Women's experiences in the hospital around the time of a stillbirth: Results from a pilot study in Georgia Open Access
Thomas, Nimmy Josephine (2017)
Abstract
Background: Qualitative studies have shown that there is insufficient support from the healthcare system for families after a recent stillbirth. The purpose of this study was to examine the prevalence of support services and clinical tests offered to families after a stillbirth and investigate whether there are differences in the receipt of these services by maternal characteristics and gestational age at delivery.
Methods: Data were analyzed from a pilot study of the expansion of the Pregnancy Risk Assessment Monitoring System (PRAMS) to include women who experienced a stillbirth in Georgia. Analyses were conducted using Fisher's exact tests and Mantel-Haenszel methods.
Results: The pilot study had an
adjusted response rate of 40% (n = 49). Most women indicated that
they were offered the opportunity to see and hold their stillborn,
but other opportunities to make memories (i.e. family photographs
with the baby, rocking, dressing, and bathing the baby) were
offered less frequently (< 50%).
The option of taking photographs of the baby with the family were
less likely to be discussed with non-white mothers (PR: 0.37; 95%
CI: 0.16 - 0.87) and mothers with stillbirths between 20 - 27 weeks
of gestation (aPR: 0.38; 95% CI: 0.16 - 0.92). Despite the fact
that women will produce breastmilk as early as 16 weeks' gestation,
women who had early stillbirths were half as likely to receive
lactation information (aPR: 0.51; 95% CI: 0.30 - 0.85). Although
most women (77.5%) reported that a fetal autopsy was offered, only
38.7% of these women indicated that an autopsy was performed (95%
CI: 21.9% - 57.8%).
Conclusions: Although this survey was conducted among a small sample of women in Georgia, these results illustrate that there are areas for improving the healthcare services women receive around the time of a stillbirth and that support services are not consistently offered to all women, particularly those who deliver a stillbirth between 20 and 27 weeks. Guidelines on stillbirth management should be updated to include information about support services and lactation information. More research is needed to better understand the circumstances surrounding the offer of a fetal autopsy, and identifying ways to improve the acceptance of these clinically-recommended evaluations.
Table of Contents
Background…………………………………………………………………………….....1 Introduction………………………………………………………………………..1
Current Guidelines for Stillbirth Management…….............2
Patient Experience……………………………………………………………..4
Clinician Experience…….…………………………………………………..10
Manuscript………………………………………………………………………….…....12 Background.………….…………………………………………...……………….14 Methods….………………………………………………………………….….......16 Results……………………………………………………………….….....…………19
Discussion……………..……………………………………………………...…….22
Conclusions……………………………………………………………………...….26
Future Directions……………………………………………………………………....32
References..………………..…………………………………………………………….34
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