Maternal experiences of care following a stillbirth at Steve Biko Academic Hospital, Pretoria, South Africa

Abstract

Background. Despite improvements in obstetrics and neonatal care, the stillbirth rate remains high (23 per 1 000 births) in South Africa
(SA). The occurrence of a stillbirth is a dramatic and often life-changing event for the family involved. The potential consequences include
adverse effects on the health of the mother, strain on the relationship of the parents, and strain on the relationship between the parents and
their other children. The standard of care in SA follows the Royal College of Obstetricians and Gynaecologists Green-top guidelines.
Objectives. To explore maternal experiences of in-patient care received in cases of stillbirth.
Methods. A descriptive phenomenological approach was performed in the obstetrics unit at Steve Biko Academic Hospital, Pretoria, SA.
Post-discharge interviews were conducted with women who experienced a stillbirth. The healthcare workers in the obstetric unit were also
interviewed on the care provided to these patients. Data analysis was performed using the Colaizzi’s method.
Results. Data from the interviews with the 30 patients resulted in five themes relating to the maternal experience of stillbirth: ‘broken
heart', ‘helping hand’, ‘searching brain’, ‘soul of service’ and ‘fractured system’. Healthcare worker participants emphasised the importance of
medical care (the clinical guidelines) rather than maternal care (the psychosocial guidelines).
Conclusion. While the medical aspects of the guidelines are adhered to, the psychosocial aspects are not. Consequently, the guidelines
require adaptation, especially taking into consideration African cultural practices, and the inclusion of allocated responsibility regarding the
application of the psychosocial guidelines, as this is the humanitarian umbilical cord between healthcare workers and those in their care.