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Good evening, everyone on a huge thank you to medal for inviting us along today to talk to you all about neonatal bereavement. I am here this evening with Nicky Fitzmorris, our head of nursing for the quality Team at Birmingham Women's and Children's NHS Foundation Trust. I am really proud to be a bereavement midwife at Birmingham Women's Hospital Burning and Women's Hospital is one of only two standalone women's hospitals in the United Kingdom. Now a confession to make. When I was writing this presentation on rehearsing it alongside my colleague, I had the claim, as is on our trust website, that we are the biggest single site maternity unit in the UK. But I just told you that there were only two, the other being liver put Women's Hospital. We checked on their website and they to acclaiming to be the biggest single site maternity unit in the UK, so I don't know. I'm not going to make that claim today, but we do the liver over 8200 babies every year. We also have a large gynecology unit two and see patients through andrology, genetics, anesthesia, conception. Amongst other things. We are part of a unique at HS tress, formed in 2017 by the joining of the women's and Children's hospitals in Birmingham to provide seamless family center care for the people of Birmingham and beyond as a specialist referral center in many areas alongside my colleague and manager Karen Henson, we are the bereavement team at the women's site. I started my allergist career 29 years ago, is a student nurse, and if anybody had told me back then that this is a job that I would be doing all of those years later, I would not have believed them before I started my nurse training my goals to work in a. I have in fact never work today on any on I'm showing my age now because I believe it is now known it's the emergency Department or a day. But I did really enjoy the short Midwich replacement that was part of my training and not long after qualifying is a nurse I started is a student midwife on the qualified midwife. I found a really passion in providing care for families who have been bereaved when the opportunity to work solely is a bereavement midwife presented, I grabbed it with both hands. Many people do not naturally think of bereavement when they consider the role of a mood drive. In fact, when you tell somebody from a non medical background that you are a midwife, they may curtains up an image of you cradling lots of newborn babies. This was a great piece of advice given to me before my interview to become a student nurse. Don't say anything about like in babies, cause the job really isn't about that, and it isn't. It's about women and families telling anyone that you are meeting for the first time that you are a bereavement midwife could stop a conversation in its tracks. That must be so hard, however, do you cope with all of the sadness All of the time At work are both responses that I have had, but the truth is that every single person that works in our hospital has a role in bereavement care. It is everybody's business from the consultant neonatologist caring for a baby on intensive care to our canteen staff serving parents cell inch. They will all care for berry families on whether that is, during their time, the baby's dying or in a subsequent pregnancy or on a visit to the hospital. All of us in healthcare has to be with families. Experiencing locks, many of us see, is a privilege to care for those families. And certainly during the last year and the visiting restrictions that Cove in 19 imposed, we may have been the only other people to actually ever meet their babies, even if their lives were painfully short. One of our bereaved mums commented recently that we are so used to seeing and hearing about death now with the awful events of the pandemic. In the last year, we see David Deaths reported on the note we news. If parallel to mortality was reported in the same way as the deaths from Covert 19, we would see, on average 13 baby deaths in the United Kingdom every day through stillbirth and neonatal death On even though paranasal mortality rates are generally falling in the UK, I'm sure many people would be surprised to know that in 2021 around 91 babies a week or 4700 babies a year, a loss to stillbirth and neonatal death in preparing to talk to you all I thought long and hard about what I wanted to say that could be helpful to anyone coming into contact with bereaved parents, nurses, midwives and doctors in our hospital always wants us to talk about how health professionals can help bereaved families. So I thought about what our parents have to go through on what we, as health professionals, conduce to be with the family. In this situation that could be considered good bereavement care. I should say that my work within new nature bereavement is limited to our delivery. Sweet in the NHL intensive care unit on, I did generally know, have to look after parents going through the unexpected death of a well baby. For example, sudden infant death in an emergency department setting, parents who are facing the death of a baby on a neonatal unit are experiencing massive amounts of accumulating trauma. They may have had the experience of a premature and expected birth coping with their baby, being in intensive care or an expected complications in what was expected to be a normal pregnancy in birth. It may have been the outcome of a stressful pregnancy where it is no, no babies and well and may not survive or that baby to be facing treatment in surgery after birth. The loss of control and shock that parents will be feeling is immense, and it is no wonder that traumatic birth and pregnancy loss can contribute to long term, post traumatic stress disorder, anxiety and other related problems. We know that the care that families receive during this time can have a long term impact on how that family goes forward. Did care could not make everything better. The only event that would do that would be for the baby not have died. But we do know that poor quality care of hinder their recovery on contribute to their distress. So how do we get it right? Putting the family at the heart of everything that we do will certainly help keep us on the correct path way for them. People will behave and reactive many different ways to what is happening to them in such a distressing time, and they may exhibit reactions that can be disturbing on, upsetting both to them and those around them. When the baby is going to die. There is such a lot of information for parents to comprehend and decisions to be made as health professionals. We need to walk them through this on, stay by their side to support them on provide some stability in a very stormy say. It is vital that we take things that paste the parents concurred with on the all members of the multi disciplinary team know what is happening to that family they're caring for on where the family are in terms of their pathway, As I mentioned previously at Birmingham Women's Hospital, we are trying to make bereavement care. Everybody's business. A few years ago, we were fortunate enough to be with some of our generous families who agreed to return to our hospital to tell us about the positive and negative aspect of the care that they're family received. One of the many things that came out of this process was about how dad's often feel sidelined on. The focus is very often towards their partner, the mother of the baby. They wanted to be recognized as bereaved parents, so our response scheme was born. Initially it was aimed at Datz, but any bereaved parent is welcome to have one of our response. The staff in our hospital have had training and they recognize the responds when they see them. This means they can just be that little bit more mindful when interacting with a family on why they might be in the hospital at that time. Communication is a huge aspect of any health professionals roll on for very families. Compassionate communication is vital. We will all have worked with people who are excellent of doing this on. We can probably talk of those who are not. We want our Berea families to remember the time that they had with their baby on the Conus of the stuff that looked after them, not the clumsy communication of a health care professional giving them probably some of the worst words that they will ever hear as health professionals. It is always our responsibility to ensure that what we say two families is understood, and this is a skill worth working on to be able to do this in a sensitive way. Not only does this include the words that we use, but also the environment that we give them in on always the use of good quality interpreting services or patient advocates where required communication skills training is always worthwhile. The phrase breaking bad news, I think, really underestimates what we do in these situations. It could be rephrased how to tell a family that their hopes and dreams have been shattered on that their lives and the lows of their family will be changed forever. The loss of a baby your child may very well be the most difficult and painful type of bereavement there couple will ever have to face during my time is a bereavement midwife. I have met several women who are now in the seventies or eighties who lost a baby in the time before my job all existed. They were told to go home, forget about water happens and to have another baby. Many of thumb never got to know where their baby went after death on. We have helped many of those women find the grave of their baby or talk to them about what was written in their notes of the time. But they will never forget their baby or what happened to them. The's women show us that the grief of losing a baby's lifelong on. They also show us how poor Karen communication stays with families forever. Many of them have expressed to May after our meeting that they are so grateful that women today have teams like us around to look after them. My both to those who were in experiencing being with very families would be to watch and learn for those who are skilled it it. I always encourage our student midwives, nurses and doctors to look after them is going through a loss, not on their own, in a sink or swim way. It's a gain, knowledge and confidence. That way, when they are really more senior rolled, they will be less apprehensive. It is, however, important to acknowledge that looking after Berry families can be stressful on we always eating like after ourselves. Even those of us who is main role is will still have times of apprehension, stress and worry about the care that we are giving on. We are all continually learning. One word that I am trying not to use in certain situations is ready. The colon's English dictionary definition of ready is that if somebody is ready for something, they are fully prepared. I heard myself using this word with the bereaved couple that were on out of every sweet having lost their baby to stillbirth. I was assisting them toe walk with their baby toe, our family room that is attached to arm or tree facility before they went home. Many of our couples elect to do this as they feel it is important to do this for their baby rather than somebody else. I have met with them several times during the admission, and we had arranged to go back at a specific time. When I went back into the room, I asked them if they were ready. Of course, they were not ready, ready to say goodbye to their baby and carry him to the mortuary. Who could ever be fully prepared for that? The next time I did this, I simply said to the family, Shall we go? Parents may appear to be understanding us, but their thoughts maybe in a very different place. For example, the Insight study, which interview families experiencing still but highlighted, has sensitive the to weigh communication between health professionals and families. Convey a woman who had just been informed her baby a died in neutros full term aspirin is aiming section. The assumption off the medical professionals was that she was thinking about avoiding labor and distress the giving birth to a baby that had died. But her mind wasn't on herself. It was on her baby, and she thought that if the baby was delivered urgently, there might still be a chance to save him. We may think that we are all understanding each other, but this is not always the case. The seamless link between the hospital and home is K bereavement, teens and or link midwives, doctors, nurses of really important on. Of course, I'm going to say that with my job title, it is wonderful to give good quality care around the time of the death of a baby. But if there is nobody available to the family wants, they have left the hospital. Parents may feel alone and isolated. Parents need emotional support and gardens with what happens next on. They need to have somebody on the hand to go over this again and again if needed. We know that trauma can impact on understanding and recall on parent should have any information that needs to be given to them in written born to on this should be presented in a kind and compassionate format at the women's Hospital. We have our own dandelion emblem for bereavement. This signals to parents and stuff that any information or correspondence with his own has relation to a baby that has died. As I've said, parents need somebody to call upon in the following weeks, minutes and even years after the death of a baby. On whether that is to find out about follow up appointments. Talk about the insert 90 that they may be feeling or disturbing thoughts that they do not want to bed in the family with the fair of upsetting them. A good relationship with parents builds trust, and many of our families will reach out to us is the first point of contact, even if the results of that is if they're going to see the GI GP or another medical professional afterwards. Bereavement teams, especially midwives and nurses, also build up a wealth of local and national knowledge about support that's available outside of the NHS on family and friends. Often it is minutes down the line that a very family may realize that being with people who have bought two similar path can be really helpful in healing. After the loss of a baby. We work a lot inside many charities on support organizations that have all been started by bereaved families for very families, and we know from the feet but that we get that their help is invaluable. It is always important. However, there any outside organization that you are referring. Parents, too, is known, tried and tested, no matter how sure the life of a baby on whether or not the baby lived outside of the womb. Parents are just that parents. Regardless of whether this is the first or fifth baby, many parents will consider their baby a part of their family from the time that they found out that they were pregnant. So the loss of that baby at any point will be devastating on the hopes and dreams for that couple on, that family will be gone. Many parents will wish to take the offer to make tangible memories of their baby that is dying or has died. For some families, the concept of doing this may not have a first come easily. However, it is always importing to sometimes explore this a few times with parents who turn the offered down initially as there is such a relatively short space of time to achieve memory making. These conversations should be done in a way as not pressure but to let a family know what is available on how it might help the time constraints that there may be on who to talk to if they change their mind. For example, for the majority of families, the concept of bereavement photography such as that offered by charities such as Remember My Baby will be new. They may need lots of gentle support to consider having footprints from in cork Low taken taking a lot of their babies hurts. Keep taking a video of thumb reading a story to their baby before carries withdrawn. A Blessing for baptism Some parents may want to take their baby outside so that they can feel the sun on their face or even home to spend time in their house with their family. All of this takes collaborative working with in the hospital charities on wider community. Ideally, hospital should create calm and kind environments where patient my parents could be with their baby away from the noise and bustle of busy maternity and neonatal units at the women's Hospital in Birmingham. We are aiming hard to achieve a kind of environment for very families. With plans for a separate unit, Woodland House will be a beautiful non clinical building for use by families experiencing pregnancy loss or neonatal death, regardless of gestation or circumstances. Woodland has will be entirely funded by charitable donations, and we hope that it will become a reality in the next couple of years. Reducing perinatal mortality is a national and international priority in our hospital. All cases of neonatal death stillbirth on late fetal loss without lethal abnormality are reviewed as part of the National Paranasal Mortality Review process. This allows us to look in great detail at all of the care given during pregnancy and in the neonatal period. A vital part of this is to listen to parents and their concerns or worries. This was highlighted last year in the publication of the Ah Condom report on how families on women did not feel listen to when they were pregnant or after the death of a baby. Listening to families helps his flex in shape the care that we give unsure, but what we do is kind of inclusive. I'm going to leave you with one last anecdote. Which to Mace, Um's a beautifully what? Good care, compassion and kindness. Convene toe a family. A baby died on our neonatal unit. Suddenly the family have experienced this. Previously there was a significant genetic condition likely to be affecting some of their babies. The family were missed them and in accordance with their faith and their wishes, we had tried to get everything in order to release the baby quickly to their chosen funeral director on the same afternoon that their baby had died. Time and circumstance conspired against us and we had to admit defeat until the morning I went to visit the mom to tell her, and she said to me that it did not matter on it. The last night that her baby spent on this earth with our hospital. It would be better than at the funeral directors because the hospital was like a home to her baby on all the care that her and her family had received throughout all of their pregnancies. Made her feel reassured that we was still caring for her baby, even after death. Thank you for listening