Gaps in Stillbirth Bereavement Care: A Cross-Sectional Survey of U.S. Hospitals by Birth Volume

Objectives The quality and scope of perinatal bereavement care in the United States has been evaluated by surveying bereaved parents, but little is known about how care varies across hospitals. We sought to survey clinicians about stillbirth bereavement care practices at U.S. hospitals and to evaluate care by hospital birth volume. Methods Using American Hospital Association data, we employed stratified random sampling to select 300 hospitals from all centers with at least 100 annual deliveries. Within each state, we divided all hospitals into size quartiles and randomly selected from each until we reached the goal number per state. We then identified a staff member knowledgeable about typical bereavement care on labor and delivery at each hospital and sent an on-line survey about care. We linked survey data with hospital characteristics and used summary statistics, Chi squared, and Fisher’s Exact test to compare care by hospital birth volume. Results We reached an eligible respondent at 429/551 hospitals and 396 of the 429 (73%) agreed to participate. We received 289 usable surveys for an overall response rate of 67%. Only one third of hospitals (n = 96, 33%) reported staff protected time for perinatal bereavement care. Of 17 bereavement topics, just six were routinely offered by at least two-thirds of the hospitals. Financial limitations and staff shortages were the most commonly identified barriers to care and were most pronounced at small-volume hospitals. Conclusions for Practice This study offers a snapshot in bereavement care and identified important gaps for both large and small hospitals. Significance What is already known on this subject? While there have been efforts to improve hospital bereavement care for families after stillbirth, no researchers have surveyed U.S. hospital practices to assess current bereavement practices or how these practices vary across hospitals. What this study adds? This study systematically sampled hospitals in all U.S. states to assess stillbirth bereavement care including memory-making, parental education, and barriers to optimal care and analyzed differences by hospital birth volume. The study found significant gaps including limited bereavement education about normal grief, mental health, impact on relationships, return to work, and the father’s experience.