{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T03:11:18Z","timestamp":1784430678644,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,7,31]],"date-time":"2017-07-31T00:00:00Z","timestamp":1501459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004922","name":"North Bristol NHS Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004922","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011243","name":"Stillborn and Neonatal Death Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To understand challenges in care after stillbirth and provide tailored solutions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multi\u2010centre case study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three maternity hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Parents with a stillborn baby, maternity staff.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thematic analysis of parent interviews and staff focus groups and service provision investigation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>1 Themes; 2 Triangulation matrix; 3 Recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010one women, 14 partners, and 22 staff participated.<\/jats:p><jats:p><jats:italic>Service Provision<\/jats:italic>: Care for parents after stillbirth varies excessively; there are misconceptions; post\u2010mortem does not delay follow\u2010up.<\/jats:p><jats:p><jats:italic>Presentation<\/jats:italic>: Women \u2018do not feel right\u2019 before stillbirth; their management is haphazard and should be standardised.<\/jats:p><jats:p><jats:italic>Diagnosis<\/jats:italic>: Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well\u2010designed bereavement space is critical.<\/jats:p><jats:p><jats:italic>Birth<\/jats:italic>: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies.<\/jats:p><jats:p><jats:italic>Post\u2010mortem<\/jats:italic>: Parents are influenced by discussions with staff. Staff should \u2018sow seeds\u2019, clarify its respectful nature, delineate its purpose, and explain the timescale.<\/jats:p><jats:p><jats:italic>Follow\u2010up<\/jats:italic>: It is not standardised; parents wish to see their multi\u2010professional team.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision\u2010making. Every bereaved parent is entitled to good, respectful care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Care too varied &amp; interactions often insensitive after stillbirth; national pathway &amp; training urgently needed<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:sec><jats:title>Why and how was the study carried out?<\/jats:title><jats:p>Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care.<\/jats:p><jats:p>At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty\u2010five parents of 21 babies agreed to participate. Twenty\u2010two obstetricians and midwives took part in focus group discussions.<\/jats:p><\/jats:sec><jats:sec><jats:title>What were the main findings?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Some women reported they did not \u2018feel right\u2019 before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>After it had been confirmed that the baby had died, staff focussed on the mothers\u2019 needs, but the parents\u2019 priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Staff influenced parents\u2019 decisions about post\u2010mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>After discharge from hospital, there was no consistent plan for how follow\u2010up care would be given. Parents would have liked more information about their next hospital appointment.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>What are the limitations of the work?<\/jats:title><jats:p>The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally.<\/jats:p><\/jats:sec><jats:sec><jats:title>What is the implication for parents?<\/jats:title><jats:p>Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single\u00a0parent is treated respectfully and participates in decision making.<\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1471-0528.14765","type":"journal-article","created":{"date-parts":[[2017,7,31]],"date-time":"2017-07-31T06:32:41Z","timestamp":1501482761000},"page":"160-170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["All bereaved parents are entitled to good care after stillbirth: a mixed\u2010methods multicentre study (<scp>INSIGHT<\/scp>)"],"prefix":"10.1111","volume":"125","author":[{"given":"D","family":"Siassakos","sequence":"first","affiliation":[{"name":"Centre for Academic Women's Health Chilterns, Women's Health, Southmead Hospital University of Bristol Westbury on Trym Bristol UK"},{"name":"International Stillbirth Alliance Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Jackson","sequence":"additional","affiliation":[{"name":"Psychology Department University of the West of England Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Gleeson","sequence":"additional","affiliation":[{"name":"University of Surrey Guildford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Chebsey","sequence":"additional","affiliation":[{"name":"Severn Deanery, Health Education England Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Ellis","sequence":"additional","affiliation":[{"name":"Severn Deanery, Health Education England Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Storey","sequence":"additional","affiliation":[{"name":"Centre for Academic Women's Health Chilterns, Women's Health, Southmead Hospital University of Bristol Westbury on Trym Bristol UK"},{"name":"International Stillbirth Alliance Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the INSIGHT Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,31]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"ManktelowBN SmithLK SeatonSE Hyman\u2010TaylorP KurinczukJJ FieldDJ et al.MBRRACE\u2010UK perinatal mortality surveillance report: UK perinatal deaths for births from January to December 2014. 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