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

Area of Science:

• Perinatal Medicine
• Public Health
• Medical Ethics

Background:

• Stillbirth remains a significant global health issue, with approximately four million annual occurrences worldwide.
• The UK faces a high stillbirth rate, ranking 33rd among 35 developed nations.
• Decreasing consent rates for post-mortem examinations (PME) in the UK hinder understanding of stillbirth causes.

Purpose of the Study:

• To investigate the views of UK obstetricians, midwives, and perinatal pathologists regarding post-mortem examinations (PME) for stillbirth.
• To identify factors influencing consent for PME in cases of stillbirth.
• To explore how professional perspectives shape interactions with bereaved families regarding PME.

Main Methods:

• An Internet-based survey was distributed to 10,000 UK midwives, 1136 obstetricians, and 40 perinatal pathologists.
• The survey included a free-text response option for qualitative data collection.
• Iterative thematic analysis was employed to analyze the free-text responses, identifying key themes and a 'line of argument' synthesis.

Main Results:

• A total of 683 midwives, 98 obstetricians, and 11 perinatal pathologists provided qualitative feedback.
• Five major themes emerged, highlighting that staff education, local resources, and information quality influence both professional views and family decisions on PME.
• These structural factors are further mediated by individual beliefs, emotions, and societal influences.

Conclusions:

• Internet surveys are effective for gathering substantial qualitative data on sensitive topics like PME after stillbirth.
• Improving PME decision-making requires enhanced staff training, user-friendly information, and consent procedures.
• Addressing the emotional and experiential aspects for both staff and parents is crucial for effective PME consent.