title: Care in subsequent pregnancies following stillbirth: an international survey of parents.
abstract: OBJECTIVE
  To assess the frequency of additional care, and parents' perceptions of quality, respectful care, in pregnancies subsequent to stillbirth.
  
  
  METHODS
  Multi-language web-based survey.
  
  
  METHODS
  International.
  
  
  METHODS
  A total of 2716 parents, from 40 high- and middle-income countries.
  
  
  METHODS
  Data were obtained from a broader survey of parents' experiences following stillbirth. Data were analysed using descriptive statistics and stratified by geographic region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth.
  
  
  METHODS
  Frequency of additional care, and perceptions of quality, respectful care.
  
  
  RESULTS
  The majority (66%) of parents conceived their subsequent pregnancy within 1 year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographic regions. Care addressing psychosocial needs was less frequently provided, such as additional visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared with parents whose stillbirth occurred at ≤ 29 weeks of gestation, parents whose stillbirth occurred at ≥ 30 weeks of gestation were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making.
  
  
  CONCLUSIONS
  Greater attention is required to providing thoughtful, empathic and collaborative care in all pregnancies following stillbirth. Specific education and training for health professionals is needed.
  
  
  CONCLUSIONS
  More support for providing quality care in pregnancies after stillbirth is needed.
  
  
  CONCLUSIONS
  Study rationale and design More than two million babies are stillborn every year. Most parents will conceive again soon after having a stillborn baby. These parents are more likely to have another stillborn baby in the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died.
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.|International Stillbirth Alliance, Bristol, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|School of Public Health, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: F M
authors.initials: FM
authors.lastname: Boyle
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: J M
authors.initials: JM
authors.lastname: Belizán
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Umamanita, Girona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cassidy
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Umamanita, Girona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Cassidy
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Department of Obstetrics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Jjhm
authors.initials: J
authors.lastname: Erwich
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|University of British Columbia, Vancouver, BC, Canada.|Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, BC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Farrales
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Hannover Medical School, Hannover, Germany.|Zurich University of Applied Sciences, Institute for Midwifery, Winterthur, Switzerland.
authors.forename: M M
authors.initials: MM
authors.lastname: Gross
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK.|St Mary's Hospital, Central Manchester University Hospitals, NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Aep
authors.initials: A
authors.lastname: Heazell
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.|International Stillbirth Alliance, Bristol, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Leisher
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Mills
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|School of Nursing and Midwifery, University College Cork, Cork, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Murphy
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Karolinska University Hospital, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Pettersson
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ravaldi
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Era en Abril, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Ruidiaz
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Academic Centre for Women's Health, University of Bristol, Bristol & Southmead Hospital, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|University of Utah Health Sciences Center, Salt Lake City, UT, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Silver
authors.affiliation: International Stillbirth Alliance, Bristol, UK.
authors.forename: C
authors.initials: C
authors.lastname: Storey
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy.|Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vannacci
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Middleton
authors.affiliation: International Stillbirth Alliance, Bristol, UK.|Griffith University and Gold Coast University Hospital, Gold Coast, Qld, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Ellwood
authors.affiliation: Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia.|International Stillbirth Alliance, Bristol, UK.
authors.forename: V
authors.initials: V
authors.lastname: Flenady
mesh_terms: D000328:Adult; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care; D050497:Stillbirth / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Epidemiology; management; psychosocial/psychology; recurrence; stillbirth; subsequent pregnancy