Collaboration of an Obstetrical Residency Program With a Community Hospice/Bereavement Agency to Implement an Obstetrician Specific Educational Curriculum to Improve Care to Bereaved Families and Support Staff During Difficult Delivery Situations

Abstract

Obstetricians face significant emotional and professional challenges caring for pregnant women experiencing fetal life-limiting diagnoses or fetal demise. Many physicians are uncomfortable offering the emotional support parents need during an unexpected end-of-life neonatal situation. Physicians who deliver life-changing bad news to families experience significant emotional and physical stress. We conducted an obstetrician needs assessment documenting interest in an educational curriculum that could enhance physician comfort and competency in communication skills; particularly for fetal abnormalities, challenging deliveries with poor outcomes, providing condolences to bereaved families and supporting colleagues after adverse outcomes. Patient-centered care requires prioritizing the needs and autonomy of each patient. Ensuring patients receive comprehensive informed consent regarding fetal diagnosis/prognosis and all available treatment options including continuing the pregnancy, termination, compassionate induction based on gestational age and personal wishes in cases of life-limiting fetal diagnoses , and delivery options including labor induction vs dilation and evacuation (D&E) is essential. We identified significant barriers. Some providers were reluctant to present termination as an option for life-limiting fetal diagnosis before 24 weeks of gestation. Many residents and faculty lacked sufficient training in the D&E procedure. The COVID-19 pandemic had disrupted essential hospital support resources. Our obstetrics residency program implemented a joint quality improvement initiative and educational research study. We collaborated with a community perinatal hospice/bereavement support organization to develop an obstetrician educational curriculum. We emphasized teamwork and consistency in delivering parent-centered bereavement care and support. To our knowledge, no similar program specific to an obstetrical residency program has been previously published.