A randomised trial of routine versus selective counselling in perinatal bereavement from congenital disease

Abstract

Objective: To find out whether routine counselling improves psychological wellbeing after bereavement for fetal abnormality.

Design: A randomised trial among bereaved couples who did not demonstrate any unexpected strain or psychopathology after bereavement.

Setting: St. James's University Hospital, Leeds.

Subjects: Fifty-seven couples.

Interventions: Independent counselling by an experienced psychotherapist.

Main outcome measures: Self-administered questionnaires measuring grief, anxiety and depression and a structured psychological interview 16 to 20 months after the loss. Anniversaries of a death or expected birth date were avoided.

Results: There were no differences in outcome between women randomised to the study group or randomised to the control group with respect to grief, anxiety, depression or the results of the structured overview. Among those in the randomised study group, women who attended for counselling had a much better outcome than women who defaulted from counselling. Overall, women who underwent termination of pregnancy did slightly worse than those who had experienced stillbirth or neonatal death. On an informal basis, the clinician concerned believes that he was better able to help bereaved couples as a result of feedback and criticism from the independent counsellor.

Conclusions: (1) The hypothesis that all couples should have independent counselling after prenatal loss for congenital abnormality is unproven, but it is likely that clinicians can benefit from feedback from a counsellor; (2) it is possible that termination of pregnancy is more psychopathogenic than other forms of fetal loss; (3) people who attend for their counselling sessions are probably inherently better able to adjust to bereavement; (4) trials of psychological intervention are feasible, but follow up is either difficult to achieve or expensive.