Background / Significance:
Obstetric departments have bereavement protocols/standards of care in place to assist grieving parents after the death of a baby (Smart & Smith, 2013). Nurses help families find meaning through ritual and memory-making to honor the brief presence of an infant in their family (Zadeh, Eshelman, Setla, & Sadatsafavi, 2017). According to Chichester & Wool (2015), “Clinicians should be aware of the potential for cultural and religious beliefs to shape parental responses. Good culturally competent care begins with cultural humility and self-awareness.” (p.228). Standards for perinatal loss are focused on the American majority culture with poor individualization to families from other cultures or faith traditions. There little research specific to how different cultures within the United States deal with the issue of perinatal loss. We have a limited understanding of Haitian’s beliefs regarding perinatal death and what families might find acceptable (Koopmans, Wilson, Cacciatore, & Flenady, 2013). End-of-life care needs to be individualized to each family's needs. Depending on acculturation, they may choose a blend of traditional and mainstream American practices. The purpose of this study is to understand how parents of Haitian background might accept standards of care for perinatal loss in the United States.
Method: Institutional Review Board approval was obtained prior to initiating the study. This is a simple survey study, which was distributed by a Haitian nurse, who served as a community liaison, at a church predominantly attended by those of Haitian background. Surveys were placed in the church with a cover letter, explaining standards of care and inquiring which of these were acceptable, which might not be, and why. Consent was assumed by participation/survey return. A box was also placed in the back of the church to permit anonymous return for a 4 week period. These survey results were compared with previously collected surveys from those identifying as American Christian and African American Christian.
Results: Ten surveys were completed and returned. Mean age was 30.7, range 27-37, with a range of education from high school completion through college. Overall, those of Haitian background concurred with mainstream American perinatal loss standards of care, desiring time to see and hold both a stillborn or a neonatal death, keeping memorial items (pictures, footprints, lock of hair, clothes/blanket), and arranging for rituals such as naming, blessing, and a funeral. Also similar to mainstream Americans and African Americans was a slightly lower comfort with other family members coming to see the baby. According to one participant, "only mom & dad of child (stillborn) should be involve per the Haitian culture." Interestingly, those identifying as Haitian had a higher acceptance rate of considering/desiring an autopsy than either American or African American. Overall, Haitian views aligned more closely with American Christian views than with African American views.
Conclusions/Implications for Practice: Literature supports providing family time after a perinatal loss and memorial items as best practice (LeDuff, Bradshaw, & Blake, 2017). It is critical for nurses to adapt standards of care when there is a perinatal loss based on a mother/family’s faith and culture, inquiring what would best help them create positive memories and meaning, while accommodating personal practices (Callister, 2014). This small pilot confirms the need to gather more information in order to provide culturally appropriate care to Haitian women and their families following a perinatal or neonatal loss. For future researchers, a larger and more diverse sample would potentially allow for these results to be better generalizable. Barriers faced were access to the Haitian community and a potential language barrier. More research is needed on other cultures and faith traditions (Simwaka, de Kok, & Chilemba, 2014). Limitations are the small number of surveys, a younger mean age, and a lower education level than those who identified as American or African American.
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