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Table 1 Summary of the main actions on supportive guidelines for families experiencing stillbirth and neonatal death

From: The perinatal bereavement project: development and evaluation of supportive guidelines for families experiencing stillbirth and neonatal death in Southeast Brazil—a quasi-experimental before-and-after study

Summary of supportive guidelines regarding perinatal bereavement
How to prepare the family to see the baby: Clean the baby (do not bathe him/her);
Dress the baby with diapers, socks, hat, clothes, blanket etc.;
Follow the same maternity ward protocol to bring alive babies to see their mothers;
Call the baby by his/her name;
Follow them up but keep some distance. Never let them unassisted
What should be provided for the memory box: Hair lock;
Handprint and footprint;
Placenta stamp (optional);
Baby’s pictures;
Baby’s first clothes;
Baby’s bracelet/identification tag;
Cards and letters written by the staff;
Leaflets about the bereavement process and bereavement support groups
Which written guidance should be provided: All information about funeral services and local civil registry office;
Information about how to deal with breast milk production;
Suppressing lactation
Breast milk donation
Post-discharge care;
Medical appointments and additional exams for further investigation (if necessary);
Bereavement support group;
Psychological services
What to do to provide continuous care: Discuss family planning;
Schedule regular appointments to assess mental and physical health, and discuss new findings about what happened to the baby (when applicable);
In the case of a new gestation, follow health care guidelines for pregnant women who had previously experienced the loss of a baby;
Arrange to assist woman during the new puerperium
Guidelines for assisting pregnant women who had previously experienced the loss of a baby: Remember: this is no longer an ordinary pregnancy, and may be considered a risk pregnancy from the mental health point of view;
The previous loss may impact the following bereaved mother’s gestation, from antenatal care through puerperium and breastfeeding;
Fear and complaints are expected responses and must be acknowledged;
Some parents may prefer to be cared for in a different hospital or by different staff members, which should not be a problem;
Mental health screening should be available for both parents;
Specialized mental health support or psychological appointments should be encouraged at any time during pregnancy and postpartum;
Consider avoiding standard antenatal classes, prioritizing individual preparation sessions for labor, birth and caring for a newborn baby;
A special sticker can be used on both notice board and at room’s door wherein a bereaved mother is in labor, so that the staff is aware of her condition;
Encourage the writing of a birth plan, so that parents’ preferences can be easily shared with all staff during labor, birth and postpartum
Consider scheduling extra and longer antenatal appointments. Extra screening options should be considered whenever necessary or demanded;
Set aside a weekly day or time at your institution for pregnant women who had previous perinatal losses to seek assistance if they have questions about their baby's well-being or their pregnancies´ normality;
A C-section without clinical recommendation may be considered, when fear from natural birth could not be dealt with after several psychological and communication interventions, as long as the women acknowledge associated risks
What to do when there is:
Stillbirth
Neonatal death or imminent neonatal death
Severe malformation (incompatible with life or high death probability)
1. Assure the mother/family privacy;
2. Deliver bad news properly;
3. Give the family all requested and necessary information;
4. Encourage the preparation of a Care Plan for the women and the baby. This Care Plan includes a birth plan, whenever possible, and a palliative care for the baby, whenever necessary;
5. Choose and prepare a private room, to avoid contact with other mothers and their babies;
6. Apply special stickers on both notice board and at the bereaved mothers’ room door, so that the staff is aware of her condition;
7. Avoid sedation;
8. Respect initial plans – whenever possible;
9. Encourage the mother/family to see the baby;
10. Encourage the mother/family to touch the baby, and to spend time with her/him;
11. Provide the memory box
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