Assessment of Guidelines for Good Practice in Psychosocial Care of Mothers After Stillbirth

Abstract & Commentary

Synopsis: Patients who saw and held their stillborn babies had the highest rates of depression, anxiety, postpartum stress disorder, and attachment behavior than others who either didn’t hold or see their stillborn babies.

Source: Hughes P, et al. Lancet. 2002;360:114-118.

In July 2002, a study appeared in the Lancet that challenged the way most providers manage patients who have fetal demises. They identified 60 women who had stillbirths and enrolled another 60 women as matched controls. These women were classified according to whether a) they saw and held their dead infants; b) simply saw the infant; or c) did not see or hold the infant. These patients and the controls, who had live births, were followed into their next healthy pregnancy and at 12 months following their next birth. Hughes and colleagues were interested in assessing the mental status of these patients with regard to depression, anxiety, postpartum stress disorder (PTSD), and attachment behavior toward the next born infant.

The ones who saw and held their babies had the highest rates of depression, anxiety, PTSD, and disorganized attachment behavior than those who saw, but didn’t hold their stillborn babies. The ones who did not see their babies had the lowest rates of all of these variables. (See Table.)

Comment by John C. Hobbins, MD

For many years, we have been encouraging mothers to hold their dead babies after birth to "help them grieve" or to "arrive at some form of closure." Some parents have been encouraged to dress these babies, to obtain mementos, and to have a funeral for these babies. Hughes et al did try to evaluate the latter 2 practices and found no difference between groups. However, the numbers of patients precluded a proper evaluation. Nevertheless, their findings regarding seeing and holding their babies was certainly eye opening.

This practice simply evolved over the last few years, not because there were any good data available to back it up, but because it seemed like a rational approach to a very tragic event. I suppose the situation might be likened to a closed casket vs. an open-casket funeral.

Based on the study alone, I am not sure that parents should be discouraged from seeing and holding their babies if they have a strong wish to do so. However, the pendulum certainly should swing away from providers leading patients toward this approach, especially at a time when patients are very vulnerable and primed for any suggestions their providers might have.

I suspect that we will hear more about this topic, as this study should stimulate many others like it.

Dr. Hobbins is Professor and Chief of Obstetrics, University of Colorado Health Sciences Center, Denver.