Background
Methods
Design
Instrument development
Population
Fieldwork and sample
Sample | 796 |
Socio-demographic details | n (%) |
Age at the time of the loss (years) | |
< 30 | 125 (17.0) |
30–34 | 364 (45.7) |
35–39 | 228 (28.6) |
≥ 40 | 69 (8.7) |
Education | |
Lower second level or less | 144 (18.1) |
Upper second level | 183 (23.0) |
Third level | 496 (58.9) |
Nationality | |
Spanish | 755 (94.8) |
Foreign resident | 41 (5.2) |
Occupation | |
Professional, technical or management | 348 (43.7) |
Administration, commercial activity | 237 (29.8) |
Services or manual worker | 96 (12.1) |
Homemaker | 67 (8.4) |
Other | 42 (5.3) |
Not stated | 6 (0.8) |
Marital status at the time of the loss/death | |
Married, civil union or cohabiting | 769 (96.6) |
Single | 22 (2.8) |
Separated or divorced | 4 (0.5) |
Widowed | 1 (0.1) |
Habitat | |
Urban | 588 (73.9) |
Rural | 207 (26.0) |
Not stated | 1 (0.1) |
Previous contact with a support association | |
Yes (email, support groups, events) | 321 (40.4) |
No (website only or none) | 470 (59.0) |
Not stated | 5 (0.6) |
Pregnancy history | |
Primigravida | |
Yes | 426 (53.5) |
No | 370 (46.5) |
Living children before the loss | |
Yes | 253 (31.8) |
No | 543 (68.2) |
Previous pregnancy loss or perinatal death | |
Yes | 197 (24.7) |
No | 596 (74.9) |
Not stated | 3 (0.4) |
Details of the pregnancy and loss/death | n (%) |
Gestational age (in weeks) | |
16–19 | 128 (16.1) |
20–25 | 193 (24.2) |
26–33 | 151 (19.0) |
≥ 34 | 324 (40.7) |
Type of death | |
Spontaneous intrauterine death | 605 (76.0) |
(Includes death during labour) | 21 |
Termination for medical reasons | 189 (23.7) |
Not stated | 2 (0.3) |
Type of pregnancy | |
Singular | 740 (93.0) |
Multiple no survivors | 24 (3.0) |
Multiple with survivor(s) | 32 (4.0) |
Time between the death and completing survey | |
≤ 3 months | 299 (37.6) |
4 to 12 months | 203 (25.5) |
13 to 24 months | 119 (14.9) |
25 to 60 months | 175 (22.0) |
Type of hospital | |
Public | 593 (74.5) |
Private | 203 (25.5) |
Analysis
Results
Postmortem contact, linking objects and photographs
Gestational age (weeks) | ||||||||
---|---|---|---|---|---|---|---|---|
Total (n = 796) | 16–19 (n = 128) | 20–25 (n = 193) | 26–33 (n = 151) | ≥ 34 (n = 324) | ||||
n (%) | n (%) | n (%) | n (%) | n (%) | χ2, p* | Cramér’s V | ||
Postmortem contact | ||||||||
Mother saw the baby | 421 (52.9) | 37 (28.9) | 66 (34.2) | 78 (51.7) | 240 (74.1) | 115.06, | p < 0.001 | .380 |
Father/partner saw the baby[1] | 469 (58.9) | 33 (25.8) | 62 (32.1) | 104 (68.9) | 270 (83.3) | 201.34, | p < 0.001 | .503 |
Family member/ friend saw the baby[1] | 276 (34.7) | 14 (10.9) | 33 (17.1) | 45 (29.8) | 184 (56.8) | 129.70, | p < 0.001 | .404 |
Mother touched or held the baby | 323 (41.3) | 16 (12.5) | 46 (24.1) | 56 (37.8) | 205 (65.1) | 141.34, | p < 0.001 | .425 |
Mother held the baby | 275 (35.1) | 10 (7.8) | 39 (20.4) | 47 (31.5) | 179 (56.6) | 125.17, | p < 0.001 | .400 |
Linking objects | ||||||||
At least one linking object | 242 (30.4) | 17 (13.3) | 38 (19.7) | 42 (27.8) | 145 (44.8) | 60.21, | p < 0.001 | .275 |
Have a photograph | 97 (12.2) | 7 (5.5) | 10 (5.2) | 21 (13.9) | 59 (18.2) | 25.65, | p < 0.001 | .180 |
Postmortem contact & linking objects | ||||||||
Postmortem contact &1 or more linking obj. | 198 (24.9) | 11 (8.6) | 25 (13.0) | 33 (21.9) | 129 (39.8) | 72.77, | p < 0.001 | .301 |
No postmortem contact or linking object | 331 (41.6) | 85 (66.4) | 114 (59.1) | 64 (42.4) | 68 (21.0) | 113.37, | p < 0.001 | .377 |
Disposition of the body/remains
Gestational age (weeks) | ||||||||
---|---|---|---|---|---|---|---|---|
Total (n = 796) | 16–19 (n = 128) | 20–25 (n = 193) | 26–33 (n = 151) | ≥ 34 (n = 324) | ||||
n (%) | n (%) | n (%) | n (%) | n (%) | χ2, p* | Cramér’s V | ||
Communication of procedures and options for the disposition of the body*** | ||||||||
“No one” explained options for disposition | 273 (34.3) | 96 (75.0) | 111 (57.5) | 20 (13.2) | 46 (14.2) | 228.05, | p < 0.001 | .535 |
A doctor | 240 (30.2) | 18 (14.1) | 46 (23.8) | 59 (39.1) | 117 (36.1) | 30.56, | p < 0.001 | .196 |
A midwife/ nurse | 156 (19.6) | 11 (8.6) | 24 (12.4) | 42 (27.8) | 79 (24.4) | 27.29, | p < 0.001 | .185 |
Representative of a funeral home | 124 (15.6) | 1 (0.8) | 6 (3.1) | 28 (18.5) | 89 (27.5) | ** | ||
Administrator/ social worker/ porter/ other HP | 51 (6.4) | 2 (1.6) | 8 (4.1) | 17 (11.3) | 24 (7.4) | ** | ||
Don’t know as a family member took charge | 9 (1.1) | 0 (0.0) | 0 (0.0) | 3 (2.0) | 6 (1.9) | ** | ||
Other | 3 (0.4) | 0 (0.0) | 2 (1.0) | 0 (0.0) | 1 (0.3) | ** | ||
Not stated | 16 (2.0) | 2 (1.6) | 3 (1.6) | 3 (2.0) | 8 (2.5) | ** | ||
Disposition method | ||||||||
Donated to research | 92 (11.6) | 6 (4.7) | 27 (14.0) | 27 (17.9) | 32 (9.9) | 13.83, | p = 0.003 | .132 |
Private (burial or cremation) | 310 (39.5) | 5 (4.0) | 19 (10.0) | 67 (44.4) | 219 (67.6) | 248.52, | p < 0.001 | .559 |
Hospital managed disposition (incineration) | 371 (46.6) | 113 (88.3) | 144 (74.6) | 50 (33.1) | 64 (19.8) | 255.09, | p < 0.001 | .566 |
Burial common plot | 12 (1.5) | 1 (0.8) | 0 (0.0) | 6 (4.0) | 5 (1.5) | ** | ||
Other (e.g. haemorrhage at home) | 11 (1.4) | 3 (2.3) | 3 (1.6) | 1 (0.7) | 4 (1.2) | ** | ||
Reason for hospital managed disposition/ incineration[1]*** | (n = 371) | (n = 113) | (n = 144) | (n = 50) | (n = 64) | |||
aOnly option/ told it was protocol early losses | 205 (55.3) | 94 (83.2) | 90 (62.5) | 15 (30.0) | 6 (9.4) | 106.10, | p < 0.001 | .535 |
bLack of information/ no information | 42 (11.3) | 9 (8.0) | 18 (12.5) | 6 (12.0) | 9 (14.1) | 1.97, | p = 0.579 | – |
cTold: body not returned in cases of autopsy | 44 (11.9) | 5 (4.4) | 15 (10.4) | 12 (24.0) | 12 (18.8) | 16.21, | p = 0.001 | .209 |
Seemed like/ was the best option | 38 (10.2) | 0 (0.0) | 6 (4.2) | 11 (22.0) | 21 (32.8) | ** | ||
Pressured decision/ in a state of shock | 24 (6.5) | 1 (0.9) | 4 (2.8) | 6 (12.0) | 13 (20.3) | ** | ||
Other[2] | 23 (6.2) | 0 (0.0) | 3 (2.1) | 6 (12.0) | 14 (21.9) | ** | ||
Not stated | 35 (9.4) | 5 (4.4) | 14 (9.7) | 5 (10.0) | 11 (17.2) | 7.85, | p = 0.049 | .146 |
a + b + cDecision not taken by the parents | 285 (76.8) | 107 (94.7) | 121 (84.0) | 31 (62.0) | 26 (40.6) | 77.7, | p < 0.001 | .458 |
As a % of all cases (n = 792) | 285 (35.8) | 107 (83.6) | 121 (62.7) | 31 (20.5) | 26 (8.0) | 312.01, | p < 0.001 | .626 |
Mode of delivery and accompaniment during the birth
Gestational age (weeks) | ||||||||
---|---|---|---|---|---|---|---|---|
Total (n = 796) | 16–19 (n = 128) | 20–25 (n = 193) | 26–33 (n = 151) | ≥ 3 4 (n = 324) | ||||
n (%) | n (%) | n (%) | n (%) | n (%) | χ2, p* | Cramér’s V | ||
Mode of delivery | ||||||||
Vaginal (total) | 667 (83.4) | 120 (93.8) | 183 (94.8) | 122 (80.8) | 242 (74.7) | 47.38, | p < 0.001 | .244 |
Vaginal - induced | 578 (72.6) | 99 (77.3) | 152 (78.8) | 115 (76.2) | 212 (65.4) | 14.46, | p = 0.002 | .135 |
Vaginal - instrumentalised | 113 (14.2) | 26 (20.5) | 26 (13.5) | 9 (6.0) | 52 (16.1) | 13.53, | p = 0.004 | .131 |
Vaginal - natural | 76 (9.5) | 16 (12.5) | 28 (14.5) | 7 (4.6) | 25 (7.7) | 12.26, | p = 0.007 | .124 |
Caesarean section (total) | 118 (14.8) | 0 (0.0) | 9 (4.7) | 29 (19.2) | 80 (24.7) | 65.34, | p < 0.001 | .286 |
Planned caesarean | 22 (2.8) | 0 (0.0) | 3 (1.6) | 4 (2.6) | 15 (4.6) |
**
| ||
Emergency caesarean | 80 (10.1) | 0 (0.0) | 6 (3.1) | 22 (14.6) | 52 (16.0) |
**
| ||
Due to failed induction | 16 (2.0) | 0 (0.0) | 0 (0.0) | 3 (2.0) | 13 (4.0) |
**
| ||
Other | 9 (1.1) | 7 (5.5) | 1 (0.5) | 0 (0.0) | 1 (0.3) |
**
| ||
Not stated | 2 (0.3) | 1 (0.8) | 0 (0.0) | 0 (0.0) | 1 (0.3) |
**
| ||
Accompaniment during the birth | ||||||||
Accompanied during the birth (total)[1] | 561 (70.7) | 84 (66.1) | 128 (66.3) | 107 (70.9) | 242 (74.9) | 5.83, | p = 0.120 | – |
Vaginal births | 534 (80.2) | 82 (68.3) | 126 (68.9) | 103 (84.4) | 223 (92.5) | 49.89, | p < 0.001 | .274 |
Caesarean births | 25 (21.2) | 0 (0.0) | 2 (22.2) | 4 (23.4) | 19 (23.8) |
**
| ||
Partner not allowed to accompany (total)[2] | 138 (17.3) | 26 (20.3) | 38 (19.7) | 25 (16.6) | 49 (15.1) | 2.70, | p = 0.439 | – |
Vaginal births | 80 (12.0) | 24 (20.0) | 35 (19.1) | 11 (9.0) | 10 (4.1) | 31.30, | p < 0.001 | .217 |
Caesarean births | 54 (45.8) | 0 (0.0) | 3 (33.3) | 14 (48.3) | 37 (46.2) |
**
| ||
Explanation/ offer of pathology studies*** | ||||||||
“No one” spoke about pathology | 171 (21.5) | 50 (39.1) | 62 (32.1) | 21 (13.9) | 38 (11.7) | 59.82, | p < 0.001 | .274 |
Doctor spoke about pathology | 524 (65.8) | 72 (56.2) | 117 (60.6) | 107 (70.9) | 228 (70.4) | 12.22, | p = 0.007 | .124 |
Nurse/ midwife spoke about pathology | 120 (15.1) | 6 (4.7) | 16 (8.3) | 28 (18.5) | 70 (21.6) | 29.94, | p < 0.001 | .194 |
Other HP spoke about pathology | 19 (2.4) | 1 (0.8) | 6 (3.1) | 3 (2.0) | 9 (2.8) |
**
| ||
Not stated | 9 (1.1) | 0 (0.0) | 0 (0.0) | 2 (1.3) | 7 (2.2) |
**
| ||
Pathology studies conducted | ||||||||
At least one pathology study/test conducted | 667 (85.5) | 89 (71.8) | 155 (83.3) | 134 (91.2) | 289 (89.5) | 27.48, | p < 0.001 | .188 |
General autopsy | 479 (61.4) | 50 (40.3) | 103 (55.4) | 109 (74.1) | 217 (67.2) | 40.74, | p < 0.001 | .229 |
Stillbirths | 396 (66.8) | 31 (41.3) | 57 (66.3) | 101 (79.5) | 207 (67.9) | 31.37, | p < 0.001 | .230 |
Termination of pregnancy | 104 (55.6) | 30 (61.2) | 54 (54.0) | 12 (60.0) | 8 (44.4) | 1.80, | p = 0.620 | – |
Placental autopsy | 299 (37.6) | 27 (21.1) | 66 (34.2) | 72 (47.7) | 134 (41.4) | 24.31, | p < 0.001 | .175 |
Not stated | 16 (2.0) | 4 (3.1) | 7 (3.6) | 4 (2.6) | 1 (0.3) | 8.44, | p = 0.038 | .103 |
Administration of sedatives/ tranquilizers (benzodiazepines)
Type of hospital | ||||||
---|---|---|---|---|---|---|
Total (n = 796) | Public (n = 593) | Private (n = 203) | ||||
n (%) | n (%) | n (%) | χ2, p* | Phi | ||
Mode of delivery | ||||||
Vaginal (total) | 667 (83.8) | 521 (87.9) | 146 (71.9) | 28.29, | p < 0.001 | −.189 |
Vaginal - induced | 578 (72.6) | 449 (86.2) | 129 (88.4) |
.46,
| p = 0.494 | – |
Vaginal - instrumentalised | 113 (16.9) | 73 (14.0) | 40 (27.4) |
14.52,
| p < 0.001 | .148 |
Vaginal - natural | 76 (11.4) | 63 (12.1) | 13 (8.9) |
1.14,
| p = 0.284 | – |
Caesarean section (total) | 118 (14.8) | 67 (11.3) | 51 (25.1) | 22.89, | p < 0.001 | .170 |
Planned caesarean | 22 (2.8) | 10 (1.7) | 12 (5.9) |
10.04,
| p = 0.002 | .112 |
Emergency caesarean | 80 (10.1) | 49 (8.3) | 31 (15.3) |
8.21,
| p = 0.004 | .102 |
Due to failed induction | 16 (2.0) | 8 (1.3) | 8 (3.9) |
5.16,
| p = 0.023 | .080 |
Other | 9 (1.1) | 3 (0.5) | 6 (3.0) |
**
| ||
Not stated | 2 (0.3) | 2 (0.3) | 0 (0.0) |
**
| ||
Mode of delivery ≥26 weeks gestation | (n = 475) | (n = 357) | (n = 118) | |||
Vaginal | 364 (76.6) | 296 (82.9) | 68 (57.6) | 31.61, | p < 0.001 | −.358 |
Caesarean section | 109 (22.9) | 60 (16.8) | 49 (41.5) | 30.64, | p < 0.001 | .254 |
Accompaniment during the birth | ||||||
Accompanied during the birth (total)[1] | 561 (70.7) | 436 (73.6) | 125 (61.9) | 10.05, | p = 0.002 | −.113 |
Vaginal births | 534 (80.2) | 427 (82.0) | 107 (73.8) |
4.76,
| p = 0.029 | −.085 |
Caesarean births | 25 (21.2) | 9 (13.4) | 16 (31.4) |
5.58,
| p = 0.018 | .217 |
Partner/other not allowed to accompany (total)[2] | 138 (17.3) | 94 (15.9) | 44 (21.7) | 3.58, | p = 0.059 | – |
Vaginal births | 80 (12.0) | 57 (10.9) | 23 (15.8) |
2.50,
| p = 0.114 | – |
Caesarean births | 54 (45.8) | 34 (50.7) | 20 (39.2) |
1.55,
| p = 0.213 | – |
Administration of sedatives/ benzodiazepines*** | ||||||
Administered at least once | 382 (48.0) | 274 (46.2) | 108 (53.2) | 2.96, | p = 0.085 | – |
Administered more than once | 61 (7.7) | 41 (6.9) | 20 (9.9) | 1.84, | p = 0.174 | – |
Reason for taking sedatives | ||||||
Patient asked for something to help her relax | 130 (34.0) | 96 (35.0) | 34 (31.5) |
.436,
| p = 0.509 | – |
HP told patient to take something to relax | 203 (53.1) | 143 (52.2) | 60 (55.6) |
.352,
| p = 0.553 | – |
HP administered without consulting | 68 (17.8) | 49 (17.9) | 19 (17.6) |
.004,
| p = 0.947 | – |
Effects of sedatives explained at 1st admin. (partially or fully)[3] | 167 (43.8) | 117 (42.7) | 50 (46.7) |
.507,
| p = 0.476 | – |
Pathology studies conducted | ||||||
At least one pathology study/test conducted | 667 (85.5) | 519 (89.2) | 148 (74.7) | 24.82, | p < 0.001 | .178 |
General autopsy | 479 (61.4) | 387 (66.5) | 92 (46.5) | 25.01, | p < 0.001 | −.179 |
Stillbirths | 396 (66.8) | 314 (71.5) | 82 (53.2) | 17.17, | p < 0.001 | −.170 |
Termination of pregnancy | 83 (44.4) | 73 (51.0) | 10 (22.7) | 10.93, | p = 0.001 | −.242 |
Placental autopsy | 301 (38.6) | 230 (39.5) | 71 (35.9) | .835, | p = 0.361 | – |
Not stated | 16 (2.0) | 11 (1.9) | 5 (2.5) | .284, | p = 0.284 | – |