By SARAH MATTHEWS

Leaders investigating a new model of maternity care for the Wimmera-southern Mallee have highlighted a need for bereavement training along with enhanced education to prevent pregnancy loss and stillbirth.

Wimmera Health Care Group nurse-midwife unit manager Michelle Coutts – who is heading up a project to design and implement the new model as part of a complete overhaul of maternity services in Horsham – said midwives provided support, care, advice and education to pregnant women across the continuum of pregnancy, labour, birth and the postnatal period.

She said while loss and death were not usually associated with midwifery, throughout their careers many midwives would care for women and their families who experienced a miscarriage or gave birth to a baby who died, or was not expected to survive once born.

Mrs Coutts made the comments in light of October being International Pregnancy and Infant Loss Awareness Month.

Each year, about 110,000 Australians experience a miscarriage, 2200 endure stillbirth, 600 lose their baby in the first 28 days after birth and many more face the grief of termination for medical reasons.

Mrs Coutts said historically, midwives were not trained to provide bereavement care.

“It’s often something that some of us learn from experience within the area and from mentors,” she said.

“It’s really important that we change that because the ramifications of providing inadequate care and support at this heartbreaking time can contribute to mental-health problems for the parents, and also for other family and friends involved.”

Mrs Coutts said project leaders were already discussing revised education and training for midwives as part of a redeveloped model of maternity care at Wimmera Base Hospital.

She said she considered having an ‘excellent understanding of the grieving process’ a vital component of midwifery.

“It acknowledges that people experience and display grief in different ways and helps tailor care that meets individual needs,” she said.

“Grief and loss can happen at any time during pregnancy or at the time of birth.

“It’s really important that the parents feel they are supported to make decisions that reflect their own wishes, morals and beliefs and be fully informed about them.

“Parental grief is something that can only be fully understood by the parents experiencing it.”

Mrs Coutts said through bereavement care, midwives had an opportunity to help parents find meaning in their loss. 

“When a baby dies, midwives now offer to help create ‘memories’ and mementoes for the family, and doing this is a skill in itself,” she said.

“This might involve taking photos, hand and foot prints, taking a lock of hair and helping the parents dress or bath their baby. 

“It can also involve offering them clothes and blankets that they would like to keep or use for if and when their baby is buried.”

Mrs Coutts said providing parents with bereavement care required a collaborative approach, with obstetricians, gynaecologists and other professionals such as social workers working closely with midwives to provide the best possible care.

She said along with bereavement training, the health-care group’s midwives would also benefit from advanced education projects such as the ‘Safer Baby Collaborative’, designed to pinpoint the best ways to help prevent pregnancy loss and stillbirth. 

Reducing stillbirth

Safer Care Victoria and Victorian Agency for Health Information worked on the project with participating Victorian health services – including East Grampians Health Service in Ararat – to reduce stillbirth rates during the third trimester.

The project focused on five areas of practice: Improving rates of smoking cessation in pregnancy; diagnosis and management of fetal growth restriction; increasing public awareness of the importance of fetal movements; raising awareness of safe maternal sleep positions; and promoting appropriate timing of birth and mitigating unintended consequences or harm.

Mrs Coutts said the project summary showed many stillbirths might be avoidable, and as a result many new resources and training programs would be developed for doctors and midwives.

She said the project, which concluded in May this year, would also form the backbone of any new education around loss and stillbirth at Wimmera Health Care Group. 

“It is also important to keep in mind that while we know so much and there have been so many advances in research and technology and improvements in clinical care over the past few decades related to perinatal loss and stillbirth, there will always be deaths where we will never know the reason as to why a baby died,” she said.

“I think we are getting better as individuals and a society in recognising that a parent is still a parent regardless of whether their baby has lived or died.

“It’s important we continue to talk about pregnancy and infant loss to ensure parents are not suffering in silence.” 

People can visit www.bettersafercare.vic.gov.au/improvement/projects/mbc/safer-baby for more information about the Safer Baby Collaborative.

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