A room of one’s own: separate accommodation after perinatal loss and the value of midwifery care

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Abstract Problem Guidelines ask that a woman whose baby has died be cared for away from the sights and sounds of newborns, but they do not say where she should be cared for instead. Background One common way to move a bereaved woman away from newborns is to admit her to a gynaecology ward, although this could undermine midwifery care. To date, no study assessed the impact of bereavement space on grief or mental health. Aim To test whether separate accommodation is associated with better outcomes and reported care, and whether achieving separation in a gynaecology ward rather than an obstetric ward is associated with a difference in midwifery care. Methods Cross-sectional analysis of the Italian OPALE observatory. Of 2601 women reporting a perinatal loss, 1662 reported both their ward and whether they shared accommodation, giving four care configurations. Measures were the Perinatal Grief Scale, the NSESSS, satisfaction with accommodation, respectful care, ratings of the midwife and the nurse, and an indicator of no midwifery care, adjusted for type of loss, gestational age, maternal age, time since loss and geographical area. Findings Overall, 35.7% of women shared accommodation with mothers and newborns, falling from 47.1% of losses before 2015 to 26.9% from 2023 onwards. Sharing was associated with higher grief (adjusted difference 3.22, 95% CI 0.81 to 5.63), more post-traumatic stress symptoms (1.13, 0.17 to 2.09), lower satisfaction with accommodation (−30.05, −33.08 to −27.02) and less respectful care (−0.51 on 0 to 4, −0.64 to −0.37). Among women for whom separation had been achieved, those in a gynaecology ward were more satisfied with their accommodation (7.33, 3.85 to 10.82) but reported lower midwifery presence (−7.13, −11.18 to −3.09) and three times the odds of receiving no midwifery care (OR 3.05, 1.49 to 6.23), with no difference in respectful care or satisfaction. Discussion Relocation to gynaecology delivers the room the guidelines ask for but erodes the midwifery care they assume will accompany it, a deficit invisible in the woman’s global satisfaction. Conclusion Guidance requiring separate accommodation should add that separation must not remove the woman from midwifery care. A separate room within the obstetric ward satisfies both, and provided the better care in our sample. Statement of significance Problem or issue Every major guideline on bereavement care asks that a woman whose baby has died not be cared for among newborns, yet the recommendation rests on consensus rather than measured outcomes, and it says nothing about where she should be cared for instead. What is already known Adherence to bereavement guidelines as a whole is associated with lower grief and post-traumatic stress symptoms. The specific contribution of physical space has not been quantified, and the professional consequences of moving a bereaved woman out of the maternity area are unknown. What this paper adds Separate accommodation is associated with lower grief, fewer post-traumatic stress symptoms and better reported care. Obtaining that separation by relocation to a gynaecology ward is associated with a measurable loss of midwifery presence and a threefold increase in the odds of receiving no midwifery care at all, which the woman’s overall satisfaction does not reveal.

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