Facilitators and Strategies for Breaking the News of an Intrauterine Death-A Mixed Methods Study among Obstetricians

(1) Background: The death of a baby in utero is a very sad event for both the affected parents and the caring doctors. By this study, we aimed to assess the tools, which may help obstetricians to overcome this challenge in their profession. (2) Methods: We conducted a cross-sectional online survey in 1526 obstetricians registered with the Austrian Society of Obstetrics and Gynecology between September and October 2020. (3) Results: With a response rate of 24.2% (n = 439), our study shows that diagnosing fetal death was associated with a moderate to high degree of stress, regardless of position (p = 0.949), age (p = 0.110), gender (p = 0.155), and experience (p = 0.150) of physicians. Coping strategies for delivering the news of intrauterine death to affected parents were relying on clinical knowledge and high levels of self-confidence (55.0%; 203/369), support from colleagues (53.9%; 199/369), and debriefing (52.8%; 195/369). In general, facilitators for breaking bad news were more commonly cultivated by female obstetricians [OR 1.267 (95% CI 1.149-1.396); p < 0.001], residents [chi(2)(3;369) = 9.937; p = 0.019], and obstetricians of younger age [41 (34-50) years vs. 45 (36-55) years; p = 0.018]. External facilitators were most frequently mentioned, including professional support, training, professional guidance, time, parents' leaflets, follow-up consultations, a supporting consultation atmosphere, and preparation before delivering the bad news. Internal facilitators included knowledge, empathy, seeking silence, reflection, privacy, and relief of guilt. (4) Conclusions: Communicating the diagnosis of fetal death evokes moderate to high levels of stress among obstetricians. Resources from both the professional and private environment are required to deal with this professional challenge on a personal level.

Automated summary

The study found that diagnosing fetal death is associated with moderate to high stress levels for obstetricians, with coping strategies including reliance on clinical knowledge, support from colleagues, and debriefing. Female, resident, and younger obstetricians are more likely to seek professional support and training when delivering difficult news. Both external and internal facilitators are important for obstetricians in communicating the diagnosis of fetal death.