title: Parents' experiences of midwife-managed care following the loss of a baby in a previous pregnancy.
abstract: OBJECTIVE
  This article reports on research that explored the impact of the Special Delivery Service, a midwife-managed intervention, developed as an addition to routine care to support and educate high-risk pregnant women and their partners subsequent to the death of a baby in a previous pregnancy.
  
  
  BACKGROUND
  Approximately 40,000 families suffer the trauma of a neonatal death* annually in the USA, while statistics for Canada and Australia give similar numbers relative to population. Since many more babies die than those accounted for in these statistics, through stillbirth, miscarriage and Sudden Infant Death Syndrome, more than the above-cited 2% of childbearing couples will face the trauma of the loss of a baby.
  
  
  BACKGROUND
  The resultant threat that this situation may pose to the health of the mother has been extensively documented in the literature. However, despite the recent growth in knowledge about the impact of perinatal loss and bereavement, few interventions are specifically designed to support Australian and Canadian women and their partners during a pregnancy following the loss of a baby.
  
  
  METHODS
  This phenomenological study explored women's and their partners' experiences of grief and loss and the support offered to them through the Special Delivery Service programme.
  
  
  CONCLUSIONS
  In the face of funding and organizational changes to both the Australian and Canadian health care systems that have eliminated or reduced some services, this research reinforced the need for individualized, compassionate midwifery care and the urgent need for genuinely empathic and supportive health care services for these women and their partners. It also emphasized the need for couples to be informed and supported so that gender differences in grieving do not become a divisive element in the relationship.
  
  
  CONCLUSIONS
  The findings have implications for both nurses and midwives in their practice in countries where optimum care of this vulnerable population is not routinely available. The research supports midwife-managed models of care to ensure women and their families are appropriately supported in crisis. The findings provide insight also into the diverse grief response among couples and the difficulties experienced in a pregnancy following the loss of a baby.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Canada. kate.caelli@ualberta.ca
authors.forename: Kate
authors.initials: K
authors.lastname: Caelli
authors.forename: Jill
authors.initials: J
authors.lastname: Downie
authors.forename: Angeline
authors.initials: A
authors.lastname: Letendre
mesh_terms: D001293:Attitude to Death; D005260:Female; D005313:Fetal Death; D006117:Grief; D006293:Health Promotion; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services; D009721:Nurse Midwives; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D012944:Social Support