Psychological support for women following perinatal loss: a systematic review of clinical practice guidance

Introduction While there is recognition of perinatal mental health worldwide, high income countries are increasingly acknowledging the mental health consequences of perinatal loss (the loss of a baby during pregnancy or shortly after birth). Frameworks and pathways have been developed to improve service provision for women who experience expected distress and/or mental health conditions following perinatal loss. Clinical practice guidelines can offer healthcare professionals direction on how to identify and treat psychological difficulties and distress after a perinatal loss. Typically, these guidelines have medical management as their primary focus, but less is known about the availability of recommendations for the assessment and management of psychological difficulties. Thus, the aim of the current review was to 1) identify perinatal mental health and perinatal loss clinical practice guidelines which contained one or more psychological recommendation(s) relevant to supporting a woman’s mental health following perinatal loss, 2) assess the quality of the guidance and 3) synthesize psychological recommendations. Methods A systematic search of literature and guideline databases alongside healthcare organizations concerning maternal and perinatal mental health care was conducted. Relevant guidelines were identified and quality assessed using the Appraisal of Guidelines for Research and Evaluation - Global Rating Scale tool. Included recommendations were analyzed through narrative synthesis. Results Sixteen guidelines met the inclusion criteria. Three had a primary focus on perinatal mental health and the remaining 13 were perinatal loss-specific guidelines. Ten of the included 16 guidelines were quality appraised as “excellent” for methodological quality, four as “good,” and two as “average.” The extracted recommendations related to psychological assessment, psychological intervention, psychosocial support, service provision, and systemic considerations. Recommendation consistency and specificity varied considerably across guidelines. Overall, recommendations for psychological assessment and longer term follow up were limited. Discussion Allowing space for the natural grieving process can mean that mental health difficulties following perinatal loss are missed. However, the lack of clear recommendations for follow up may hinder women’s access to evidence-based intervention, should they need it. Thus, there is a need for a cross-disciplinary clinical practice guideline to be developed which outlines evidence-based recommendations specifically focused on supporting women’s wellbeing and mental health following perinatal loss. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/home , identifier CRD420261291353.