum stillbirth rates, all in southern Africa and Asia, ranged from 25 to 35/1,000 births. Intrapartum stillbirth rates averaged 0.9/1,000 births for developed countries compared to 7.3/1,000 in developing countries (p=0.0024), but ranged as high as 20–25/1,000 births for some countries in southern Africa and Asia. The relationship between intrapartum stillbirth and the various measures of care were generally stronger than those for antepartum stillbirth. Over the entire range of values, for each 1% increase in the percentage of women with at least 4 antenatal visits, the intrapartum stillbirth rate decreased by 0.16 per 1,000 births (p
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