Health workers’ experience of communicating the bad news to parents following a stillbirth at sub-national level in Uganda

Health workers’ experience of communicating the bad news to parents following a stillbirth at sub-national level in Uganda

Eric Ssegujja (1,2), Michelle Andipartin (3)

(1) Makerere University School of Public Health, Kampala Uganda; (2) University of Western Cape, School of Public Health, South Africa; (3) University of Western Cape, Department of Psychology, South Africa

essegujja@musph.ac.ug

Background
Losing a loved one due to stillbirth is a heartbreaking experience to parents and devastating to a health worker. Delivering news is every pregnant woman’s worst nightmare and a daunting task to health workers more so in the absence of a structured protocol to aid in communication. It remains an everyday challenge in the fight against stillbirth and systematic documentation of experiences especially from resource-constrained setting is still missing. This paper explores the health workers’ experience in communicating stillbirth loss to the mothers from a relatively high stillbirth burden district in Uganda

Methods
A cross-sectional descriptive study was conducted in a single district case in Uganda. Qualitative interviews were conducted from August to October 2018 on a purposively selected sample of 15 key informants using audio recorders and interviews transcribed verbatim. Content analysis technique using Atlas ti guided the analysis

Results
Overall great feelings of vulnerability due to inadequate skills were noted among health workers. Doubts about key message to communicate, the cause and context hence guided the nature of communication and delivery of bad news. Cases due to facility-related causes differed to either a doctor or facility in-charge while direct disclosure by midwives was done for cases due to maternal and fetal conditions. Sequencing of disclosure events was common where some information was shared at discharge and later after discharge. When space allowed, mothers were isolated before disclosure while c-section cases, disclosure was withheld until recovery and thereafter led to an isolation room for emotional recovery before discharge. Reported difficulty to deliver bad news to compliant mothers was noted.

Conclusion
Health workers felt their competence to manage was challenged first by the loss but also by inadequacy in communication skills calling for interventions to bridge this gap.

Ethics statement
Ethical approval was from University of Western Cape Biomedical Research Ethics Committee (BM/17/9/1), Makerere University School of Social Sciences Research and Ethics Committee (MAKSS REC 12.17.110) and Ugandan National Council for Sciences and Technology (SS 4575). Permission from district authorities and individual written consent were obtained before interviews. Respondents’ safety was ensured by conducting the interviews in a secure and quiet location, giving assurance that data collection was purely for study purposes, anonymizing the data and keeping it on a password protected computer only accessed by the study team.

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