Breaking Bad News to Pregnant Mothers Experiencing Stillbirth: Reporting a Gap in Practice

Abstract

Dear Editor, Human beings have always expected good news upon the pregnancy of a dear member of their family, together with both midwives and physicians. Unfortunately, not all pregnancies lead to good news, such as a normal childbirth or the birth of a healthy baby. Stillbirth gives rise to social, psychological, and physical challenges.[1] Both parents often experience grief, anxiety, fear, and suffering. Tolerance of bad news may be less agonizing if, thanks to ultrasound technology, fetal abnormalities are detected before childbirth and even during the early phases of gestation; timely interventions and treatment can then be conducted.[2] Among the undesirable news such as genetic defects, abnormalities, and abortion, the most painful and unexpected news may be the stillbirth, particularly a late stillbirth or a term stillbirth. Therefore, breaking the news of fetal death requires a sensitive approach and empathetic communication toward the affected parents.[3] The way mothers respond to these events and the loss of their babies can be a function of how nurses, midwives, and obstetricians/gynecologists treat the stillbirth. Maternal responses may vary from severe (but short-lived shocking) reactions to long periods of depression, all requiring trained and highly skillful personnel to take interventional measures before breaking the painfully unexpected news. Reports from diverse centers suggest that despite studies on breaking bad news and relevant consequences, training the target group of healthcare providers has received less attention and that practical steps are required to provide psychiatric counseling to mothers experiencing stillbirth. The training may be conceived of two stages: a course for the healthcare providers for their presence in labor, delivery, and recovery and another course for post-op counselors who are expected to follow-up with the mourning mother after recovery. Various protocols including Spikes, Breaks, ABCD, Connect, and Sunburn can be widely used to break bad news. To sum up, preparation for a secure, convenient, and relaxing environment, concentration on what the mourning mother may wish to express, breaking the bad news into smaller fragments, responding to their feelings, and relying on empathy rather than sympathy are some practical pieces of advice. Training the human elements and research on preservice and in-service training may enrich our corpus of case studies. The role of the family is also very important. Family members are in a better position to judge and make decisions, and it is easier for physicians to communicate with them. Financial support and sponsorship Nil. Conflicts of interest Nothing to declare.

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