Seeing and Holding Baby: Systematic Review of Clinical Management and Parental Outcomes After Stillbirth

Carol Kingdon · Jennifer L. Givens · Emer O’Donnell · Mark A. Turner

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Grief, Bereavement, and Mental Health Global Maternal and Child Health Infant Development and Preterm Care

Abstract

BACKGROUND: In 2009 there were an estimated 2.6 million stillbirths worldwide. In the United States, a 2007 systematic review found little consensus about professional behaviors perceived by parents to be most helpful or most distressing. In the United Kingdom, a bereaved parents' organization has highlighted discordance between parental views and clinical guidelines that recommend clinicians do not encourage parents to see and hold their baby. The objective of this review was to identify and synthesize available research reporting parental outcomes relating to seeing and holding. METHODS: We undertook a systematic review. We included studies of any design, reporting parental experiences and outcomes. Electronic searches (PubMed and PsychINFO) were conducted in January 2014. Three authors independently screened and assessed the quality of the studies before abstracting data and undertaking thematic analysis. RESULTS: We reviewed 741 records and included 23 studies (10 quantitative, 12 qualitative, and 1 mixed-method). Twenty-one studies suggested positive outcomes for parents who saw or held their baby. Increased psychological morbidity was associated with current pregnancy, choice not to see their baby, lack of time with their baby and/or insufficient mementos. Three themes were formulated "positive effects of contact within a traumatic life event," "importance of role of health professionals," and "impact on mothers and fathers: similarities and differences." CONCLUSIONS: Stillbirth is a risk factor for increased psychological morbidity. Parents seeing and holding their stillborn baby can be beneficial to their future well-being. Since 2007, there has been a proliferation of studies that challenge clinical guidelines recommending that clinicians do not encourage parental contact.

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2009Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement 2009Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement 2005Appraising the quality of qualitative research 2002Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study 2007Navigating care after a baby dies: a systematic review of parent experiences with health providers 2013Support for mothers, fathers and families after perinatal death 1996Psychological complications after stillbirth—influence of memories and immediate management: population based study 2012Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis

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2017Care following stillbirth in high-resource settings: Latest evidence, guidelines, and best practice points

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