One in 200 births in the UK ends in stillbirth, and of those, 1 in 3 occurs at term (37+ weeks' gestation). According to MBRRACE-UK (Draper et al, 2015: 7), ‘although there has been a small reduction in the stillbirth rate for the UK over the past 10 years, it remains relatively high compared to the rest of Europe and other high-income countries'. In response to the specific needs of families suffering the loss of their baby, many Trusts have introduced the role of bereavement midwife to provide a bespoke service for this vulnerable group.
In this article, bereavement midwife Tracy Rea of Milton Keynes University Hospital discusses her own experience and her teaching.
The journey to becoming a bereavement midwife: Tracy's story
As a result of a personal bereavement while pregnant with my second child, the care that I received from my midwife inspired me to become a midwife myself, in the hope that I could make a difference. It also gave me the qualification to make change. I am very proud to be a midwife and feel passionate about the care that women and their families receive.
Role and responsibilities
As infant mortality rates have only marginally reduced in the past 10 years, the Trust where I work advertised for a bereavement midwife in 2008 and I was the successful applicant. This was the perfect role for me, and I continued to develop my career by becoming a Supervisor of Midwives in 2010 and successfully completing an MSc in leadership in 2015. I have just started the V300 Nurse Prescribing module and, on completion of this module, the bereavement service I provide to women who find out their baby has died in utero could be improved as I will be able to prescribe medication, rather than asking women to wait until a doctor is available. I will also be qualified to prescribe pain relief for women in labour. This qualification will have benefits for the women in terms of enabling me to provide total holistic care throughout their emotional and often traumatic experience, and in terms of service provision my ability to prescribe will take pressure off the doctors.
Why teach?
I have a particular interest in the role of supporting both students and qualified midwives to develop their skills to care for bereaved women and their families. I have been teaching second-year students at the University of Northampton for the past 6 years around the role of the bereavement midwife and the importance of treating women and their families who have lost a baby with the care and respect they deserve. This article will focus on one such session.
The session
The session with the second-year students lasted for approximately 2½ hours. I gave a keynote lecture looking at classifications of stillbirth (Box 1) and the principles of bereavement care including causes of stillbirth, bereavement services for parents, and staff training and support. My aim was to give the students background information prior to the family arriving, with the hope that the couple's narrative of their experiences of the care they were provided with would confirm that they had received the best care possible under the circumstances.
While the keynote lecture provided students with information on the processes and procedures that should be undertaken, there is nothing more powerful than hearing the parents' perspective of what happened. Chris and Katie, who had lost their son, Stanley, wanted to speak about him so I asked if they would like to come to the university and share their story (Box 2).
In preparation for the session, the students were informed that the couple wanted them to ask questions to make the session interactive. They wanted to share as much information as possible so that when the students qualify as midwives they will have an insight into how bereaved parents feel. The couple has since gone on to have a second child, a little girl called Betsy whom they brought along to the university to introduce to the students.
The student midwives asked many questions and were interested in both the mother's and father's perspective. The information that Chris and Katie shared was invaluable as it came from their real-life experience. They had experienced difficulties with communication; for example, they had named their son Stanley and felt strongly about acknowledging his identity in the short time they had with him, but he was referred to by health professionals as ‘a baby boy’ or ‘your son’. When Stanley died, Chris and Katie spent hours with him, washing and dressing him and taking in all his features. Memories were all they were going to have, so they wanted as many as possible. They hugely appreciated the time they had with their son; however, they did not appreciate staff, family and friends telling them that they could have another baby or that it was ‘God's will’. Rather than helping them, such comments only served to make them feel angry at the injustice of their situation.
‘When Katie became pregnant again, I regularly auscultated the fetal heart… I was providing individualised, holistic care and this helped manage Katie's anxiety throughout the antenatal period’
When Katie became pregnant again, I had the privilege of sharing her care with her named consultant throughout the antenatal period. Katie also had a community midwife, so she felt reassured that she was getting the best possible care, and I met with her on a weekly basis. I regularly auscultated the fetal heart; while this is not in the current antenatal care pathway (National Institute for Health and Care Excellence, 2015), my rationale for doing so was that I was providing individualised, holistic care and this helped manage Katie's anxiety throughout the antenatal period. I also facilitated Katie's induction of labour and delivered her beautiful baby, Betsy, with no complications. Not only was this continuity of care very important to the couple, it gave me great professional and personal satisfaction.
Student evaluation
Students were asked for feedback on the session such as: what they found useful; what they found least useful; whether they were aware of the role of the bereavement midwife; what their understanding of this specialist area of practice was; and how they felt about Chris and Katie sharing their experience of the loss of Stanley.
Feedback from students was overwhelmingly positive, with all students commenting on the benefits of the session and how grateful they were that Chris and Katie shared their very personal and emotional story to benefit their education.
One student, Beth Burns, was particularly touched, saying:
‘I really struggled to write feedback as I wanted to convey how the session changed my opinion and thinking. Prior to the session, having never experienced stillbirth etc I would have empathised but I am sad to say I never truly considered the long-lasting effect of a child dying for a family. I was naïve in thinking that if a family were lucky enough to go on to have other children then this would heal the heartache. To explain how much I felt I had learnt from the session, I have written a poem (Box 3) to show how I now see a mother in this position from their perspective. I hope this will help you to understand how useful, and invaluable the lecture was.’
Summary
It is clear that Tracy's session with personal accounts from Katie and Chris had a profound impact on the second-year student midwives' knowledge and understanding of the important role of the bereavement midwife. It gave students an invaluable insight into the experiences of a couple who had suffered the loss of a child and, upon hearing their story, deep learning and reflection took place. The power of bringing real-life experiences into the classroom should not be underestimated, and huge thanks go to Chris, Katie, Stanley and Betsy for their courage and altruism to share their story for the benefit of the midwives and bereaved families of the future. BJM