Does poor communication contribute to stillbirths and infant deaths? A review.
BACKGROUND
Assessors from the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) have cited poor communication as a contributory factor in a proportion of such deaths. This review assesses what research evidence exists to support or explain this.


METHODS
A structured review was carried out, including all studies of sub-optimal care in stillbirth or infant death and studies of litigation in perinatal care. The following databases were searched: MEDLINE, PsycLIT, The Cochrane Library, BIDS Science and Social Science Citation Indexes, Cinahl and Embase. For included studies, information was extracted on the type of study, the selection criteria and number of cases studied, other methods used and results relevant to the question.


RESULTS
One hundred and four studies of potential relevance to the review were identified. Of these, 52 did not meet the inclusion criteria and were excluded. Of the remaining 52 studies, 11 considered communication failure explicitly as a factor in sub-optimal care leading to stillbirth or infant death. In three out of the four studies that presented their findings in terms of numbers of cases, communication failure was noted in between 24 and 29 per cent of cases. There was some consistency across different types of study in the types of communication problems noted.


CONCLUSIONS
Poor communication may contribute to a proportion of stillbirths and infant deaths. However, given the small number of papers that looked explicitly at poor communication as a factor in sub-optimal care and the lack of comparative information on communication in cases that do not end in poor outcome, caution is needed in drawing conclusions based on the findings of these papers.
Rowe
R E
RE
National Perinatal Epidemiology Unit, Institute of Health Sciences, Headington, Oxford. rachel.rowe@perinat.ox.ac.uk
Garcia
J
J
Macfarlane
A J
AJ
Davidson
L L
LL
D003142:Communication; D005069:Evaluation Studies as Topic; D005260:Female; D005313:Fetal Death; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007400:Interprofessional Relations; D008427:Maternal Health Services / Q000592:standards*; D010349:Patient Compliance; D011247:Pregnancy; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D006113:United Kingdom / Q000453:epidemiology