Introducing Bereavement as part of the mandatory training for midwives

Introducing Bereavement as part of the mandatory training for midwives


            Mourning is the entire process precipitated by the loss of a family member or a loved one.During childbirth, the loss of a newly born baby is a profound loss to new mothers, prompting the need to introduce bereavement as part ofmandatory training for newly qualified midwives.Given the trauma that is experienced by not only the new mothers but also the attending midwife, the approach of such a situation is critical to the process of grieving(Barry et al., 2017). Moreover, bereavement elicits a lot of emotional and psychological reactions that may eventually result into psychological harm to both the mother and the newly qualified midwife due to inadequate training in bereavement such as coping with perinatal loss(Chiarella et al., 2008).

Training newly qualified midwives on how to cope with perinatal loss is an essential intervention to improve midwifery services in hospitals (Stephen and Macduff, 2012).Parents find it difficult to cope with the sad news of perinatal loss since most parents try to envision the life of their baby even before they are born, thus building expectations over the time of pregnancy with the climax when the mother goes into labor. During this time both the father and the mother are highly expectant of a live child who will live their entire lifetime and achieve milestones. However, despite all the expectation, one thing that the expectant parents do not prepare themselves for is the possibility of perinatal loss (Canadian-Peadriatric-Society, 2001). The sensitivity of such a loss calls for additional mandatory training of newly qualified midwives on bereavement to help them gain necessary skills to walk the bereaved mother through the grieving process(Gardner et al., 2004).

Bereavement is a critical area that ought to be included in the midwifery training to equip the newly qualified midwives with skills and knowledge of handling bereaved mothers.According to Fenwick and colleagues, the current midwifery training does not provide the essential skills and psychological techniques for managing bereavement during pregnancy or childbirth (Fenwick et al., 2007).

Much of the research in perinatal loss is profoundly focused on the psychology aspect of midwifery which particular emphasis on psychometric evaluation of specific components including care such as naming newly born babies (Allott, 1996). Hughes described the dramatic changes which have been experienced in this field for more than 20 years and credits the positive changes realized to the initial interest in the clinical benefit in the experience during a perinatal loss(Hughes and Goodall, 2013).

More recently, there has been a shift in the focus on how perinatal bereavement care is provided in the hospital setting(Hughes and Goodall, 2013). However, the care provided to women who have suffered the unfortunate perinatal bereavement has not been strengthened and optimized to achieve positive care outcomessignaling the need for an urgent assessment of the guidelines for bereavement. This paper proposes new aspects for improving perinatal loss care such as the introduction of holistic care, woman-centered care, and evidence-based care. Moreover, there is a need to revise the perinatal loss care policies appropriately.Along with the changes above that can be used as the basis for improving perinatal bereavement care, further research in the area of perinatal bereavement should thus be encouraged(Kara et al., 2017).

The existence of structures in healthcare organizations as well as government policies that establish perinatal bereavement care does reflect good care for bereaved mothers and their families. The quality of care provided by newly qualified midwives to the bereaved families is gradually diminishing in the United Kingdom, as a result of sub-standard college training of midwives. The newly qualified midwives have limited skills in handling bereaved mothers affecting the effectiveness of care provided to the victims of bereavement. To ensure that the newly qualified midwives are highly versatile and are positioned appropriately to handle bereavement cases, additional mandatory training is recommended so to facilitate training of the newly qualified midwives in critical areas such as bereavement (Schott and Henley, 2007).

According to past studies, newly qualified midwives face the challenge of inadequate support to care for bereaved women and their families(Simwaka, De Kok and Chilemba, 2014). Thus, different approaches have been implemented to support the newly qualified midwives to cope with bereavement. Midwives training includes the application of educational tools such as workshops seminars and internships to gain practical skills (Hall and Mitchell, 2017).The core value of postnatal care includes respect and dignity which can be achieved through participating in workshops and short course training.According to Alghamdi& Jarrett (2016), workshops and seminars are essential in equipping newly qualified midwives with the necessary skills to perform their duties effectively(Alghamdi and Jarrett, 2016). The need for supporting early careers midwives has been demonstrated widely including in the UK(Barry et al., 2017; Doherty et al., 2018). The national maternity review newly qualified midwives need to be trained particularly on the topics of communication as well as specialized (Better Births, 2018) bereavement support. This training will particularly help the newly qualified midwives to improve on their skills of communicating with perinatal loss victims. With proper communication skills, the newly qualified midwives will be able to connect professionally with bereaved mothers.This report discusses the role of self-care strategies, mother-centered care and holistic care in the perspective of policies and effective leadership to enable newly qualified midwives to cope with bereavement(Better Births, 2018). These approaches are meant to facilitate the enhancement of perinatal as well as postnatal care provided to bereaved mothers.

Organizational structures and government policies have a significant impact on midwifery professional practice. The quality of services rendered to mothers who have lost their infants is significantly determined by the existing organizational structures in health care facilities as well as the government policies in place. In the UK, the perinatal loss has been associated with an interplay of complex risk factors such as maternal age, smoking, and obesity. Majority of the risk factors contributing to perinatal bereavement can be addressed through formulation and putting in place simple policies such as health education policies. This policy will require that all pregnant women are registered in healthcare facilities and are educated throughout the pregnancy period by professional midwives. Besides, all pregnant women must be monitored throughout their pregnancy as a policy.

High rates of perinatal bereavement have been reported among minority ethnic and socio-economic groups suggesting that the policies must be strengthened to ensure that all pregnant mothers from minority groups are monitored throughout their pregnancy.Strengthening government policies on perinatal bereavement is particularly crucial since the currently existing systems have not been followed carefully(Mukherjee and Bandyopadhyay, 2016).

Management and leadership theories are frameworks/models that define different types of leadership approaches. Leadership is the reflects one’s ability to convince other people to willingly behave differently while on the other hand management is more or less making things happen(Armstrong, 2016).Leadership theories are anchored on the different behaviors and traits exemplified by leaders in various fields. There are different traits associated with varying styles of leadership such as transformative and transactional leadership, authoritarian leader, democratic leaders, and Laissez-faire leader. Every leadership approach influences the outcome and achievement of the organization’s primary objectives differently. For instance, transformative leaders base their leadership approach on the need to transform the organization from the current state to a better status that at the end of his/her tenure, the organization will be proud of him/her.

In line with the introduction of bereavement as an essential aspect of a mandatory midwifery training, this paper delves into the influences of leadership/management theories on team building, prioritization, motivation and change management. The proposed change in midwifery practice focusses on creating an enabling environment for the enhancement of midwifery training to optimize their practice outcomes(Andrews, 2002). The proposed changes will ensure that parents who have suffered perinatal bereavement receive holistic, woman-centered, and evidence-based care approaches. These proposed changes will partly be achieved through a revision of the existing policies. However, to make these recommendations, there is a need to involve different groups of people including voluntary organizations, head of midwifery, bereavement midwife and matron. It is evident that the participantsin the practice change introduction are drawn from diverse backgrounds creating the need to put in place a versatile leadership to ensure cohesion and team building within the group.

There are many leadership theories to choose from; however, the primary objective is to select a leadership approach that will maximize team building, motivating group members, prioritization and managing change. Example of the leadership theories that can be applied in this context includes transformative, authoritarian leader, democratic leaders, and Laissez-faire leader. Transformative leadership approach, for instance, is concerned with the ability of leaders to inspire followers to achieve great things. Transformational leaders are regarded as agents of change, and their primary objective is to change the organization positively.In view of introducing change in the midwifery practice, transformational leadership approach is the best approach as it promotes team building, motivated the group members, and provided capacity for managing change(Aga, Noorderhaven and Vallejo, 2016).

Leaders and managers are the determinants of organizational performance. Organizational leaders play the primary role in ensuring that a conducive environment and culture that promote employee performance exist in their organizations(Mathew et al., 2016).Employee motivation and productivity are closely related in the sense that motivated employees are likely to be more productive as compared to un-motivated employees. According to Alghazo, the management and leadership theory adopted in organizations significantly influences team building, change management and motivation(Alghazo and Al-anazi, 2016). Some of the leadership approaches such as transformative, democratic and Laissez-faire leadership are known to promote team building, motivation and managing change whereas authoritarian leadership hinders team limits team building, motivation and change management.

The proposed change in practice is the introduction of bereavement as a mandatory component of the midwifery training curriculum. The introduction of this practice change is aimed at optimizing perinatal loss care that women receive following the death of their newly born infants. Perinatal bereavement is a long-standing problem in the UK triggering the UK government to formulate policies that will work towards the reduction of these cases. In the year 2014, an estimated 3, 245 stillbirths and 2,689 infant deaths were reported in England and Wales(Office of National Statistics, 2014).The loss of a child during or immediately after birth is a traumatic experience that the mother and relatives go through. Based on the quality of care victims of perinatal loss receive afterward, the events may leave a long-lasting impact on the family(Montacute and Bunn, 2016).

Based on the above evidence, it is of primary importance to establish strategies that can facilitate practice change on how the victims of perinatal bereavement are treated and the quality of care they receive. This paper proposes a practice change in which a component of bereavement is introduced into the midwifery teaching curriculum. The practice change will entail expanding the scope of the curriculum to include pre and post-bereavement care techniques(Mitchell, 2005). By equipping bereavement midwives with such skills is an important priority which will not only promote good care for the mothers who experience perinatal bereavement but also accelerate their recovery from the traumatic experience and resume their healthy lives(Kurinczuk et al., 2014).

The model for the proposed practice change will involve process enhancement and capacity building with the target of equipping bereavement midwives with skills necessary for optimizing perinatal bereavement care. Thus, the primary objective of the practice change is to introduce bereavement techniques and handling psychosocial impact on bereaved parents. Training optimization is the major component of the practice change which has two significant outcomes. The first outcome is the optimization of perinatal loss victim’s care and the second outcome is the building capacity for transformative leadership among bereavement midwives. The optimization of care provided to bereaved parents will be realized through various approaches such as the provision of holistic care, evidence-based care, and policy formulation. Transformative leadership among bereavement midwives is encouraged partly due to its effectiveness and partly due to its association with change.

Most importantly, transformative leadership encourages team building; hence it will ensure that all the grief midwives in the UK collaborate and work as a team to attain the primary objective of care optimization. Another desirable aspect of transformative leadership is the motivation aspect implying that the transformative leader will motivate followers and foster for the implementation of the proposed change.Transformative leaders have the necessary skills and techniques for managing changes suggesting that once trained on transformative leadership; bereavement midwives will be able to effectively manage the change process eventually attaining all the set objectives.

Voluntary community-based organizations will be in recruited to facilitate the change process by reaching out to community health care workers and newly qualified bereavement midwives stationed in rural areas. The head of midwifery for all the hospitals that will participate in the change process will also be recruited to help educate and lead all the midwives through the change process. Finally, but most importantly, the newly qualified bereavement midwives and matronswho will be involved in the change process as the primary target. The Newly qualified midwives will attend a 3- days additional training in which bereavement will be discussed as the main topic. Subsequently, the newly qualified nurses will be required to apply the skills and knowledge acquired to facilitate bereavement services in all local hospitals and healthcare centers.

Quality of care provided to bereaved parents determines how fast the bereaved parents recover from the traumatic experience of losing a newly born baby. Therefore, good quality care before and after delivery will ensure that the parent safely delivers the baby hence reducing the cases perinatal bereavement. In my opinion, good quality care is the purpose for which midwifery as a profession exists. Thus all midwives should be ready to go out of their way to help pregnant mothers to deliver their infants safely. It is also important to note that quality determines the purpose for which professional midwives exist and as such, there is need to ensure that newly qualified midwives receive quality training covering all aspects of their profession including the component of bereavement. It is also a common practice to build a good brand and win the trust of the patients in the health care industry. Earning the trust of patients requires high-quality services is at the heart of the care provided. Sound quality is an indicator of patient satisfaction and must be maintained to ensure that patients are satisfied. I believe that the joy of every pregnant woman is to hold in their hands live newborn infants. Midwives are the facilitators of this joy by providing quality are which reflects the professional practice of midwifery(Shorey, André, and Lopez, 2017).



Aga, D. A., Noorderhaven, N., and Vallejo, B. (2016) ‘Transformational leadership and project success: The mediating role of team-building,’ International Journal of Project Management. Elsevier, 34(5), pp. 806–818.

Alghamdi, R. and Jarrett, P. (2016) ‘Experiences of student midwives in the care of women with perinatal loss: A qualitative descriptive study,’ British Journal of Midwifery. MA Healthcare London, 24(10), pp. 715–722.

Alghazo, A. M. and Al-anazi, M. (2016) ‘The Impact of Leadership Style on Employee ‘ s Motivation The Impact of Leadership Style on Employee ‘ s Motivation,’ (November).

Allott, H. (1996) ‘Picking up the pieces: the post-delivery stress clinic,’ British Journal of Midwifery. MA Healthcare London, 4(10), pp. 534–536.

Andrews, S. (2002) Clinical risk management study day review, RCM midwives : the official journal of the Royal College of Midwives.

Armstrong, M. (2016). Armstrong’s Handbook of management and leadership for HR: Developing effective people skills for better leadership and management. Kogan Page Publishers.

Barry, M. et al. (2017) ‘Exploring perinatal death with midwifery students’ using a collaborative art project,’ Nurse education today. Elsevier, 48, pp. 1–6.

Canadian-Peadriatric-Society (2001) ‘Guidelines for health care professionals supporting families experiencing a perinatal loss,’ 6(7), pp. 469–477.

Chiarella, M. et al. (2008) ‘An overview of the competency movement in nursing and midwifery,’ Collegian. Elsevier, 15(2), pp. 45–53.

Cumberlege, J. (2018) ‘Better births. Improving outcomes of maternity services in England: A Five Year Forward View for maternity care. The National Maternity Review. London: NHS England; 2016’.

Doherty, J. et al. (2018) ‘Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives,’ Midwifery. Elsevier, 66, pp. 1–9.

Fenwick, J. et al. (2007) ‘Providing perinatal loss care : Satisfying and dissatisfying aspects for midwives.’ doi: 10.1016/j.wombi.2007.09.002.

Gardner, G. E. et al. (2004) Nurse practitioner standards project: report to Australian Nursing and Midwifery Council. Australian Nursing & Midwifery Council.

Hall, J. S., and Mitchell, M. (2017) ‘Educating student midwives around dignity and respect,’ Women and Birth. Elsevier, 30(3), pp. 214–219.

Hughes, K. H. and Goodall, U. A. (2013) ‘Perinatal bereavement care: are we meeting families’ needs?’, British Journal of Midwifery. MA Healthcare London, 21(4), pp. 248–253.

Kara, N. et al. (2017) ‘The BetterBirth Program: pursuing effective adoption and sustained use of the WHO Safe Childbirth Checklist through coaching-based implementation in Uttar Pradesh, India,’ Global Health: Science and Practice. Global Health: Science and Practice, 5(2), pp. 232–243.

Kurinczuk, J. J. et al. (2014) ‘Experiences with maternal and perinatal death reviews in the UK—the MBRRACE‐UK programme,’ BJOG: An International Journal of Obstetrics & Gynaecology. Wiley Online Library, 121, pp. 41–46.

Mathew, J. et al. (2016) ‘Organizational leadership and culture in the advertising industry,’ Journal of Business and African Economy, 2(1), pp. 43–58.

Mitchell, M. (2005) ‘Preparing student midwives to care for bereaved parents,’ Nurse Education in Practice. Elsevier, 5(2), pp. 78–83.

Montacute, R. and Bunn, S. (2016) ‘Bereavement Care after the Loss of a Baby in the UK,’ (527), pp. 1–6.

Mukherjee, S. B., and Bandyopadhyay, T. (2016) ‘Perinatal mortality-what has changed,’ Indian Pediatr, 53, pp. 242–243.

Office-of-National-Statistics (2014) ‘Deaths registered in England and Wales: 2014’, Social Psychology. Hogrefe & Huber Publishers, 39(3), pp. 151–156.

Schott, J. and Henley, A. (2007) ‘Pregnancy loss and death of a baby: the new Sands Guidelines 2007’, British Journal of Midwifery. MA Healthcare London, 15(4), pp. 195–198.

Shorey, S., André, B. and Lopez, V. (2017) ‘The experiences and needs of healthcare professionals facing perinatal death: A scoping review,’ International journal of nursing studies. Elsevier, 68, pp. 25–39.

Simwaka, A. N. K., De Kok, B., and Chilemba, W. (2014) ‘Women’s perceptions of Nurse-Midwives’ caring behaviors during the perinatal loss in Lilongwe, Malawi: an exploratory study,’ Malawi medical journal. Medical Association of Malawi, 26(1), pp. 8–11.

Stephen, A. I., and Macduff, C. (2012) ‘Scoping of education and training for bereavement care Final Report for NHS Education for,’ (June).