Person-Centred Care in Clinical Plans

When it comes to clinical plans in pregnancy after loss (PAL) there is no one-size fits all. Clearly medical teams need to make plans around clinical needs for the safety and wellbeing of mum and baby. However – clinical care in pregnancy after loss should also be shaped around emotional support and wellbeing. Below are some key principles to consider when working with families who are pregnant after loss.  

• Person-centred care: take into consideration individual needs. This includes their history including consideration of certain dates/gestations/procedures. Take time to understand what the challenges and triggers are likely to be this pregnancy and how you can support them;
• Partnership working: bereaved parents are experts in their own experience – give them the space and support to find the words to tell you how this feels for them and what might help them get through this time;
• Trauma-informed care: the death of a baby is traumatic. Trauma-informed care involves understanding the widespread impact of trauma for individuals and families, recognising the signs and symptoms of trauma and being able to respond in ways which are not re-traumatising. Focus on building trust and consider what a person might need to enable them to feel as safe as possible given that they are revising spaces and experiences which are deeply traumatic for them.

Considering person-centred care you may consider that an individual requires longer/more frequent appointments than is clinically indicated. They are likely to have lots of questions and are unlikely to be reassured. You can work in partnership with your patients to understand whether having ‘extra’ (ie surplus to clinical need) is likely to be experienced as stressful or supportive. Consider how you might use trauma-informed practice to identify key triggers in this pregnancy and how and if any can be avoided or mitigated.

Here are some things that clinicians can consider or parents can ask for in pregnancy after loss:

• Ensure details of loss including the baby’s name and date of birth are on the file (if a baby’s name who has died is listed on a file please use their name);
• Acknowledge – often it is helpful for someone else to acknowledge how difficult a situation is for us because it means that we then feel able to agree and to begin to think about what might make it more bearable;
• Additional appointments/scans;
• Continuity of care – where possible to see the same sonographer/midwife/consultant to build trust and avoid parents having to retell their story;
• Be allowed to have one (or more) support people with them;
• Ensure that detailed explanations and information are given before tests or examinations;
• Referrals to Tommy’s Rainbow Clinics for additional care;
• Allocated to a bereavement midwife or specific pregnancy after loss midwife;
• Joined-up care – good communication between midwives and consultants and also between teams involved in physical and mental health care;
• Birth planning – the timing and mode of delivery will need to be discussed with parents, it is important to book time to do this when it feels right for parents. Birth plans should consider emotional needs as well as clinical needs.