Stillbirth : a psychosocial crisis
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University of Cape Town
This study is an investigation of the psychosocial trauma of stillbirth and the implications of that trauma for case management. Stillbirth is considered a crisis for parents that calls for immediate intervention and constructive management. It strains family coping mechanisms and can overwhelm them if not properly handled. Additionally, a grief response follows a stillbirth which must be recognised, accepted, and treated therapeutically if needed. Parents' problems and needs have not been adequately met by medical, social or community services. There is also little recognition of the training needed by medical personnel in the management of stillbirths. Stillbirth is also a crisis for medical personnel as the delivery of a dead baby evokes feelings of confusion and stress for those dealing with the confinement and aftercare. By highlighting the psychological and emotional sequelae of stillbirths for parents, the needs of parents after the event, and the needs of personnel providing care, the writer intended to contribute to an improved understanding of the issues related to stillbirth and, ultimately, to more compassionate care for those who experience this unhappy event. Issues analyzed and recorded are as follows: The emotional and physical reactions of mothers following a stillbirth; the assistance that parents need in order to adjust constructively; the impact that the stillbirth has upon the family; the mothers' interpretation of their management in hospital; and the hospital and community services rendered and needed to assist with constructive adjustment. Study data was collected over a six month period. Subjects were selected from one hospital and were residents of the municipal areas of Cape Town. Two face-to-face interviews were conducted with each respondent using a semi-structured interview schedule. The first interview, which took place within a week of the mothers' discharge from hospital, gathered data on the reactions of the respondents to stillbirth, the impact of stillbirth on the family, and respondents' interpretation of their management in hospital. This interview was tape-recorded. The second interview followed the interview schedule and obtained information on the needs of families after a stillbirth. Data was coded on the interview schedules and statistical analysis was done by computer. The findings of this study agreed with previous ones, that mothers display typical grief reactions after a stillbirth. The stillbirth was experienced as a disappointment that caused significant distress for the majority of mothers. Management was found to be satisfactory with the exception of post-natal placement. The need for options in this area became evident. A lack of social and psychological services, both within the hospital and in the community, was found. Using knowledge gained from this study, a support organization for parents experiencing stillbirths has been organized with the writer's assistance. A breakdown in communication between the hospital and the local authority health nursing services, in terms of knowledge about the stillbirth, was apparent, and improvement in this area is needed. Recommended guidelines for management based on the research findings and literature review have been proposed. The role of the social worker, doctor and nursing sister have been outlined.
Friedlander, A. 1986. Stillbirth : a psychosocial crisis. University of Cape Town.