9th October 2023
In support of Baby Loss Awareness Week, 9-15 October, we are delighted to share this Voices blog by Amanda Hall , Family Nurse at the Family Nurse Partnership – Shropshire. Amanda shares an overview of the successful Rainbow Baby Health Visiting Pilot in Shropshire.
Health visitors are well placed within the community to provide support to bereaved families (Noakes, 2017 & SANDS, 2019). However, currently due to the significant workforce shortages both locally and nationally, it is difficult for health visitors to offer families bereavement support. This is particularly poignant for parents following the birth of a rainbow baby (a baby born after a pregnancy or baby loss). As early intervention can make a big difference to families’ outcomes, it is vital that, as health visitors, we ensure that these families receive the support that they need during this time.
This is particularly significant where I work in Shropshire, following the Ockenden review (2022) which investigated maternity services at Shrewsbury and Telford Hospitals NHS Trust (SATH) between 2000- 2019. Failings were discovered which sadly resulted in numerous baby deaths within the Trust. As Shropshire health visitors, we serve the same population as SATH. Many of these families will go on to have their rainbow baby and will receive universal health visiting support from our team, even if they give birth at a different hospital. However, within our existing health visiting model, no provision for additional support was available.
As a result of identifying this gap within our service, we felt that it was vital we were responsive to these families’ needs – we needed a case for change. We developed a proposal for an increased schedule of visits to provide additional support for these parents, above our universal offer of core health visiting contacts. This proposal was then presented to our nursing director. It was envisaged that by offering families a more extensive schedule of visits, adjusted to their needs, this would offer extra support during pregnancy and following the birth of their rainbow baby. Stakeholders were consulted, and a Quality, Equality, Impact Assessment and business proposal were both completed. We presented our proposal in numerous presentations within the Trust and to the Care Quality Commission and received approval for a pilot project.
“The Rainbow Baby Health Visiting Pilot” was then delivered over the course of fifteen months to five families residing within the Central Shropshire caseload. The pilot offered additional support to parents that met the criteria of suffering a previous stillbirth or neonatal loss. Families that had also suffered a loss within a multiple pregnancy or following a maternal death were also part of the eligibility criteria – however, there were no families in either of these categories in the pilot project. The pilot offered additional home visits, starting in the antenatal period and through to the child’s second birthday.
Following completion of the Rainbow Baby health visiting pilot, a full audit was carried out via a survey which all five families completed. The benefits of the rainbow baby pilot were seen to be positive and far-reaching.
All families found that they felt more reassured and supported having regular visits from the same health visitor, the continuity of care spared them the trauma of repeating their story to numerous professionals, allowing them to build up a trusting relationship with their health visitor.
The pilot has uniquely delivered parenting support alongside health visiting contacts to improve both short- and long-term outcomes. It has enabled parents to navigate their grief alongside their rainbow baby, allowing the delivery of trauma-informed, sensitive care to these families who had already suffered so much.
Parents reported that “Parenting, following loss, is the hardest challenge I have faced, feeling anxious and lost, coupled with feelings of guilt, grief and joy.”
The audit findings also demonstrated wider benefits in the healthcare system. Parents reported that they did not need to access the GP or mental health services as much as they felt they might have done if they were not part of the pilot. One of the parents identified that she did not need to go back on antidepressants due to having the additional support, and another stopped her counselling.
It was also evident from the audit that the Rainbow Baby Pilot had improved parents’ lives. Parents felt that their parenting journey would not have been as positive if they had not received the support from the pilot. Additionally, it was recognised that being part of the pilot had allowed them valuable time and space to talk about the baby they had lost, and parents reported that they felt very grateful for this.
Having a safe space within the pilot enabled parents to ask questions that they may not have been able to ask other professionals. As a result, their emotions for the baby that they had lost were contained and they were also given the ‘head space’ to connect with their rainbow baby.
Parents reported that “No question was too silly, no judgement was made, just caring, personalised, regular continuity of support; someone to give advice and listen to our worries”.
The service provided was also responsive to both parents’ needs: “my husband was also very grateful for this service, he felt confident to ask questions and felt very supported by all the advice we received”.
Parents explained that it “exceeded their expectations” and was quoted as a service they will “always be grateful for”, reinforcing the need going forward for targeted health visiting support during pregnancy and following the birth of a rainbow baby.
The work undertaken on the Rainbow Baby Pilot has gained national recognition. I received a Silver Chief Nursing Officer award in August 2022 and was also awarded The Shropshire Community NHS Trust Innovation Award in November 2022. The pilot has also been short-listed in the public health nursing category of the Nursing Times Awards 2023
Going forward, it is hoped that funding will be secured within the next tender to roll the service out in Shropshire.
Amanda Hall , Family Nurse at the Family Nurse Partnership – Shropshire
- Independent Maternity Review (2022). Ockenden report – Final: Findings, conclusions, and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust (HC 1219). Crown.
- Noakes, A. (2017) Ensuring families receive appropriate care after infant loss. Journal of Health Visiting, 5 (10), pp. 490-491. doi.org/10.12968/johv.2017.5.10.490
- Stillbirth and neonatal death society (SANDS) (2019). National bereavement pathway for pregnancy and baby loss. London: SANDS.