Improving care in pregnancies after perinatal loss: A national survey of maternity services in Australia

Abstract

Problem Pregnancy following perinatal loss is associated with significant parental anxiety and potential increased risks of adverse perinatal outcomes. Background Standard antenatal care often fails to meet the needs of these families. As care provision varies widely across services, the most effective care model remains unclear. Aim To gain an overview of current pregnancy after perinatal loss practice across Australian maternity services. Methods National web-based survey administered to hospital-based maternity services, completed by a senior clinician or administrator from each service. Data were analysed descriptively. Findings Sixty-one maternity services responded. Obstetrician involvement was the most consistent element of care, reported “always” by 83 % of services and “sometimes” by 17 %. Specialist midwives were absent in 51 % of services, and 70 % did not offer antenatal classes for pregnancy after loss. While 44 % of services had a written policy/guideline for pregnancy after loss care – which appeared to emphasise medical over psychosocial care – 77 % lacked a dedicated model or specialised service. The most common barrier to providing pregnancy after loss care was the absence of a specialist bereavement role (52 %), with only 7 % reporting a lack of support from clinical staff. Discussion Despite high levels of clinician support for better meeting the needs of women during pregnancies after perinatal loss, dedicated services were infrequently reported and appeared to focus on medical components of care over psychosocial support. Conclusion Addressing policy, administrative, and workforce barriers may be an important step towards improving care for women and families during pregnancies after perinatal loss.