Is it possible for parents to endure a stillbirth diagnosis? Initially experiences, perceptions and internal strategies: Individual in-depth interviews in Sweden 2021-2023

Is it possible for parents to endure a stillbirth diagnosis? 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Initially experiences, perceptions and internal strategies: Individual in-depth interviews in Sweden 2021-2023 Berit Höglund, Ingegerd Hildingsson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4566174/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jan, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Stillbirth occurs 3.0 per thousand in Sweden, and in-depth thoughts, feelings and worries among affected parents in a longitudinal study is rather unknown. The aim of this qualitative in-depth study is to deepen and widely explore parents’ initially experiences and perceptions and internal processes and strategies from awareness and suspicion of stillbirth until one month after stillbirth in Sweden. Methods: Ten individual in-depth interviews were conducted in 2021-2023 and data were evaluated in thematic network analysis. Results: Two organizing themes ‘Pregnancy, Awareness, Information, Reactions and Reflections at Tragical Stillbirth Diagnosis’ and ‘Support and Structured Activities and Internal Processes at Stillbirth’ captured significant deepen consequenses of sudden unexpected and devastating end of the pregnancy. The suspicion of and the stillbirth diagnosis was initially associated with sudden discomfort and fears and bottomless grief and intensive pain, but a vaginal birth became in total the optimal method both for the body and soul. Caring for the stillborn baby with physical proximity for an extended period of time facilitated understanding and coping with the grieving process and embracing parenthood. Conclusions: Parents experiencing stillbirth were exposed to an unimaginable and irreversible life-changing event, but almost all developed coping strategies during the first intensive and painful month after the stillbirth in order to move on in the grieving process. coping strategies fetal movements grieving process in-depth interviews parents professionals stillbirth Background Losing a baby through stillbirth affects women and men throughout their lifetime. In Sweden, stillbirth is defined as the death of a baby in utero after 22 completed gestational weeks ( 1 ). In 2022, 315 babies were stillborn after 22 completed weeks of pregnancy in Sweden, with 294 (93%) diagnosed with stillbirth before labor commenced. In 2021, stillbirths mostly occurred during 32–36 completed gestational weeks ( 1 ). Although the rate of stillbirth has decreased in recent years due to changes in healthcare practices, this irreversible, life-changing event remains. A recent study identified two primary reasons for stillbirth: placental complications (40.5%) and umbilical cord complications (30.2%) ( 2 ). Another study from 2014 confirmed various complications associated with gestational age at stillbirth ( 3 ). Furthermore, that study highlighted preterm complications in stillbirths, such as a higher proportion of placental abruption, preeclampsia or hypertension, malformations or chromosomal abnormalities, and intrauterine growth restriction or placental insufficiency. Similarly, umbilical cord complications, birth hypoxia, and infections were more commonly associated with post-term stillbirths ( 3 ). To identify the exact cause of stillbirth is important for parents, but it is also critical for gaining essential information for future pregnancies to possibly prevent stillbirth. Even if an autopsy is performed, it can be difficult to determine the cause of each individual stillbirth ( 4 , 5 ). Moreover, an Australian study describes bereaved parents after stillbirth with feelings of shame, blame, devaluation of motherhood, and discrimination. Parents also perceived that healthcare providers did not inform them about the possibility of stillbirth during antenatal care ( 6 ). There are quite few studies about labouring with an antepartum fetal death. Although a recent study affirms that parents’ experiences of labour with a fetal death in utero bring an important perspective to intrapartum care ( 7 ). Furthermore, that study describes that parents want care providers to facilitate their choices, their sense of control, their autonomy, and their agency, and in addition, to feel that they had received the best care available at stillbirth. Another study states that stillbirth has a profound and pervasive impact on bereaved parents and highlights the importance of clear and sensitive communication from professionals ( 8 ). A Spanish study ( 9 ) explores parents’ experiences of stillbirth and highlights the importance of tailoring support and systems according to their needs. There is a lack of studies focusing on the early experiences of parents when facing a stillbirth. Hence, the aim of this qualitative in-depth study was to deepen and widely explore parents’ initial experiences and perceptions and internal processes and strategies from awareness of reduced or absent fetal movements or other serious pregnancy complications until one month after stillbirth. Methods Design A descriptive design involving individual in-depth interviews of parents who had experienced stillbirth. Sample The sample consisted of parents with stillbirths after 22 completed gestational weeks, approximately one month after the stillbirth. Data collection The mangers of all Women's clinics in Sweden and the Swedish Infant Death Foundation were contacted and asked to participate with inviting parents who experienced stillbirth. Ten clinics responded positively and expressed their willingness to participate. Informants who wished to participate further confirmed their interest, and signed a written consent form. This study constitutes the first part of a longitudinal study, which spans over two years for each informant who participates and deals with stillbirths occurring after 22 completed gestational weeks. Ten individual in-depth interviews were conducted via mobile phone between November 2021 and July 2023, approximately one month after the stillbirth. The informants consisted of six women and four men, ranging in age from 22 to 53 years, with a median age of 31.5 years. Their marital statuses were either cohabiting with a partner (n = 6) or married (n = 4). The pregnancies ranged from 22 to 39 completed gestational weeks (Mean = 34 weeks), and four of the informants had undergone IVF (in vitro fertilisation). Three of the informants had previous children. The informants rated their current mental health based on four options: ‘very good’, ‘good’, ‘partly bad’, and ‘bad’. Most of the informants were employed, and one was an adult student. The informants resided in different locations; one living in a town, and nine in the countryside. They were distributed across various parts of Sweden, including southern Sweden (n = 3), mid-Sweden (n = 5), and northern Sweden (n = 2). The duration of each in-depth interview ranged from 38 to 183 minutes (Mean = 121.1 minutes) for a total of approximately 20.11 hours. Each in-depth interview was audio-recorded with the informants’ permission. Prior to the start of each interview, the interviewer verified that the informant was alone in a disturbance-free room. The interviews followed a semi-structured interview guide that began with the question, ‘Please, would you tell me what you experienced and perceived when you became aware and suspected a difference in your womb and the baby had reduced or absent fetal movements?’ The interviews were transcribed verbatim prior to data analyis. Efforts to recruit in-depth interviews continued until no one else agreed to participate in the study, resulting in a total of ten in-depth interviews. Data saturation was achieved after nine in-depth interviews, when no new data emerged. This study was approved by the Regional Ethics Committee (Dnr: 2021-06536-01), and ethical considerations were upheld throughout the study. Each informant received oral and written information about the longitudinal study and signed an informed consent form. Participation in the study was voluntary, and informants had the opportunity to ask questions before and after their in-depth interview. Additionaly, if the in-depth interview subsequently raised thoughts or concerns among the informants and they wished to contact professional support, they were offered to contact the researcher responsible for the study for advice and referral to the appropriate agency. Analysis In this study, a thematic network analysis was conducted to systematize, organize, and describe the study findings. Interpretation was employed during this analysis to elicit abstract themes ( 10 ). Each study author then independently analysed the data material on an inductive basis according to Attride-Stirling’s thematic network analysis model ( 10 ), which divides themes derived from a thematic network analysis into three levels: basic, organizing, and global ( 10 ). Both authors individually read the transcribed data several times to gain an overall understanding of the content. Meaningful text segments, such as sentences, were then organized into the aforementioned three levels; basic themes were merged to form organizing themes, and organizing themes were grouped together into a global theme. Lastly, patterns were interpreted and clarified with verbatim quotes. The interview number, gender, number of parity or pregnancy, and age of the informants are presented below in the Results section. The study authors discussed and revised all analytical decisions until consensual validation was achieved. See Table 1 for the analytical scheme. Table 1 Example sentences, basic themes, organizing themes and global theme. Sentence Basic theme Organizing theme Global theme It was different in my womb on Tuesday so I called my midwife who said call the hospital Suspicion and awareness of changes in pregnancy and parents’ activity Pregnancy, awareness, information, reactions and reflections at tragical stillbirth diagnosis It was horrible to carry a dead baby inside the body, and it was scary to give birth Caring and giving birth to the stillborn baby Stillbirth is a roller coaster, from the bright miracle of life, to the deepest black grief and bottomless pain Almost all of the informants experienced the treatment and support as human and trusting and very good at hospital Professional treatment and support during stillbirth and postpartum Support and structured activities and internal processes at stillbirth To leave and hand over the stillborn baby to professionals at discharge was an intolerable and difficult act Handing over the stillborn baby to professionals upon discharge from the hospital Results The informants generously shared their lived experiences, internal feelings, and deep grief of stillbirth. The in-depth interviews assumed a natural flow, and the informants showed ample interest and significance in sharing their traumatic, severe, and irreversible life-changing event. A thematic network was developed, and eleven basic themes emerged, from which the following two organizing themes were created: ‘Pregnancy, awareness, information, reactions, and reflections at tragic stillbirth diagnosis’ and ‘Support and structured activities and internal processes at stillbirth’. Together, these organizing themes constituted one global theme: ‘Stillbirth is a roller coaster, from the bright miracle of life to the deepest black grief and bottomless pain’ . See Table 2 . Table 2. Network of global, organization and basic themes describing parents experiences and perceptions of stillbirth during pregnancy, birth and postpartum. This global theme encapsulated the informants’ perceptions and experiences regarding the consequences of an abrupt ending pregnancy, akin to a worst-case scenario: a life that ended before it began, a feeling of profound smallness and powerlessness, and a perception that healthcare professionals could not intervene to rescue the baby, resulting in a desperate sense of being forever robbed of the baby. Nearly all of the informants emphasised the priceless value of holding the stillborn baby on their chest or in their arms after birth, especially during the first moments when the baby was still soft and warm. Additionally, almost all of the parents cherished the time spent together with the stillborn baby postpartum. During this precious time, they tenderly cared for and welcomed the stillborn baby as a new member of their family. They highlighted the importance of maintaining close physical proximity to the stillborn baby as much as possible, recognising that their time together was limited and viewing this closeness as the most meaningful way to comprehend and cope with the tragic situation. Handling the stillborn baby in the same manner as living babies, such as wiping when needed, putting on a diaper, dressing the baby, and ensuring the baby appeared comfortable in bed, was deemed important. They also preserved valuable and poignant mementos for the future, such as photographs and hand and footprints of the stillborn baby. Being separated from their stillborn baby at discharge was described as the worst thing ever in their lives. The organizing theme ‘Pregnancy, Awareness, Information, Reactions and Reflections at Stillbirth Diagnosis’ consisted of seven basic themes: ‘Information during Pregnancy at Antenatal Clinic and on Own way’; ‘Suspicion and Awareness of Changes in Pregnancy and Parents’ Activity’; ‘Information, Reactions, Thoughts, and Feelings of Stillbirth Diagnosis at Hospital’; ‘Carrying and Giving birth to the Stillborn Baby’; ‘Mental Health of Parents’; ‘Causes and Explanations of Stillbirth and their Significance’; and ‘Possible Future Pregnancy and Support from Healthcare’. Information during Pregnancy at Antenatal Clinic and on Own way The informants’ information and knowledge about serious and fatal risks during pregnancy from midwives at antenatal clinics differed. Some of the informants described that they had not received any information about reduced or absent fetal movements in pregnancy or other serious causes that could lead to a stillbirth. An informant stated, ‘The midwife referred to 1177 (digital national advice of healthcare) and nothing was available to read about decreased fetal movements – I think it would be better to talk about it’ (interview no. 2, man, first pregnancy, 32 years). A mother of two older children affirmed that her midwife had never informed her about minor or termination of fetal movements, and a baby dying in the womb. Although, she knew it could happen but just in case of delayed birth. Furthermore, one informant described that ‘The midwife indicated only smoking and travels as risks during pregnancy’ (interview no. 10, man, first pregnancy, 39 years). Two other informants clarified that they already knew about reduced or absent fetal movements and that stillbirth could occur early or later in pregnancy. The first informant had read a lot about it on own basis, and the other had experienced during childhood, when a younger sibling died in the mother’s womb. Table 2 IN HERE Suspicion and Awareness of Changes in Pregnancy and Parents’ Activity Several of the informants were aware that something different had happened in their pregnancies. Some experienced reduced or absent fetal movements in their wombs during the last stages of pregnancy. These informants arrived at the hospital from only a few hours to four days after registering no fetal movements. One informant described, ‘I felt it different in my womb on Tuesday so I called my midwife who said call the hospital – but I answered her that the baby usually moves in the evening and I wanted to wait, so we went to the hospital on Wednesday’ (interview no. 1, woman, primipara, 27 years). Some female informants tried pushing on the baby, drinking cold water, and then waited for some movements, without any result. Furthermore, three other women were not aware of or did not register decreased fetal movements at all, and received the unsuspected stillbirth diagnosis when they arrived at the hospital. Their reasons for seeking healthcare included experiencing labour pain and bleeding, prelabour rupture of membranes (PROM), and undergoing a check-up of the baby’s growth. One of these women said, ‘I went to the hospital with labour pain and bleeding, and I didn’t know then that the baby was dead’ (interview no. 3, woman, 1-para, 31 years). Information, Reactions, Thoughts, and Feelings of Stillbirth Diagnosis at Hospital All the informants experienced calm and matter-of-fact information from obstetricians and midwives at the hospital, informing them that their baby had died in the womb. The parents expressed various reactions to this information. Several reacted directly and asked if it was quite sure and did not immediately realize it was true. Other informants reacted with expressive shock feelings such as crying and shaking, while some remained silent and showed understanding through glances and body language. One informant said, ‘We were very sad, completely unimaginable, it was just over and nothing to do – the pregnancy was walked over’ (interview no. 6, woman, primipara, 39 years). Another informant described this unreal situation, where the midwife couldn’t hear any heartbeats and then an obstetrician arrived and confirmed there were no visible heartbeats - and after some minutes another obstetrician came and confirmed the same thing. A female informant described that she did not remember what she and her partner had said to each other at the information at the hospital, nor did she react with feelings until they got home. However, this female informant was far-sighted and asked the obstetrician, in this chaotic situation, if this could happen again in a future pregnancy. Some of the male informants described receiving this tragic message as unbearable, expressing feelings of anger and disappointment that the life task of raising and caring for a baby had suddenly disappeared. One of them stated, ‘It was terrible, I had never felt so intensive pain in my life before’ (interview no. 4, man, first pregnancy, 22 years). Another male affirmed that he could not identify fetal movements at ultrasound as before, feeling sad and describing the whole world as collapsing, experiencing unreal feelings and a sense of not being awake. Furthermore, he felt as though he had lost something inside his soul, experiencing himself as different, and felt unsure if this feeling would persist in life. A female informant expressed how heavy it was to lose the baby, particularly when it was towards the end of pregnancy and her previous pregnancy had gone well. Another female informant blamed herself for not paying enough attention to decreased fetal movements and felt overwhelming guilt about this feeling and behaviour. Some informants expressed profound sadness at witnessing their partners’ traumas and felt as though their life’s path had been crushed. A male informant felt explicitly traumatised by the stillbirth but stated that initially, he could not find understanding and comfort for his part from the midwives at the hospital. Carrying and Giving birth to the Stillborn Baby Some of the women agreed that it was a horrible and unpleasant thought and feeling to carry a dead baby inside the body, and they were scared and worried about giving birth to a stillborn baby naturally. Furthermore, some of the informants feared meeting a stillborn baby and how it would look. One informant stated, ‘The dead baby is only a shell in my womb now, and I regret that any photos were taken of my womb during pregnancy’ (interview no. 5, woman, 1-para, 31 years). Other women described this particular situation as not scary per se, but they thought more about the fact that they would soon be separated and say farewell to their baby. A female informant reported that when she was told her baby was dead inside her, she could not pat the baby’s foot on the left side as before. They had shared such a close and strong bond, had done many fun things together, and finally, the baby had become her best friend. All births except two proceeded naturally, but two informants had to undergo emergency caesarean sections due to birth complications. All of the informants were satisfied with the birth, and almost all experienced the pain relief during birth as adequate. They wished to keep the stillborn baby near themselves afterward. Several females expressed that it was desirable to keep the baby skin-to-skin on the chest directly after birth, and one of them considered it important for her partner to hold the stillborn baby in his arms when the baby was still soft and warm. A female informant described holding her baby in her arms as the greatest and most beautiful thing that had ever happened to her. Another female informant regretted that she had never kept her stillborn baby skin-to-skin, neither at birth nor after birth. A male informant expressed being overwhelmed when his stillborn baby was born, enjoying every minute, feeling an awesome feeling, holding him, 2850 grams of love, and experiencing a strong and proud father-and-son connection. Another male informant thought he would identify his stillborn baby only as a dead baby at birth, but he experienced a special feeling - seeing, meeting, and holding him close in his arms - he had become a father and a parent forever. A third male informant stated, ‘I felt sad but not uncomfortable, there was no rush for him to go out, he is our baby even though he is not alive’ (interview no. 7, man, first pregnancy, 53 years) . However, there were a few informants who did not wish to have the stillborn baby on the chest or held in arms for a longer time after birth. A fourth male informant affirmed that the stillborn baby only laid for a very short time on the mother’s chest at birth and then further 30 minutes in his arms. Afterward, the couple could not bear to see their stillborn baby any longer, wanting to say farewell as soon as possible, which they did not regret, and then they discharged from the hospital. Mental Health of Parents The informants self-estimated their current mental health as ranging from very good to very bad. Six informants rated their mental health as very bad, including five women and one man, while one informant rated it as partly bad. Some of the women who rated their mental health as very bad experienced symptoms such as waking up at night with panic attacks triggered by flashbacks and having difficulty breathing. Another woman reported feeling very tired and crying a lot every day, although she no longer experienced anxiety and panic feelings as she did at the hospital. A third woman felt extremely depressed and unsure of how to feel better, while a fourth woman had managed to overcome the most difficult moments despite facing significant challenges. One female informant rated her mental health as good and expressed a positive outlook on most things, finding it easier to think positively rather than focusing solely on difficulties. Two male informants rated their mental health as good or very good. One mentioned receiving good support from his partner and engaging in conversations with others, while the other expressed being open-minded and capable of processing his feelings in a positive manner, allowing him to move through sadness more quickly. Causes and Explanations of Stillbirth and their Significance Almost all of the informants recieved no obvious reasons or explanations of the stillbirths. One female informant had not received any explanation and felt that it had no meaning, particularly as she opted out of an autopsy for the stillborn baby. Few informants had partially received explanations. For instance, one male informant immediately received the cause and explanation of the stillbirth at the hospital, where the obstetrician showed them on ultrasound that the stillborn baby was lying with the stomach downwards, resulting in a kinked umbilical cord in the vagina. Another informant mentioned having been informed at a routine ultrasound about the baby’s heart defect and subsequent heart failure. A male informant partly knew the cause and considered it important for future pregnancies to be able to react if something would deviate. Nearly all informants emphasized the importance of receiving the cause and explanation of stillbirths, currently, and for future pregnancies. One female expressed that knowing why the baby died in her womb would alleviate the need to constantly question and wonder about it. The informants did not blame healthcare professionals for the stillbirths, considering them innocent of the occurrences. Possible Future Pregnancy and Support from Healthcare All informants expressed a desire for a subsequent pregnancy. Nearly half of the informants had undergone IVF pregnancies that resulted in stillbirths. Some expressed awareness of the uncertainty of IVF attempts resulting in pregnancy and hoped for a healthy and living baby next time. Informants voiced fears and worries about future pregnancies but also expressed a strong desire for subsequent siblings. Both female and male informants highlighted similar wishes for future pregnancies, including several and more frequent check-ups with midwives and obstetricians, particularly in the second trimester, as well as a controlled start of labor at specific gestational weeks using the induction method. Some informants emphasized the importance of extended professional and psychological support in case of a future pregnancy. The organizing theme ‘Support and Structured Activities and Internal Processes at Stillbirth‘ comprised four basic themes: ‘Professional Treatment and Support during Stillbirth and Postpartum’; ‘Caring and Spending Time and Keeping Memories of the Stillborn Baby and Parents’ Support Network’; ‘Handling Over the Stillborn Baby to Professionals upon Discharge from Hospital’; and ‘Relationship with the Partner and the Grieving Process’. Professional Treatment and Support during Stillbirth and Postpartum Almost all informants encountered various professionals, including midwives, obstetricians, psychologists, social workers, deacons, priests, and pathologists at the hospital. They described the treatment and support as human, trusting, and significant, with professionals offering professional, calm, and supportive care throughout the process. While most informants were satisfied with the treatment, a few requested more information and guidance during labor and the postpartum period. Some highlighted the value of the postpartum time and the support received from professionals, appreciating their ability to understand and empathize with their experiences, and one of these females pointed out, ‘I could feel that she was my baby and I was her mother, I stayed with her as long as possible’ (interview no. 8, woman, 2-para, 29 years). However, a few informants desired more information, such as pain relief options, labour sessions, postpartum care, autopsy procedures, and funeral arrangements. An informant even requested one-to-one care from a midwife, feeling disturbed by sharing the midwife with other patients during labour. Another informant suggested that some obstetricians could display more empathy. Caring for and Spending Time with the Stillborn Baby and Parents’ Support Network The time spent with the stillborn baby after birth varied from one hour to 98 hours, with an average of 44.8 hours. Seven informants were informed about the option to spend additional time at home with the stillborn baby using a Cubitus baby (cot with cooling blocks). Despite that, all of these informants declined to take the stillborn baby home. Reasons cited included discomfort and concerns about the baby’s small and fragile state, and the presence of siblings at home. One female informant expressed her desire to keep the tragic situation within the hospital, fearing that returning the stillborn baby back to hospital would make it more difficult to cope with the situation. However, all informants agreed on the importance of routinely preserving memories for the future, such as through photos, hand and footprints, and plaster casts of the stillborn baby’s hands and feet. Almost all managed to take their own photos, and some even made videos. An informant conveyed the sentiment, ‘Everything that belongs to him has so much value for us even though we don’t have him physically at home’ (interview no. 2, man, first pregnancy, 32 years) , while another expressed appreciation for the professionals’ support and guidance in taking photos of the baby and she expressed, ‘The professionals confirmed that he was so beautiful, and they were so receptive to what we wanted to do, and advised us to take own photos of the baby which I appreciate so much now’ (interview no. 9, woman, 0-para, 36 years) . However, some informants expressed a need for more support and reminders from professionals to take photos and spend time holding the stillborn baby close, especially when they felt tired or confused after birth. Several parents mentioned that visits from extended family, relatives, and close friends at the hospital provided a sense of unity and support, alleviating feelings of loneliness and fostering a sense of togetherness around the stillborn baby, which they believed could benefit them in the future. Handling Over the Stillborn Baby to Professionas upon Discharge from Hosptial For almost all informants, the act of leaving and handing over the stillborn baby to professionals upon discharge from the hospital was intolerable and difficult. Some informants described handing over their stillborn baby when they noticed changes in the body or when they felt a sense of respect for the baby’s dignity, allowing them to proceed in the process. It was crucial for them to entrust the stillborn baby to a trustworthy and caring individual. In most cases, the baby was handed over to a known midwife, although in some instances, it was directly to a pathologist. Many informants appreciated the opportunity to visit their stillborn baby at the pathology department or mortuary before the funeral. One female informant shared, "We visited him several times, it became a sanctuary, we cherished these moments, we held him and patted him – he was the most beautiful baby we had seen" (interview no. 6, woman, 0-para, 39 years). Some informants visited their stillborn baby multiple times before the funeral, even though they noticed slight changes in the baby’s appearance. They felt reassured knowing that the baby was resting comfortably in the coffin. Nearly all informants recalled the birth experience four weeks postpartum, with some affirming memories overall. One female informant reminisced, "When the baby was coming on my chest and thereafter when I had himself postpartum" (interview no. 1, woman, 0-para, 27 years). A male informant preferred to focus on the joy before the sorrow, while a female informant acknowledged both the grand and beautiful aspects along with the painful and terrible ones. Some informants recalled specific interactions with their partners during this time, with the stillborn baby’s non-living status not being the focal point. However, two informants described a paradoxical experience - the stillborn baby’s hands were described as beautiful and soft, yet the sight of the cold and blue body lying alone on a bench in the labour room was unsettling. Relationship with the Partner and the Grieving Process Nearly all informants described their relationship with their partners as stronger and more stable following the stillbirth. They felt increased love and trust, a sense of growing together, and heightened closeness during times of strain. A female informant expressed, ‘We have been through this together and we feel that we have and love each other, but you can’t take anything for granted’ (interview no. 3, woman, 1-para, 31 years). A male informant affirmed, ‘This tragic situation has made us closer and we are stronger together’ (interview no. 10, man, first pregnancy, 39 years). However, one woman felt bitter towards her partner, feeling that she bore the brunt of the struggle and that her partner avoided discussing the stillborn baby. The grieving process involved conversations with partners, professionals, extended family, friends, and co-workers. Almost all informants experienced profound sadness and cried frequently, with poor relaxation and sleep. They harbored deep and painful feelings and thoughts about the stillborn baby and sought solace in discussions, particularly with their partners. Professional conversations were deemed important and necessary for understanding in the tragic situation. Informants believed that frequent discussions about the stillborn baby were crucial for progressing through the grieving process. Some chose to openly acknowledge their parenthood and the existence of the stillborn baby to others, despite the baby not being physically present. Memories of the stillborn baby played a crucial role in the grieving process for almost all informants. They frequently revisited these memories, especially by looking at photos of the stillborn baby several times a day, particularly during the first month after the stillbirth. Additionally, some informants described participating in both a name-giving ceremony at the hospital and a burial ceremony for the stillborn baby in church. These ceremonies were seen as ways to honor and respect the baby, making their existence visible and dignified, and were considered integral parts of the grieving process. However, an informant, due to strong religious traditions, did not participate at the burial ceremony and had not visited the grave. Visiting the grave held different significance for different informants. For some, it was a crucial, tranquil, and peaceful place where they could communicate with their buried baby. Others viewed it as an important place to tend to, adorned with stuffed animals, flowers, and candles, for the sake of the baby. Initially, some informants visited the grave once or twice daily. Discussion The thematic network analysis uncovered two organizing themes: ‘Pregnancy, awareness, information, reactions, and reflections at tragical stillbirth diagnosis’ and ‘Support and structured activities and internal processes at stillbirth’, culminating in one overarching global theme: ‘ Stillbirth is a roller coaster, from the bright miracle of life, to the deepest black grief and bottomless pain.’ These themes emerged from the individual experiences of the participants, tracing their journey from the initial awareness of differences and fears during pregnancy to the stark reality of stillbirth. The analysis highlighted the profound impact of this tragically irreversible life event, starting from the onset of suspicion during pregnancy and extending through the concrete confirmation of stillbirth, with a continuum of emotions and experiences in the first month thereafter. In the organizing theme ‘Pregnancy, awareness, information, reactions and reflections at tragical stillbirth diagnosis’, the results unveiled that Information during pregnancy at antenatal clinics and on own way was lacking, specifically about decreased fetal movements and the risk of stillbirth. Consequently, parents was neither aware nor preparared for the possibility that a stillbirth could occur during pregnancy, although there was some knowledge of the diagnosis of stillbirth from before. In addition, the basic theme also demonstrated that, in the majority of cases, there were different levels of Suspicion and awareness of changes in pregnancy and parents’ activity at various stages of pregnancy, which was later confirmed at the hospital . Discrimination attributed to stillbirth and missed warning signs has been documented in prior research ( 6 ). The failure to pay attention to reduced or absent fetal movements in the womb, and subsequently not taking appropriate action, often resulted in feelings of guilt and shame. This was interpreted as a failure to properly safeguard the pregnancy, leading to self-perceptions of being a neglectant or inadequate mother. The result of the present study align with previous studies that have highlighted similar experiences of stigma, including feelings of shame, blame, ( 6 , 11 ) and a sense of devaluation of motherhood following stillbirth ( 12 ). The result showed that Carrying and giving birth to the stillborn baby was perceived frightening and unpleasant, yet it also provided a sense of safety in knowing where the baby was kept, regardless of its condition. The experience brought about deep fears and inconveniences for the parents, placing them in a completely new and unavoidable situation in life. The loss of dreams about raising a living baby disappeared. All labours, except for two, resulted in vaginal births. This finding is consistent with a previous study, which demonstrated that vaginal birth is the most common and recommended mode of birth in cases of stillbirth, whether the labour occurred spontaneously or was induced, regardless of whether the individual had previously undergone a cesarean section ( 13 ). Hence, it emerged that vaginal birth became the best outcome for both physical and emotional wellbeing, and keeping the stillborn baby close and recurrently holding it, especially through skin-to-skin contact, promoted the grieving process. Previous studies have supported the overall beneficial effect of holding a stillborn baby ( 14 , 15 ). The parent role arose and became clear when closeness, openness and love flowed to the stillborn baby for a longer time together. This scenario harks back to the early 1980s when the practices and procedures surrounding stillbirth were vastly different in Swedish healthcare. During that time, professionals often treated stillbirth as a non-event, neglecting to provide adequate care or support. This approach was motivated by a desire to shield parents from emotional attachment and encourage them to forget about the stillborn baby as quickly as possible. In reality, this meant that immediately after birth, the stillborn baby was separated from the parents and swiftly taken away from the labour room, never to be seen again. Under this approach, parents were hardly given the opportunity to see, hold, or bid farewell to their stillborn baby. As a result, the stillbirth remained invisible to the parents, others, and society at large. However, a previous study described that treating stillbirth as a non-event has been largely, if not entirely, abandoned in Sweden ( 16 ). Further these parents, deprived of the chance to physically and emotionally care for and mourn their stillborn babies, likely harbored unprocessed and deeply sorrowful memories, thoughts, and fantasies about their loss for years to come. A previous retrospective study presented one in three women with a clinically significant level of post-traumatic distress symptoms (PTSD) 5–18 years after stillbirth ( 17 ). The basic theme Mental health of parents showed different strategies to cope with the grief, ranging from panic attacks and severe depression to feeling exhausted and sleeping excessively, but there were also attempting to adopt a more positive outlook on the grief and not solely focusing on the problems. However, a problem arose when the mental health was rated as very poor and values in religious traditions precluded discussing the stillborn baby, neither with partner nor with relatives. This approach may have provided an unhealty bubble of loneliness and hindered the grieving process. A previous systematic review has confirmed poorer mental health outcomes following stillbirth, which is consistent with the present findings ( 18 ). Furthermore, there were limited treatment options available for those who reported worsening mental health following stillbirth, highlighting the need for further research in this area ( 19 ). Additionally, the basic theme Causes and explanations of stillbirth and their significance showed that parents were mostly unaware of the cause and explanation behind the stillbirth, which was unsatisfactory, also for a future pregnancy. A previous Swedish research underscored the importance of understanding the cause of stillbirth ( 2 ). The result showed that it was common to have a desire to achieve a new healthy pregnancy in the future, which was mirrored in the basic theme Possible future pregnancy and support from health care . This theme contained for nearly one-half of the informants that their IVF pregnancy ended in stillbirth, a relatively common occurance, which is consistent with a systematic review, that indicates an increased risk of stillbirth associated with IVF pregnancies compared to natural conception ( 20 ). In the case of a future pregnancy the importance of receiving continued high-quality healthcare, more information about pregnancy risks, examinations, assessments, and measures were highlighted. Some studies have investigated the provision of care for parents during pregnancies following stillbirth, and a UK study ( 21 ) showed numerous examples of good practice. However, that study indicated the overall lack of consistency in providing adequate emotional and psychological support for women during pregnancies after stillbirth. Another study underscored the importance of tailoring support systems not only to the mother but also to the father, who reported a lack of opportunities for grieving ( 11 ), and a third study emphasized the necessity for greater attention to providing thoughtful, empathic, and collaborative care in all pregnancies following stillbirth ( 22 ). At the organizing theme ‘Support and structured activities and internal processes at stillbirth’ the result revealed almost satisfying results with the treatment and communication from professionals following stillbirth and was described as credible, respectful, knowledgeable, and responsive, mirrored in the basic theme Professional treatment and support during stillbirth and postpartum. However, more experiential and fact-based information about labour and the postpartum period was requested and even more consideration in the labour room during full-scale labour from other professionals. This theme included the postpartum period as friendly and humane support, and accommodating professionals, and the support compromised by sharing experiences and to balance between seeing the beauty and the sadness simultaneously. This approach facilitated that every stillborn baby was unique and valuable, deserving of unlimited time for understanding, reflection, and respect, which ultimately aided in the grieving process. Similarly, a recent Swedish systematic review identified four key aspects of care and support following stillbirth: personification, respectful attitude, existential issues, and stigmatization ( 11 ), which highlighted the complex impacts that stillbirth had on everyone involved. This basic theme also acknowedged the duration of time spent with the stillborn baby at the hospital, which varied widely, from one to 98 hours, and was related to personal needs and to put up with bottomless pain and grief. Although, the Cubitus baby was offered to parents to take the babies home, none of the participants chose to do so, based on their perceptions of the fragile condition of the stillborn baby, and the anticipated difficulty and intense pain of returning the baby. Additionally, the presence of extended family and close friends at the hospital, as well as at the funeral, had a significance in sharing the sadness of this irreversible life-changing event, both in the moment and for the future. However, it is worth noting that not all mothers attended the funeral, due to their religious traditions, which may have hindered or delayed the ongoing grieving process. Furthermore, this theme included the extremely painful and agonizing part; Handling over the stillborn baby to professionals upon discharge from hospital. However, the care and respect, and inclusive attitude provided some relief amidst the intense pain and loss. To visit the stillborn baby multiple times before the burial process gave a valuable insight to the grieving process. Reflecting on the stillbirth one month after labour was intertwined with memories of the baby’s physical appearance and the overall thoughts and reflections about the tragic event. The relationship with their partner in the grieving process had strengthened after the stillbirth and included a lot of crying, talking, and reminiscing with their partner, often repeatedly, and became necessarily and healing in the grieving process. Seeking support and discussions with professionals and others in their network were also very important for furthering grieving process. Moreover, the theme included memories of the stillborn baby as the only tangible connection that could be retained in life, and were considered incredibly important multiple times on daily basis for navigating the grieving process. A previous study confirmed when a baby is stillborn, labour departments encourage parents and other family members to take photographs and gather other momentos ( 23 ). Visiting the baby’s grave became an important part of the mourning process, allowing to feel closer to the buried baby. Methodolocical considerations The study has some limitations. Its qualitative nature preluded any quantitative claims about the individuals affected by stillbirth. Only ten informants were included in the study, and no new data emerged after nine interviews. Stillbirth is a rare phenomenon, making it difficult to recruit parents to longitudinal studies, but it is possible that recruiting more participants might bring new insights and nuances to the results. The authors’ pre-understanding and experiences of this topic may have influenced both the research process and the results. The authors were both midwives, and when discussing the analysis, these researchers focused their attention on their prior understandings ( 10 ). As midwives typically interact with individuals who are in the progress of starting a family, included with a childbirth and a living baby but rarely with individuals affected by stillbirth, the authors had a decidedly outsider perspective. It should be noted that all informants were represented a crystallised group of individuals who were affected by an irreversible tragic live-changing event, but wanted to participate in the study and share their experiences and perceptions and values and deep sadness at stillbirth. The affected individuals and their feelings of loss and deep black sadness, was based on their individual and personal mental current status one month after the stillbirth; a longitudinal study is ongoing to explore the individuals over time based on their irreversible and tragic life-changing stillbirth event. Trustworthiness is one important aspect in qualitative research which, includes how to judge the similarities and differences between themes ( 24 ). Dependablity is one way to ensure this. In addition, trustworthness was enhanced by describing the process in detail to allow the reader to follow the analytical process. The authors are experienced midwives and familiar with qualitative methods, which ensures the trustworthiness of the translation. A special focus was on the citations and to maintain the integrity of the data. Performing the steps in the analysis process individually and jointly ensured credibility and conformability. Transferability was assured by providing detailed descriptions of the content and the context of the the interviews as well as the selection and characteristics of the participants, data collection, and process of analysis and findings. One strength of the study was that the informants were recruited from a wide geographical region that included both sparsely and densely populated areas. Further, we had information about the informants socio-demographic and ethnicity background. The informants were followed from awareness and suspicion of reduced or absint fetal movements at home, or seeking healthcare for other important reasons in pregnancy until one month after stillbirth. The first author conducted all the in-depth interviews according to the same interview guide, and all rules for conducting in-depth interviews and analysing data were carefully followed. The basic themes were corroborated with quotes from the informants. Finally, both study authors collaborated to collect and analyse the data and interpret the results. Conclusion This study sheds light on the profound and devastating impact of stillbirth on parents, who are confronted with the loss of their long-awaited and cherished baby without immediate understanding of why it occurred. The intense grief and pain experienced by parents in the first month after stillbirth is described as a heavy burden that persists day and night, and mirrows in poor/very poor mental health. In spite the immense challenges faced by parents, the study highlights the importance of developing individual strategies to cope with this tragic and irreversible life-changing event. Additionally, it underscores the need for healthcare professionals to provide enhanced support and normalized information to parents, including the option to take their stillborn baby home in a Cubitus baby. This approach can facilitate a longer period of physical and psychological grieving, enabling parents to navigate the grieving process more effectively. Declarations Competing interests None declared. Availability and materials section Our data (individual in-depth interviews) cannot be shared openly due to participants privacy concerns. Funding This research did not receive any specific grant funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution BH initiated the study. BH analysed the data with assistance from IH. Both authors contributed to the drafting of the paper. Acknowledgements None. Data Availability Our data (individual in-depth interviews) cannot be shared openly due to participants privacy concerns. References National Board of Health and Social Welfare. Socialstyrelsen. Statistik om graviditeter, förlossningar och nyfödda. https://www.socialstyrelsen.se/statistik-och-data/statistik/alla-statistikamnen/graviditeter-forlossningar-och-nyfodda/ Accessed 22 April 2024. Höglund B, Rådestad I, Hildingsson I. Few women receive a specific explanation of a stillbirth – an online survey of women’s perceptions and thoughts about the cause of their baby’s death. BMC Pregnancy Childbirth. 2019;19:139–139. https://doi.org/10.1186/s12884-019-2289-4 . Stormdal Bring H, Hulthén Varli IA, Kublickas M, Papadogiannakis N, Pettersson K. Causes of stillbirth at different gestational ages in singleton pregnancies. Acta Obstet et Gynecol Scand. 2014;93:86–92. https//:doi.10.1111/aogs.12278. Rowland A, Goodnight WH. Fetal loss: addressing the evaluation and supporting the emotional needs of parents. J Midwifery Women’s Health. 2009;54:241–8. https//:doi:10.1016/j.mwh.2009.02.011 . McPherson E. Discovering the cause of stillbirth. Current Opinion in Obstetrics & Gynecology. 2013; 25:152–156. https//:doi.1097/GCO.0b013e32835e0f26. Pollock D, Pearsson E, Cooper M, Ziaian T, Foord C, Warland J. Voices of the unheard: A qualitative survey exploring bereaved parents experiences of stillbirth stigma. Women Birth. 2020;33:165–74. https://doi.org/10.1016/j.wombi.2019.03.002 . Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents’ description of labouring with an antepartum fetal death: Finding from the Birthing in Grief study. Aust N J Obstet Gyneaecol. 2024;64:133–40. 10.1111/ajo.13759 . https://doi-org.ezproxy.its.uu.se/ . Nuzum D, Meaney S, O’Donoghue K. The impact of stillbirth on bereaved parents: A qualitative study. PLoS One. 2018; 13:e0191635. https://doi10.1371/journal.pone.0191635. Martinez-Serrano P, Pedraz-Marcos A, Solis-Munoz M, Palmar-Santos AM. The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study. Midwifery. 2019;77:37–44. https://doi.org/10.1016/j.midw.2019.06.013 . Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qualitative Res. 2001;1(3):385–405. https://doi.org/10.1177/146879410100100307 . Campbell-Jackson L, Bezance J, Horsch A. A renewed sense of purpose: mothers’ and fathers’ experience of having a child following a recent stillbirth. BMC Pregnancy Childbirth. 2014;14:423. Persson M, Hildingsson I, Hultcrantz M, Kärrman Fredriksson M, Peira N, Silverstein R, Sveen J, Berterö C. Care and support when a baby is stillborn: A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries. PLoS ONE. 2023;18:e0289617. https//:doi:10.1371/journal.pone.0289617 . Boyle A, Preslar J, Hogue C, Silver R, Reddy U, Goldenberg R, Stoll B, Varner M, Conway D, Saade G, Bukowski R, Dudley D. Route of Delivery in Women with Stillbirth. Obstet Gynecol. 2017;129:693–8. https//:doi:10.1097/AOG.0000000000001935 . Erlandsson K, Warland J, Cacciatore J, Rådestad I. Seeing and holding a stillborn baby: mothers’ feelings in relation to how their babies were presented to them after birth – findings from an online questionnaire. Midwifery. 2013;29:246–50. https://doi:10.1016/j.midw.2012.01.007 . Kingdon C, Givens JL, O’Donnell E, Turner M. Seeing and Holding Baby: Systematic Review of Clinical Management and Parental Outcomes after Stillbirth. Birth. 2015;42:206–18. https//:doi:10.1111/birt.12176 . Rådestad I, Nordin C, Steineck G, Sjögren B. Stillbirth is no longer managed as a non-event: A nationwide study in Sweden. Birth. 1996;23:209–15. https://doi.org/10.1111/j.1523-536X.1996.tb00496.x . Gravensteen IK, Helgadóttir LB, Jacobsen E. Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study. BMJ Open. 2013;3:e003323. https://doi:10.1136/bmjopen-2013-003323 . Rådestad I, Sandset PM, Ekeberg Ö. Westby C, Erlandsen A, Nilsen S, Visted E, Thimm J. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy Childbirth. 2021;21:782. https//:doi:10.1186/s12884-021-04254-x . Hildingsson I, Berterö C, Hultcrantz M, Kärrman Fredriksson M, Peira N, Siverstein R, Persson M, Sveen J. Support interventions to reduce psychological distress in families experiencing stillbirth: A Systematic review. Women Birth. 2024;24:S1871–5192. 00019 – 2. PMID 38242808. Sarmon K, Eliasen T, Knudsen U, Bay B. Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis. Fertility Sterility. 2021;116:784–792. https//:doi:10/1016/j.fertnstert.2021.04.007. Mills TA, Ricklesford C, Heazell AEP, Cooke A, Lavender T. Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death. BMC Pregnancy Childbirth. 2016;101. https//:doi.org/10.1186/s12884-016-0891-2 . Wojcieszek AM, Boyle FM, Belizán JM, Cassidy J, Cassidy P, Erwich JJHM, Farrales L, Gross MM, Heazell AEP, Leisher SH, Mills T, Murphy M, Pettersson K, Ravaldi C, Ruidiaz J, Siassakos D, Silver RM, Storey C, Vannacci P, Middleton P, Ellwood D, Flenaddy V. Care in subsequent pregnancies following stillbirth: an internationel survey of parents. BJOG; 2016. https//:doi.org/10.1111/1471-0528.14424 . Godel M. Images of stillbirth: memory, mourning and memorial1. Visual Stud. 2007;22:253–69. https://doi.org/10.1080/14725860701657159 . Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Program Evaluation. 1986;1986(30):73. https://doi.org/10.1002/ev.1427 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4566174","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318696088,"identity":"0513cb4b-a2fa-4a94-8cd1-b43d40868c81","order_by":0,"name":"Berit Höglund","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACAyA+AEbsQBZPRUKCAVFaDoC0MIO0nCFSCwNcC28bEVrM2XsfHv7AcEdO3pnH7MHbeWl55gw8ZhIMf2xwarHsOW4AdNgzY8PDPOaGc7flFFs2ALUwtqXhdtiNNJBfDidubOYxk+bdVpG44QBIS8Nh3FruP0PWMgeqheHPfzy2sEG0zGcGaWnIgWphO4DHL0CHnTE4bGzAzFYmOedYWrHBYbZii8S2ZJxazNmPMX+oqDgsJ9/evE3iTU1ynsHx5o03Pvyxw6kF6jwggrsEFEEJBDSAgXwDMapGwSgYBaNgRAIAz15V/28RXT0AAAAASUVORK5CYII=","orcid":"","institution":"Uppsala University","correspondingAuthor":true,"prefix":"","firstName":"Berit","middleName":"","lastName":"Höglund","suffix":""},{"id":318696089,"identity":"d7310804-fe49-4228-94bd-a56ba67b31c5","order_by":1,"name":"Ingegerd Hildingsson","email":"","orcid":"","institution":"Uppsala University","correspondingAuthor":false,"prefix":"","firstName":"Ingegerd","middleName":"","lastName":"Hildingsson","suffix":""}],"badges":[],"createdAt":"2024-06-11 20:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4566174/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4566174/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-024-07055-0","type":"published","date":"2025-01-03T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73093269,"identity":"fc3b5f7c-cbe5-4309-8698-22167835c004","added_by":"auto","created_at":"2025-01-06 16:12:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":642981,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4566174/v1/fa0c1434-8efd-48fd-a7ae-c8899d6ccc8c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Is it possible for parents to endure a stillbirth diagnosis? Initially experiences, perceptions and internal strategies: Individual in-depth interviews in Sweden 2021-2023","fulltext":[{"header":"Background","content":"\u003cp\u003eLosing a baby through stillbirth affects women and men throughout their lifetime. In Sweden, stillbirth is defined as the death of a baby in utero after 22 completed gestational weeks (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2022, 315 babies were stillborn after 22 completed weeks of pregnancy in Sweden, with 294 (93%) diagnosed with stillbirth before labor commenced. In 2021, stillbirths mostly occurred during 32\u0026ndash;36 completed gestational weeks (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although the rate of stillbirth has decreased in recent years due to changes in healthcare practices, this irreversible, life-changing event remains. A recent study identified two primary reasons for stillbirth: placental complications (40.5%) and umbilical cord complications (30.2%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Another study from 2014 confirmed various complications associated with gestational age at stillbirth (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, that study highlighted preterm complications in stillbirths, such as a higher proportion of placental abruption, preeclampsia or hypertension, malformations or chromosomal abnormalities, and intrauterine growth restriction or placental insufficiency. Similarly, umbilical cord complications, birth hypoxia, and infections were more commonly associated with post-term stillbirths (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo identify the exact cause of stillbirth is important for parents, but it is also critical for gaining essential information for future pregnancies to possibly prevent stillbirth. Even if an autopsy is performed, it can be difficult to determine the cause of each individual stillbirth (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Moreover, an Australian study describes bereaved parents after stillbirth with feelings of shame, blame, devaluation of motherhood, and discrimination. Parents also perceived that healthcare providers did not inform them about the possibility of stillbirth during antenatal care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are quite few studies about labouring with an antepartum fetal death. Although a recent study affirms that parents\u0026rsquo; experiences of labour with a fetal death in utero bring an important perspective to intrapartum care (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Furthermore, that study describes that parents want care providers to facilitate their choices, their sense of control, their autonomy, and their agency, and in addition, to feel that they had received the best care available at stillbirth. Another study states that stillbirth has a profound and pervasive impact on bereaved parents and highlights the importance of clear and sensitive communication from professionals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A Spanish study (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) explores parents\u0026rsquo; experiences of stillbirth and highlights the importance of tailoring support and systems according to their needs. There is a lack of studies focusing on the early experiences of parents when facing a stillbirth. Hence, the aim of this qualitative in-depth study was to deepen and widely explore parents\u0026rsquo; initial experiences and perceptions and internal processes and strategies from awareness of reduced or absent fetal movements or other serious pregnancy complications until one month after stillbirth.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign\u003c/p\u003e \u003cp\u003eA descriptive design involving individual in-depth interviews of parents who had experienced stillbirth.\u003c/p\u003e \u003cp\u003eSample\u003c/p\u003e \u003cp\u003eThe sample consisted of parents with stillbirths after 22 completed gestational weeks, approximately one month after the stillbirth.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eThe mangers of all Women's clinics in Sweden and the \u003cem\u003eSwedish Infant Death Foundation\u003c/em\u003e were contacted and asked to participate with inviting parents who experienced stillbirth. Ten clinics responded positively and expressed their willingness to participate. Informants who wished to participate further confirmed their interest, and signed a written consent form. This study constitutes the first part of a longitudinal study, which spans over two years for each informant who participates and deals with stillbirths occurring after 22 completed gestational weeks.\u003c/p\u003e \u003cp\u003eTen individual in-depth interviews were conducted via mobile phone between November 2021 and July 2023, approximately one month after the stillbirth. The informants consisted of six women and four men, ranging in age from 22 to 53 years, with a median age of 31.5 years. Their marital statuses were either cohabiting with a partner (n\u0026thinsp;=\u0026thinsp;6) or married (n\u0026thinsp;=\u0026thinsp;4). The pregnancies ranged from 22 to 39 completed gestational weeks (Mean\u0026thinsp;=\u0026thinsp;34 weeks), and four of the informants had undergone IVF (in vitro fertilisation). Three of the informants had previous children. The informants rated their current mental health based on four options: \u0026lsquo;very good\u0026rsquo;, \u0026lsquo;good\u0026rsquo;, \u0026lsquo;partly bad\u0026rsquo;, and \u0026lsquo;bad\u0026rsquo;. Most of the informants were employed, and one was an adult student. The informants resided in different locations; one living in a town, and nine in the countryside. They were distributed across various parts of Sweden, including southern Sweden (n\u0026thinsp;=\u0026thinsp;3), mid-Sweden (n\u0026thinsp;=\u0026thinsp;5), and northern Sweden (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003cp\u003eThe duration of each in-depth interview ranged from 38 to 183 minutes (Mean\u0026thinsp;=\u0026thinsp;121.1 minutes) for a total of approximately 20.11 hours. Each in-depth interview was audio-recorded with the informants\u0026rsquo; permission. Prior to the start of each interview, the interviewer verified that the informant was alone in a disturbance-free room. The interviews followed a semi-structured interview guide that began with the question, \u0026lsquo;Please, would you tell me what you experienced and perceived when you became aware and suspected a difference in your womb and the baby had reduced or absent fetal movements?\u0026rsquo; The interviews were transcribed verbatim prior to data analyis. Efforts to recruit in-depth interviews continued until no one else agreed to participate in the study, resulting in a total of ten in-depth interviews. Data saturation was achieved after nine in-depth interviews, when no new data emerged.\u003c/p\u003e \u003cp\u003eThis study was approved by the Regional Ethics Committee (Dnr: 2021-06536-01), and ethical considerations were upheld throughout the study. Each informant received oral and written information about the longitudinal study and signed an informed consent form. Participation in the study was voluntary, and informants had the opportunity to ask questions before and after their in-depth interview. Additionaly, if the in-depth interview subsequently raised thoughts or concerns among the informants and they wished to contact professional support, they were offered to contact the researcher responsible for the study for advice and referral to the appropriate agency.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eIn this study, a thematic network analysis was conducted to systematize, organize, and describe the study findings. Interpretation was employed during this analysis to elicit abstract themes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Each study author then independently analysed the data material on an inductive basis according to Attride-Stirling\u0026rsquo;s thematic network analysis model (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), which divides themes derived from a thematic network analysis into three levels: basic, organizing, and global (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Both authors individually read the transcribed data several times to gain an overall understanding of the content. Meaningful text segments, such as sentences, were then organized into the aforementioned three levels; basic themes were merged to form organizing themes, and organizing themes were grouped together into a global theme. Lastly, patterns were interpreted and clarified with verbatim quotes. The interview number, gender, number of parity or pregnancy, and age of the informants are presented below in the \u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003eResults\u003c/span\u003e section. The study authors discussed and revised all analytical decisions until consensual validation was achieved. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the analytical scheme.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExample sentences, basic themes, organizing themes and global theme.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSentence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasic theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrganizing theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlobal theme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt was different in my womb on Tuesday so I called my midwife who said call the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuspicion and awareness of changes in pregnancy and parents\u0026rsquo; activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePregnancy, awareness, information, reactions and reflections at tragical stillbirth diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt was horrible to carry a dead baby inside the body, and it was scary to give birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaring and giving birth to the stillborn baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStillbirth is a roller coaster, from the bright miracle of life, to the deepest black grief and bottomless pain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlmost all of the informants experienced the treatment and support as human and trusting and very good at hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional treatment and support during stillbirth and postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupport and structured activities and internal processes at stillbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo leave and hand over the stillborn baby to professionals at discharge was an intolerable and difficult act\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHanding over the stillborn baby to professionals upon discharge from the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe informants generously shared their lived experiences, internal feelings, and deep grief of stillbirth. The in-depth interviews assumed a natural flow, and the informants showed ample interest and significance in sharing their traumatic, severe, and irreversible life-changing event. A thematic network was developed, and eleven basic themes emerged, from which the following two organizing themes were created: \u0026lsquo;Pregnancy, awareness, information, reactions, and reflections at tragic stillbirth diagnosis\u0026rsquo; and \u0026lsquo;Support and structured activities and internal processes at stillbirth\u0026rsquo;. Together, these organizing themes constituted one global theme: \u003cstrong\u003e\u0026lsquo;Stillbirth is a roller coaster, from the bright miracle of life to the deepest black grief and bottomless pain\u0026rsquo;\u003c/strong\u003e. See Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\n\u003cp\u003eTable 2. Network of global, organization and basic themes describing parents experiences and perceptions of stillbirth during pregnancy, birth and postpartum.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cimg 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\" alt=\"\" /\u003e\u003c/p\u003e\n\u003cp\u003eThis global theme encapsulated the informants\u0026rsquo; perceptions and experiences regarding the consequences of an abrupt ending pregnancy, akin to a worst-case scenario: a life that ended before it began, a feeling of profound smallness and powerlessness, and a perception that healthcare professionals could not intervene to rescue the baby, resulting in a desperate sense of being forever robbed of the baby. Nearly all of the informants emphasised the priceless value of holding the stillborn baby on their chest or in their arms after birth, especially during the first moments when the baby was still soft and warm. Additionally, almost all of the parents cherished the time spent together with the stillborn baby postpartum. During this precious time, they tenderly cared for and welcomed the stillborn baby as a new member of their family. They highlighted the importance of maintaining close physical proximity to the stillborn baby as much as possible, recognising that their time together was limited and viewing this closeness as the most meaningful way to comprehend and cope with the tragic situation. Handling the stillborn baby in the same manner as living babies, such as wiping when needed, putting on a diaper, dressing the baby, and ensuring the baby appeared comfortable in bed, was deemed important. They also preserved valuable and poignant mementos for the future, such as photographs and hand and footprints of the stillborn baby. Being separated from their stillborn baby at discharge was described as the worst thing ever in their lives.\u003c/p\u003e\n\u003cp\u003eThe organizing theme \u003cem\u003e\u0026lsquo;Pregnancy, Awareness, Information, Reactions and Reflections at Stillbirth Diagnosis\u0026rsquo;\u003c/em\u003e consisted of seven basic themes: \u0026lsquo;Information during Pregnancy at Antenatal Clinic and on Own way\u0026rsquo;; \u0026lsquo;Suspicion and Awareness of Changes in Pregnancy and Parents\u0026rsquo; Activity\u0026rsquo;; \u0026lsquo;Information, Reactions, Thoughts, and Feelings of Stillbirth Diagnosis at Hospital\u0026rsquo;; \u0026lsquo;Carrying and Giving birth to the Stillborn Baby\u0026rsquo;; \u0026lsquo;Mental Health of Parents\u0026rsquo;; \u0026lsquo;Causes and Explanations of Stillbirth and their Significance\u0026rsquo;; and \u0026lsquo;Possible Future Pregnancy and Support from Healthcare\u0026rsquo;.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eInformation during Pregnancy at Antenatal Clinic and on Own way\u003c/h2\u003e\n\u003cp\u003eThe informants\u0026rsquo; information and knowledge about serious and fatal risks during pregnancy from midwives at antenatal clinics differed. Some of the informants described that they had not received any information about reduced or absent fetal movements in pregnancy or other serious causes that could lead to a stillbirth. An informant stated, \u0026lsquo;The midwife referred to 1177 (digital national advice of healthcare) and nothing was available to read about decreased fetal movements \u0026ndash; I think it would be better to talk about it\u0026rsquo; \u003cem\u003e(interview no. 2, man, first pregnancy, 32 years).\u003c/em\u003e A mother of two older children affirmed that her midwife had never informed her about minor or termination of fetal movements, and a baby dying in the womb. Although, she knew it could happen but just in case of delayed birth. Furthermore, one informant described that \u0026lsquo;The midwife indicated only smoking and travels as risks during pregnancy\u0026rsquo; \u003cem\u003e(interview no. 10, man, first pregnancy, 39 years).\u003c/em\u003e Two other informants clarified that they already knew about reduced or absent fetal movements and that stillbirth could occur early or later in pregnancy. The first informant had read a lot about it on own basis, and the other had experienced during childhood, when a younger sibling died in the mother\u0026rsquo;s womb.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e IN HERE\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eSuspicion and Awareness of Changes in Pregnancy and Parents\u0026rsquo; Activity\u003c/h2\u003e\n\u003cp\u003eSeveral of the informants were aware that something different had happened in their pregnancies. Some experienced reduced or absent fetal movements in their wombs during the last stages of pregnancy. These informants arrived at the hospital from only a few hours to four days after registering no fetal movements. One informant described, \u0026lsquo;I felt it different in my womb on Tuesday so I called my midwife who said call the hospital \u0026ndash; but I answered her that the baby usually moves in the evening and I wanted to wait, so we went to the hospital on Wednesday\u0026rsquo; \u003cem\u003e(interview no. 1, woman, primipara, 27 years).\u003c/em\u003e Some female informants tried pushing on the baby, drinking cold water, and then waited for some movements, without any result. Furthermore, three other women were not aware of or did not register decreased fetal movements at all, and received the unsuspected stillbirth diagnosis when they arrived at the hospital. Their reasons for seeking healthcare included experiencing labour pain and bleeding, prelabour rupture of membranes (PROM), and undergoing a check-up of the baby\u0026rsquo;s growth. One of these women said, \u0026lsquo;I went to the hospital with labour pain and bleeding, and I didn\u0026rsquo;t know then that the baby was dead\u0026rsquo; \u003cem\u003e(interview no. 3, woman, 1-para, 31 years).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInformation, Reactions, Thoughts, and Feelings of Stillbirth Diagnosis at Hospital\u003c/h3\u003e\n\u003cp\u003eAll the informants experienced calm and matter-of-fact information from obstetricians and midwives at the hospital, informing them that their baby had died in the womb. The parents expressed various reactions to this information. Several reacted directly and asked if it was quite sure and did not immediately realize it was true. Other informants reacted with expressive shock feelings such as crying and shaking, while some remained silent and showed understanding through glances and body language. One informant said, \u0026lsquo;We were very sad, completely unimaginable, it was just over and nothing to do \u0026ndash; the pregnancy was walked over\u0026rsquo; \u003cem\u003e(interview no. 6, woman, primipara, 39 years).\u003c/em\u003e Another informant described this unreal situation, where the midwife couldn\u0026rsquo;t hear any heartbeats and then an obstetrician arrived and confirmed there were no visible heartbeats - and after some minutes another obstetrician came and confirmed the same thing. A female informant described that she did not remember what she and her partner had said to each other at the information at the hospital, nor did she react with feelings until they got home. However, this female informant was far-sighted and asked the obstetrician, in this chaotic situation, if this could happen again in a future pregnancy.\u003c/p\u003e\n\u003cp\u003eSome of the male informants described receiving this tragic message as unbearable, expressing feelings of anger and disappointment that the life task of raising and caring for a baby had suddenly disappeared. One of them stated, \u0026lsquo;It was terrible, I had never felt so intensive pain in my life before\u0026rsquo; \u003cem\u003e(interview no. 4, man, first pregnancy, 22 years).\u003c/em\u003e Another male affirmed that he could not identify fetal movements at ultrasound as before, feeling sad and describing the whole world as collapsing, experiencing unreal feelings and a sense of not being awake. Furthermore, he felt as though he had lost something inside his soul, experiencing himself as different, and felt unsure if this feeling would persist in life. A female informant expressed how heavy it was to lose the baby, particularly when it was towards the end of pregnancy and her previous pregnancy had gone well. Another female informant blamed herself for not paying enough attention to decreased fetal movements and felt overwhelming guilt about this feeling and behaviour. Some informants expressed profound sadness at witnessing their partners\u0026rsquo; traumas and felt as though their life\u0026rsquo;s path had been crushed. A male informant felt explicitly traumatised by the stillbirth but stated that initially, he could not find understanding and comfort for his part from the midwives at the hospital.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eCarrying and Giving birth to the Stillborn Baby\u003c/h2\u003e\n\u003cp\u003eSome of the women agreed that it was a horrible and unpleasant thought and feeling to carry a dead baby inside the body, and they were scared and worried about giving birth to a stillborn baby naturally. Furthermore, some of the informants feared meeting a stillborn baby and how it would look. One informant stated, \u0026lsquo;The dead baby is only a shell in my womb now, and I regret that any photos were taken of my womb during pregnancy\u0026rsquo; \u003cem\u003e(interview no. 5, woman, 1-para, 31 years).\u003c/em\u003e Other women described this particular situation as not scary per se, but they thought more about the fact that they would soon be separated and say farewell to their baby. A female informant reported that when she was told her baby was dead inside her, she could not pat the baby\u0026rsquo;s foot on the left side as before. They had shared such a close and strong bond, had done many fun things together, and finally, the baby had become her best friend.\u003c/p\u003e\n\u003cp\u003eAll births except two proceeded naturally, but two informants had to undergo emergency caesarean sections due to birth complications. All of the informants were satisfied with the birth, and almost all experienced the pain relief during birth as adequate. They wished to keep the stillborn baby near themselves afterward. Several females expressed that it was desirable to keep the baby skin-to-skin on the chest directly after birth, and one of them considered it important for her partner to hold the stillborn baby in his arms when the baby was still soft and warm. A female informant described holding her baby in her arms as the greatest and most beautiful thing that had ever happened to her. Another female informant regretted that she had never kept her stillborn baby skin-to-skin, neither at birth nor after birth.\u003c/p\u003e\n\u003cp\u003eA male informant expressed being overwhelmed when his stillborn baby was born, enjoying every minute, feeling an awesome feeling, holding him, 2850 grams of love, and experiencing a strong and proud father-and-son connection. Another male informant thought he would identify his stillborn baby only as a dead baby at birth, but he experienced a special feeling - seeing, meeting, and holding him close in his arms - he had become a father and a parent forever. A third male informant stated, \u0026lsquo;I felt sad but not uncomfortable, there was no rush for him to go out, he is our baby even though he is not alive\u0026rsquo; \u003cem\u003e(interview no. 7, man, first pregnancy, 53 years)\u003c/em\u003e. However, there were a few informants who did not wish to have the stillborn baby on the chest or held in arms for a longer time after birth. A fourth male informant affirmed that the stillborn baby only laid for a very short time on the mother\u0026rsquo;s chest at birth and then further 30 minutes in his arms. Afterward, the couple could not bear to see their stillborn baby any longer, wanting to say farewell as soon as possible, which they did not regret, and then they discharged from the hospital.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMental Health of Parents\u003c/h3\u003e\n\u003cp\u003eThe informants self-estimated their current mental health as ranging from very good to very bad. Six informants rated their mental health as very bad, including five women and one man, while one informant rated it as partly bad. Some of the women who rated their mental health as very bad experienced symptoms such as waking up at night with panic attacks triggered by flashbacks and having difficulty breathing. Another woman reported feeling very tired and crying a lot every day, although she no longer experienced anxiety and panic feelings as she did at the hospital. A third woman felt extremely depressed and unsure of how to feel better, while a fourth woman had managed to overcome the most difficult moments despite facing significant challenges. One female informant rated her mental health as good and expressed a positive outlook on most things, finding it easier to think positively rather than focusing solely on difficulties. Two male informants rated their mental health as good or very good. One mentioned receiving good support from his partner and engaging in conversations with others, while the other expressed being open-minded and capable of processing his feelings in a positive manner, allowing him to move through sadness more quickly.\u003c/p\u003e\n\u003ch3\u003eCauses and Explanations of Stillbirth and their Significance\u003c/h3\u003e\n\u003cp\u003eAlmost all of the informants recieved no obvious reasons or explanations of the stillbirths. One female informant had not received any explanation and felt that it had no meaning, particularly as she opted out of an autopsy for the stillborn baby. Few informants had partially received explanations. For instance, one male informant immediately received the cause and explanation of the stillbirth at the hospital, where the obstetrician showed them on ultrasound that the stillborn baby was lying with the stomach downwards, resulting in a kinked umbilical cord in the vagina. Another informant mentioned having been informed at a routine ultrasound about the baby\u0026rsquo;s heart defect and subsequent heart failure. A male informant partly knew the cause and considered it important for future pregnancies to be able to react if something would deviate. Nearly all informants emphasized the importance of receiving the cause and explanation of stillbirths, currently, and for future pregnancies. One female expressed that knowing why the baby died in her womb would alleviate the need to constantly question and wonder about it. The informants did not blame healthcare professionals for the stillbirths, considering them innocent of the occurrences.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003ePossible Future Pregnancy and Support from Healthcare\u003c/h2\u003e\n\u003cp\u003eAll informants expressed a desire for a subsequent pregnancy. Nearly half of the informants had undergone IVF pregnancies that resulted in stillbirths. Some expressed awareness of the uncertainty of IVF attempts resulting in pregnancy and hoped for a healthy and living baby next time. Informants voiced fears and worries about future pregnancies but also expressed a strong desire for subsequent siblings. Both female and male informants highlighted similar wishes for future pregnancies, including several and more frequent check-ups with midwives and obstetricians, particularly in the second trimester, as well as a controlled start of labor at specific gestational weeks using the induction method. Some informants emphasized the importance of extended professional and psychological support in case of a future pregnancy.\u003c/p\u003e\n\u003cp\u003eThe organizing theme \u003cem\u003e\u0026lsquo;Support and Structured Activities and Internal Processes at Stillbirth\u0026lsquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ecomprised four basic themes: \u0026lsquo;Professional Treatment and Support during Stillbirth and Postpartum\u0026rsquo;; \u0026lsquo;Caring and Spending Time and Keeping Memories of the Stillborn Baby and Parents\u0026rsquo; Support Network\u0026rsquo;; \u0026lsquo;Handling Over the Stillborn Baby to Professionals upon Discharge from Hospital\u0026rsquo;; and \u0026lsquo;Relationship with the Partner and the Grieving Process\u0026rsquo;.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eProfessional Treatment and Support during Stillbirth and Postpartum\u003c/h2\u003e\n\u003cp\u003eAlmost all informants encountered various professionals, including midwives, obstetricians, psychologists, social workers, deacons, priests, and pathologists at the hospital. They described the treatment and support as human, trusting, and significant, with professionals offering professional, calm, and supportive care throughout the process. While most informants were satisfied with the treatment, a few requested more information and guidance during labor and the postpartum period. Some highlighted the value of the postpartum time and the support received from professionals, appreciating their ability to understand and empathize with their experiences, and one of these females pointed out, \u0026lsquo;I could feel that she was my baby and I was her mother, I stayed with her as long as possible\u0026rsquo; \u003cem\u003e(interview no. 8, woman, 2-para, 29 years).\u003c/em\u003e However, a few informants desired more information, such as pain relief options, labour sessions, postpartum care, autopsy procedures, and funeral arrangements. An informant even requested one-to-one care from a midwife, feeling disturbed by sharing the midwife with other patients during labour. Another informant suggested that some obstetricians could display more empathy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eCaring for and Spending Time with the Stillborn Baby and Parents\u0026rsquo; Support Network\u003c/h2\u003e\n\u003cp\u003eThe time spent with the stillborn baby after birth varied from one hour to 98 hours, with an average of 44.8 hours. Seven informants were informed about the option to spend additional time at home with the stillborn baby using a Cubitus baby (cot with cooling blocks). Despite that, all of these informants declined to take the stillborn baby home. Reasons cited included discomfort and concerns about the baby\u0026rsquo;s small and fragile state, and the presence of siblings at home. One female informant expressed her desire to keep the tragic situation within the hospital, fearing that returning the stillborn baby back to hospital would make it more difficult to cope with the situation. However, all informants agreed on the importance of routinely preserving memories for the future, such as through photos, hand and footprints, and plaster casts of the stillborn baby\u0026rsquo;s hands and feet. Almost all managed to take their own photos, and some even made videos. An informant conveyed the sentiment, \u0026lsquo;Everything that belongs to him has so much value for us even though we don\u0026rsquo;t have him physically at home\u0026rsquo; \u003cem\u003e(interview no. 2, man, first pregnancy, 32 years)\u003c/em\u003e, while another expressed appreciation for the professionals\u0026rsquo; support and guidance in taking photos of the baby and she expressed, \u0026lsquo;The professionals confirmed that he was so beautiful, and they were so receptive to what we wanted to do, and advised us to take own photos of the baby which I appreciate so much now\u0026rsquo; \u003cem\u003e(interview no. 9, woman, 0-para, 36 years)\u003c/em\u003e. However, some informants expressed a need for more support and reminders from professionals to take photos and spend time holding the stillborn baby close, especially when they felt tired or confused after birth. Several parents mentioned that visits from extended family, relatives, and close friends at the hospital provided a sense of unity and support, alleviating feelings of loneliness and fostering a sense of togetherness around the stillborn baby, which they believed could benefit them in the future.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eHandling Over the Stillborn Baby to Professionas upon Discharge from Hosptial\u003c/h2\u003e\n\u003cp\u003eFor almost all informants, the act of leaving and handing over the stillborn baby to professionals upon discharge from the hospital was intolerable and difficult. Some informants described handing over their stillborn baby when they noticed changes in the body or when they felt a sense of respect for the baby\u0026rsquo;s dignity, allowing them to proceed in the process. It was crucial for them to entrust the stillborn baby to a trustworthy and caring individual. In most cases, the baby was handed over to a known midwife, although in some instances, it was directly to a pathologist. Many informants appreciated the opportunity to visit their stillborn baby at the pathology department or mortuary before the funeral. One female informant shared, \"We visited him several times, it became a sanctuary, we cherished these moments, we held him and patted him \u0026ndash; he was the most beautiful baby we had seen\" \u003cem\u003e(interview no. 6, woman, 0-para, 39 years).\u003c/em\u003e Some informants visited their stillborn baby multiple times before the funeral, even though they noticed slight changes in the baby\u0026rsquo;s appearance. They felt reassured knowing that the baby was resting comfortably in the coffin.\u003c/p\u003e\n\u003cp\u003eNearly all informants recalled the birth experience four weeks postpartum, with some affirming memories overall. One female informant reminisced, \"When the baby was coming on my chest and thereafter when I had himself postpartum\" \u003cem\u003e(interview no. 1, woman, 0-para, 27 years).\u003c/em\u003e A male informant preferred to focus on the joy before the sorrow, while a female informant acknowledged both the grand and beautiful aspects along with the painful and terrible ones. Some informants recalled specific interactions with their partners during this time, with the stillborn baby\u0026rsquo;s non-living status not being the focal point. However, two informants described a paradoxical experience - the stillborn baby\u0026rsquo;s hands were described as beautiful and soft, yet the sight of the cold and blue body lying alone on a bench in the labour room was unsettling.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eRelationship with the Partner and the Grieving Process\u003c/h2\u003e\n\u003cp\u003eNearly all informants described their relationship with their partners as stronger and more stable following the stillbirth. They felt increased love and trust, a sense of growing together, and heightened closeness during times of strain. A female informant expressed, \u0026lsquo;We have been through this together and we feel that we have and love each other, but you can\u0026rsquo;t take anything for granted\u0026rsquo; \u003cem\u003e(interview no. 3, woman, 1-para, 31 years).\u003c/em\u003e A male informant affirmed, \u0026lsquo;This tragic situation has made us closer and we are stronger together\u0026rsquo; \u003cem\u003e(interview no. 10, man, first pregnancy, 39 years).\u003c/em\u003e However, one woman felt bitter towards her partner, feeling that she bore the brunt of the struggle and that her partner avoided discussing the stillborn baby.\u003c/p\u003e\n\u003cp\u003eThe grieving process involved conversations with partners, professionals, extended family, friends, and co-workers. Almost all informants experienced profound sadness and cried frequently, with poor relaxation and sleep. They harbored deep and painful feelings and thoughts about the stillborn baby and sought solace in discussions, particularly with their partners. Professional conversations were deemed important and necessary for understanding in the tragic situation. Informants believed that frequent discussions about the stillborn baby were crucial for progressing through the grieving process. Some chose to openly acknowledge their parenthood and the existence of the stillborn baby to others, despite the baby not being physically present.\u003c/p\u003e\n\u003cp\u003eMemories of the stillborn baby played a crucial role in the grieving process for almost all informants. They frequently revisited these memories, especially by looking at photos of the stillborn baby several times a day, particularly during the first month after the stillbirth. Additionally, some informants described participating in both a name-giving ceremony at the hospital and a burial ceremony for the stillborn baby in church. These ceremonies were seen as ways to honor and respect the baby, making their existence visible and dignified, and were considered integral parts of the grieving process. However, an informant, due to strong religious traditions, did not participate at the burial ceremony and had not visited the grave. Visiting the grave held different significance for different informants. For some, it was a crucial, tranquil, and peaceful place where they could communicate with their buried baby. Others viewed it as an important place to tend to, adorned with stuffed animals, flowers, and candles, for the sake of the baby. Initially, some informants visited the grave once or twice daily.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe thematic network analysis uncovered two organizing themes: \u0026lsquo;Pregnancy, awareness, information, reactions, and reflections at tragical stillbirth diagnosis\u0026rsquo; and \u0026lsquo;Support and structured activities and internal processes at stillbirth\u0026rsquo;, culminating in one overarching global theme: \u0026lsquo;\u003cb\u003eStillbirth is a roller coaster, from the bright miracle of life, to the deepest black grief and bottomless pain.\u0026rsquo;\u003c/b\u003e These themes emerged from the individual experiences of the participants, tracing their journey from the initial awareness of differences and fears during pregnancy to the stark reality of stillbirth. The analysis highlighted the profound impact of this tragically irreversible life event, starting from the onset of suspicion during pregnancy and extending through the concrete confirmation of stillbirth, with a continuum of emotions and experiences in the first month thereafter.\u003c/p\u003e \u003cp\u003eIn the organizing theme \u0026lsquo;Pregnancy, awareness, information, reactions and reflections at tragical stillbirth diagnosis\u0026rsquo;, the results unveiled that \u003cem\u003eInformation during pregnancy at antenatal clinics and on own way\u003c/em\u003e was lacking, specifically about decreased fetal movements and the risk of stillbirth. Consequently, parents was neither aware nor preparared for the possibility that a stillbirth could occur during pregnancy, although there was some knowledge of the diagnosis of stillbirth from before.\u003c/p\u003e \u003cp\u003eIn addition, the basic theme also demonstrated that, in the majority of cases, there were different levels of \u003cem\u003eSuspicion and awareness of changes in pregnancy and parents\u0026rsquo; activity\u003c/em\u003e at various stages of pregnancy, which was later confirmed \u003cem\u003eat the hospital\u003c/em\u003e. Discrimination attributed to stillbirth and missed warning signs has been documented in prior research (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The failure to pay attention to reduced or absent fetal movements in the womb, and subsequently not taking appropriate action, often resulted in feelings of guilt and shame. This was interpreted as a failure to properly safeguard the pregnancy, leading to self-perceptions of being a neglectant or inadequate mother. The result of the present study align with previous studies that have highlighted similar experiences of stigma, including feelings of shame, blame, (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and a sense of devaluation of motherhood following stillbirth (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe result showed that \u003cem\u003eCarrying and giving birth to the stillborn baby\u003c/em\u003e was perceived frightening and unpleasant, yet it also provided a sense of safety in knowing where the baby was kept, regardless of its condition. The experience brought about deep fears and inconveniences for the parents, placing them in a completely new and unavoidable situation in life. The loss of dreams about raising a living baby disappeared.\u003c/p\u003e \u003cp\u003eAll labours, except for two, resulted in vaginal births. This finding is consistent with a previous study, which demonstrated that vaginal birth is the most common and recommended mode of birth in cases of stillbirth, whether the labour occurred spontaneously or was induced, regardless of whether the individual had previously undergone a cesarean section (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Hence, it emerged that vaginal birth became the best outcome for both physical and emotional wellbeing, and keeping the stillborn baby close and recurrently holding it, especially through skin-to-skin contact, promoted the grieving process. Previous studies have supported the overall beneficial effect of holding a stillborn baby (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The parent role arose and became clear when closeness, openness and love flowed to the stillborn baby for a longer time together. This scenario harks back to the early 1980s when the practices and procedures surrounding stillbirth were vastly different in Swedish healthcare. During that time, professionals often treated stillbirth as a non-event, neglecting to provide adequate care or support. This approach was motivated by a desire to shield parents from emotional attachment and encourage them to forget about the stillborn baby as quickly as possible. In reality, this meant that immediately after birth, the stillborn baby was separated from the parents and swiftly taken away from the labour room, never to be seen again. Under this approach, parents were hardly given the opportunity to see, hold, or bid farewell to their stillborn baby. As a result, the stillbirth remained invisible to the parents, others, and society at large. However, a previous study described that treating stillbirth as a non-event has been largely, if not entirely, abandoned in Sweden (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Further these parents, deprived of the chance to physically and emotionally care for and mourn their stillborn babies, likely harbored unprocessed and deeply sorrowful memories, thoughts, and fantasies about their loss for years to come. A previous retrospective study presented one in three women with a clinically significant level of post-traumatic distress symptoms (PTSD) 5\u0026ndash;18 years after stillbirth (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe basic theme \u003cem\u003eMental health of parents\u003c/em\u003e showed different strategies to cope with the grief, ranging from panic attacks and severe depression to feeling exhausted and sleeping excessively, but there were also attempting to adopt a more positive outlook on the grief and not solely focusing on the problems. However, a problem arose when the mental health was rated as very poor and values in religious traditions precluded discussing the stillborn baby, neither with partner nor with relatives. This approach may have provided an unhealty bubble of loneliness and hindered the grieving process. A previous systematic review has confirmed poorer mental health outcomes following stillbirth, which is consistent with the present findings (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, there were limited treatment options available for those who reported worsening mental health following stillbirth, highlighting the need for further research in this area (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the basic theme \u003cem\u003eCauses and explanations of stillbirth and their significance\u003c/em\u003e showed that parents were mostly unaware of the cause and explanation behind the stillbirth, which was unsatisfactory, also for a future pregnancy. A previous Swedish research underscored the importance of understanding the cause of stillbirth (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe result showed that it was common to have a desire to achieve a new healthy pregnancy in the future, which was mirrored in the basic theme \u003cem\u003ePossible future pregnancy and support from health care\u003c/em\u003e. This theme contained for nearly one-half of the informants that their IVF pregnancy ended in stillbirth, a relatively common occurance, which is consistent with a systematic review, that indicates an increased risk of stillbirth associated with IVF pregnancies compared to natural conception (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In the case of a future pregnancy the importance of receiving continued high-quality healthcare, more information about pregnancy risks, examinations, assessments, and measures were highlighted. Some studies have investigated the provision of care for parents during pregnancies following stillbirth, and a UK study (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) showed numerous examples of good practice. However, that study indicated the overall lack of consistency in providing adequate emotional and psychological support for women during pregnancies after stillbirth. Another study underscored the importance of tailoring support systems not only to the mother but also to the father, who reported a lack of opportunities for grieving (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and a third study emphasized the necessity for greater attention to providing thoughtful, empathic, and collaborative care in all pregnancies following stillbirth (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt the organizing theme \u0026lsquo;Support and structured activities and internal processes at stillbirth\u0026rsquo; the result revealed almost satisfying results with the treatment and communication from professionals following stillbirth and was described as credible, respectful, knowledgeable, and responsive, mirrored in the basic theme \u003cem\u003eProfessional treatment and support during stillbirth and postpartum.\u003c/em\u003e However, more experiential and fact-based information about labour and the postpartum period was requested and even more consideration in the labour room during full-scale labour from other professionals. This theme included the postpartum period as friendly and humane support, and accommodating professionals, and the support compromised by sharing experiences and to balance between seeing the beauty and the sadness simultaneously. This approach facilitated that every stillborn baby was unique and valuable, deserving of unlimited time for understanding, reflection, and respect, which ultimately aided in the grieving process. Similarly, a recent Swedish systematic review identified four key aspects of care and support following stillbirth: personification, respectful attitude, existential issues, and stigmatization (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), which highlighted the complex impacts that stillbirth had on everyone involved.\u003c/p\u003e \u003cp\u003eThis basic theme also acknowedged the duration of time spent with the stillborn baby at the hospital, which varied widely, from one to 98 hours, and was related to personal needs and to put up with bottomless pain and grief. Although, the Cubitus baby was offered to parents to take the babies home, none of the participants chose to do so, based on their perceptions of the fragile condition of the stillborn baby, and the anticipated difficulty and intense pain of returning the baby. Additionally, the presence of extended family and close friends at the hospital, as well as at the funeral, had a significance in sharing the sadness of this irreversible life-changing event, both in the moment and for the future. However, it is worth noting that not all mothers attended the funeral, due to their religious traditions, which may have hindered or delayed the ongoing grieving process.\u003c/p\u003e \u003cp\u003eFurthermore, this theme included the extremely painful and agonizing part; \u003cem\u003eHandling over the stillborn baby to professionals upon discharge from hospital.\u003c/em\u003e However, the care and respect, and inclusive attitude provided some relief amidst the intense pain and loss. To visit the stillborn baby multiple times before the burial process gave a valuable insight to the grieving process. Reflecting on the stillbirth one month after labour was intertwined with memories of the baby\u0026rsquo;s physical appearance and the overall thoughts and reflections about the tragic event. \u003cem\u003eThe relationship with their partner in the grieving process\u003c/em\u003e had strengthened after the stillbirth and included a lot of crying, talking, and reminiscing with their partner, often repeatedly, and became necessarily and healing in the grieving process. Seeking support and discussions with professionals and others in their network were also very important for furthering grieving process. Moreover, the theme included memories of the stillborn baby as the only tangible connection that could be retained in life, and were considered incredibly important multiple times on daily basis for navigating the grieving process. A previous study confirmed when a baby is stillborn, labour departments encourage parents and other family members to take photographs and gather other momentos (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Visiting the baby\u0026rsquo;s grave became an important part of the mourning process, allowing to feel closer to the buried baby.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMethodolocical considerations\u003c/h2\u003e \u003cp\u003eThe study has some limitations. Its qualitative nature preluded any quantitative claims about the individuals affected by stillbirth. Only ten informants were included in the study, and no new data emerged after nine interviews. Stillbirth is a rare phenomenon, making it difficult to recruit parents to longitudinal studies, but it is possible that recruiting more participants might bring new insights and nuances to the results.\u003c/p\u003e \u003cp\u003eThe authors\u0026rsquo; pre-understanding and experiences of this topic may have influenced both the research process and the results. The authors were both midwives, and when discussing the analysis, these researchers focused their attention on their prior understandings (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). As midwives typically interact with individuals who are in the progress of starting a family, included with a childbirth and a living baby but rarely with individuals affected by stillbirth, the authors had a decidedly outsider perspective.\u003c/p\u003e \u003cp\u003eIt should be noted that all informants were represented a crystallised group of individuals who were affected by an irreversible tragic live-changing event, but wanted to participate in the study and share their experiences and perceptions and values and deep sadness at stillbirth. The affected individuals and their feelings of loss and deep black sadness, was based on their individual and personal mental current status one month after the stillbirth; a longitudinal study is ongoing to explore the individuals over time based on their irreversible and tragic life-changing stillbirth event. Trustworthiness is one important aspect in qualitative research which, includes how to judge the similarities and differences between themes (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDependablity is one way to ensure this. In addition, trustworthness was enhanced by describing the process in detail to allow the reader to follow the analytical process. The authors are experienced midwives and familiar with qualitative methods, which ensures the trustworthiness of the translation. A special focus was on the citations and to maintain the integrity of the data. Performing the steps in the analysis process individually and jointly ensured credibility and conformability. Transferability was assured by providing detailed descriptions of the content and the context of the the interviews as well as the selection and characteristics of the participants, data collection, and process of analysis and findings.\u003c/p\u003e \u003cp\u003eOne strength of the study was that the informants were recruited from a wide geographical region that included both sparsely and densely populated areas. Further, we had information about the informants socio-demographic and ethnicity background. The informants were followed from awareness and suspicion of reduced or absint fetal movements at home, or seeking healthcare for other important reasons in pregnancy until one month after stillbirth. The first author conducted all the in-depth interviews according to the same interview guide, and all rules for conducting in-depth interviews and analysing data were carefully followed. The basic themes were corroborated with quotes from the informants. Finally, both study authors collaborated to collect and analyse the data and interpret the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study sheds light on the profound and devastating impact of stillbirth on parents, who are confronted with the loss of their long-awaited and cherished baby without immediate understanding of why it occurred. The intense grief and pain experienced by parents in the first month after stillbirth is described as a heavy burden that persists day and night, and mirrows in poor/very poor mental health. In spite the immense challenges faced by parents, the study highlights the importance of developing individual strategies to cope with this tragic and irreversible life-changing event. Additionally, it underscores the need for healthcare professionals to provide enhanced support and normalized information to parents, including the option to take their stillborn baby home in a Cubitus baby. This approach can facilitate a longer period of physical and psychological grieving, enabling parents to navigate the grieving process more effectively.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNone declared.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAvailability and materials section\u003c/h2\u003e \u003cp\u003eOur data (individual in-depth interviews) cannot be shared openly due to participants privacy concerns.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBH initiated the study. BH analysed the data with assistance from IH. Both authors contributed to the drafting of the paper.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eOur data (individual in-depth interviews) cannot be shared openly due to participants privacy concerns.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNational Board of Health and Social Welfare. Socialstyrelsen. Statistik om graviditeter, f\u0026ouml;rlossningar och nyf\u0026ouml;dda. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.socialstyrelsen.se/statistik-och-data/statistik/alla-statistikamnen/graviditeter-forlossningar-och-nyfodda/\u003c/span\u003e\u003c/span\u003e Accessed 22 April 2024.\u003c/li\u003e\n\u003cli\u003eH\u0026ouml;glund B, R\u0026aring;destad I, Hildingsson I. 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Birth. 1996;23:209\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1523-536X.1996.tb00496.x\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eGravensteen IK, Helgad\u0026oacute;ttir LB, Jacobsen E. Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study. BMJ Open. 2013;3:e003323. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1136/bmjopen-2013-003323\u003c/span\u003e\u003c/span\u003e. R\u0026aring;destad I, Sandset PM, Ekeberg \u0026Ouml;.\u003c/li\u003e\n\u003cli\u003eWestby C, Erlandsen A, Nilsen S, Visted E, Thimm J. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy Childbirth. 2021;21:782. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//:doi:10.1186/s12884-021-04254-x\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eHildingsson I, Berter\u0026ouml; C, Hultcrantz M, K\u0026auml;rrman Fredriksson M, Peira N, Siverstein R, Persson M, Sveen J. Support interventions to reduce psychological distress in families experiencing stillbirth: A Systematic review. Women Birth. 2024;24:S1871\u0026ndash;5192. 00019\u0026thinsp;\u0026ndash;\u0026thinsp;2. PMID 38242808.\u003c/li\u003e\n\u003cli\u003eSarmon K, Eliasen T, Knudsen U, Bay B. Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis. Fertility Sterility. 2021;116:784\u0026ndash;792. https//:doi:10/1016/j.fertnstert.2021.04.007.\u003c/li\u003e\n\u003cli\u003eMills TA, Ricklesford C, Heazell AEP, Cooke A, Lavender T. Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death. BMC Pregnancy Childbirth. 2016;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//:doi.org/10.1186/s12884-016-0891-2\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eWojcieszek AM, Boyle FM, Beliz\u0026aacute;n JM, Cassidy J, Cassidy P, Erwich JJHM, Farrales L, Gross MM, Heazell AEP, Leisher SH, Mills T, Murphy M, Pettersson K, Ravaldi C, Ruidiaz J, Siassakos D, Silver RM, Storey C, Vannacci P, Middleton P, Ellwood D, Flenaddy V. Care in subsequent pregnancies following stillbirth: an internationel survey of parents. BJOG; 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//:doi.org/10.1111/1471-0528.14424\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eGodel M. Images of stillbirth: memory, mourning and memorial1. Visual Stud. 2007;22:253\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14725860701657159\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eLincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Program Evaluation. 1986;1986(30):73.\u0026nbsp;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ev.1427\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"coping strategies, fetal movements, grieving process, in-depth interviews, parents, professionals, stillbirth","lastPublishedDoi":"10.21203/rs.3.rs-4566174/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4566174/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground: \u003c/em\u003eStillbirth occurs 3.0 per thousand in Sweden, and in-depth thoughts, feelings and worries among affected parents in a longitudinal study is rather unknown. The aim of this qualitative in-depth study is to deepen and widely explore parents’ initially experiences and perceptions and internal processes and strategies from awareness and suspicion of stillbirth until one month after stillbirth in Sweden.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods: \u003c/em\u003eTen individual in-depth interviews were conducted in 2021-2023 and data were evaluated in thematic network analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults: \u003c/em\u003eTwo organizing\u003cem\u003e \u003c/em\u003ethemes ‘Pregnancy, Awareness, Information, Reactions and Reflections at Tragical Stillbirth Diagnosis’ and ‘Support and Structured Activities and Internal Processes at Stillbirth’ captured significant deepen consequenses of sudden unexpected and devastating end of the pregnancy. The suspicion of and the stillbirth diagnosis was initially associated with sudden discomfort and fears and bottomless grief and intensive pain, but a vaginal birth became in total the optimal method both for the body and soul. Caring for the stillborn baby with physical proximity for an extended period of time facilitated understanding and coping with the grieving process and embracing parenthood.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions: \u003c/em\u003eParents experiencing stillbirth were exposed to an unimaginable and irreversible life-changing event, but almost all developed coping strategies during the first intensive and painful month after the stillbirth in order to move on in the grieving process.\u003c/p\u003e","manuscriptTitle":"Is it possible for parents to endure a stillbirth diagnosis? Initially experiences, perceptions and internal strategies: Individual in-depth interviews in Sweden 2021-2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 09:05:36","doi":"10.21203/rs.3.rs-4566174/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-16T17:53:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-16T11:37:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-14T16:05:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124157356272082779308525131065468877171","date":"2024-08-12T17:17:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105154843669795350367418194673927505270","date":"2024-08-11T09:54:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-19T20:29:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-14T11:54:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-13T06:23:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-13T06:21:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-06-11T19:57:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"24a0a7da-9983-461b-949c-4760389156c2","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:01:19+00:00","versionOfRecord":{"articleIdentity":"rs-4566174","link":"https://doi.org/10.1186/s12884-024-07055-0","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-01-03 15:57:26","publishedOnDateReadable":"January 3rd, 2025"},"versionCreatedAt":"2024-06-28 09:05:36","video":"","vorDoi":"10.1186/s12884-024-07055-0","vorDoiUrl":"https://doi.org/10.1186/s12884-024-07055-0","workflowStages":[]},"version":"v1","identity":"rs-4566174","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4566174","identity":"rs-4566174","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}