Undergraduate Midwifery Students' First Experiences with Stillbirth and Neonatal Death
McKenna, Lisa, Rolls, Colleen, Contemporary Nurse : a Journal for the Australian Nursing Profession
Direct entry, undergraduate midwifery education has been offered in Victoria, Australia for eight years. Previous to the course introduction, people wanting to become midwives were required to undertake three years of general nurse training then postgraduate studies in midwifery. As registered nurses prior to studying midwifery, students had previous experience with death and dying, albeit largely with adults. With the new pathway, students could face the death of a baby early in their course with little, or no, prior exposure to death and dying. The first year of the Bachelor of Midwifery focuses on normal childbearing, and there is little coverage of perinatal death elsewhere in the course. This is not, however, unique to this course but common across midwifery programs. Given the unpredictable nature of midwifery practice, students could potentially encounter perinatal death prior to this being covered in-depth in the classroom. This raises many issues and our concern around this was the impetus for this study.
Care provided by health professionals is important in parents' adjustments to a stillbirth or neonatal death yet it is still not commonly discussed (Thompson, 2008). Many midwives (Fenwick, Jennings, Downie, Butt, & Okanaga, 2007) and physicians (Gold, Kuznia, & Hayward, 2008) find such circumstances challenging to manage, as they are usually required to deal with positive events. Thompson (2008) argues that this topic is difficult for contemporary society with concepts of perfect reproduction permeating with availability of prenatal screening and mothers' responsibilities to produce normal babies. Stillbirth and neonate death are significant events in women's lives, and midwives are usually at the forefront of the experience and provide care. They 'are in the unique position of having seen and/or "known" the dead baby' (Warland, 2000, p. xv). Care needs to incorporate many aspects including spiritual and cultural beliefs (Gardner, 1999; Hsu, Tseng, Banks, & Kuo, 2004) supporting parents through seeing and separating from the baby (Dyson & While, 1998; Saflund, Sjogren, & Wredling, 2004), sensitivity (Dyson & While, 1998), counseling and giving clear information (Davis, Stewart, & Harmon, 1988; Dyson & While, 1998) while ensuring care remains individualized (Hutti, 2005). Language used can assist or inhibit the grieving process (Jonas- Simpson & McMahon, 2005).
Midwifery has been described as being emotion work (Hunter, 2004). Caring for bereaved families has been described as stressful for midwives who also have to deal with their own grief simultaneously. They may have had little experience in working with bereaved parents, have little knowledge about grief process, lack appropriate communication skills or not receive necessary support from their colleagues (Gardner, 1999). Hence, many may experience difficulties with this area of practice (Mitchell, 2005). In one study Fenwick et al. (2007) explored Western Australian midwives' experiences of providing perinatal loss care. They found that midwives felt satisfied connecting with families, facilitating their understandings, providing support, creating special memories, listening and sharing grief. Conversely, least satisfying aspects were personal emotional challenges, uncertainty and perceived lack of support. The levels to which they provide empathic and intimate care may, therefore, put midwives at risk of developing secondary traumatic stress (Leinweber & Rowe, 2010).
Little is known about the various ways in which midwifery students learn to deal with this aspect of their practice and their reactions to such traumatic events. While difficult to teach in a classroom situation, students commonly report being discouraged in practice from being involved in the care of women who have experienced stillbirth or neonatal death. Consequently, students may have little experience in dealing with these situations (Whyte, 1994) following graduation and lack important requisite skills. …