One of the most emotionally challenging aspects of midwifery is supporting women and families to cope with perinatal death. In January, the Lancet (2016) launched a series on ending preventable stillbirths. The five papers in the series consider global data on stillbirth and offer ‘a roadmap for eliminating, by 2030, one of the most neglected tragedies in global health today’. The series reveals wide variations in stillbirth rates owing to inequalities—not only across the world, but within high-income countries such as the UK, where the poorest families are at the highest risk. Another key message is that there is still a stigma attached to stillbirth, with parents often feeling obliged to hide their grief in public, and health professionals not always knowing how to approach the subject and support families.
In the UK, various initiatives and campaigns aim to tackle the issue of preventable stillbirth. The Royal College of Obstetricians and Gynaecologists (2015) launched the Each Baby Counts project to reduce the number of stillbirths, neonatal deaths and babies born with brain injuries. It is collecting and analysing data from maternity units throughout the UK, with the aim of improving future care. Meanwhile, the Perinatal Institute's (2016) Growth Assessment Protocol (GAP) programme helps to detect babies at risk of stillbirth because they are not growing well in the womb, and then take measures to ensure they are born safely. Largely thanks to this programme, over the last 5 years the rate of stillbirths in England has dropped to the lowest level since records began—the most significant reduction of any country in western Europe. But there is still more to be done to address preventable stillbirths in England, with 39% of Trusts yet to implement the GAP programme. This contributes to the inequalities in stillbirth rates, as a woman's access to interventions is dependent on what her local Trust offers. The Lancet series highlights the importance of skilled birth attendance and facilities, which emphasises the need for adequate investment in maternity services to ensure women and babies receive the best care.
Reducing the number of preventable stillbirths is crucial, but equally important is providing appropriate support to those women and families who experience stillbirth or neonatal death. Commenting on the Lancet series, Homer et al (2016) state that bereavement training must be included in midwifery education. They also point out that coping with stillbirth can be extremely difficult for midwives and other health professionals, and suggest that all health-care providers should have access to debriefing and professional support for themselves following a perinatal death.
Midwifery is about the start of life, but it is sadly inevitable that it sometimes involves the end of life as well. It is vital that midwives are equipped with the skills, compassion and resilience to care for families during such a distressing time. Across the UK, there are some excellent examples of specialist services providing bereavement care for families following perinatal death, but arguably this should not have to be a specialist aspect of care. All midwifery services have a responsibility to ensure they can offer appropriate bereavement support and must, therefore, be given sufficient funding and resources to provide this.