Bereaved parents involvement in maternity hospital perinatal death review processes: 'Nobody even thought to ask us anything'.

INTRODUCTION: The death of a baby is devastating for parents, families and staff involved. Involving bereaved parents in their baby's care and in the maternity hospital perinatal death review can help parents manage their bereavement and plan for the future. In Ireland, bereaved parents generally have not been involved in this review process. The aim of our study was to assess parents' perception of how they may be appropriately involved in the maternity hospital perinatal death review in ways that benefit them and the review process itself. METHODS: Bereaved parents (n = 20) in Ireland were invited to take part in semistructured interviews. Thematic analysis was carried out on the interview transcripts. RESULTS: Four main themes were identified based on the participants' views and opinions on how they experienced the review process and how they feel this process may be improved. The themes reflect the journey of the parents through the different stages of the review process: Throughout process; On leaving the hospital; Interaction with the hospital 'waiting in limbo'; Review itself. Identified subthemes highlighted essential aspects of this process and care provided to parents. For the parents, open, honest communication with staff, as well as having a key hospital contact was essential. Parents wished to provide feedback on their experience and wanted to be included in the review of their baby's death, in a way that was sensitive to their needs and the hospital's schedule. CONCLUSION: A respectful, flexible system that allows bereaved parents' involvement in their baby's perinatal death review and is tailored to their needs is essential. A collaborative process between staff and parents can highlight clinical areas in need of change, enhance lessons learned, improve bereavement services and may prevent future perinatal deaths. PUBLIC CONTRIBUTION: Bereaved parents were interviewed for this study.

Parents and clinicians: partners in perinatal bereavement research -experiences from the International Stillbirth Alliance Conference 2017.

In recent years, there has been a global call to reduce the numbers of preventable stillbirths and increase public awareness about the incidence and impact of pregnancy loss. The lived experiences of bereaved parents have much to contribute to developing the research agenda and clinical care in pregnancy loss. The multidisciplinary Pregnancy Loss Research Group (PLRG) based at the INFANT Centre at University College Cork and Cork University Maternity Hospital, has an established practice of active engagement and participation of patient members. This partnership provided the catalyst to model a similar collaborative approach between clinicians, researchers and bereaved parents when the PLRG was successful in their bid to host the International Stillbirth Alliance (ISA) annual conference in 2017. Over 400 hundred delegates from around the globe attended the conference, of which one quarter were bereaved parents. Establishing a culture of collaboration, support and mutual respect in the field of pregnancy loss, requires scientists, clinicians and parents to be brought together so each can be informed by the other in the efforts to prevent stillbirth and improve bereavement care. As part of ISA 2017 conference, a sub-committee of staff and parents was established to ensure that the voice of parents could contribute to the research agenda and developments in clinical and bereavement care. A creative workshop specifically for parents, followed by a parent assembly were organised to facilitate this. Remembrance activities, organised by the parent committee, were central to the conference and actively engaged in by parents, clinicians and researchers. This commentary, written collaboratively by a parent, a chaplain, a bereavement and loss specialist midwife and a consultant obstetrician, gives voice to this experience, identifying four key messages that arose from our reflection on the conference. These include; the value of active partnership between clinicians and patients, the use of creativity as a unifying expression of grief and as a means to facilitate learning, the value of collaboration with global stakeholders in raising awareness about stillbirth, and the importance of facilitating meaningful patient/public engagement in scientific research. The potential for education and learning opportunities are also explored, highlighting the connection between parents, researchers and clinicians as central stakeholders in the prevention of stillbirth and in improving bereavement care.

Caring for parents at the time of stillbirth: How can we do better?

BACKGROUND: Many bereavement practices have become standard within maternity hospitals however little published evidence is available to confirm their benefit. We wanted to establish which aspects of care are valued, which could be improved and which, if any, cause distress. METHODS: This study aimed to survey parents who experienced stillbirth in a tertiary referral centre. There were seven question areas including receiving bad news, involvement of the multidisciplinary team, facilitation to grieve and have time with baby, autopsy communication process, post-discharge support and the importance parents placed on aspects of care. Mothers were contacted months following stillbirth to obtain verbal consent, before surveys were posted to both parents. Data were analysed using IBM SPSS Statistics version 22.0. FINDINGS: 70% (n=21) of mothers and 51% (n=15) of fathers responded. Responses between partners tended to agree. Predominantly positive replies to the survey suggested that our priorities in the provision of care were relevant but themes of dissatisfaction were identified regarding communication, written information, post-mortem information and post discharge follow-up. The overwhelming importance of caregivers' interactions with the parents was notable in terms of the extent to which the parents recalled and wrote in detail about these encounters. DISCUSSION: Parents place a great deal of importance on their interactions with caregivers. Staff education and training needs to reflect this to ensure that professionals relate unambiguously and knowledgeably while focusing on the quality of the connection so that care provided will be experienced as sensitive, empathic and attuned to each individual parent.

Carotenoid micellarization varies greatly between individual and mixed vegetables with or without the addition of fat or fiber.

Carotenoid bioavailability is influenced by a number of factors, including the type of food matrix and the presence of fat, fiber, and other carotenoids. Therefore, the objectives of the present study were: first, to assess the effects of mixing raw vegetables on the micellarization of beta-carotene, lycopene, beta-cryptoxanthin, and lutein compared with individual vegetables; second, to investigate the effects of adding different oils on carotenoid transfer to the micelles; and third, and to a minor extent, to determine carotenoid micellarization following the addition of fiber. The two mixed vegetable meals were TRS (tomato, red pepper, and spinach) and CRS (courgette/zucchini, red pepper, and spinach). Similar trends in carotenoid micellarization were seen between individual vegetables and the TRS meal but not with the CRS meal. In general, the addition of olive, peanut, or rapeseed oil to the CRS meal significantly enhanced carotenoid micellarization but this effect was not concentration-dependent. In relation to the TRS meal, adding either vegetable oils or fiber (oat bran, wheat bran, and pectin) significantly decreased the micellarization of carotenoids to varying degrees. The results from this study indicate that changes to a combination of raw vegetables, with or without the addition of dietary fat or fiber, can have varying results on carotenoid bioavailability.