Life after death: The bereavement midwife's role in later pregnancies

Milton Keynes University Hospital offers a bespoke antenatal care pathway to women who have suffered a previous loss, by offering care led by their community midwife at their GP's surgery or being offered a referral to the bereavement midwife, Tracy Rea. A benefit of choosing to see Tracy is that women will have continuity of care, thereby avoiding the need to discuss their previous obstetric history with different healthcare professionals as the pregnancy progresses. By giving women this choice they are empowered to be active partners in their care. Equally, if women choose to be cared for by their community midwives, they are reassured that they can contact the bereavement midwife at any point in the pregnancy if they need additional advice or support.

The pathway followed by the bereavement midwife is that when women contact her, Tracy asks for their date of birth and first day of their last period and then takes a full history, including discussing the plan that was agreed with them when they lost their baby. It is important the consultant plan of care for the next pregnancy is noted, to ensure they are reviewed by the appropriate health professionals as early as possible in the pregnancy, depending upon the circumstances of their previous loss. A viability scan is then arranged with the Early Pregnancy Assessment Unit (EPAU). There they will note the history, arrange the 12-week dating scan and refer the woman to the appropriate care pathway. The booking appointment is completed by the bereavement midwife, who places a SANDS teardrop sticker on the maternity notes to ensure everyone involved in her ongoing care is aware of her obstetric history. From here, the women will be seen as regularly as they wish and have shared care between the bereavement midwife and consultant. If the previous loss was due to a fetal abnormality, following a ‘normal’ 20-week anomaly scan they will continue to be cared for by the bereavement midwife.