The blame game: Experience and impact of stillbirth on midwives

Introduction After the diagnosis of a stillbirth, parents need supportive care from health professionals to deal with the loss. However, while health professionals are expected to provide appropriate bereavement care during and after stillbirth diagnosis, they also have their own grief and sadness to deal with. Lack of understanding of health professionals' experience of stillbirth can affect the quality of bereavement care they provide, which can lead to negative grief trajectory for parents. However, there is limited research on health professionals' experience of stillbirth and how it impacts them. Aim The aim of this study was to understand the experience of health professionals who have delivered a stillbirth in clinical practice. Methods Individual interviews were conducted with 11 registered midwives in Nigeria about their stillbirth experience. The interviews were analyzed thematically, and the analysis yielded four main findings. Results In the first theme, midwives discussed their emotional/psychological reaction to stillbirth, which includes self-blame, blaming others (even parents), guilt and emotional trauma. In the second theme, the midwives discussed the impact of stillbirth on their professional identity, which includes employers' scrutinization of their midwifery competence, violence from dissatisfied family members, loss of the 'joy of midwifery', loss of job satisfaction, and self-doubts about professional competence. In the third theme, the midwives discussed the impact of stillbirth on their practice, such as increased assisted births and caesarean sections due to fear. However, they also said they had more motivation to learn about stillbirth prevention after they experienced it. In the fourth theme, the midwives discussed their coping mechanisms, which they described as a combination of personal resilience, requesting day offs and seeking the support of colleagues to regain professional confidence. Conclusion As this study shows, stillbirth occurs within the context of culpability. As the health professional, family and the health system try to process the loss, a health professional's practice might be questioned and scrutinized. As a result, stillbirth increases the risk of second victim phenomenon for health professionals. This suggests that health professionals need more support to deal with the personal and professional impact of stillbirth before they can appropriately manage the grief of stillbirth-affected families.