Having challenging conversations after stillbirth

In Australia, hospitals vary in the bereavement support services offered to parents after stillbirth, with limited evidence of their effectiveness, particularly from a parent perspective. Research has found that one key, and often challenging, part of providing care to families at this time is undertaking investigations to understand why their baby died. This is vital in helping parents recover and to inform future pregnancy planning.

Having conversations with families following a stillbirth is incredibly challenging and, in rural areas, may be something that healthcare workers are infrequently exposed to. It may also mean that resources are scarcer and there may not be designated healthcare professionals available to have these conversations.

Feeling supported and empowered to undertake the many facets of work in rural areas is crucial to attracting and retaining staff. That is why Red Nose, in partnership with The Stillbirth CRE and The Stillbirth Foundation, have developed resources to not only better support parents when making decisions around autopsy and investigations, but to assist healthcare workers when having these conversations.

Optimal investigation of stillbirth relies on parents being fully informed of their options, understanding the process and being provided with opportunities to process information and for healthcare professionals to understand and implement the best practice recommendations. These resources will:

• give healthcare professionals a framework to guide these conversations and help them better understand the process from a parent perspective
• assist and empower parents in their decision-making process
• promote shared understanding and decision making between parents and their care team.

Our aim is to not only ensure parents have access to these resources – no matter where they experience a stillbirth – and make them available in all maternity hospitals, but for these resources to also help health professionals get more comfortable sitting in the discomfort of these challenging situations.

The resource comprises two brochures, one specifically developed for the Indigenous community. They have also been translated into a number of languages.

The brochures encourage parents to think about what’s important to them after a stillbirth and encourages families to ask questions of their healthcare team and write down the things of importance.

A QR code takes parents to the Red Nose web page. Here they can watch two videos. The first is an animation with voice over and subtitles. It contains comments from parents from diverse cultures and backgrounds discussing why they made the decisions they did. It contains varied perspectives from different cultures and religions.

The second video is from a perinatal pathologist and a perinatal-loss midwife. They discuss the different types of autopsy and investigations and the support they provide. On this page there is also a link to the Guiding Conversations resource.

We acknowledge that:

• Making decisions following a stillbirth is incredibly challenging.
• Parents need to feel supported and empowered to make decisions around autopsy, and other investigations, that are best for them.
• Parents need time and space to make decisions.
• Health professionals feel a level of discomfort having these conversations with families who are experiencing acute grief.

Ensuring workers have the tools and knowledge to support them in their work is crucial in developing confidence and high work morale. This will, in turn, assist regional and remote hospitals to retain and attract workers. We hope these resources will not only ensure parents are supported in the best way possible at this incredibly difficult time but that rural workforces will feel supported in their ability to have these conversations.

Thank you to the Australian Government Department of Health and Aged Care who funded this project.