“The hardest 9 months of my life”: Parents’ experiences of care in pregnancies after perinatal loss in Australia

Abstract

Problem Pregnancy after perinatal loss is associated with increased risks of adverse psychosocial and biomedical outcomes. Background Standard antenatal care often fails to meet these parents’ needs. Aim To explore parents’ experiences of pregnancy after perinatal loss in Australia and understand the care and support they find most meaningful. Methods National cross-sectional web-based survey of parents in Australia who had experienced perinatal loss and were pregnant or had completed a subsequent pregnancy in the preceding five years. Quantitative data were analysed largely descriptively; qualitative data underwent thematic analysis. Findings Of 332 participants (97 % mothers), most experienced adverse mental health issues at least sometimes during the subsequent pregnancy (70–98 %). Most received additional or specialised care plans (74 %) and reported elements of respectful and compassionate care most-, or all of the time (73–91 %). Participants typically rated their care favourably. Most had access to medical components of care, such as an obstetrician (89 %) and additional ultrasound scans (87 %), while few reported the involvement of a specialist midwife (17 %), bereavement counsellor (23 %) or specialist antenatal classes for pregnancy after loss (5 %). Thematic analysis identified one overarching theme: recognition of the subsequent pregnancy and previous loss; and four subthemes: trusted healthcare professional in a continuity of carer model, additional care and monitoring, emotional and mental health support, and respectful communication. Discussion Recognition of the subsequent pregnancy in the context of prior loss is essential. Conclusion Improving access to integrated, trauma-informed continuity of care models may better support parents in pregnancies after loss.