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Best Practices for Perinatal Bereavement Care Across Different Cultures and Ethnicities
Every week, we deliver evidence-based strategies for modern perinatal bereavement care. Written by Jay CRNA, MS, specializing in obstetrical anesthesia, and Trina, a bereavement expert, both who have experienced loss.
Trina Parkin
December 11, 2025 • Read time: 12 minutes
In Today’s Issue:
🔗 The best resources I found this week
📖 Deep dive: Best Practices for Perinatal Bereavement Care Across Different Cultures and Ethnicities
Know a co-worker who would benefit from this newsletter? Subscribe here
Want to learn how to get Forget Me Not Boxes in your hospital? Reply “Bereavement boxes”
🔗 The Best Resources I Found This Week
🗣️ How to Support Families When You Don’t Speak Their Language
Since we are talking about culture, we have to talk about language barriers. If you missed it, we did a specific breakdown on bridging the gap when you can’t rely on words.
Read the guide here (Forget Me Not)
🌺 Why the Placenta Matters (It’s Not Just Medical Waste)
I mentioned this in the deep dive, but this deeper look into global placenta rituals is fascinating. It explains why for many families (Hmong, Navajo, Maori), the placenta is a sacred companion that must go home.
Read the study on placenta rituals (Int. Journal of Environmental Research)
🧠 "Cultural Humility" vs. "Cultural Competence"
This critical review challenges the old idea that you can master a culture from a textbook. It argues for "humility"—the lifelong commitment to self-evaluation and critique. It’s a bit academic, but it really shifts how you view your role.
Read the critical review (BMC Palliative Care)
📖 Deep Dive
Best Practices for Perinatal Bereavement Care Across Different Cultures and Ethnicities
Before we get started, I just want to say… your submissions mean everything to us.
Every week at the bottom of the deep dive, there’s a quick poll + an optional comment box where you can share ideas, stories, frustrations, or topics you’d love us to cover.
We read every one. Truly. Keep them coming — they shape this newsletter more than you know.
This week’s deep dive comes straight from one of your responses, and it’s a good one:
“100% thrilled to have come across your site & newsletter….I would like to suggest deep diving into how to handle losses (early & late) with families of other ethnicities…No where else in healthcare do I see SUCH an impact & participation in “cultural tradition” as I do in Labor & Delivery. Being culturally aware is important when handling all discussions pertaining to loss.”
She’s absolutely right — nowhere else in healthcare does cultural tradition show up as strongly as labor and delivery. And when a baby dies, those traditions matter even more.
“Cultural humility is not a mastery of a list of beliefs or behaviors. It’s a commitment to self-awareness, curiosity, and centering what the patient says matters most.”
This quote shows up in so many bereavement and palliative care papers for a reason.
It’s the posture that actually helps families feel seen — no matter where they’re from.
Why culture changes everything
Studies from Uganda, Asia, and multicultural settings all say the same thing: perinatal death is often viewed as the death of a child with full child-level rituals, not a footnote in the pregnancy.
There are also big inequities.
Babies from Black, Asian, and other marginalized communities have significantly higher stillbirth and neonatal mortality rates, yet their voices are underrepresented in palliative and bereavement research and policy.
📃 More reading here: The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby (Ying-Fen Tseng PhD, RN, 2017)
Principles, not checklists
The experts are pretty blunt about this: “cultural competence” that reduces families to checklists of beliefs can actually increase stereotyping.
Instead, newer frameworks talk about cultural humility—getting curious, asking, and partnering with families instead of assuming you know what “their culture” wants.
📃 More reading here: The relationship between the nurse work environment and delivering culturally sensitive perinatal hospice care (Dr Sandra J Mixer, PhD, RN, CTN-A, 2016)
One review of culturally diverse neonatal palliative care recommends focusing less on memorizing every ritual and more on: asking open questions, recognizing power imbalances, and letting families define what matters most.
That’s good news for both new grads and seasoned nurses—it means you don’t need to be an anthropologist to do this well; you need a framework and a few go-to phrases.
Five questions you can always ask
Across multiple studies, families and clinicians said the most helpful thing staff did was to ask rather than assume.
You can adapt these depending on whether it’s an early miscarriage or a stillbirth/infant death, but the backbone is the same:
“Can you share anything about your beliefs or traditions around death that you would like us to understand?”
“Are there any specific rituals, prayers, or practices that are important to you right now?” (Leave space here; let them think.)
“Who in your family or community needs to be involved in decisions today?”
“Is there anything we could accidentally do that would feel disrespectful, so we can avoid it?”
“How would you like us to talk about your baby with you and with your family?”
Those questions work in a 12-bed rural unit and a big academic center.
The difference is usually how fast you’re charting while you ask them.
Rituals: why they matter so much
Qualitative studies on stillbirth in Asian and African settings show something really powerful: rituals help parents feel they are “doing something” for their baby and can reduce guilt and complicated grief.
That might be washing the baby, wrapping in specific cloth, chanting, writing scriptures, lighting incense, or participating in a ceremony to send the child’s spirit to a safe place.
Other studies describe stillbirth and early neonatal death being treated with the same level of ritual as an older child—family attendance, viewing, and non-rushed burial or memorial practices.
When healthcare teams block or minimize these rituals because of discomfort or “policy,” parents later describe regret, anger, and feeling that their baby wasn’t honored.
Your role isn’t to know every ritual.
Your role is to ask, “What would honoring your baby look like in your family?” and then see what’s possible inside your unit’s constraints.
Common scenarios to look out for
Scenario | What tends to be happening | What the literature suggests helps |
|---|---|---|
Father or elder speaking for mother | In some cultures, decision-making is communal or hierarchical. The husband may be "protecting" the grieving mother from hard questions. | Acknowledge his role but verify safety. Use the "both/and" approach: "I want to respect how your family makes decisions. For safety/legal reasons, I also need to hear directly from [Mother] for just a moment." |
Refusal of autopsy | Fear of disfigurement or religious prohibition against cutting the body (common in Islam, Judaism, Hmong, and others). | Offer "Virtual Autopsy": If your facility can do post-mortem MRI or CT scans, offer this. It provides medical answers without incisions and is often culturally acceptable when a traditional autopsy isn't. pmc.ncbi.nlm.nih |
Request to take the placenta home | In many cultures (Hmong, Filipino, Native Hawaiian, Navajo, and others), the placenta is viewed as a "twin" or sacred companion that must be buried to protect the baby’s spirit/health. | Don't treat it like medical waste. Check your hospital’s release policy now so you know the steps (usually a release form + keeping it cool). If they can't take it immediately, offering to freeze it for release later shows immense respect. pmc.ncbi.nlm.nih |
"Loud" or Wailing Grief | Some cultures (Middle Eastern, Mediterranean, some African/Latino communities) view loud wailing as the respectful, loving way to mourn. Quiet grief is seen as "not caring." | Do not call security. Unless staff are unsafe, recognize wailing as a distress signal, not a behavioral problem. Close the door for privacy, offer water/tissues, and simply witness their pain without trying to "shush" it. aljazeera |
"Quiet" or Stoic Grief | In contrast, some Asian and Northern European cultures may value stoicism to "save face" or protect the baby's peaceful transition. | Don't assume they "don't care." Avoid judging their lack of tears. Continue to offer the same memory-making options (footprints, photos) even if they seem detached—they often regret saying "no" later once the shock wears off. pmc.ncbi.nlm.nih |
Gentle compassionate phrases to help
1. Who is the decision-maker?
In some cultures, it’s not the birthing parent.
It may be a father, grandparent, or religious leader.
“Who would you like me to check in with when decisions need to be made?”
2. Holding, touching, or seeing the baby
Some families find deep healing in bathing or dressing their baby.
Others see viewing the baby as taboo.
Your job is not to persuade.
Your job is simply to offer:
“Some families like to hold and bathe their baby. Some prefer not to. We’ll support whatever feels right to you.”
3. Photography
In some cultures it’s precious.
In others, absolutely not.
A quick check-in protects families and staff:
“Are photographs okay in your culture or faith tradition? If not, we’ll avoid them.”
4. Timing of rituals
This one comes up all the time in units with large international populations.
Families may request time for prayer, relatives to arrive, or specific care before burial.
If bed flow is tight:
“I want to give you as much uninterrupted time as possible. There will be a point when we need to transition rooms, but we can make sure your next space allows you to continue what’s important to your family.”
This is the kind of care parents remember forever.
Protecting your heart in this work
Caring for families through stillbirth and miscarriage is already heavy; adding cultural complexity can make nurses feel like they’re “one wrong move away” from doing harm.
The research on nurses in perinatal and neonatal palliative care shows increased emotional burden, moral distress, and a strong need for debriefing and peer support.
A few evidence-informed moves you can advocate for on your unit:
Brief, structured debriefs after complex deaths, especially when there were cultural or language challenges.
Access to employee assistance or counseling and permission to use it without stigma.
Standardized tools—bereavement boxes, checklists, scripts—that reduce the mental load of “reinventing” care with every loss.
You are not expected to be a cultural expert for every community that walks through your doors.
You are allowed to say, “I don’t know, but I want to get this right—can you help me understand what matters most to you?” and let that be the standard of care.
If this topic hit home for you, scroll down and vote in today’s survey.
After you vote, there’s a space to share your own stories, challenges, and ideas for future deep dives—we read every single one and honestly, they shape this newsletter more than any journal article ever will.
Quick Poll: How was today's newsletter for you?No judgment. Every answer helps us improve our newsletters in the future. |
👋 That’s a Wrap!
Before you go: Here are ways we can help your hospital
Education: Please share our newsletter with your co-workers. Our priority is empowering nurses with the tools to support patients with modern, evidence-based bereavement education.
Bereavement boxes: Our bereavement boxes were designed out of a need for a modern high quality solution for families suffering from miscarriage, stillborn, or infant death.
Reply to this email “Sample” to get a free sample sent to your hospital.
What we prioritize:
Tools for hospitals to create a bereavement experience for families to begin their grief journey
Educating nurses with modern bereavement standards and continuing education.
Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.
These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.
Until next week,
Trina and Jay
Co-founders of Forget Me Not
