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Correspondence |
Plymouth NHS Primary Care Trust, Westbourne, Scott Hospital, Beacon Park Road, Plymouth PL2 2PQ, UK
The study by Turton et al (2001) on post-traumatic stress disorder (PTSD) in the pregnancy after stillbirth represents ground-breaking research in this area. It is a welcome addition to the world literature in a hitherto neglected field of enquiry. It is of serious concern, however, that they present their results in such a way as to implicate the practice of seeing and holding the dead infant as being related to the development of PTSD in subsequent pregnancies. Of those who had not seen the infant, one (17%) of 14 developed PTSD compared with 12 (26%) of 47 who had (P=0.26). This is a statistically non-significant correlation and as such no relationship can be assumed.
The current practice of encouraging mothers to see and hold their dead babies was initiated by Lewis's seminal work (Lewis, 1976, 1979; Lewis & Page, 1978) on the special difficulties of mourning a loss that frequently mothers had never seen and that often led to later psychological difficulties. Although in practice most maternity departments have developed protocols which give parents this opportunity, the nature of this service is extremely variable. Some units have specially trained bereavement midwives who offer support at the time of death and during subsequent pregnancies. Units may provide special suites to allow parents to spend time privately with their dead child. In other units a brief time in a delivery suite may be all the contact they are allowed. Staff may have little or no training in psychological care. Turton et al "presumed supportive management of the stillbirth itself" but do not discuss the nature of the service provided by any of the three centres included in the study. In future studies this is an important confounding variable that should be considered in examining the hypothesis that holding the dead infant following stillbirth is a risk factor for developing PTSD in subsequent pregnancies. What Turton et al assert as a clinical implication is nothing more than an interesting but, as yet, untested hypothesis. It would be a pity if policy-makers gave this research undue emphasis and abandoned current practice hastily. In establishing evidence-based best practice, longer-term outcome, morbidity in partners and views of maternity service users will be important areas of enquiry. It is disappointing that Turton et al have been tempted to emphasise a relationship between clinical practice and outcome that their own results did not demonstrate.
REFERENCES
Lewis, E. (1976) The management of stillbirth: coping with an unreality. Lancet, ii, 619-620.
Lewis, E. (1979) Inhibition of mourning by pregnancy: psychopathology and management. BMJ, ii, 27-28.
Lewis, E. & Page, A. (1978) Failure to mourn a stillbirth: an overlooked catastrophe. British Journal of Medical Psychology, 51, 237 -241.
Turton, P., Hughes, P., Evans, C. D. H., et al
(2001) Incidence, correlates and predictors of post-traumatic
stress disorder in the pregnancy after stillbirth. British Journal
of Psychiatry, 178, 556
-560.
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Psychiatric Bulletin | Advances in Psychiatric Treatment | All RCPsych Journals |
