Improving the Prenatal Care of Women with a History of Stillbirth or Intrauterine Fetal Demise: An Educational Module for Prenatal Care Providers

The overarching goal of this project is to increase the knowledge and sensitivity of prenatal care providers toward pregnant women with a history of stillbirth or intrauterine fetal demise (IUFD) through the development and implementation of an educational training module. The vast majority of women who have experienced stillbirth or IUFD will go on to have subsequent pregnancies. Throughout the subsequent pregnancy, the fear of another loss puts women at increased risk for harmful levels of stress, which can be associated with adverse pregnancy-related outcomes. While qualitative studies have shown that women who have experienced loss desire specialized care, many providers have not integrated these services into their everyday clinical practice. The educational module developed for this project seeks to teach providers how to care for this population with sensitivity, compassion, and empathy using the easily remembered acronym, PEACE (Promote Confidence, Ease Doubts, Acknowledge the Past, Coordinate Resources, and Empower Mom). Midwives belonging to the Utah chapter of the American College of Nurse-Midwives (ACNM) were recruited to view the education module and complete pre- and post-tests. The pre-test asked questions about demographics followed by 10 knowledge-based questions and the post-test asked the same 10 knowledge-based questions followed by questions about intentions to use this information in future clinical practice. The responses on the pre- and post-tests were compared to assess the learning of the participants, and post-test scores showed a statistically significant improvement of knowledge. 14 midwives completed both the pre- and post-tests and the educational module. Comparison of the average of pre-test scores (79.64%) and average of post-test scores (86.40%) showed an increase in correct responses following participation in the educational module. Further analysis using the Wilcoxon signed rank test showed that providers' knowledge was statistically significantly higher after completion of the module. Another important result in addition to the evidence of increased knowledge was that all participants reported an intention to use the information learned from the module in their current practice. This result confirmed that current training methods have not exposed providers to the specific needs of this pregnant population. Furthermore, these results support the available evidence that women with a history of stillbirth or IUFD need specialized care, and more can be done to educate providers about these needs in order to improve outcomes for this population.