| A – Respect |
| Aa – Baby |
| ☐ |
A1 |
Name the baby |
| ☐ |
A2 |
Touch, bath and dress the baby |
| ☐ |
A3 |
Take pictures |
| ☐ |
A4 |
Put the baby in a cot in the same room of the parents |
| Ab – Parents |
| ☐ |
A5 |
Use a recognisable symbol for the staff, to denote bereavement |
| ☐ |
A6 |
Acknowledge cultural, religious and spiritual needs of parents |
| ☐ |
A7 |
Make repeated offers for holding the baby |
| ☐ |
A8 |
Provide privacy (but not abandoning) |
| ☐ |
A9 |
Allow women to spend time with their partner (or person of choice) before and after birth |
| |
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| B -Information and Communication |
| Ba – Timing |
| ☐ |
B1 |
Discuss issues at most appropriate time |
| ☐ |
B2 |
Choose a quiet and private environment |
| ☐ |
B3 |
If the mother is unaccompanied, offer to contact the partner or a friend |
| Bb – Delivery of information |
| ☐ |
B4 |
Be clear, honest, and sensitive |
| ☐ |
B5 |
Repeat important information |
| ☐ |
B6 |
Assure parents that it is normal to feel uncomfortable |
| ☐ |
B7 |
Do not avoid questions |
| Bc – Mode of information |
| ☐ |
B8 |
Give written information |
| ☐ |
B9 |
Be comfortable showing emotions |
| ☐ |
B10 |
Answer questions honestly |
| ☐ |
B11 |
Listen to parents |
| ☐ |
B12 |
Do not argue with parents |
| Bd – Terminology |
| ☐ |
B13 |
Use parent-friendly language (simple and straightforward) |
| ☐ |
B14 |
Use sensitive terms (avoid dehumanising terms as ‘fetus’, ‘product of conception’ etc) |
| ☐ |
B15 |
Do not use medical jargon |
| Be – Burial and funeral services |
| ☐ |
B16 |
Inform parents on laws and regulations |
| ☐ |
B17 |
Provide parents help with funeral arrangements |
| Bf – Post-mortem examination |
| ☐ |
B18 |
Give verbal and written information on autopsy/histology |
| ☐ |
B19 |
Allow time for discussion issues regarding autopsy/histology |
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|
| C – Birth options |
| Ca -Timing |
| ☐ |
C1 |
Inform in advance parents of factors relating to birth (when, how, etc) |
| ☐ |
C2 |
Allow parents time to make appropriate decisions regarding birth |
| Cb – Mode of birth |
| ☐ |
C3 |
Offer parents choices in birthing options (when available) |
| ☐ |
C4 |
Offer parents the option of returning home (if possible) |
| ☐ |
C5 |
Always offer obstetric analgesia |
| ☐ |
C6 |
Avoid using sedation |
| |
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|
| D – Hospital stay |
| Da – Environment |
| ☐ |
D1 |
Offer parents the choice of the less distressing ward (possibly provide a private room) |
| ☐ |
D2 |
Always allow to spend time with the baby |
| Db – After-birth care |
| ☐ |
D3 |
Do not urge parents to leave the hospital |
| ☐ |
D4 |
Offer continuity of care |
| |
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|
| E – Creating memories |
| Ea – Spending time with baby |
| ☐ |
E1 |
Clearly explain parents the length of time they are allowed to spend with their baby |
| ☐ |
E2 |
Let the parents all the time they need to stay with the baby |
| ☐ |
E3 |
Always offer parents to see and hold the baby, but do not force them; discuss what is the best option for them |
| ☐ |
E4 |
Respect their wishes regarding seeing and holding the baby |
| ☐ |
E5 |
Prepare parents for the appearance of the baby |
| Eb – Parenting |
| ☐ |
E6 |
Allow parents to bath and dress their baby |
| ☐ |
E7 |
Allow siblings to spend time with the baby |
| Ec – Mementos |
| ☐ |
E8 |
Take pictures of the baby and keep them in the hospital |
| ☐ |
E9 |
Provide parents with mementos (lock of hair, hand and footprints, ID bracelet, cot card, pictures) |
| |
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| F – Aftercare |
| Fa – Spiritual / religious needs |
| ☐ |
F1 |
Allow parents to bless, baptize or perform any other religious ceremony for their baby |
| Fb – Maternal changes |
| ☐ |
F2 |
Inform mothers on milk production |
| ☐ |
F3 |
Offer a consultation with a lactation consultant |
| ☐ |
F4 |
Inform mothers on bleeding |
| ☐ |
F5 |
Inform mothers on psychological consequences of perinatal loss |
| ☐ |
F6 |
Provide a follow-up at 6 weeks post birth. Give name and number of the case manager |
| Fc – Support services |
| ☐ |
F7 |
Provide early psychological support |
| ☐ |
F8 |
Provide written information on support services (include fathers) |
| Fd -Follow-up |
| ☐ |
F9 |
Provide name and number of the case manager |
| ☐ |
F10 |
Provide an appointment with a senior obstetrician within 2 months |
| ☐ |
F11 |
Where possible, use rooms away from the hospital |
| ☐ |
F12 |
Give and explain results of post-mortem examinations |
| ☐ |
F13 |
Discuss implication for future pregnancies |
