Support in the community
Aim to keep ongoing clinical and emotional care of the family at the centre, during and following handover from secondary to primary care and ensure families have the emotional support they need.
Families tell us they get lost between services and that their expectations about follow on appointments, review and further support are not met.
What do we need to do?
- On hearing of the stillbirth, the GP (or duty doctor/practice manager) should send a letter expressing sorrow and offer an appointment.
- The loss should be coded in the GP notes and references to an ongoing pregnancy cancelled.
- Carefully share information between the community midwife, GP and health visitor (if involved) with the family’s key contact acting as coordinator.
- Ensure primary care staff are aware of the timing of and outcomes from clinical follow up and the Perinatal Mortality Review.
- Arrange a clear final handover from the obstetric and community midwifery teams to primary care teams and make sure the family know who to contact from this point onwards.
- Ensure you and your colleagues are aware of the types of bereavement support available from local organisations and provide details as appropriate.
- At the GP follow up:
- pay attention to the mother’s physical and emotional wellbeing as well as providing routine follow up for the mother
- arrange follow up care for her partner.
- At the obstetric follow up:
- discuss care for potential future pregnancies and what, if anything, can be done to reduce risk
- make sure families know who to contact for a preconception discussion.
- Offer referral for specialist psychological support if there are signs that might indicate PTSD or clinical depression, and, if appropriate, for mental health assessment for parents and/or siblings.
- Consider NICE guidance QS115 on antenatal/ postnatal mental health and SIGN guidance 127 on perinatal mood disorders.
Clinical follow up
- Check that the family have received an appointment for clinical follow up. Help them consider questions they want to ask before their follow up appointment. Remind parents what the follow up does and does not cover, and who can attend.
Perinatal Mortality Review
- Key contact should confirm parents’ wishes about having their questions answered in the review. Prompt parents to think about their questions and comments beforehand. A form to help parents do this is available from the Parent Engagement Materials on the Perinatal Mortality Review Tool (PMRT) website.
- Check whether and how they want to be informed of the outcomes of the review of their baby’s death.
- Ensure the review looks at parents’ clinical and emotional care, and covers the whole pathway of care, both antenatal and postnatal, with input from community healthcare professionals.
There are people that slip through the net – when you leave the hospital, you might not read the bereavement pack.
Once the shock and numbness wears off, then you are so vulnerable – not ready to leave the house or share your story.
We got a lot of written information, and you need verbal explanation as well. If no one follows up, you are left to it. You leave the hospital with a memory box and have nothing, no other contact. You are forgotten about and already feeling so isolated.
How will we know we have achieved our aim?
Families tell us they knew who had responsibility for their bereavement care after they left hospital and felt confident about the support available to them.
Staff will say they feel confident and competent coordinating care and support, sharing information and referring families for support.