Maternity staff views on implementing a national perinatal mortality review tool: understanding barriers and facilitators

Objectives: Perinatal death reviews investigate the causes of perinatal mortality, identify potentially avoidable factors, and may help prevent further deaths. This study aimed to identify barriers and facilitators to the implementation of a standardised perinatal mortality review tool in Irish maternity units by engaging with healthcare professionals about their opinions on the existing system and implementing a standardised system. Methods: This study involved semi-structured interviews with staff from three maternity units of various sizes in Ireland. Recruitment involved purposive and snowball sampling. Interviews took place from May to December 2022 and covered topics such as the existing perinatal mortality review process, staff experiences with reviews and proposed changes to the system. Thematic analysis was performed. Results: Participants (n=32) included medical and midwifery staff with varying levels of seniority and experience with perinatal mortality reviews. Four themes were identified: the review process, time challenges of reviews, institutional culture and staff needs. Our findings demonstrated that the review process was structured differently across units, with varying levels of staff involvement. Institution culture, leadership and transparency were highlighted as essential aspects of the review process. Reviews have an impact on staff wellbeing, emphasising the need for continued support. Conclusions: Implementing a standardised perinatal mortality review system is viewed positively by staff, though addressing the highlighted barriers to change is important. A standardised perinatal mortality review tool and review process may help strengthen perinatal death reviews, provide more information and opportunity for involvement for bereaved parents and help reduce future perinatal deaths.