Nursing care for parents who have experienced fetal demise: integrative review

Bezerra, Nycarla de Araújo; Santos, Cibelle Nayara Sena dos; Silva, Adrian Thaís Cardoso Santos Gomes da; Linhares, Francisca Márcia Pereira; Morais, Sheila Coelho Ramalho Vasconcelos

doi:10.1590/0034-7167-2022-0811

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0811 copy

Nursing care for parents who have experienced fetal demise: integrative review

Cuidado de enfermería a padres que han experimentado la pérdida fetal: revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify scientific evidence regarding nursing care for parents who have experienced grief following fetal demise.

Methods:

an integrative review of original studies was conducted across six databases. The studies were classified according to the level of evidence.

Results:

the qualitative analysis of the nine studies comprising the sample involved thematic categories, exploring the impact of perinatal loss on families, inadequate communication by healthcare professionals, and the importance of a holistic approach in care. The role of the nurse is highlighted in making a positive contribution to the team, emphasizing participation in training and the provision of essential information.

Final Considerations:

grieving affects not only family dynamics but also the social environment, emphasizing the urgency of a more empathetic and comprehensive approach. Care should be holistic, going beyond technical nursing assistance, and addressing the biopsychosocial context of the parents.

Descriptors:
Fetal Death; Bereavement; Professional Practice; Nursing Care; Review

Database	Search Strategy
PUBMED Central (PMC)	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”
MEDLINE	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”
CINAHL	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”
SCOPUS	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”
BVS LILACS	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”
Web of Science	P AND I AND Co P ALL FIELDS “Bereavement” OR “Bereavements” OR “Maternal Mourning” AND I ALL FIELDS “Professional Practice” OR “Practice, Professional” OR “Practices, Professional” OR “Professional Practices” OR “Nursing Care”OR “Nursing, Care” OR “Nursings, Care” OR “Nursing” AND Co ALL FIELDS “Fetal Death” OR “Death, Fetal” OR “Deaths, Fetal” OR “Demise, Fetal” OR “Fetal Deaths” OR “Fetal Demise” OR “Fetal Mummification” OR “Mummification Fetal”

Study and Authors	Year/ Country	Objectives	Outcomes	Level of Evidence
E1(¹⁵15 Jialu Q, Shiwen S, Mengwei W, Lu L, Sun Y, Xiaoyan Y. Preparing nurses and midwives to provide perinatal bereavement care: A systematic scoping review. Nurse Educ Today. 2021;103:e104962. https://doi.org/10.1016/j.nedt.2021.104962 https://doi.org/10.1016/j.nedt.2021.1049... ) Qian, J et al.	2021 China	Provide a much-needed and comprehensive overview of current programs for perinatal grief care education, thus laying the foundation for the development and optimization of educational programs while identifying needs for future research.	A comprehensive view of the current state of perinatal grief care education programs was presented, both in university and hospital settings. It was observed that the implementation of these programs has positive effects in assisting nurses and midwives in preparing for perinatal grief care.	I
E2(¹⁶16 Mills TA, Ayebare E, Mukhwana R, Mweteise J, Nabisere A, Nendela A, et al. Parents' experiences of care and support after stillbirth in rural and urban maternity facilities: a qualitative study in Kenya and Uganda. BJOG. 2020;128(1):101-09. https://doi.org/10.1111/1471-0528.16413 https://doi.org/10.1111/1471-0528.16413... ) Mills TA et al.	2020 Kenya / Uganda	Explore the experiences of parents in the period following the death of their baby in healthcare units in Kenya and Uganda to understand the healthcare system’s response and barriers and facilitators for effective support.	Parents were observed to describe devastating impacts and profound responses to the baby’s death. Interactions with healthcare professionals were significant influences, but deficient communication was noted. Environmental barriers and unsupportive facility practices meant that needs were often unmet.	V
E3(¹⁷17 Camacho-Ávila M, Fernández-Sola C, Jiménez-López FR, Molina JG, Fernández-Medina IM, Martínez-Artero L, et al. Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study. BMC Pregnancy Childbirth. 2019;19(512). https://doi.org/10.1186/s12884-019-2666-z https://doi.org/10.1186/s12884-019-2666-... ) Ávila MC et al.	2019 Spain	Describe and understand the experiences and perceptions of parents who have suffered perinatal death.	Parents facing perinatal loss tend to anticipate the baby’s death, often perceiving that “something was wrong with the pregnancy.” It was also evident that the shock of losing a baby and the pain of giving birth to a dead baby trigger an emotional wave in parents who feel they “had a child” and need to assign an identity to legitimize grief.	IV
E4(¹⁸18 Christou A, Alam A, Hofiani SMS, Mubasher A, Rasooly MH, Rashidi MK, et al. ‘I should have seen her face at least once’: parent’s and healthcare providers’ experiences and practices of care after stillbirth in Kabul province, Afghanistan. J Perinatol. 2021;41(9):2182-95. https://doi.org/10.1038/s41372-020-00907-5 https://doi.org/10.1038/s41372-020-00907... ) Christou A et al	2021 Afghanistan	Explore the experiences of bereaved parents and healthcare professionals in postpartum care.	Inadequate and insensitive communication and practices by healthcare professionals, including avoiding or delaying the disclosure of fetal death.	IV
E5(¹⁹19 Kalu FA, Larkin P, Coughlan B. Development, validation and reliability testing of ‘Perinatal Bereavement Care Confidence Scale (PBCCS)’. Women Birth. 2020;33(4):311-9. https://doi.org/10.1016/j.wombi.2019.07.001 https://doi.org/10.1016/j.wombi.2019.07.... ) Kalu FA et al	2020 Ireland	Develop a validated and reliable scale for perinatal grief care trust.	Hospitals were not equipped to separate women who had stillbirths and acknowledged that psychological support would be beneficial. However, the lack of trained personnel and resource constraints hindered the provision of such support.	IV
E6(²⁰20 Fernández-Sola C, Camacho-Ávila M, Hernández-Padilla JM, Fernández-Medina IM, Jiménez-López FR, Hernández-Sánchez E, et al. Impact of Perinatal Death on the social and Family Context of the Parents. Int J Environ Res Public Health. 2020;17(10):e3421. https://doi.org/10.3390/ijerph17103421 https://doi.org/10.3390/ijerph17103421... ) Fernández-Sola C et al	2020 Spain	Explore, describe, and understand the impact of perinatal death on the social and family lives of parents.	The use of the Perinatal Grief Care Trust Scale will facilitate the identification of needs and educational and support strategies to promote midwives’ knowledge and skills in supporting parents who have experienced perinatal loss. The results of these assessments will provide input for areas of education and training in grief care that need improvement to enhance midwives’ perinatal support knowledge and skills in practice.	IV
E7(²¹21 Golan A, Leichtentritt RD. Meaning reconstruction among women following stillbirth: a loss fraught with ambiguity and doubt. Health Soc Work. 2016;41(3):147-54. https://doi.org/10.1093/hsw/hlw007 https://doi.org/10.1093/hsw/hlw007... ) Golan A; Leichtentritt DR.	2016 Israel	Examine the meaning that women who have experienced the loss of a child attribute to their loss and the lost figure.	Perinatal death affects family dynamics, including a couple’s relationship, which can be strengthened or weakened. It is important for women to be informed by professionals about the loss directly and respectfully, avoiding language that minimizes the loss and may hinder attempts to forge personal meaning for it.	V
E8(²²22 Martínez-Serrano P, Pedraz MA, Solís-Muñoz M, Palmar-Santos AM. The experience of mothers and fathers in cases of stillbirth in Spain: a qualitative study. Midwifery. 2019;77:37-44. https://doi.org/10.1016/j.midw.2019.06.013 https://doi.org/10.1016/j.midw.2019.06.0... ) Martínez PS et al.	2019 Spain	Explore the experiences of mothers and fathers regarding the care received during childbirth in cases of stillbirth.	Healthcare professionals and educators need to understand the impact of this loss on family dynamics, as well as on the social and work environment, paying attention not only to mothers but also to fathers and siblings.	IV
E9(²³23 Paris GF, Montigny F, Pelloso SM. Factors associated with the grief after stillbirth: a comparative study between Brazilian and Canadian women. Rev Esc Enferm USP. 2016;50(4):546-53. https://doi.org/10.1590/S0080-623420160000500002 https://doi.org/10.1590/S0080-6234201600... ) Paris GF; Montigny F; Pelloso MS.	2016 Brazil/ Canada	Investigate the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after fetal demise.	Provides insight into the process of meaning reconstruction after fetal demise. Identifies grief after this loss as a private disenfranchised grief. To create meaning for birth-related losses, one must first understand who was lost. The results of this study also indicate that coping with loss by women is a long-term process.	V

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[1] Corresponding author: Nycarla de Araújo Bezerra, E-mail: nycarlaa@gmail.com