Healthcare professionals’ confidence in providing perinatal bereavement care for women and their families in low- and middle-income countries

Background/Aims Perinatal death has a high burden in low- and middle-income countries. Inadequate care and support from healthcare professionals is a major factor in negative experiences and impacts parents’ adjustment after stillbirth and neonatal death. Understanding healthcare professionals’ experiences in these settings is key to developing context-appropriate tools to assess confidence, which could support improvement in care for women and families. This review's aim was to synthesise the literature on healthcare professionals’ experiences of providing perinatal bereavement care in low- and middle-income countries and factors impacting their confidence. It was also to identify existing tools available to assess healthcare professionals’ confidence in providing perinatal bereavement care in these settings. Methods This integrative literature review searched CINAHL, Medline, Cochrane Library, PsycINFO and Global Health for studies that explored the provision of perinatal bereavement care by healthcare professionals in low- and middle-income countries. Included studies were critically appraised using the Crowe Critical Appraisal Tool and their findings were synthesised using a four-stage constant comparison method involving data reduction, display, comparison and conclusion. Results Six papers were included and five main themes identified: communication difficulties, fear of complaints and personal safety, psychological and emotional impact of poor outcomes, care environment in facilities and limited formal education and training. Healthcare professionals experienced communication difficulties with women and families, contributed to by fear of litigation and feelings of guilt over poor outcomes. Healthcare system barriers, including the lack of guidelines, staff, resources and formal education and training, had a negative impact on healthcare professionals’ ability to provide bereavement care to the standard they wished. No tools were identified that were specific to low- and middle-income countries for assessing healthcare professionals’ confidence in providing perinatal bereavement care. Conclusions There is limited research exploring healthcare professionals’ experiences in low- and middle-income countries when caring for women and families after stillbirth. Existing studies suggest that healthcare professionals were deeply impacted by their experiences, lacked confidence in their ability to provide care and wanted more education, evidence-based guidelines and support from facility management in order to improve care. Implications for practice There is a need for more research in low- and middle-income countries in order to develop strategies aimed at improving care for parents affected by stillbirth and neonatal death.