Key considerations: reproductive loss and grief

Disclosure of bad news (Queensland Health - Multicultural Services, 2009)

Health professionals can elicit culturally sensitive ways of disclosing bad news at the beginning of antenatal care.

The following points offer advice for disclosing bad news to CALD families:

• For some cultures bad news is not given directly to the woman.
• It is highly inappropriate to use a family member to interpret for the woman, especially when giving bad news to her.
• Ideally, ask the woman’s preferences about communication of test results at the beginning of antenatal care and not after she is sent for medical investigations.
• Ask women whether they wish to be directly informed about their diagnosis and treatment information on their own, or informed together with family member(s), or otherwise. If the woman decides that she does not wish to receive the diagnostic information alone; and she prefers a delegated family member(s) to receive the diagnosis, find out which family member(s). NB. Clinicians must let women know that they are obligated to inform/discuss the woman’s condition with her directly, unless she prefers otherwise.
• The outcome of discussion with the woman should be clearly noted in her medical records and should also be verbally communicated to subsequent care providers, when making referral to other services.

Communicating reproductive loss (Queensland Health - Multicultural Services, 2009)

• Explain in simple language.
• Allow time for grief.
• Encourage expressions of emotion.
• Be aware of, and respect, cultural variations of mourning.
• Be aware of individual variations of mourning (eg do not assume that a quiet person experiences less grief).
• Remember that some people in mourning may be dissatisfied with health services and blame health professionals without reason (be patient and consider their grief and shock).
• Access cultural support if available.
• Reassure the woman that mourning is normal.
• Pay attention to the father’s grief as well.
• Promote open communication between the couple.
• If desired, communicate or allow communication with other family members.
• Discuss the cause of the baby’s death or miscarriage and encourage questions.
• Ask the couple if they want to see or hold the stillborn baby.
• Ask the couple if they would like to name the stillborn baby.
• Discuss with the couple any traditional or religious rituals or ceremonies that should be observed.
• If available, ask the couple if they would like support from a mental health professional (face-to-face professional counselling, telephone helpline). You may need to explain the benefits of using these services.
• Try to elicit potential reasons for refusing psychological support.
• If needed and where available, refer the woman for a psychiatric assessment.
• Encourage early contact with the general practitioner or other health professional.
• Where available, if the couple is in a state of denial, reassure them that mental health support is available to them. See http://www.sands.org.nz/ (NB: Resources are in English only).
• Respect a woman’s or a couple’s decision not to seek mental health support, as many people prefer coping with grief in a personal manner.
• If available, provide printed information (eg booklet, pamphlet) about grief, preferably in the woman’s or couple’s own language. See http://www.sands.org.nz/ (NB: Resources are in English only).