Midwives’ experiences of breaking bad news to mothers at the birth of an infant with congenital anomalies

Abstract

The role of the midwife in breaking bad news (BBN) to mothers at the birth of an infant with a congenital anomaly is anticipated as being stressful for both the midwife and the parents, as it is a unique moment in life where an assemblage of happiness from giving birth and great sadness from the unexpected news is experienced. The aim of this study is to explore the midwives’ experiences of BBN at birth, when the infant has a congenital defect. The objectives of this study are to explore the midwives’ competence (knowledge, skills and attitudes) of BBN to mothers at the birth of an infant with a congenital anomaly; to identify procedures carried out by the midwife when BBN; and to explore the midwives’ own emotional impact when coping with such situations. In order to fulfil the aim of this research study, a qualitative approach was adopted using self-designed, face-to-face semi-structured interviews. A target population of ten midwives, working at the delivery suite in the local general hospital were chosen by convenience sampling. A response rate of 100% was achieved. The interview recordings were transcribed via verbatim transcription and data was analysed by thematic content analysis, as described by the framework by Braun and Clarke (2006). The findings of this study demonstrate that the midwives’ competence in BBN is varied. The main challenges faced by midwives included being unprepared for such unexpected situations and their lack of knowledge on congenital anomalies. The participants’ confidence in BBN is mostly dependent on the type of the congenital anomaly. From data analysis, it was demonstrated that while midwives possess effective non-verbal communication skills to assist mothers with their emotions, they lack the required verbal communication skills to answer maternal concerns. Midwives identified several mandatory procedures to ease the facilitation of BBN for both themselves and the mothers. All midwives expressed a feeling of unhappiness, shock and trauma upon the realisation of the baby’s anomaly, with most midwives claiming of becoming emotionally involved. The results exhibited several recommendations for practice, education and further research. These include the need for improving the midwives’ knowledge on congenital anomalies, improving the midwives’ communication skills, investing a special designated area in the postnatal maternity wards for such families and the need for a large-scale study to identify the phenomena being studied in greater depth.