In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: Part 3 of 3: The Follow-Through - Preparing for Discharge and Follow-Up Care.
🩷 Self-care moment

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🔗 The Best Resources I Found This Week

💬 Coping with Grief—A Compassionate Talk by Dr. Joanne Cacciatore
“I gave a little talk about coping with grief…exploring dysregulated patterns and grief-informed alternatives to build resilience.” (LinkedIn)

📱 Automated Text Messaging & Health Care Follow-Up
A fascinating study shows automated text reminders post-discharge significantly improve follow-up care engagement and reduce acute visits. (Jama Network)

📖 Deep Dive

Part 3: The Follow-Through - Preparing for Discharge and Follow-Up Care.

Over the past two weeks, we've covered getting the communication basics right and navigating those difficult conversations that don't have easy scripts. Today, we're tackling something that's often overlooked but absolutely critical: what happens when families leave your unit.

Here's the reality: most bereaved parents feel "dropped off the radar" once they leave the hospital. Research shows that parents consistently report feeling abandoned by the healthcare system just when they need ongoing support most. But here's what might surprise you - effective follow-up care doesn't require massive resources or complicated systems. It requires intentional planning and smart use of the tools you already have.

What bereaved parents want health care providers to know when their babies are stillborn

I found this study conducted by BMC Psychology. Their study explores the experiences of grieving parents during their interaction with health care providers during and after the stillbirth of a baby.

Here were some common themes:

First and foremost, they wanted the provider’s acknowledgement of the baby as an irreplaceable individual.

Here were some more themes:

1) acknowledgement of parenthood and grief
2) recognition of the traumatic nature of stillbirth
3) acknowledgement of enduring grief coupled with access to support. It was important that providers realized how grief was experienced within health care and social support systems, concretized by their desire for long-term, specialized support.

Why Follow-Up Care Actually Matters

Before we dive into the "how," let's talk about the "why" with some hard numbers. Research shows that mothers who experience perinatal bereavement require continuity of care after discharge, with psychological screening and counseling support essential for both parents.

Studies reveal concerning statistics:

• 49.8% of women experience depression or anxiety following stillbirth

• Only 41% of participants showed normal decline of grief scores, while 59% experienced either pervasive or delayed grief resolution

• Parents with poor social support show significantly higher rates of complicated grief reactions

But here's the encouraging part: research consistently demonstrates that structured follow-up care significantly improves bereavement outcomes. A study from Australia's "Hospital to Home" program shows that bereaved parents who received structured support for three months post-discharge demonstrated high levels of satisfaction and significant improvements in wellbeing domains.

The Current State: What Hospitals Are Actually Doing

Our recent research reveals significant variations in follow-up care practices. A 2024 national survey of 289 U.S. hospital staff found major gaps in communication practices, training, and debriefing after stillbirth. Many hospitals provide excellent immediate care but struggle with the transition to community support.

Common current approaches include:

• Single follow-up appointment with obstetric team after 6-8 weeks

• Basic discharge information packet

• Referral list to community resources

• Social work consultation before discharge

The gap: Most of these approaches are one-time interventions rather than ongoing support systems.

What Bereaved Families Actually Need

Recent qualitative research with 15 mothers and 6 midwives identified two main categories of post-discharge needs:

1. Continuous Healthcare

• Comprehensive Mother Tracking System: A liaison between hospital and community care

• Psychological welfare provision: Regular screening and counseling support

• Educational needs: Clear information about physical and emotional recovery

2. Support Network Provision

• Professional support: Access to trained bereavement specialists

• Peer support: Connection with other families who've experienced similar experiences

One midwife with 27 years of experience explained:

Building Follow-Up Systems That Work: For Every Hospital Size

For Small Hospitals (1-2 Cases Per Month)

The Simple but Effective Approach:

Week 1: Phone call from discharge nurse or social worker

• Check on physical recovery and emotional wellbeing

• Answer questions about autopsy results if pending

• Confirm follow-up appointment is scheduled

• Provide crisis contact information

Week 3: Brief check-in call or text

• How are you managing day-to-day?

• Any concerning symptoms (physical or emotional)?

• Do you need help accessing community resources?

6-8 Weeks: Comprehensive follow-up with obstetric provider

• Physical examination and emotional assessment

• Discuss autopsy results and implications for future pregnancies

• Address questions about recurrence risk

Automated Option for Small Hospitals:
Services like automated texting platforms can handle basic check-ins, with escalation to human staff when families express needs. One study showed a 41% reduction in acute care usage when automated texting was used for post-discharge follow-up.

For Large Hospitals (20+ Cases Per Month)

The Systematic Approach:

Designated Bereavement Coordinator Role:
Research shows that dedicated bereavement coordinators significantly improve outcomes. Key responsibilities include:

• Conducting discharge planning for all stillbirth families

• Managing follow-up schedules and tracking

• Coordinating community resource referrals

• Providing crisis intervention when needed

Structured Follow-Up Protocol:

• 48-72 hours: Text or call to check immediate needs

• 1 week: Phone assessment of physical/emotional status

• 2-4 weeks: Follow-up call with screening for depression/anxiety

• 6-8 weeks: Comprehensive appointment with medical team

• 3, 6, 12 months: Brief check-ins on significant dates

Technology Integration:
Large hospitals can benefit from automated systems that handle routine check-ins while flagging families who need immediate human intervention.

🖥️ The Power of Technology: Automating Without Losing Humanity

Recent research shows promising results for technology-enhanced follow-up care. Internet-based bereavement programs demonstrate moderate effects on grief, depression, and post-traumatic stress symptoms, with high user satisfaction.

Automated Texting Systems

The evidence is compelling: automated text messaging programs show 82.8% response rates - far higher than traditional phone calls. This study was fascinating! I definitely recommend reading. Key features include:

• Tapering schedule: Frequent contact initially, spacing out over time

• Human escalation: When families express needs, real staff respond immediately

• Personalization: Messages can include baby's name and specific circumstances

• Two-way communication: Families can reach out anytime, not just when prompted

What This Looks Like in Practice

A successful program might text:

If parents reply YES, they receive:

Creating Your Discharge Checklist: The Non-Negotiables

Based on comprehensive research, every stillbirth discharge should include:

Medical Clearance:

• Physical examination complete with no ongoing medical needs

• Lactation suppression provided if desired

• Follow-up appointment scheduled with obstetric provider

• Contact information for primary healthcare provider documented

Information Provision:

• Clear explanation of autopsy process and timeline for results

• Written information about physical recovery expectations

• Educational materials about grief responses and when to seek help

• Crisis contact information available 24/7

Resource Connection:

• List of local support groups and counseling services

• Contact information for peer support organizations

• Financial assistance resources if needed

• [Insert link to "Family in the Room: Tips for When Support Isn't So Supportive" here]

Within 72 Hours Post-Discharge

• Confirmation that family arrived home safely

• Assessment of immediate physical and emotional needs

• Verification that follow-up appointments are scheduled

• Offer of additional resources or crisis support if needed

Timing Matters

Be sensitive to significant dates:

• Due dates (if different from birth date)

• Holidays can be particularly difficult

• Monthly anniversaries of the baby's birth for the first year

• Mother's Day and Father's Day require special sensitivity

Cultural and Language Considerations

• Offer materials in families' preferred languages

• Respect different cultural approaches to grief and mourning

• Ask about spiritual or religious preferences rather than assuming

• Consider community-specific resources and support systems

Measuring Success: How to Know It's Working

Quantitative Measures

• Response rates to follow-up contacts

• Attendance at scheduled appointments

• Usage of provided resources

• Readmission rates for complications

Qualitative Feedback

• Family satisfaction surveys (sent 6 months post-discharge)

• Staff feedback on follow-up experiences

• Community partner input on referral quality

• Annual review of follow-up protocols and outcomes

The Business Case: Why This Matters Beyond Compassion

Effective bereavement follow-up care provides measurable benefits:

• Reduced liability through comprehensive care documentation

• Improved patient satisfaction scores and online reviews

• Enhanced staff satisfaction through better patient outcomes

• Community reputation as a center of excellence in maternal care

• Potential revenue through follow-up appointments and future pregnancies

Research shows that hospitals with structured bereavement programs report significantly higher staff and family satisfaction scores.

Looking Forward: The Next Evolution of Bereavement Care

Emerging trends in follow-up care include:

• Telehealth integration for remote counseling support

• Mobile apps designed specifically for pregnancy and infant death

• Peer mentor programs connecting families with trained volunteers

• Virtual support groups accessible regardless of location

• AI-assisted screening for complicated grief requiring intervention

Self-Care for Healthcare Providers: Supporting the Supporters

Providing follow-up care means continuing emotional investment in families' grief journeys. This requires sustainable approaches:

• Regular debriefing after difficult follow-up calls

• Clear boundaries about availability and crisis coverage

• Team approach to sharing emotional burden

• Professional development in grief support techniques

• Personal support through employee assistance programs

[Insert link to "The Realities of Caring for IUFD When You've Experienced Your Own Experience" here]

The Bottom Line: It Doesn't Have to Be Perfect to Be Powerful

You don't need a perfect system or unlimited resources to make a profound difference in families' lives. Research shows that even simple, consistent follow-up contact significantly improves bereavement outcomes.

Start where you are, with what you have:

• One phone call is better than none

• A simple text message shows you remember and care

• A resource list can provide lifelines during dark moments

• A follow-up appointment offers hope for future healing

The families you serve will remember that you cared enough to follow through long after they left your unit. That's not just good medicine - it's sacred work that extends healing beyond hospital walls.

👋 That’s a Wrap!

Before you go: Here are ways we can help your hospital

We offer bereavement boxes to give as gifts to those who leave the hospital after a miscarriage, stillborn, or infant death. Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. 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