Improving parents’ experiences of care and support following stillbirth: a review of reviews

Introduction
We conducted a systematic review of reviews to synthesise evidence relating to improving parents’ experiences of care and support following stillbirth.

Material and Methods
Publications were eligible for inclusion if they used a structured approach (i.e. had an explicit search strategy and defined inclusion/exclusion criteria) and included primary studies related to parents’ experiences of care and support following stillbirth of a single fetus. Searches of 13 electronic databases and the websites of SANDS and the International Stillbirth Alliance were conducted in September 2016. Two reviewers screened records independently. Reviews were critically appraised using the ROBIS tool and data relevant to care and support following stillbirth were extracted by one reviewer and checked by a second reviewer.

Results
The search produced 10,278 original records and 10,198 were excluded. The full texts of 82 papers were screened (two titles were unobtainable) and 17 reviews were included. Three reviews included health care staff as well as parent participants. Four of the reviews included qualitative studies only, three included controlled trials only and 10 included a range qualitative, quantitative and mixed methods studies. The included studies in the reviews were predominantly from high income countries with only one study from a low income country.
Three key themes reported in the included reviews were: general experiences of care and support for bereaved parents; choices and decision-making; interactions with healthcare professionals, and the effectiveness of specific interventions. While there were mixed experiences of care and support many women felt unsupported and ignored and would have liked more emotional support, support that was tailored to their individual needs, and continuity of care especially between hospital and community.
In terms of decision-making the most common theme was about the option for parents to have contact (seeing and holding) with their baby and memory-making. Other choices related to options for the birth, such as timing of induction and pain relief, post-mortem, and burial. Parents appreciated clear, sensitive information about options, presented in more than one format, with time for both parents to process the information. There was evidence that interactions with health professionals have a memorable impact on parents. Positive behaviours included staying with parents, supporting them to express concerns, treating babies as if they are alive, and honest and clear communication. There was clear need for ongoing and consistent training for health professionals to improve support offered.
Generally, there was a lack of robust evidence examining effectiveness of interventions. When trial evidence was available, e.g. for counselling interventions, results were mixed. More promising interventions appear to be those with multiple components that simultaneously target psychological, social and practical issues.