Every year, more than 6 500 babies and children under the age of five die in the UK (Child Bereavement UK, 2017). While it is widely recognised that bereaved parents should receive high-quality support and care from professionals, it is equally important that professionals have the necessary training to feel supported and validated in this most challenging area of their work. I have noticed in recent years that there has been a growing awareness of the need to offer training and support to professionals working with bereaved families. In my experience, whilst high-quality training is available, uptake remains frustratingly low.
The All-Party Parliamentary Group for Baby Loss (2016) has recognised that ‘all professionals coming into contact with bereaved parents require and deserve continuous professional development on this subject’. However, bereavement training remains restricted for many midwives due to a lack of funding and the inability for staff to be released within the NHS. While a limited amount of mandatory bereavement training is sometimes available, management may consider this to be a lower priority than other competing demands. Even when it is available, it is often limited in terms of time and scope. I know that some healthcare professionals feel so strongly about providing good bereavement support that they often resort to self-funded training and taking annual leave to attend a course.
We all know it's impossible not to be emotionally affected when a baby dies, yet too often professionals working with bereaved parents have had little to no specialist support when it comes to ensuring their own wellbeing. I worked for more than 10 years in the NHS before joining a national child bereavement charity as Director of Training. Here, I designed and delivered training programmes to midwives and allied healthcare professionals across the UK. Much of my work is centred around providing professionals with the skills and confidence to support bereaved parents. However, it is equally important to ensure professionals feel valued, supported and listened to in this challenging area of their work.
Good bereavement training should include advice and techniques on how to look after yourself and your colleagues. This can be achieved through the provision of staff debriefs, reflective practice and supervision, as well as suggestions for how to maintain a good work-life balance. I believe that perhaps the most important element of self-care is peer support and feeling that you are part of a cohesive and encouraging team. It can be too easy to sacrifice your own wellbeing for the sake of others—for example, taking on extra shifts, working through your break and generally never being able to say, ‘No’.
According to the 2016 Labour Force Survey, those who are working in health and social care have the highest incidence of sickness due to stress, out of all occupations recorded (Office for National Statistics, 2016). Psychotherapist Sass Boucher (2019) talks about ‘professional trauma and fatigue’ to describe the risks that can be associated with working with other human beings who are in need of support and potentially affected by trauma. Stress, compassion fatigue, secondary trauma, burnout and vicarious trauma are all terms also used to describe this impact (Stillbirth and Neonatal Death Society [Sands], 2019).
‘Good bereavement training should include advice and techniques on how to look after yourself and your colleagues’
In Kitchen Table Wisdom (1996), Rachel Naomi Remen, clinical professor of family and community medicine at the University of California, says that ‘the expectation that we can be immersed in suffering and loss daily, and not be touched by it, is as unrealistic as being able to walk through water without getting wet’.
Midwives are on the frontline when it comes to supporting bereaved families. In 2015, the Sands charity issued a position statement relating to the role of the bereavement midwife, saying that, ‘It is essential for maternity units to have access to at least one member of staff who has specialist knowledge and training in bereavement care’. Progress is being made, with projects like the National Bereavement Care Pathway (Sands, 2019) created to ensure that ‘all bereaved parents are offered equal, high-quality, individualised, safe and sensitive care in any experience of pregnancy or baby loss…’. In some maternity units, there are now specialist bereavement midwives, although in many areas this provision is still somewhat patchy. I believe strongly that, in order for midwives and other professionals to provide bereavement support, there needs to be a step change in the number of staff being offered and receiving specialist training.
I have trained many midwives over the years and one of the key themes that emerges is their fear of saying the wrong thing. We know that the words midwives use at critical times, such as the death of a baby, will stay with parents forever and that they only have one chance to get it right. That pressure can have a huge impact on the quality of the care midwives provide, as well as for their own psychological wellbeing. Specialist training will help midwives feel more confident to offer the best care to families.
The feedback I get from midwives following a training workshop is overwhelmingly positive. They feel relieved to be in an environment where they can share their experiences, learn from each other, and realise that, on the whole, they are doing an excellent job of supporting parents around the time of a baby's death. The training often provides a safe learning space away from the hustle and bustle of their daily routine, enhancing their skillsets, increasing their confidence and knowledge, and empowering them to do an even better job in the future.
I feel privileged working with midwives and other healthcare professionals. It is incredibly rewarding to help them find ways to provide the best care for families during this most traumatic experience, as well as ensuring they take good care of themselves and each other.