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Good Practice Guidelines For Mothers After Stillbirth 'unjustified' (p 114)

July 10, 2002

Authors of a UK study in this week's issue of THE LANCET suggest that guidelines introduced in the 1980s to help mothers overcome the death of a stillborn child do not appear to reduce symptoms of grief, and may actually traumatise some mothers.

Stillbirth occurs in around 0.5% of births in more-developed countries. UK guidelines were changed in 1985, recommending that mothers should see and hold their stillborn child to help them come to terms with their loss. Patricia Hughes and colleagues from St George's Hospital, London, UK, assessed whether adherence to the current guidelines was associated with beneficial effects on the psychological health of the mother and next-born child.

The study assessed 65 women who were pregnant for the second time after a previous stillbirth. Depression occurred in 39% of women who saw and held their stillborn infant, compared with 21% of women who only saw the infant; only 6% of those women who did not see or hold their stillborn child were depressed. Women who had seen their stillborn infant had greater anxiety and higher symptoms of post traumatic stress disorder; their next-born infants were more likely to show disorganised attachment behaviour than infants of mothers who had not seen the stillborn child (42% compared with 8%).

Patricia Hughes comments: "We believe that when parents have a stillbirth, their wishes about psychosocial management should be respected. Our result suggest there is no justification for telling parents that not seeing their dead baby could make mourning more difficult, and that those who are reluctant to see and hold their child should not be encouraged to do so. We hope that our findings will stimulate further debate and research in this area."

Lancet