Undergraduate Midwifery Students' First Experiences with Stillbirth and Neonatal Death
McKenna, Lisa, Rolls, Colleen, Contemporary Nurse : a Journal for the Australian Nursing Profession
While midwifery practice predominantly deals with happy experiences, unexpected and unpredictable events occur. This paper reports on a study that explored undergraduate midwifery students' first experiences of stillbirth and neonatal death. It sought to better understand their encounters to ensure curricula were responsive to students' needs. Semi-structured interviews were conducted with eight Bachelor of Midwifery students. Many were found to have been exposed to perinatal death early in their courses and were ill prepared for the confrontations. Furthermore, the existence of support services was varied. Dealing with these experiences appears to occur through a developmental process and resonates with previous research around compassion, fatigue and posttraumatic stress disorder. Overall, students require specific preparation prior to undertaking placements, as well as clearly identified support strategies if such experiences are encountered.
Keywords: midwifery student; stillbirth; perinatal death; practice readiness
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). …