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Exploring the impact of healthcare workers communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia. A grounded theory study

Actis-Danna, Valentina ORCID: https://orcid.org/0000-0003-2476-1659, Lavender, Tina, Laisser, Rose, Chimwaza, Angela, Chisuse, Isabella, Tembo Kasengele, Chowa, Kimaro, Debra, Kuzenza, Flora, Lyangenda, Kutemba, Mwamadi, Milcah, Shayo, Happiness, Tuwele, Khuzuet, Wakasiaka, Sabina and Bedwell, Carol (2022) 'Exploring the impact of healthcare workers communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia. A grounded theory study'. Women and Birth. (In Press)

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Abstract

Background
Communication and interaction with healthcare workers at the time of stillbirth remain in parents’ long-term memories and impact on emotional and psychological well-being. Cultural attitudes and norms influence how stillbirth is acknowledged and discussed in society. There is limited evidence on how women from sub-Saharan Africa became aware of the death of their babies. This research explored how women perceived the approach adopted by healthcare workers when the news of their stillbirth was disclosed to them.

Methods
Grounded theory study. Women (n = 33) who had birthed a stillborn baby in the preceding 12 months were purposively sampled and participated in in-depth interviews (9 in Zambia, 16 in Tanzania and 8 in Malawi). Informed consent was gained from all participants. Data were analysed via a coding process using constant comparative analysis.

Findings
Women sacrificed individualized and personal grieving strategies to conform and behave according to what was expected within their community. An overarching theme of cultural conformity overrides personal grief incorporated four sub-themes: perceiving something was wrong, the unexpected outcome, experience contrasting emotions, bonding with the baby.

Discussion and conclusions
Most participants embarked on a negative ‘emotion work’ to adapt and suppress emotions and grief due to cultural expectations. Inability to voice the trauma of losing a baby may lead to perinatal mental health issues and needs addressing. Maternity healthcare workers should encourage women to express their feelings and grief. Appropriate training in perinatal bereavement care including good communication, appropriate attitudes and provision of meaningful information to grieving women is recommended.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.wombi.2022.04.006
Depositing User: Mary Creegan
Date Deposited: 21 Apr 2022 10:56
Last Modified: 21 Apr 2022 10:56
URI: https://archive.lstmed.ac.uk/id/eprint/20265

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