1. AN EXPLORATORY STUDY OF THE FACTORS THAT AFFECT MIDWIVES’ CONFIDENCE TO PROVIDE BEREAVEMENT SUPPORT TO PARENTS WHO HAVE EXPERIENCED A PERINATAL LOSS
Felicity Agwu Kalu

2. Introduction and Background to the problem
Perinatal loss is the loss of a baby at any stage of pregnancy (miscarriage, ectopic pregnancy and stillbirth) and the death of a liveborn baby in the first twenty eight days after birth (Armstrong 2002, Ewing 2005, John & Cooke 2006, Radestad et al. 2007).
Perinatal loss is one of the most painful, traumatic and devastating experiences for many parents (Simmons et al. 2006, Henley & Scott 2008, Kean 2008).

3. Introduction and Background to the problem
The outcomes for many parents depends on the midwives’ ability to provide effective bereavement support (Cote Arsenault & Donato 2007, Henley & Scott 2007).
Caring for, and supporting bereaved parents is demanding, difficult, stressful, and emotionally demanding, thus making the provision of effective bereavement support challenging (Mitchell 2005, Chan et al. 2007, 2008, 2009).

4. Theoretical Context of Perinatal Bereavement Support
Grief theories
Empirical studies
Socio-cultural perspectives on grief

5. Theoretical Context Grief theories Freud (1915, 1917, 1933)
Klein (1940, 1955)
Bowlby (1969, 1973, 1980, 1988)
Ainsworth (1967, 1985).
Socio-cultural perspectives on grief
- Disenfranchised grief (Doka 2002)
- Gender differences in grieving (O’Leary & Thorwick 2006, Serrano & Lima 2006).

6. Empirical studies Effects of perinatal bereavement on grieving parents
-High levels of psychological distress around the time of loss and in subsequent pregnancies (Cote- Arsenault & Donato 2007, Henley & Scott 2008).
Some midwives have the ability to provide perinatal bereavement support while many others are unable to do so (Roehrs et al. 2008).

7. Aim of the study
To explore the factors that affect midwives’ confidence to provide bereavement support to parents who have experienced a perinatal loss.

8. Research Questions
What is the level of the confidence of midwives to provide perinatal bereavement support to grieving parents?
What are the factors that predict confidence in midwives to provide bereavement support to bereaved parents?
What organisational support do midwives need to promote their confidence to provide perinatal bereavement support to parents in maternity hospitals and in the community?

9. Research Design Mixed Method approach Explanatory sequential design
Quantitative Qualitative
Quan data Quan data Qual data Qual data Combined
collection analysis collection analysis data
(Creswell et al. 2003) Interpretation

10. Rationale for Mixed Method approach
To gain a more comprehensive knowledge (breadth and depth) about the factors that influence midwives’ confidence in providing perinatal bereavement support.
- To provide more robust evidence to understand the complexity of this new and relatively unexplored area of research.
To draw on the complementary strengths of both quantitative and qualitative methods (Hunter & Brewer 2003, Bryman 2008 Teddlie & Tashakkori 2010).

11. Phase 1 Study design: The quantitative phase
Method: Cross sectional survey
Setting: Three maternity teaching hospitals in Ireland.
Population and Sample: An estimated sample size of 273 midwives and nurses will be required to achieve a 95% confidence level. With the addition of a 10% attrition rate to account for missing data the target sample required for this study will be 300 midwives and nurses.
Plan and procedure
Questionnaire development
Testing and piloting of the questionnaire
Main survey implementation
Data Analysis to include, descriptive statistics, a series of univariate and multivariate analysis

12. Phase 2 Study design: The qualitative phase
Participants
Purposive sampling of 6 to 8 midwives and nurses
Data collection method: focus group discussions
Data analysis: Content analysis (Krippendorf, 2004)

13. Interpretation of the Connected Results
Summary and interpretation of the quantitative results
Summary and interpretation of the qualitative results
Discussion of the extent and in what ways the qualitative research findings help to explain the quantitative results.

14. Thank you.