Pregnancy or baby loss

Pregnancy or baby loss

Grief is a natural response to pregnancy or baby loss (miscarriage, stillbirth or neonatal death). However, some parents who experience baby loss will develop mental health difficulties that require specialist support (105).

  • Bereavement following baby loss increases risk of mental health problems in both parents (40), including anxiety, depression and PTSD (106).
  • The impact of pregnancy or baby loss can be long-lasting: one study carried out 9 months after women had experienced early pregnancy loss (miscarriage or ectopic pregnancy) found that 18% had PTSD and 17% had moderate to severe anxiety (107).
  • Women who have experienced miscarriages or stillbirth report there is often a lack of acknowledgement of how this can impact their mental health in subsequent pregnancies (108) and experience high levels of pregnancy-specific anxiety in the first trimester of subsequent pregnancies (109).
  • High rates of miscarriage, pregnancy loss and/or child loss were reported by Gypsy, Roma and Traveller participants in research carried out by the national charity Friends, Families and Travellers, with very few participants having received any professional support relating to these experiences. (188)

Local population

  • The stillbirth rate in Peterborough has increased since 2016, whilst it has declined in Cambridgeshire. Both areas have stillbirth rates which are similar to the national average (15).

Figure 18: Stillbirth rate (foetal deaths occurring after 24 weeks of gestation) in Cambridgeshire and Peterborough. Data source: Fingertips

  • There has been a decreasing trend in infant mortality rates across Cambridgeshire and Peterborough since 2016. Stillbirth rates in 2019 – 21 were below average in Cambridgeshire and similar to the national average in Peterborough (15).

Figure 19: Infant mortality rate (infant deaths under 1 year of age) in Cambridgeshire and Peterborough. Data source: Fingertips

  • National data shows that there are strong association between deprivation, ethnicity, and infant mortality rates. There are 3 deaths per 1,000 live births for babies of Pakistani and Black African ethnicity from the most deprived areas (45). Gypsy and Traveller women also report higher rates of miscarriages and stillbirths (104).

Figure 20: Neonatal mortality rates per 1000 live births by babies’ ethnicity and mothers’ socio-economic deprivation quintile of residence, for UK births in 2016 to 2020. Image source: MBRRACE-UK

Experience

A national survey of parents bereaved by baby loss carried out in 2019 found that 60% felt they needed psychological support; but were not able to access it on the NHS (105). Parents who have experienced pregnancy or baby loss may not meet the criteria for perinatal mental health services, or may not find services appropriate (for example, if clinics are surrounded by families with babies) (105).

Currently there are no specialist bereavement services offered by Cambridgeshire & Peterborough Integrated Care System to support parents who suffer baby and/or pregnancy loss.

  • Guidelines from the Royal College of Obstetricians and Gynaecologists recommend that counselling should be offered to parents who suffer baby and/or pregnancy loss.
  • Professionals working for CPSL Mind have raised concerns about the gap in specialist provision as they often receive referrals from professionals, as well as self-referrals, from women who are experiencing mental health issues due to miscarriage, stillbirth or neonatal death and they are not able to signpost them to specialist local support. They relay that this can lead to women developing mental health issues which carry on into future pregnancies and have a negative impact to the mother’s mental health during the perinatal period and their ability to bond with their baby.
    • This is also reflected in national research, which highlights associations between perinatal trauma and loss with greater levels of depression and anxiety; and that specialist counselling can help to reduce stress in subsequent pregnancies.
  • Traditional mum and baby groups are inadequate environments to offer low-level mental health support to bereaved parents as being amongst parents who had a successful pregnancy and delivery are often triggering environments.
  • 4 % of local respondents said they would like to have support with pregnancy loss and neonatal bereavement in the perinatal mental health survey (118) carried out by Rosie Maternity and Neonatal Voices in 2021. This was the 6th highest ranking issue that parents would like to see addressed.

References 

15. Office for Health Improvement and Disparities. Child and Maternal Health [Internet]. Fingertips. 2023 [cited 2023 Mar 20]. Available from: https://fingertips.phe.org.uk/profile/child-health-profiles/data#page/1/gid/1938133228
40. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Vol. 384, The Lancet. 2014.
45. Draper ES, Gallimore ID, Smith LK, Matthews RJ, Fenton AC, Kurinczuk JJ, et al. Maternal, Newborn and Infant Clinical Outcome Review Programme MBRRACE-UK Perinatal Mortality Surveillance Report [Internet]. 2022 [cited 2023 Jan 31]. Available from: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/perinatal-surveillance-report-2020/MBRRACE-UK_Perinatal_Surveillance_Report_2020.pdf
104. Parry G, van Cleemput P, Peters J, Walters S, Thomas K, Cooper C. Health status of Gypsies and Travellers in England. J Epidemiol Community Health (1978). 2007;61(3).
105. Baby Loss Awareness Week. Out of Sight, Out of Mind: Bereaved parents falling through the gaps in mental health care [Internet]. 2019 [cited 2023 Feb 17]. Available from: https://babyloss-awareness.org/wp-content/uploads/2019/10/BLAW-Out-of-Sight-Out-of-Mind-Report-2019.pdf
106. Jones K, Robb M, Murphy S, Davies A. New understandings of fathers’ experiences of grief and loss following stillbirth and neonatal death: A scoping review. Vol. 79, Midwifery. 2019.
107. Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol. 2020;222(4).
108. Royal College of Obstetricians and Gynaecologists. Maternal Mental Health: Women’s Voices [Internet]. 2017 [cited 2023 Mar 2]. Available from: https://www.rcog.org.uk/media/3ijbpfvi/maternal-mental-health-womens-voices.pdf
109. Bergner A, Beyer R, Klapp BF, Rauchfuss M. Pregnancy after early pregnancy loss: A prospective study of anxiety, depressive symptomatology and coping. Journal of Psychosomatic Obstetrics and Gynecology. 2008;29(2).

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