OBJECTIVE: To systematically review parent experiences with hospital care after perinatal death.
DATA SOURCES: An evaluation of more than 1,100 articles from 1966 to 2006 was performed to identify studies of fetal death in the second or third trimester and neonatal death in the first month of life.
METHODS OF STUDY SELECTION: Studies were limited to those that were in English, evaluated care in U.S. hospitals, and contained direct parent data or opinions.
TABULATION, INTEGRATION, AND RESULTS: Results were compiled on five aspects of recommended care: 1) obtaining photographs and memorabilia of the deceased infant, 2) seeing and holding the infant, 3) labor and delivery of the child, 4) autopsies, and 5) options for funerals or memorial services. Sixty eligible studies with over 6,200 patients were reviewed. In general, parents reported appreciating time and contact with their deceased infant, being given options about labor, delivery, and burial, receiving photographs and memorabilia, and having appropriate hospital follow-up after autopsy.
CONCLUSION: Although care after perinatal death often adheres to published guidelines, substantial room for improvement is apparent. Parents with perinatal losses report few choices during labor and delivery and inadequate communication about burial options and autopsy results. Hospitals, nurses, and doctors should increase parental choice about timing and location of delivery and postpartum care, encourage parental contact with the deceased infant, and facilitate provision of photos and memorabilia.
Fetal or infant death is often a traumatic event for parents, and hospital care could be improved by adopting specific measures to assist grieving parents.
From the 1Department of Family Medicine and the Department of Internal Medicine, Robert Wood Johnson Clinical Scholars Program, University of Michigan; 2Department of Obstetrics and Gynecology, University of Michigan; and 3Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Dr. Gold is a Robert Wood Johnson Clinical Scholar with salary support by the Robert Wood Johnson Foundation.
The authors thank Ms. Deborah Lauseng of Taubman Medical Library for assistance in the initial search, Dr. Sanjay Saint for assistance in structuring the systematic review, and Dr. Rodney Hayward for statistical consultation and editorial review.
Corresponding author: Katherine J. Gold, University of Michigan Health System, 6312 Medical Science Building 1, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0604; e-mail: email@example.com.