Parental decision making around perinatal autopsy: a qualitative investigation.
BACKGROUND
Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth.


OBJECTIVE
This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths.


METHODS
A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011.


RESULTS
Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse.


CONCLUSIONS
Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure.
National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.
Sarah
S
Meaney
Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland.
Stephen
S
Gallagher
National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.|Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jennifer E
JE
Lutomski
Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
Keelin
K
O'Donoghue
D001291:Attitude of Health Personnel; D001344:Autopsy; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D010290:Parents / Q000523:psychology*; D066087:Perinatal Death; D011247:Pregnancy; D036301:Qualitative Research; D050497:Stillbirth / Q000523:psychology
autopsy; decision-making; qualitative; stillbirth