What are the recommended steps for managing a patient who has experienced a stillbirth in terms of physical and emotional support?

Managing a patient who has experienced a stillbirth involves both physical and emotional support, with a focus on sensitive communication and informed decision-making ¹,³.

• Physical Management:
  • In the event of an intrauterine fetal death, offer support to help women and their partners and family cope with the emotional and physical consequences ¹.
  • If the woman is physically well, her membranes are intact, and there is no evidence of infection or bleeding, discuss options for birth, including expectant management, induction of labour, or caesarean birth, respecting her decision ¹.
  • If there is evidence of ruptured membranes, infection, or bleeding, offer immediate induction of labour or caesarean birth ¹.
  • If induced labour is chosen, provide one-to-one midwifery care during labour and birth, with monitoring of uterine contractions (preferably manual assessment) ¹.
  • For induced labour, offer oral mifepristone followed by vaginal dinoprostone or oral/vaginal misoprostol, or a mechanical method, based on clinical circumstances and national protocols ¹.
  • For women with a previous caesarean birth, discuss methods of induction to enable an informed decision ¹.
• Emotional and Psychological Support:
  • Offer information about specialist support ¹.
  • Treat all women with dignity and respect, acknowledging that reactions to pregnancy loss vary ³. Provide information and support sensitively, considering individual circumstances and emotional responses ³.
  • Healthcare professionals and non-clinical staff (e.g., receptionists) should receive training in sensitive communication and breaking bad news ³.
  • Provide the woman and, with her consent, her partner, specific evidence-based information in various formats throughout her care ³.
  • Discuss options for seeing a photograph of the baby, having mementos, seeing the baby, or holding the baby with the woman, her partner, and family ⁴. This discussion should occur before delivery if the baby's death in utero is known, and continue after delivery if needed ⁴.
  • This process should be facilitated by an experienced practitioner, and a follow-up appointment in primary or secondary care should be offered ⁴.
  • For women who develop post-traumatic stress disorder (PTSD) resulting from a stillbirth, offer a high-intensity psychological intervention such as trauma-focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR) ⁴.