“The hardest 9 months of my life”: Parents’ experiences of care in pregnancies after perinatal loss in Australia

PROBLEM: Pregnancy after perinatal loss is associated with increased risks of adverse psychosocial and biomedical outcomes. BACKGROUND: Standard antenatal care often fails to meet these parents' needs. AIM: To explore parents' experiences of pregnancy after perinatal loss in Australia and understand the care and support they find most meaningful. METHODS: National cross-sectional web-based survey of parents in Australia who had experienced perinatal loss and were pregnant or had completed a subsequent pregnancy in the preceding five years. Quantitative data were analysed largely descriptively; qualitative data underwent thematic analysis. FINDINGS: Of 332 participants (97 % mothers), most experienced adverse mental health issues at least sometimes during the subsequent pregnancy (70-98 %). Most received additional or specialised care plans (74 %) and reported elements of respectful and compassionate care most-, or all of the time (73-91 %). Participants typically rated their care favourably. Most had access to medical components of care, such as an obstetrician (89 %) and additional ultrasound scans (87 %), while few reported the involvement of a specialist midwife (17 %), bereavement counsellor (23 %) or specialist antenatal classes for pregnancy after loss (5 %). Thematic analysis identified one overarching theme: recognition of the subsequent pregnancy and previous loss; and four subthemes: trusted healthcare professional in a continuity of carer model, additional care and monitoring, emotional and mental health support, and respectful communication. DISCUSSION: Recognition of the subsequent pregnancy in the context of prior loss is essential. CONCLUSION: Improving access to integrated, trauma-informed continuity of care models may better support parents in pregnancies after loss.