Post-mortem examination after stillbirth: views of UK-based practitioners

Abstract

Objectives:
Worldwide, around four million stillbirths occur annually. The UK was recently ranked as 33rd out of 35 developed nations for stillbirth rates. The reasons for many stillbirths remain unexplained. Post-mortem examination (PME) can provide information for grieving families, and for future pregnancies. Rates of consent for PME are decreasing in the UK. The views of professionals may influence their approach to bereaved families, and, therefore, rates of consent. Arguably, obtaining qualitative insights into emotive areas such as PME from large numbers of practitioners is increasingly possible as electronic surveys become more sophisticated. Therefore we aimed to describe, using electronic media, the views of UK obstetricians, midwives and perinatal pathologists about PME for stillbirth.

Study design:
10,000 UK midwives, 1136 UK obstetricians and all 40 UK perinatal pathologists received a link to an Internet survey via their professional organizations. A box was included for free-text responses. Iterative thematic analysis generated five themes and a ‘line of argument’ synthesis.

Results:
683 midwives, 98 obstetricians, and 11 perinatal pathologists provided open comments, generating five themes and the following line of argument: both professional views and family decision-making about postmortem after stillbirth are affected by the education and training of staff, local resources, and the quality of information available. All of these structural issues are interpreted by individual staff, women and families through personal beliefs and emotions, and professional and social discourses.

Conclusions:
Internet-based surveys can generate valuable qualitative data. Effective decision-making for post-mortem after stillbirth may be improved by the introduction of user-friendly information and consent procedures, and staff training that takes account of existing innovations, and of the emotions and prior experiences of both staff and parents.