The experience of mothers and fathers regarding gestational losses has been deeply influenced by different factors, mainly the lack of social knowledge that these situations are likely to occur. This entails limited understanding of the process and low acknowledgement of the loss of the son or daughter, resulting in poor or no support for parents (1). These social factors are transferred to the professionals responsible for care around birth, which have traditionally lacked sufficient training and institutional support, as shown by the limited number of protocols to orient and support them in this task.

The concern regarding gestational grief in countries around us has been gradually developing since the 70s. However, the first publications in Spain appeared tentatively in the 90s and started acquiring more importance at the start of the 21st century. Currently we have an increasing number of research projects, and doctoral theses addressing this matter are no longer anecdotal. From the perspective of care, Nursing professionals from different settings have approached mothers, fathers and/or professionals, in many cases with a qualitative perspective, which has allowed a deep knowledge about the experience and needs of everyone involved in the process (2-5). This knowledge has driven sensitive professionals who are committed to this matter to translate their interest into institutional and care protocols. The work by Parent Associations is equally important, as they participate in the preparation of said protocols and work actively for a social and institutional visibility of their children, and for family rights

As in other healthcare settings, paternalism is one of the behaviours that has been traditionally maintained around birth in gestational loss, making decisions based on what is assumed to be better for parents. However, today we know that care must be focused on the woman, and therefore on the couple and family, considering all their needs, and based on a humane and empathetic relationship which encourages an informed decision-making. This will generate a trust relationship that empowers mothers and fathers and allows them to have a feeling of control, which is in itself a factor that facilitates the mourning process (2).
 
We know that parents are in a state of shock at the start of their mourning process, where it is difficult to assimilate knowledge and make decisions; therefore, emotional support is required from the time of diagnosis and throughout the process. Within this support we may consider the communication skills of all professionals involved, on one hand to prevent hampering the process, and on the other hand to encourage decision making, which will be key for grief resolution.

Many aspects have been defined as enabling the mourning process. Some are “tangible”, such as seeing and holding the newborn, washing and dressing them, treating them with respect as any other newborn, or calling them by their name. Other are “tangible”, such as the keepsake box, where objects associated with the newborn can be kept, such as a tuft of hair, a baby blanket, their bonnet, the cord clamp, or their handprints and/or footprints. It is also important to take photographs with the family, and particularly integrating the newborn in the family circle, enabling any relatives who want to say goodbye, and paying special attention to siblings, if any. Support in the search for the cause of death also represents an important factor, among others, for the subsequent grieving process.

These aspects are collected in most protocols from recent years, in a more or less extensive way, and they contribute to a great extent to improve family care (6-10). However, there are other elements defined as not enabling the grieving process, which persist regardless of being included in new protocols, because there is resistance to their practical application. This is the case of the likelihood of delaying the moment of labor induction, giving time to parents to adapt to the loss scenario, to manage their situation and emotions, to talk with each other or with the family, or to cry freely. This time for parents can be an element that facilitates an adequate grieving process (2). Other logistical aspects, such as the location of the place of birth, seem more difficult to solve, because they require awareness by institutions to adapt the birth places to the reality of gestational loss. Currently they are sharing space with other live births where the happiness expressions of parents or the newborns crying cannot be silenced, but will leave a deep imprint in those mothers and fathers whose child died before being born.

Our job around birth as professionals is to contribute to a healthy mourning initiation, facilitating the aspects that will enable grieving, and avoiding the barriers that will make it difficult as much as possible, so that birth will be part of the process. Evidence states that we professionals will present difficulties at the time of providing care to these families, that we don’t feel we are sufficiently prepared, even though we have awareness of the matter (11). In this sense, the new institutional protocols and guidelines capture this reality, and assign a specific section to consider the needs of professionals who provide care to these mothers and fathers (6-10). It is highlighted that there is a need to provide curricular and continuous training on grieving, specifically gestational or perinatal, as well as training in communication skills. Other important need is to set up support resources for professionals.

We can say that a deep change has initiated regarding care around birth in gestational loss cases, but there is still a long road ahead (12). If we want to move forward in care for parents who experience a gestational or perinatal loss, it is essential to consider their needs, and an advance in research will contribute to understand these needs (13), but it will be difficult to move forward unless we address the needs of those professionals who provide care for these mothers and fathers.