“How do I navigate the joy and the grief at the same time?” – Mothers' postnatal experiences following care in a specialist pregnancy after loss clinic: A qualitative study

BACKGROUND: In a subsequent pregnancy after perinatal death, mothers likely experience anxiety, depression, grief, and post-traumatic stress. Personalised antenatal care at a specialist clinic supports mothers; however, little is known about their experiences after birth. Mothers may have anxiety and fear postnatally, and face challenges transitioning from specialist antenatal care to standard postpartum care, however this transition remains unstudied. AIM: To explore mothers' postnatal experiences in a subsequent pregnancy after previously experiencing perinatal death. METHODS: A qualitative study using semi-structured interviews of 28 mothers 3-6 months after birth. Interviews were transcribed and analysed using thematic analysis. FINDINGS: Three overarching themes were identified: 'End of personalised care' which included two subthemes describing mothers losing connections to trusted healthcare professionals, and changes to the quality of care. 'Navigating emotions' which consisted of three subthemes describing how mothers experienced high anxiety; fluctuations between grief, joy, and guilt; and how emotions impacted their partner. 'The responses of others' which described the impact of other people on mothers' postnatal experience; which included three subthemes: the taboo of baby loss, justification that the baby was not a replacement, and gestures of acknowledgment. DISCUSSION: Many mothers who have previously experienced perinatal death experience grief, anxiety and isolation postnatally. The quality of postnatal maternity care varies and many mothers feel unsupported by standard maternity services after previously receiving supportive specialist antenatal care. CONCLUSION: Postnatal maternity care pathways should be developed and resourced to deliver trauma-informed care to parents who have previously experienced perinatal death.