Abstract
Problem
Background
Aim
Methods
Findings
Discussion
Conclusions
Keywords
Statement of Significance
1. Introduction
World Health Organisation (WHO, 2021. Why we need to talk about losing a baby. [Online]. Available from: 〈https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby〉. (Accessed 14 December 2021).
World Health Organisation, 2021a. Stillbirth. [Online]. Available from: 〈https://www.who.int/health-topics/stillbirth#tab=tab_1〉 (Accessed 1 December 2021).
World Health Organisation (WHO, 2020. New-borns: improving survival and well-being. [Online]. Available at: 〈https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality〉 (Accessed 14 January 2021).
UNICEF. 2020. Levels & trends in child mortality; estimates developed by the UN Inter-agency group for child mortality estimation United Nations – Report 2020. [Online]. Available at: 〈https://www.unicef.org/media/79371/file/UN-IGME-child-mortality-report-2020.pdf.pdf〉. Accessed: 2 January 2021.
UNICEF, 2021a. Levels & trends in child mortality; Estimates developed by the UN inter-agency group for child mortality estimation United Nations – Report 2021. [Online]. Available at: 〈https://data.unicef.org/wp-content/uploads/2022/01/UNICEF-IGME-2021-Child-Mortality-Report.pdf〉 〈https://data.unicef.org/wp-content/uploads/2022/01/UNICEF-IGME-2021-Child-Mortality-Report.pdf〉. Accessed: 8 April 2022.
World Health Organisation, 2021. The Global Health Observatory. [Online]. Available from: 〈https://www.who.int/data/gho/indicator-metadata-registry/imr-details/67〉 (Accessed 1 December 2021).
United Nations, 2021b. The 17 goals (sustainable development goals) – 3 - Ensure healthy lives and promote well-being for all at all ages. [Online]. Available at: 〈https://sdgs.un.org/goals/goal3〉. Accessed 10 February 2021.
World Health Organisation, 2015. Health in 2015: from MDGs to SDGs. [Online]. Available from: 〈https://www.who.int/gho/publications/mdgs-sdgs/en/〉. (Accessed 20 November 2019).
World Health Organisation, 2020. Ending preventable newborn deaths and stillbirth by 2030. [Online]. Available from: 〈https://cdn.who.int/media/docs/default-source/mca-documents/nbh/enap-coverage-targets-and-milestones-2025.pdf?sfvrsn=2add2482_2〉 (Accessed 8 April 2022).
2. Methods
2.1 Search strategy and data sources
Higgins, J.P.T. and Green, S., 2011. Cochrane Handbook for systematic review of interventions. [Online]. Available from: 〈https://handbook-5-1.cochrane.org/index.htm#chapter_8/8_4_introduction_to_sources_of_bias_in_clinical_trials.htm〉 (Accessed 29 May 2019).
Spider | Search terms |
---|---|
SAMPLE | “Women” or “mothers” or “parent* ” or “Famil* ” |
PHENOMENON OF INTEREST | “Perinatal death” or “baby death” or “neonatal death” or “neonatal loss” or “neonatal death” or “death of a baby” or “neonatal bereavement” or “neonatal mortality” or “foetal loss” or “Stillbirth” or “Neonatal bereave* ” or “Stillb* ” |
DESIGN | “qual* ” or “qualitative” or “mixed methods” |
EVALUATION | “Experience” or “views” or “perceptions” or “perspectives” or “feelings” or “opinions” or or “Narrative” or “Thoughts” |
RESEARCH TYPE | “interpretive” or “descriptive” |
2.2 Study selection
2.3 Inclusion criteria
UNICEF, 2021a. Levels & trends in child mortality; Estimates developed by the UN inter-agency group for child mortality estimation United Nations – Report 2021. [Online]. Available at: 〈https://data.unicef.org/wp-content/uploads/2022/01/UNICEF-IGME-2021-Child-Mortality-Report.pdf〉 〈https://data.unicef.org/wp-content/uploads/2022/01/UNICEF-IGME-2021-Child-Mortality-Report.pdf〉. Accessed: 8 April 2022.
World Health Organisation (WHO, 2021. Why we need to talk about losing a baby. [Online]. Available from: 〈https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby〉. (Accessed 14 December 2021).
2.4 Exclusion criteria
World Health Organisation (WHO, 2021. Why we need to talk about losing a baby. [Online]. Available from: 〈https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby〉. (Accessed 14 December 2021).
2.5 Quality appraisal
2.6 Data extraction and synthesis
2.7 Reflexivity
3. Findings
3.1 Search outcome

3.2 Characteristics of included studies
Subthemes | Relevant Studies | Main Themes | Example Quotes | Core Concept |
---|---|---|---|---|
My baby died, I embarked on a wasted journey it’s my fault | Kiguli et al., [33] , Simwaka et al.,[39] , Modiba and Nolte,[40] , Roberts et al.,[36] , Onaolapo et al.,[35] , Mills et al.,[34] , Meyer et al.,[38] | Mothers’ reaction to their baby’s death | I was filled with sorrow because I was expecting something, I was eagerly waiting, and I was also happy that I would have a baby. I was heart-broken… I become depressed [39] . | Perinatal death causes a range of emotions in mothers, particularly feelings of guilt which is compounded when others blame them for the loss. There is an understanding amongst mothers that the absence of a living baby makes them of less concern to healthcare professional. Family and communities contribute to the grief due to lack of support. Consequently, coping strategies are adopted by women to help in managing their experience of perinatal death and its impact. There is a need for appropriate bereavement support for mothers. |
I don’t have a live baby so staff don’t care | Simwaka et al., [39] , Modiba and Nolte,[40] , Roberts et al.,[36] , Onaolapo et al.,[35] , Mills et al.,[34] , Meyer et al.,[38] , Conry and Prinsloo,[37] | Care and support following perinatal death | “nurses … should try hard to comfort patients. They should try hard to look at the other person’s problem, try to comfort her the way they have been taught, and according to their capability, because most of the time, at home there is no time for this” … “The doctor avoided me, and when I pressured him, he said: ‘These things happen and you should try to put that behind you’. He really offered no support, he was so cold”. Modiba and Nolte [40] | |
Lack of support from partners, family and community | Kiguli et al., [33] , Modiba and Nolte,[40] , Roberts et al.,[36] , Onaolapo et al.,[35] , Mills et al.,[34] , Meyer et al.,[38] | “they all acted as if I intentionally killed the baby myself. People’s attitude sometimes can make someone’s situation worse” [35] | ||
Stoicism and acceptance | Onaolapo et al., [35] , Meyer et al.,[38] | Coping strategies in the absence of care and support | Because I knew that, actually, the baby is gone and there’s nothing that I can do. So there’s no need for me to cry and scream and shout for people to know. Meyer et al., [38] . | |
Living children and faith as a protective factor | Kiguli et al., [33] , Mills et al.,[34] , Meyer et al.,[38] , Onaolapo et al.,[35] | “I think I have to concentrate on how to help raise my children to get to somewhere in life than to think of bringing another one into the world.” [38] | ||
Avoidance | Kiguli et al., [33] , Meyer et al.,[38] | “I believe God has a purpose for everything, he allowed this to happen for a reason” [35] | ||
“even the pictures we took of the baby have been seized by my uncles, in a bid to help me not talk or remember the event, to prevent me from crying or being sad…They [my family] said if I talk or think about it so much, I will be so depressed and also that chances of having another baby will be so slim” [38] |
Authors, Date, Country | Aim | Methodology | Sampling Strategy | Recruitment setting | Data Collection Method | Data Analysis Approach | Quality Assessment Grade |
---|---|---|---|---|---|---|---|
Conry and Prinsloo, [37] , South Africa | To explore access of bereaved mothers to services following perinatal death. | Exploratory study | Purposive sampling (n = 15) 15 women | Hospital | Interviews | Mixed methods (dominant/less dominant approach). | C |
Kiguli et al. [33] , Uganda | To explore local definitions and perceived causes of stillbirths as well as coping mechanisms used by families affected by stillbirth in rural eastern Uganda. | Interpretive phenomenological research | Convenience sampling (n = 29) 14 women (who experienced stillbirth) 6 men (husbands of women who experienced stillbirth) 4 Grandmothers 1 Grandfather 4Traditional Birth Attendants | Hospital maternity ward register, and village community leaders. | In-depth interviews and observation | Content analysis using Granheim and Lundman approach | B |
Modiba and Nolte [40] , South Africa | To describe the experience of mothers with the loss of a baby during pregnancy (stillbirth included) and the professional care received during the time. | Interpretive phenomenological research | Purposive sampling (n = 10) 10 women who had experienced perinatal death. | Maternity ward in a hospital. | In-depth unstructured interviews | Tesch’s data analysis approach. | D |
Meyer et al. [38] , Ghana | To further understand the notion that suggests that women in sub-Saharan Africa are discouraged from publicly mourning a perinatal death and discussing their loss for fear of social ramifications such as stigma, gossip and blame. | Mixed methods | Convenience sampling (n = 8) 8 women | Mother and baby Unit in a hospital | Interview and quantitative survey for demographics. | Content Analysis | C |
Mills et al., [34] , Nairobi, Western Kenya, Kampala and Central Uganda. | To explore the lived experience of care and support following stillbirth in urban and rural health facilities. | Qualitative interpretative design (Heidegerrian phenomenology) | Purposive sampling (n = 134) 75 women and 59 men | Hospital and postnatal clinics | Interviews | Van Manen’s reflexive approach | B |
Onaolapo et al. [35] , Ghana | To explore experiences, coping strategies and support systems available for perinatally bereaved mothers. | Descriptive phenomenological design | Purposive sampling (n = 12) 12 women | Hospital | Interviews | Thematic analysis using Colaizzi’s approach | B |
Roberts et al. [36] , India | To explore how poor, rural central Indian women perceive and cope with stillbirths. | Grounded theory | Snowballing sampling (n = 33) 17 women 16 healthcare professionals and hospital staff | General hospital | Interviews and focus groups | Standard qualitative data analysis | B |
Simwaka et al., [39] , Malawi | To explore women’s perceptions of and satisfaction with nursing care they received following stillbirth and neonatal death. | Qualitative exploratory study | Purposive and snowballing sampling (n = 20) 20 women | Villages around the community hospital | Interviews | Thematic analysis using Colaizzi’s approach | C |
3.3 Themes
4. Mothers’ reactions to their baby’s death
“The baby died, I embarked on a wasted journey it’s my fault”
“I just felt confused. I could not cry, I really felt empty …When a child is born dead, there is nothing. The world remembers nothing and the gap in the womb is replaced by an emptiness in your arms. You are not recording a birth or a death.” [[40]].
"I felt very sorry for myself because it was as if I had worked for nothing." [[39]]
“I felt myself it was my fault. I felt it was something wrong with me…I feel it’s my body rejecting the baby”. I think really I am blaming myself for going into labour, for getting out of bed. If only I had stayed in bed that extra day, would it have made any difference?” [[40]].
5. Care and support after perinatal death
“I don’t have a live baby so staff don’t care”
"Nurses don’t communicate with you”. “Doctors don’t have time for the patients. Just a few. But they don’t have time for the patients! Most of them don’t have time for the patients." [[40]].
"I think it is the nurse’s negligence because if she had attended to me a way could have been found to save my baby." [[39]].
“She [healthcare professional] said I should not worry too much because that is how God planned it, He gives and takes away so maybe God will give me another gift at a later time” [[39]]
"What do you want us to help you with? Your thing has already died, for us we save those who are still alive, if your baby was still alive, we could have saved him. So, on that note, help yourself because we also have no way of saving you." [[34]].
"then after that delivery[sic] and the incident of losing my child I was being put in the same room with other women holding their baby. I felt very bad because I too wanted to hold mine and feel like them." [[34]]
5.1 Lack of support from partners, family and community
“I have the most amazing and supportive husband in the whole world…he did not let me feel bad. He is so funny and dramatic that all his dramatic acts in the house make me forget my loss” [[35]].
"I had a previous [perinatal] loss, and this again! At a point my husband started frustrating me, coming back home late at night…he even threatened to bring in another woman as a wife" [[35]].
6. Coping strategies in the absence of care and support
6.1 Stoicism and acceptance
"All mothers have to be strong for themselves especially during their loss because whatever loss or pain or tragedy we are experiencing we would always get through it. I know it hurts but my Allah will do another one, I know" [[35]].
6.2 Living children and faith as protective factors
"Do I even have the time [to dwell on the death of the baby]? Look at the children around me. If I lost one, will I not get on my feet to support the rest that are alive?." [[38]]
“I believe God has a purpose for everything, he allowed this to happen for a reason” [[35]].
6.3 Avoidance
“even the pictures we took of the baby have been seized by my uncles, in a bid to help me not talk or remember the event, to prevent me from crying or being sad…They [my family] said if I talk or think about it so much, I will be so depressed and also that chances of having another baby will be so slim" [[38]].
6.3.1 Line of argument synthesis
7. Discussion
7.1 Main findings
7.2 Interpretation
7.3 Strength and weaknesses
8. Conclusion
8.1 Implication for research
References
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