LSTM Home > LSTM Research > LSTM Online Archive

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

Mills, Tracey ORCID:, Roberts, Stephen A., Camacho, Elizabeth, Heazell, Alexander E. P., Massey, Rachael N., Melvin, Cathie, Newport, Rachel, Smith, Debbie M., Storey, Claire O., Taylor, Wendy and Lavender, Tina (2022) 'Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study'. BMC Pregnancy and Childbirth, Vol 22, Issue 1, e634.

Tracey Mills 2.pdf - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS).

A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8).

Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited.

Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WQ Obstetrics > Labor > WQ 330 Complications of labor
WQ Obstetrics > WQ 500 Postnatal care
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Clare Bennett
Date Deposited: 13 Sep 2022 13:34
Last Modified: 13 Sep 2022 13:34


View details

Actions (login required)

Edit Item Edit Item