Care in a time of loss and pain

A nurse/midwife is undertaking a study to help midwives improve their support for women who experience miscarriage or stillbirth. 

Louise Harper, clinical nurse specialist at Genea in Port Macquarie and resource midwife on the area hospital’s miscarriage and stillbirth program, has seen the devastation caused to women and families who experience the loss of a baby in the late stages of pregnancy or through stillbirth.

Caring for a couple that has just experienced a pregnancy loss can also be traumatic for health professionals, who are often at a loss as for what to say. This, Harper explains, can at times lead to uncomfortable situations or comments.

Although midwives and doctors are provided with guidelines, pathways and resources to follow in the case of a late-stage miscarriage or stillbirth, cases are still occurring where their actions may be seen as inappropriate or uncaring.

Harper highlights a recent example, where parents of a full-term stillborn baby were presented with a “congratulations on the birth of your baby” cot card. In another instance, items routinely given to the families of live babies, such as library books and nappy rash lotion, were left under the cot used by the family of a 22-week stillborn baby.

“To truly understand and therefore demonstrate appropriate respect for these babies and provide excellent care to these women … we must investigate this area and loss further, as currently a disparity does exist between care provided and the needs of these women and families,” Harper recently told a Fertility Society of Australia conference in Sydney.

To enable higher quality, more sensitive care, Harper believes education for and engagement with healthcare professionals is paramount. She confirms this should be aimed primarily at midwives, but not exclusively.

“This [should include] education and support in ensuring the environment is appropriate, that cultural needs are considered, that bereavement support is arranged and guidance in the collection of mementos is provided in a sensitive, individualised manner,” she says.

To help with this, Harper is leading a study to explore the needs of women and their partners who have experienced a late miscarriage or stillbirth. Ten families were invited to be interviewed and to share their personal experience.

The recorded interviews will be de-identified and, with permission, used as a resource to facilitate forums with local midwives. Harper hopes sharing these narratives can lead to midwifery care that is more sensitive to the needs of these women and their families.

“Midwives need to provide care in an emotionally competent and respectful manner, and there is currently little knowledge of local women’s needs, their experiences of care following the loss of their baby and how midwives might best meet their needs,” Harper says. “What’s missing is the power of those women’s words, so we need to hear their experience and voice. I think the power [of these women’s voices] will have a much stronger impact than any in-service I could provide.”

The hope is that through this process, midwives will develop further mindfulness and awareness of how far-reaching their actions and words are in influencing memories of this time.

“[These families] are missing a lifetime,” Harper says. “We only get one go at this. If you have a well baby and you don’t get photos of the baby’s first bath, well, you can do it tomorrow, who’s going to know. [But] with these babies, we have them for 24 to 48 hours, or however long, and what you miss you can’t go back and do again.”

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“Every life counts, no matter how gentle or brief its whisper. Perhaps those babies are like stars in the day time – they are still there – we just can’t see them.” – Author unknown

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