New care standards for bereaved parents

Bereavement teams will be placed in maternity hospitals as part of plans to overhaul the health service and make it more compassionate to pregnancy loss.

Guidelines published yesterday state that women who miscarry or have complicated or unviable pregnancies will be treated separately in waiting rooms from those expecting or with newborns.

Parents will be consulted about their preferences for stillbirths and funeral arrangements. Specialist counselling will be offered to women and their families in cases where pregnancies go wrong and every grieving mother will be offered a meeting with a midwife trained in bereavement care.

The new national standards for bereavement care following pregnancy loss and perinatal death also advise staff on what to do in cases of ectopic pregnancies, miscarriages, life-limiting conditions, stillbirths and in cases of fatal foetal abnormalities where parents choose to end the pregnancy or continue.

All maternity hospitals and units will be required to have teams of bereavement specialists to support grieving parents, families and staff involved in their care. The team will include a dedicated clinical midwife who specialises in bereavement care along with obstetricians, paediatricians, neonatologists, chaplains, social workers and palliative care staff.

There were 500 perinatal deaths in 2013, including 301 stillbirths. Each year, there are an estiamted 14,000 miscarriages in Ireland. There were 26 terminations under the Protection of Life During Pregnancy Act in 2014 and last year, while approximately 12 women a day leave Ireland for abortions abroad.

Simon Harris, the health minister, said that women in Ireland had historically not received support and care “from our health service and indeed from other parts of society”.

“I am pleased that the standards will ensure that clinical and counselling services will be in place to support women and their families in all pregnancy loss situations, from early pregnancy loss to perinatal death, as well as situations where there is a diagnosis of a life-limiting or fatal foetal anomaly,” he said.

“I am grateful to the many families who generously shared their experiences during the strategy consultation process and offered suggestions on how care could be improved.”

As part of the new standards, a symbol will be placed on wards and departments or medical files, if requested by a woman, to indicate loss or bereavement. A woman who experienced a stillbirth or perinatal death would be able to access counselling throughout any following pregnancies.

Hospitals will be required to sensitively facilitate funeral arrangements, birth options, photographs, memory boxes and keepsakes in cases of stillbirths. Staff will be committed to ensuring women do not leave the hospital alone after receiving a bad diagnosis about the viability of their pregnancy.

With the exception of cases of fatal foetal abnormalities and life-limiting conditions, all antenatal appointments will be automatically cancelled within a day of a pregnancy loss.

The guidelines also reference women who choose to travel to terminate a pregnancy after being told that there is no chance of survival.

The implementation of the guidelines will be overseen by a group chaired by Keelin O’Donoghue, a consultant obstetrician and senior lecturer at University College Cork. Dr O’Donoghue said that the new guidance was evidence of the HSE’s compassion towards women experiencing difficult pregnancies and that it would treat those who chose to terminate equally with those who decide to continue with the pregnancy.

Ciarán Browne, chairman of the standards development group, said that the new guidelines included several recommendations from two separate reports into the death of Savita Halappanavar in 2012. Mr Browne said that Ms Halappanavar and other women who had experienced maternal deaths had been “at the core” of the process of putting the new guidance together. A copy of the new standards was sent to Mrs Halappanavar’s husband Praveen.

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