Retningslinjer for psykososial omsorg for mødre ved prenatal fosterdød. : et historisk tilbakeblikk og aktuelle retningslinjer i Helse Sør og Helse Øst i 2003

Abstract

Objective: The main aims of this thesis were to describe the background for and development of hospital practice and guidelines after pregnancy loss, and to assess guidelines currently in use at Norwegian obstetrical departments in ”Helse Sør” and ”Helse Øst”. Material and methods: A literature search in Medline up to 2004 with search words stillbirth, grief gave 119 references. Search words perinatal death, grief gave 150 references. All abstracts were read and 19 papers were chosen for further study. A letter asking for existing guidelines was sent to the 18 obstetrical departments in ”Helse Sør” and ”Helse Øst”. Fourteen guidelines were received and studied. Results: Psychosocial care of mothers after stillbirth has changed both internationally and nationally from 1970 until today. Previously this was treated as a non-event , now practice is founded on guidelines which claim that seeing and holding the dead infant will benefit the parents grief reactions. The Norwegian guidelines of 14 departments in ”Helse Øst” and ”Helse Sør” vary to some extent in their recommendations, but in general they correspond with the international guidelines. However,one recent study indicates that seeing and holding the dead infant may have negative effects on the psychological health of the mother and the next-born child. Discussion: Hardly any of the studies are prospective or have adequate control groups or outcome measures for mental health. It is not possible to conclude about todays practice by just reading guidelines, but most empirical studies and existing guidelines are clear in their recommendations: seeing and holding the dead infant and having concrete memories will benefit the mother. A few studies discuss the negative consequences of basing practice solely on guidelines and emphasize the importance of asking the parents about their preferences. Only one of the Norwegian guidelines mention the importance of asking the parents about their preferences. Conclusion: More studies are needed on this subject. Guidelines should be adjusted according to findings based on empirically sound studies. But opening up for the needs of the parents and their wishes is to be recommended.