Appendix 3: The Importance of Sensitive Contraception Counselling after Pregnancy Loss and the Death of a Baby: a View of Those Supporting Bereaved Parents
The experiences of bereaved parents must be considered when discussing contraception after pregnancy. Miscarriage is the most common adverse pregnancy outcome in the UK with 10% to 15% of all pregnancies ending in miscarriage and an estimated 12% of these result from unintended pregnancies. Data from Tommy’s estimates that around 1 in every 250 pregnancies ends in a stillbirth in the UK. Every day in the UK, 13 babies die shortly before, during or soon after birth. NHS guidance advises women that they “will need to use contraception from day 5 after a miscarriage or ectopic pregnancy.” 100 Progestogen-only pills and implants can be started immediately, while oestrogen-containing methods like the pill, patch, ring, or injection are generally safe to start a few weeks after a stillbirth in the second trimester. For third-trimester stillbirths, oestrogen-containing methods should be avoided for at least 21 days. An IUD can be inserted immediately or any time after, unless there’s a severe infection. Guidance from Sands and other charities working to support bereaved parents who have experienced neonatal death and stillbirth, advise healthcare professionals to take a sensitive approach to discussing contraception with bereaved parents. The National Bereavement Care Pathways Guidance , which all NHS Trusts have signed up to, advises that the loss is acknowledged, recognised and the emphasis should be on personalised sensitive care to support the parents at this difficult time. Most families where there has been a stillbirth will become pregnant again within a year, but everyone is different, and these decisions are highly personal and so informed choice is critical.
Therefore, one of the bereavement care standards embedded in the National Bereavement Care Pathway is to have a system in place to clearly signal to all healthcare professionals and staff that a parent has experienced a bereavement. This is to ensure that all paper and electronic documentation provides clear communication about a bereavement and enables joined-up, responsive care. Information should be provided in different formats for women to access when they feel ready, and healthcare professionals should practice compassion, empathy and sensitivity and understand why women may want to wait to receive certain information on contraception. Sands also recommends that healthcare professionals arrange for a follow-up health check to take place, and contraception could form part of this conversation. Overall, professionals should take a holistic view of women’s health, and the delivery of personalised care is essential and should be adopted as a standard model of PPC care. There are multiple resources available to support healthcare professionals to hold sensitive conversations with bereaved parents, including a Sands training microsite that anyone can register to attend online training sessions. Further information can be accessed via the resources list at the end of this report. Sands is a charity working to support anyone affected by pregnancy loss or the death of a baby. The charity also carries out vital work to improve maternity safety through targeted research, campaigning for change, working with Government and reducing inequalities in healthcare to save babies’ lives .
Having a stillbirth or experiencing pregnancy loss or neonatal death is often a very traumatic event for women and birthing partners.
100 NHS.UK. Sex and contraception after birth
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