The challenge

Perinatal loss is a complex and painful experience with physical, psychological and social impacts. Appropriate perinatal bereavement care can benefit bereaved parents and reduce further distress. Poor training can impact healthcare professionals at a personal and professional level. Healthcare professionals have reported poor preparation to care for bereaved parents. High-quality perinatal bereavement care training for all maternity staff is essential.

The availability of specialist training on bereavement care for healthcare and, especially, maternity staff is limited. Furthermore, studies have shown that training in bereavement care lacked completeness as it did not address the emotional demands of care and the personal facets of the job for healthcare staff. 

The Irish National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death were developed and launched in 2016 and revised in 2022. These Standards recognise the importance of perinatal bereavement care training for professionals in the healthcare context. There was a clear gap in training in this field in Ireland where perinatal bereavement care was generally not adequately covered in the education of healthcare professionals and where specialised programmes on bereavement care were scarce.

Our work

We developed, piloted, evaluated the multidisciplinary, interactive TEARDROP (Teaching, Excellent, pArent, peRinatal, Deaths-related, inteRactions, tO, Professionals) workshop to address the educational needs of all health professionals involved in maternity and neonatal care in managing perinatal death and pregnancy loss. The workshop is based on the Irish National Bereavement Standards for Pregnancy Loss and Perinatal Death and members of the National Oversight Group for the Implementation of the Standards were involved in its development.

The aim was to provide the teaching in blended multidisciplinary groups and to establish a consistent, hospital-wide compassionate culture by all staff caring for bereaved parents in maternity settings.

The workshop consists of six interactive 30-minute stations using an internationally-recognised teaching style (SCORPIO method) which is frequently used in the Maternity setting for multidisciplinary team learning. Each small multidisciplinary group of participants (seven people) rotates through all six stations. Topics covered include: Communication, Investigation and Management, Perinatal Pathology, Fatal Fetal Anomalies, Pregnancy after Loss, and Risk Factors, Audit and Reporting. Each station is facilitated by 2-3 members of the multidisciplinary bereavement team at Cork University Maternity Hospital (CUMH).

Our impact

From 2020 to 2022, the TEARDROP workshop was delivered four times, to 150 members of staff across the South / South West Hospital Group (Table 1).

The first (pilot) workshop took place at CUMH on the 9^th August 2019. It was attended by 42 members of staff from midwifery, obstetrics and allied health professions. The second workshop took place in January 2020 and was opened to all staff from the four maternity units in the South/ SouthWest Hospital Group. Due to the COVID-19 pandemic and ongoing public health restrictions, no further workshops were held until 2022, when two workshops were held.

Table 1. TEARDROP Workshops 2019-2022

The pilot and first TEARDROP workshop were evaluated; the paper was published in the journal Midwifery in March 2021. Overall, participants were highly satisfied with the workshop. The level of information and quality of teaching in the pilot and workshop scored highly. Most participants stated not being adequately prepared to communicate or care for bereaved parents. The pre-workshop evaluation showed that only 8% of participants received prior training on discussing post-mortems with bereaved parents. Participants (100%) would recommend the workshop be available nationally and would recommend it to a colleague.

To our knowledge this is one of few participant-centred perinatal bereavement care training for maternity staff in Ireland. Adequate training for all maternity staff is essential and TEARDROP has the potential to impact on the quality of bereavement care provided in Irish maternity units.

Given the positive evaluation of TEADROP, and the success of the workshops to date, in 2023 it is being rolled out across the Saolta Hospital Group, with a view to national roll-out thereafter. We are also exploring tailoring TEARDROP to specific audiences, including medical and midwifery students.

Behaviours and actions of healthcare workers at different levels and stages of care can leave a memorable effect on parents. Multi-disciplinary training is crucial to improve bereavement care for parents. TEARDROP has the potential to impact on the quality of bereavement care provided in maternity units/hospitals across the country.

Professor Keelin O’Donoghue, National Implementation Lead-National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death, NWIHP, and Lead, Pregnancy Loss Research Group

For more information

Please contact Professor Keelin O’Donoghue: k.odonoghue@ucc.ie