title: Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death.
abstract: Pregnancy after stillbirth or neonatal death is an emotionally challenging life-event for women and adequate emotional support during pregnancy should be considered an essential component of quality maternity care. There is a lack of evidence surrounding the role of UK maternity services in meeting womens' emotional and psychological needs in subsequent pregnancies. This study aimed to gain an overview of current UK practice and womens' experiences of care in pregnancy after the death of a baby.
  
  
  
  Online cross-sectional surveys, including open and closed questions, were completed on behalf of 138 United Kingdom (UK) Maternity Units and by 547 women who had experience of UK maternity care in pregnancy after the death of a baby. Quantitative data were analysed descriptively using SPSS software. Open textual responses were managed manually and analysed using the framework method.
  
  
  
  Variable provision of care and support in subsequent pregnancies was identified from maternity unit responses. A minority had specific written guidance to support care delivery, with a focus on antenatal surveillance and monitoring for complications through increased consultant involvement and technological surveillance (ultrasound/cardiotocography). Availability of specialist services and professionals with specific skills to provide emotional and psychological support was patchy. There was a lack of evaluation/dissemination of developments and innovative practice. Responses across all UK regions demonstrated that women engaged early with maternity care and placed high value on professionals as a source of emotional support. Many women were positive about their care, but a significant minority reported negative experiences. Four common themes summarised womens' perceptions of the most important influences on quality and areas for development: sensitive communication and conduct of staff, appropriate organisation and delivery of services, increased monitoring and surveillance and perception of standard vs. special care.
  
  
  
  These findings expose likely inequity in provision of care for UK parents in pregnancy after stillbirth or neonatal death. Many parents do not receive adequate emotional and psychological support increasing the risk of poor health outcomes. There is an urgent need to improve the evidence base and develop specific interventions to enhance appropriate and sensitive care pathways for parents.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK. tracey.mills@manchester.ac.uk.|Manchester Academic Health Sciences Centre, Manchester, UK. tracey.mills@manchester.ac.uk.
authors.forename: T A
authors.initials: TA
authors.lastname: Mills
authors.affiliation: Central Manchester Foundation NHS Trust, Manchester, UK.|Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ricklesford
authors.affiliation: Institute of Human Development, The University of Manchester, Manchester, UK.|Central Manchester Foundation NHS Trust, Manchester, UK.|Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: A E P
authors.initials: AE
authors.lastname: Heazell
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.|Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cooke
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.|Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Lavender
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D010290:Parents / Q000523:psychology*; D017060:Patient Satisfaction; D066087:Perinatal Death; D011181:Postnatal Care / Q000523:psychology*; D011247:Pregnancy; D011787:Quality of Health Care; D050497:Stillbirth / Q000523:psychology*; D006113:United Kingdom
keywords: Antenatal care; Maternity services; Neonatal death; Stillbirth; Subsequent pregnancy; Womens’ experiences