Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study.
BACKGROUND
Most maternity units have good practice protocols, advising that after stillbirth parents should be encouraged to see and hold their dead infant. Our aim was to assess whether adherence to these protocols is associated with measurably beneficial effects on the psychological health of mother and next-born child. This study forms part of a wider case-control study of the psychological effects of stillbirth.


METHODS
We identified 65 women in the pregnancy after stillbirth, and enrolled matched controls for 60 of them. Outcome measures included depression, anxiety, and post-traumatic-stress disorder (PTSD) in pregnancy and 1 year after the next birth, and disorganised attachment behaviour in the next-born infant. Comparison variables included seeing and holding the stillborn infant, having a funeral, and keeping mementoes.


RESULTS
Behaviours that promote contact with the stillborn infant were associated with worse outcome. Women who had held their stillborn infant were more depressed than those who only saw the infant, while those who did not see the infant were least likely to be depressed (13 of 33, 39%, vs three of 14, 21%, vs one of 17, 6%; p=0.03). Women who had seen their stillborn infant had greater anxiety (p=0.02) and higher symptoms of PTSD than those who had not (p=0.02), and their next-born infants were more likely to show disorganised attachment behaviour (18 of 43, 42%, vs one of 12, 8%, p=0 x 04). Having a funeral and keeping mementoes were not associated with further adverse outcomes, but small numbers limited interpretation.


CONCLUSIONS
Our findings do not support good-practice guidelines, which state that failure to see and hold the dead child could have adverse effects on parents' mourning.
Department of Psychiatry, St George's Hospital Medical School, London SW17 0RE, UK. p.hughes@sghms.ac.uk
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Hughes
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Turton
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Hopper
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Evans
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D006117:Grief; D006801:Humans; D017410:Practice Guidelines as Topic; D011610:Psychosocial Deprivation