Background Stillbirth is a devastating event for women and their partners. Actions surrounding the stillbirth, have been identified as critical events with short and long term implications. Standard care for parents has changed over time and it is essential that present guidelines for care reflect best available evidence. This systematic review aimed to collate and critically appraise evidence for the impact of contact with the stillborn infant on parental mental health, wellbeing and satisfaction.
Methods Studies providing quantitative comparison of outcomes for parents who held their baby or engaged in other memory-making activities, such as having photos and handprints, compared to those who did not were eligible for inclusion. Primary outcomes included clinically diagnosed mental health issues, standardised assessment of mental health issues or self-reported psychological distress. Secondary outcomes included poor health, relationship difficulties, and satisfaction with the decision to have contact with the baby. Structured systematic searching was conducted in thirteen databases, complemented by hand-searching. Titles and abstracts were screened for eligibility by two reviewers. Study quality was appraised by two reviewers using a framework based on a recent assessment of quality appraisal tools for observational studies. Narrative synthesis was undertaken and standardised measures of effects calculated for each study to aid comparison. Methodological heterogeneity precluded meta-analysis.
Results Searches returned 1,294 unique titles. Two authors independently screened titles and abstracts, and assessed 29 full-text articles were assessed. Eleven studies reported in eighteen papers met criteria. Studies were heterogeneous in approach and presented high risks of bias, particularly in regards to sample representativeness, and confounder adjustment. Results were mixed concerning the impact of holding the stillborn on mental health and wellbeing. One study found no significant effects on any outcomes, and two studies reported no impact on depression. Conflicting effects were found for anxiety and posttraumatic stress. Other memory-making activities were not found to have a significant association with mental health or wellbeing outcomes. Across studies, mothers were satisfied with their decision to hold their baby or engage in other memory-making activities.
Conclusion Evidence for the impact of holding the stillborn baby on mental health and wellbeing is sparse and of poor quality. High quality research guided by a-priori hypotheses, with attention to potential confounders and moderating effects, is needed to provide more rigorous evidence to guide practitioners and parents’ decision-making for care following stillbirth.
- systematic review
- mental health
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