Study ID | N | Time since stillbirth | Outcomes assessed | Measure of effect* | Adjustment for |
---|---|---|---|---|---|
Bennett et al36 | 55 | 0–5 years, mean=35 months | Complicated Grief (ICG) | d=−0.02 (−0.66 to 0.62)† | None |
PTSD symptoms (PCL) | d=0.17 (−0.47 to 0.81)† | ||||
Depression/anxiety (combined PGS, Brief Symptom Inventory) | d=0.17 (−0.47 to 0.81)† | ||||
Satisfaction with decision to hold baby | Of the 78% of the sample who held their baby, 85% of women reported this to be extremely helpful | ||||
Cacciatore et al22 | 2292 | <1–3+ years <1 years 51% 1–2 years 15% 2–3 years 9% >3 years 25% | Anxiety (HSCL) | Not currently pregnant: OR 0.68 (0.49 to 0.95) Currently pregnant: OR 3.79 (1.42 to 10.1) | Gestation of stillbirth (by trimester) Time since loss |
Depression (HSCL) | Not currently pregnant: OR 0.72 (0.51 to 1.02) Currently pregnant: OR 2.13 (0.90 to 5.06) | ||||
Satisfaction with decision to hold baby | 99.5% of 2035 mothers who held their baby were glad they did 8.2% of 226 mothers who did not hold their baby were glad they did not; 79.5% wished they had held their baby and 12.3% were ‘indifferent’ | None | |||
Crawley et al37 | 162 | 0–10 years, median 18.5 months | Depression in the past month (DASS-21) | Authors collapsed comparisons across holding the infant and memory-making activities (including photographs, hand/footprints, creating memory box) as a single variable. Authors reported no relationship between memory-making and mental health outcomes. Data not shown and proportions/effect sizes not reported | |
Anxiety in the past month (DASS-21) | |||||
PTSD symptoms in the past month (PSSS) | |||||
Gravensteen et al38 | 101 | 5–18 years | Post-traumatic Stress Symptoms (IES) IES >20 vs <20 (20 was considered possible clinical case level) | OR 0.17 (0.05 to 0.56) | Maternal age, parity, induced abortion prior to stillbirth |
Satisfaction with decision to hold baby | 86% of mothers who held their baby reported ‘it felt good’ 62% of the mothers who did not hold their baby regretted this decision | None | |||
Hughes et al2 3 20 39 | T1: 65 T2: 55 T3: 52 | T1: 10 months to -5 years (median 18.5 months) T2: 1 year after subsequent live birth T3: 6–8 years after subsequent live birth | Depression (EPDS >14)/(EPDS continuous) Depression (BDI, continuous) | T1: OR 4.18 (1.19 to 14.69)/d=0.48 (−0.009 to 0.98)‡ T2: d=0.42 (−0.12 to 0.96)‡ | None |
Anxiety (STAI state >44)/(continuous) | T1: OR 2.67 (0.87 to 8.17)/d=0.51 (0.01 to 1.00)‡ T2: OR 3.83 (0.73 to 20.04)/d=0.43 (−0.10 to 0.99)‡ | None | |||
PTSD-1 interview (diagnosis met)/(continuous)§ PTSD (DSM-IV SCID) | T1: OR 4.35 (0.84 to 22.63)/d=0.59 (0.05 to 1.09)‡§ T2: (not assessed)/d=1.0 (0.44 to 1.56)‡§ T3: d=0.78 (0.21 to 1.35)‡ | None | |||
Marital separation | T3: OR 4.50 (1.23 to 16.49)‡ | None | |||
Kuti and Ilesanmi40 | 45 | 6 months to 16 years | Maternal self-assessment of ‘recovery’ from stillbirth | No mothers were given the opportunity to hold the baby and thus comparisons could not be conducted | |
Satisfaction with decision to hold infant | 8 (17.8%) of women wished they had had the opportunity to hold their infant | ||||
Lasker and Toedter9 | 138 | T1: 2 months T2: 1 year T3: 2 years | Postnatal grief (PGS) | Postnatal grief outcome was only evaluated using a combined variable representing the total number of interventions, thus the individual impact of any single intervention cannot be determined | |
Satisfaction with decision to hold infant (time 1) | Early fetal death (16–28 weeks): no significant difference in satisfaction with decision Late fetal death (27+ weeks): women who held their baby significantly more satisfied with their decision than women who did not hold their baby (proportions not reported) | None, results split by gestation of stillbirth | |||
Rådestad et al21 41–44 | 314 | 3 years | Anxiety (STAI state) | 28–37 weeks’ gestation: OR 0.70 (0.30 to 1.66) 37+ weeks’ gestation: OR 1.70 (0.34 to 8.62) | None (only education significantly differed between those who held and those who did not) |
Depression (CES-D) (dichotomous, scores above 90th centile) | 28–37 weeks’ gestation: OR 0.50 (0.20 to 1.30) 37+ weeks’ gestation: OR—(Fisher's exact test, p=0.055) | ||||
Backache, stomach problems, headache, tachycardia, chest pressure, panic attacks, nausea or fainting, weakness, sleep disturbances, situation in home and family, situation at work, health, leisure time, physical fitness, appetite, temper, energy, patience, self-confidence | No significant differences with the exception of: 28–37 weeks’ gestation: stomach problems: OR 0.10 (0.02 to 0.94) 37+ weeks’ gestation: headache: OR 0.23 (0.06 to 0.96); sleep OR: 0.28 (0.13 to 0.60) | ||||
Rådestad et al45 | 33 | 3 months | Fear, regret, tenderness, warmth, pride, insecurity, discomfort, grief | 94% of 33 women held their baby When holding their baby, all mothers felt tenderness and grief; 94% warmth, 81% pride; 48% insecure, 39% discomfort and 35% fear. The mothers of stillborn babies born before 28 weeks’ gestation experienced more fear and insecurity when they held their baby, but differences were not statistically significant (proportions not reported) | None—follow-up comparisons according to gestation of stillbirth |
*Where possible standardised mean differences (d) or ORs and 95% CIs were calculated.
†Calculated using study reported frequencies and correlations.
‡Calculated using study reported mean and SD for continuous outcomes, and study reported frequencies for dichotomous outcomes.
§Based on proportions reported in Hughes et al20 (proportions for time 1 and 2 PTSD differ between refs 3 and 20).
BDI, Beck Depression Inventory; CES-D, Centre for Epidemiological Studies Depression Scale; DASS-21, Depression, Anxiety and Stress Scale; DSM, Diagnostic and Statistical Manual of Mental Disorders; EPDS, Edinburgh Postnatal Depression Scale; HSCL, 25-item Hopkins Symptom Check List; ICG, Inventory of Complicated Grief; IES, Impact of Event Scale; PCL, PTSD Checklist; PGS, perinatal grief scale; PTSD, post-traumatic stress disorder; SCID, Structured Clinical Interview for DSM Disorders; STAI, Spielberger State-Trait Anxiety Inventor.