"Preferable care" following perinatal death, care-givers' evaluation of perinatal death care, and factors associated with their evaluation

Abstract

Purpose
To clarify the actual status of the "preferable care" following perinatal death (stillbirth and early neonatal death), care-givers' evaluation of such care, and factors associated with their evaluation.
Method
Among care-givers' working for maternity units in the Hokuriku area and engaged in perinatal death care, a questionnaire survey was conducted on "preferable care" (care desired by many mothers who had experienced perinatal death, extracted from the literature) among them, their evaluation of perinatal death care, and factors associated with their evaluation (their personal factors, care-related factors, environmental factors, and target-related factors). Analyses covered 276 care-givers who had evaluated cases of less than 5 years.
Results
Their mean age was 35.5±9.3 years and the mean period of working for maternity units was 9.2±7.0 years. As for the occupation, 71% were midwives. Out of 20 items of "preferable care", 13 were practiced in 70%. Among these items, care for the child and family to live together was practiced in more than 80%, but continuous involvement after discharge, including referral to a mental specialist or support group, was only practiced in some 10%. Their evaluation of perinatal death care resulted in scores ranging from 0 to 96.8 points (mean: 47.4±22.1 points), correlated with the prevalence of "preferable care", the time spent on care, the amount of knowledge (represented by the levels of learning experience and knowledge, and self-evaluation of knowledge), and the level of experience (based on age, the number of years of working for maternity units, and the number of care cases experienced) (r=0.26-0.58, p<0.01). The evaluation score was higher in midwives (occupation), and in care-givers engaged as the person in charge or the administrator (role in care). The evaluation of perinatal death care was affected by the prevalence of "preferable care", the time spent on care, and the number of years of working for maternity units; 46.4% of the evaluation was explained by 4 factors.
Conclusion
Out of 20 items of "preferable care", 13 were practiced in 70%. Among these items, care for the child and family to live together was practiced in more than 80%, but post-discharge care was only practiced in some 10%. The evaluation of perinatal death care resulted in 47.4±22.1 points on average, affected by the prevalence of "preferable care", the time spent on care, and the number of years of working for maternity units.