Main title: Authors’ reply re: Why stillbirth deserves a place
on the medical school curriculum
Authors’ title: The role of medical students in delivering culturally
sensitive stillbirth teaching and care
Sir,
We thank Drs. Cornish and Siassakos for their encouraging
response1 to our article2, and for
highlighting that stillbirth care must account for the needs of fathers,
and those from varied sociocultural backgrounds.
In addition to endorsing the importance of culturally sensitive
stillbirth care1, we advocate for solutions to tackle
culturally specific stillbirth-related stigma. For instance, a
qualitative study in rural Ethiopia3 revealed that
grandmothers, married women and mothers associated stillbirths with
malevolent spirits: “Families lose their newborn because of an evil
spirit.” Whereas, younger girls believed poverty, lack of education,
maternal ill health and improper care during birth to be contributory
factors to stillbirth. Thus, it may be possible to harness the increased
awareness and understanding of certain groups within communities to
combat the stigma around stillbirth.
We agree that it is essential to avoid homogenising the experiences and
needs of communities. For example, some Muslim Pakistani families have
differences in burial practices and the assignment of personhood
depending on readings of Islamic scholarship. Some believe that when
babies are born alive, they have the opportunity for the azān(meaning the baby can be recognised in religion by name and have a
Muslim funeral), but others feel stillborn babies are entitled to a
Muslim funeral4. These differences within the same or
similar cultures may lead to varied expressions of parental grief, and
differences in the levels of openness about their grief.
Research and teaching on the range of attitudes towards and experiences
of stillbirth, especially in low- and middle-income countries and
minority communities in the UK, is therefore crucial. Moreover, in order
to provide holistic care following a stillbirth, perspectives from
fathers1 and other involved family and community
members (e.g. in-laws, community leaders) is required.
Medical students undertaking elective placements, collaborating with
local clinicians, midwives and/or translators, are ideally positioned to
fill this research void. Speaking with an ‘outsider,’ such as a medical
student, may allow bereaved parents to speak more openly about their
experiences. As the study would likely take several months to years,
including time required for recruitment and
follow-up5, we propose the establishment of long-term
medical school–hospital partnerships, allowing batches of students to
undertake a sustainable collaborative project. Research methodology can
be adapted to better enable compassionate discussions around stillbirth.
For example, in a study looking at rituals performed by Taiwanese women
after a stillbirth, a 6-month period was allowed between the loss of the
baby and conducting the in-depth research interviews5.
Overall, we believe the best stillbirth-related teaching and care is
achieved through flexibility, by adopting a “case-by-case” approach.
Counselling, signposting to other services, holding the newborn and the
use of photos may be helpful for some parents, but prolong grief in
others1. Some parents may seek help from family
networks and prefer to avoid institutional bereavement care altogether.
Although we can be informed by overarching principles, care should be
sensitive to individual needs and patient led.