reflective practice case study examples

• SCU Library
• Library guides
• Subject Guides

Reflective Practice

• Examples of reflective practice
• Why use reflective practice?
• When to use reflective practice
• Some models of reflection
• Writing reflectively
• Recommended readings
• Need help? This link opens in a new window

Superficial

Superficial (= descriptive reflection)   non-reflectors

Reflection at this level is very basic – some would say it is not reflection at all, as it is largely descriptive! However the description should not just be of what happened but should include a description of why those things happened. Reflection at a superficial level makes reference to an existing knowledge base, including differing theories but does not make any comment or critique of them.

Example - Superficial reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James.

I wanted to reassure them that things were OK because I knew this was what they needed to know. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed and I felt I had really stuffed things up for this family. I need to get some advice about how to handle angry families.

Medium (= dialogic reflection) reflectors At this level of reflection, the person takes a step back from what has happened and starts to explore thoughts, feelings, assumptions and gaps in knowledge as part of the problem solving process. The reflector makes sense of what has been learnt from the experience and what future action might need to take place.

Example - Medium reflection

Today I spent time with James (client) and his family on the ward. The family had a lot of questions about the rehabilitation process and wanted to know what was going to happen for James. I wanted to reassure them that things were OK because I remembered from a uni lecture by a carer that carers needed reassurance, information and hope for the future of the person they cared for. I said that while it was difficult for anyone to know the rate of James’ improvement I could be sure that he would improve and that it was important for the family to keep hopeful about his future.

James’ father became angry and after raising his voice at me, telling me I was a “patronising little fool”, he stormed out of the room. James mother sat weeping beside his bed. I felt confused and like I had done the wrong thing. I remembered from the same lecture about the emotional rollercoaster of caring for someone after a brain injury and how families could experience a range of emotional responses as they adjusted to their new reality.

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling.

I decided to ask James’ mother how things were going for the family and she started to open up about how she felt. She revealed that James’ accident had opened up longstanding conflict between her and her husband, and that she didn’t feel hopeful about anything. It seemed like a useful conversation.

Deep (= critical reflection) critical reflectors

This level of reflection has the most depth. This level of reflection shows that the experience has created a change in the person – his/her views of self, relationships, community of practice, society and so on. To do so, the writer needs to be aware of the relevance of multiple perspectives from contexts beyond the chosen incident – and how the learning from the chosen incident will impact on other situations.

For some critical reflective writing tasks it is expected that your writing will incorporate references to the literature - see  Example - Deep reflection incorporating the literature below. Note that these are short excerpts from longer documents previously submitted for assessments (Permission granted by author).

Example - Deep reflection

I started thinking about what was happening in this family and how James’ parents were both clearly distressed and may have been having difficulty supporting each other due to their own distress. James’ father’s abuse of me was possibly not a fair reflection on me but said a lot about how he was feeling. I wondered about his parent’s differing emotional responses and tried to put myself “in their shoes” to consider what it must be like for them. I could see that their questions and behaviours were driven by their extreme emotional states. They both needed an outlet for their emotions.

I also thought about what James needed from his parents to optimise his participation in the rehabilitation program and how I could support them to provide that. I knew I didn’t have the skills or confidence to provide the grief counselling they probably needed but I thought I could provide them with some space to share and acknowledge their grief and to suggest options for them to get further assistance in this area. I sat by his mother and said “This is really hard for you all isn’t it”. She responded with “so hard” and cried some more. We sat without talking for a while and when she was calmer I said “a lot of families find it helpful to talk with our social workers about how they are feeling when things like this have happened”. She agreed it would be good to talk and I helped her organise an appointment for the next day.

From the experience today I have learned that families don’t need superficial reassurance and that this can be perceived as patronising. It will be more helpful if I can acknowledge their emotional distress and fears and reassure them that their response – whatever it is – is normal and expected. If I show that I can cope with their distress I can assist them to get the support they need and this will be critical in getting the best outcome for clients like James.

Example - Deep reflection incorporating the literature

NOTE: These short excerpts are from longer documents previously submitted for assessments (Permission granted by authors). Also note the format of the in-text citations reflect this.

I needed to understand more about what resilience actually is, and whether it is learnable or inherent in a person’s personality.  McDonald, Jackson, Wilkes, & Vickers, (2013) define resilience as the capacity to deal with “significant disruption, change or adversity” (p.134) and that in the workplace, adversity relates to the difficult or challenging aspects of the role. The authors identify traits associated with resilience such as “hardiness, hope, self-confidence, resourcefulness, optimism flexibility and emotional intelligence” (McDonald et al., p.134) and discuss how training programs have been established within the workplace to teach people these skills.

A plan for building resilience for my future role as a midwife would need to start now in order that positive patterns are embedded in my practice and everyday life. This would include activities discussed above as well as attempting to engage in habits of mindfulness on a day to day basis (Foureur, Besley, Burton, Yu, & Crisp, 2013).

Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse: A Journal for the Australian Nursing Profession , 45 (1), 114-125.

McDonald, G., Jackson, D., Wilkes, L., & Vickers, M. (2013). Personal resilience in nurses and midwives: Effects of a work-based educational intervention. Contemporary Nurse: A Journal for the Australian Nursing Profession , 45 (1), 134-143.

It is vital to ensure a healthy work-life balance (Pelvin, 2010). Imbalances in professional and personal life can cause burnout (Fereday & Oster, 2010). Burnout increases with the incidence of family-work conflict (Jordan et al., 2013). Non work-related interests help reduce the risk of burnout; exercising, resting, leisure-time and self-pacing all assist in managing stress (Jordan et al., 2013; Mollart et al., 2013). Self-awareness and mindfulness positively affect our personal relationships and make valuable contributions to the professional workplace (van der Riet et al., 2015). Mindfulness also enables midwives to be totally present with women and their families (White, 2013). Keeping an up-to-date family diary has assisted in planning and pacing my study, work, personal and social activities.

Fereday, J., & Oster, C. (2010). Managing a work–life balance: The experiences of midwives working in a group practice setting.  Midwifery, 26 (3), 311-318.

Jordan, K., Fenwick, J., Slavin, V., Sidebotham, M., & Gamble, J. (2013). Level of burnout in a small population of Australian midwives.  Women and Birth , 26 (2), 125-132.

Mollart, L., Skinner, V. M., Newing, C., & Foureur, M. (2013). Factors that may influence midwives work-related stress and burnout.  Women and  Birth , 26 , 26-32.

Pelvin, B. (2010). Life skills for midwifery practice. In S. Pairman, S. Tracy, C. Thorogood & J. Pincombe (Eds), Midwifery: Preparation for practice (2 nd ed.). (pp. 298-312). Chatswood, NSW: Elselvier Australia.

van der Riet, P., Rossiter, R., Kirby, D., Dluzewska, T., & Harmon, C. (2015). Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned.  Nurse Education Today , 35 , 44-49.

White, L. (2013). Mindfulness in nursing: An evolutionary concept analysis. J ournal of Advanced Nursing , 70 (2), 282-294.

• << Previous: When to use reflective practice
• Next: Types of reflection >>
• Last Updated: Nov 6, 2023 9:23 AM
• URL: https://libguides.scu.edu.au/reflectivepractice

Southern Cross University acknowledges and pays respect to the ancestors, Elders and descendants of the Lands upon which we meet and study. We are mindful that within and without the buildings, these Lands always were and always will be Aboriginal Land.

• Cancer Nursing Practice
• Emergency Nurse
• Evidence-Based Nursing
• Learning Disability Practice
• Mental Health Practice
• Nurse Researcher
• Nursing Children and Young People
• Nursing Management
• Nursing Older People
• Nursing Standard
• Primary Health Care
• RCN Nursing Awards
• Nursing Live
• Nursing Careers and Job Fairs
• CPD webinars on-demand
• --> Advanced -->

• Clinical articles
• CPD articles
• CPD Quizzes
• Expert advice
• Career advice
• Revalidation

CPD Previous    

How to write a reflective practice case study, bob price independent health services training consultant, surrey, england.

As evidence and experience play an important role in underpinning primary healthcare, combining them in a reflective practice case study has significant potential for purposes of publication and revalidation of professional practice.

Reflective practice case studies have the potential to help other nurses in the community re-examine care challenges and the opportunities before them. Nurses writing about a clinical case experience can add to the relevant evidence, as can discussion of the insights and issues that emerge. While research and reflective practice are regularly written about more generally in the press, there remains scope for nurses to combine them in a more analytical and pertinent way.

This article guides the reader through the process of identifying suitable case studies to write about and structuring the work they produce. Clear distinctions are made between case study as research methodology and case study as reflective practice process.

Primary Health Care . 27, 9, 35-42. doi: 10.7748/phc.2017.e1328

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

None declared

Prepare for revalidation: read this CPD article, answer the questionnaire and write a reflective account: rcni.com/reflective-account

Please email [email protected] . Guidelines on writing for publication are available at: rcni.com/writeforus

For information about writing for RCNi journals, contact [email protected]

For author guidelines, go to rcni.com/writeforus

Received: 13 June 2017

Accepted: 22 August 2017

case study - evidence review - reflective practice - revalidation - writing for publication

User not found

Want to read more?

Already have access log in, 3-month trial offer for £5.25/month.

• Unlimited access to all 10 RCNi Journals
• RCNi Learning featuring over 175 modules to easily earn CPD time
• NMC-compliant RCNi Revalidation Portfolio to stay on track with your progress
• Personalised newsletters tailored to your interests
• A customisable dashboard with over 200 topics

Alternatively, you can purchase access to this article for the next seven days. Buy now

Are you a student? Our student subscription has content especially for you. Find out more

30 October 2017 / Vol 27 issue 9

TABLE OF CONTENTS

DIGITAL EDITION

• LATEST ISSUE
• SIGN UP FOR E-ALERT
• WRITE FOR US
• PERMISSIONS

Share article: How to write a reflective practice case study

We use cookies on this site to enhance your user experience.

By clicking any link on this page you are giving your consent for us to set cookies.

• Schools & departments

Case studies of reflective practice in the University

A series of case studies from initiatives within the University showcasing how reflective practice is being used.

Below are a few case studies that will give you glimpses into the wide range of practice across the University – more are coming soon!  

If you have practice that you would like to share, please get in touch.

Share your practice

Chemistry: reflective workshop after placements

The edinburgh award, edinburgh award in the business school, geoscience/psychology outreach and engagement course, historian's toolkit, the mastercard foundation scholars program, the mastercard foundation summer school in transformative leadership, postgraduate placement-based dissertations in school of social and political science, professional and clinical skills courses in the veterinary school, professional development in the veterinary school, sliccs (student-led, individually-created courses).

In this section

HOME   PREVIOUS SECTION   NEXT SECTION

REFLECTION: CASE STUDIES

Reflection gives the brain an opportunity to pause amidst the chaos, untangle and sort through observations and experiences, consider multiple possible interpretations, and create meaning. This meaning becomes learning, which can then inform future mindsets and actions (Porter 2017).

The following case study offers you the opportunity to practise the skill of reflection and apply your knowledge and skills to a hypothetical case:

Reflection: What, Why, How

Reflection can help manage the emotional impact of professional life. This can be personal or shared with a colleague/ trainer/ appraiser the next few examples illustrate a professional approach to managing your emotional health and personal development

What do you want to reflect on? This should contain enough information to allow you to recall the event.

Why do you want to reflect on it?

What do you hope to get out of this reflection – how will it help you?

How have you been affected by this?

How will this affect your practice and make you a better doctor?

What are your overall conclusions from this episode? How do you feel about the reflection?

The Academy of the Royal Colleges has an excellent Reflective Toolkit which offers a range of reflective templates and examples of SCIs on which to reflect. https://www.aomrc.org.uk/wp-content/uploads/2018/09/Reflective_Practice_Toolkit_AoMRC_CoPMED_0818.pdf

HEE has also undertaken video interviews with senior clinicians reflecting on SCIs and trainees which offer perspective and advice.

This website is intended for healthcare professionals

• { $refs.search.focus(); })" aria-controls="searchpanel" :aria-expanded="open" class="hidden lg:inline-flex justify-end text-gray-800 hover:text-primary py-2 px-4 lg:px-0 items-center text-base font-medium"> Search

Search menu

Borton T: McGraw Hill; 1970

Broderick S, Cochrane RLondon: Radcliffe; 2012

Cacciatore J, Rådestad I, Frøen J Effects of contact with stillborn babies on maternal anxiety and depression. Birth. 2008; 35:(4)313-20

Cox E, Briggs S Disaster Nursing: new frontiers for critical care. Critical Care Nurse. 2004; 24:(3)16-22

Davies R New understandings of parental grief: Literature review. J Adv Nurs. 2004; 46:(5)506-13

Driscoll JLondon: Elsevier; 2007

Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Yee Khong T Stillbirths: the way forward in high-income countries. The Lancet. 2011; 377:(9778)1703-17

Gardosi J, Giddings S, Clifford S, Wood L, Francis A Association between reduced stillbirth rates in england and regional uptake of accreditation training in customised fetal growth assessment. BMJ Open. 2013; 3:(12)1-10

Gibbs GOxford: Oxford Further Education Unit; 1988

Gissler M, Alexander S, Macfarlane A, Small R, Stray-Pedersen B, Zeitlin J, Zimbeck M, Gangon A Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstetricia et Gynecologica Scandinavica. 2009; 88:(2)134-48

2010. http://uk-sands.org/sites/default/files/SANDS-BEREAVEMENT-CARE-REPORT-FINAL.pdf (accessed 21 March 2014)

Jasper M, Rosser M, Mooney GLondon: John Wiley & Sons; 2013

Kenworthy D, Kirkham MLondon: Radcliff; 2011

McDonald SD, Murphy K, Beyene J, Ohlsson A Perinatal outcomes of singleton pregnancies achieved by in vitro fertilization: a systematic review and meta-analysis. J Obstet Gynaecol Can. 2005; 27:(5)449-59

Mullan Z, Horton R Bringing stillbirths out of the shadows. The Lancet. 2011; 377:(9774)1291-2

London: NMC; 2008

London: NICE; 2007

O'Carroll M, Park ARJLondon: Elsevier; 2007

Reid B ‘But we're doing it Already!’ Exploring a response to the concept of reflective practice in order to improve its facilitation, 4th ed.. In: Bulman C, Schutz S Oxford: John Wiley and Sons; 1993

Säflund K, Sjögren B, Wredling R The role of caregivers after a stillbirth: views and experiences of parents. Birth. 2004; 31:(2)132-7

Statham H, Sobmou W, Green JM When a baby has an abnormality; a study of parents' experiences.Cambridge: University of Cambridge; 2001

Trulsson O, Radestad I The silent child—mothers' experiences before, during and after stillbirth. Birth. 2004; 31:(189)

Van Manen M Linking ways of knowing with ways of being practical. Curriculum Inquiry. 1977; 6:205-28

Stillbirth: A reflective case study

Sarah Stott

Midwife, Whiston Hospital, Liverpool

View articles

Stillbirth rates both in the UK and worldwide are extremely high. This reflective case study is centred on my first experience at caring for a bereaved couple who lost their baby boy, stillborn, at 27 weeks gestation. Whilst causes of stillbirth are often multi-factorial and unexplained, this reflection aims to explore how midwives can adopt simple measures to care for bereaved parents and how they can support themselves. Although research has focused on how improvements in research and training have contributed to a decline in stillbirth rates, this reflection also gives particular emphasis to the emotional aspects of bereavement care.

This reflective paper seeks to explore some of the issues surrounding bereavement care and the importance of sensitive and individualised care when dealing with bereaved parents. Reflection is a key concept of learning within the health and social care professions that allows us to look at our practice and understand it within the context in which it occurs ( O'Carroll and Park, 2007 ). Without reflection, midwifery care can become automatic, thereby disregarding the concept of individualised care, which is outlined in the Nursing and Midwifery Council (NMC) code of conduct (2008) . Reid (1993) described a process of reviewing experience under headings such as description, feelings, evaluation and analysis, which consequently informs and changes practice. A variety of reflective models currently exist, which involve this systematic process ( Van Manen, 1977 ; Gibbs, 1988 ; Driscoll, 2007 ). This reflective case study will adopt Borton's (1970) developmental framework, which incorporates all the core skills of reflection from these current models, yet its simplicity is useful for those inexperienced in undertaking deeper reflection ( Jasper et al, 2013 ). Through Borton's (1970) framework, the practitioner describes (what), analyses (so what) and synthesises (now what) their experience. All names have been changed to protect confidentiality, in accordance with NMC (2008) guidelines.

Amanda, a 43-year-old para 5 was admitted to hospital for medical induction of labour in view of a 27-week intrauterine fetal death. At handover for a late shift, I was asked whether I would be willing to care for Amanda, which would enable me to gain experience in this field. I had not had much exposure to bereavement care during my time as a student midwife, therefore I felt unprepared to deal with it. Instead, my training largely involved ‘catching’ babies so that I could be signed off as competent in facilitating ‘normal’ birth. Nevertheless, I reluctantly volunteered, meanwhile experiencing feelings of panic and anxiety. I had never dealt with such a situation before. What would I say? What if I said the wrong thing?

A stillbirth, as defined by the Stillbirth (Definition) Act 1992, section 1(1), is:

‘Any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life.’

Research has shown that almost 3 million babies worldwide are born stillborn every year ( Mullan and Horton, 2011 ). This means that every day, 11 sets of parents will suffer the pain and grief of having a stillborn baby. Despite cumulative advances in medical science and an ever developing health system ( Mullan and Horton, 2011 ), in the UK, the rate of unexplained stillbirths runs exceedingly higher, at approximately 1000 a year, than deaths from sudden infant death syndrome (SIDS), which is about 200 deaths per year ( Henley and Schott, 2010 ). Despite this wide variation, there appears to be little research conducted on why babies die unexpectedly in utero. It could be possible that the topic of stillbirth is often overlooked because of its profoundly emotive nature and complexity. While causes of stillbirth may be multifactorial, and sometimes unexplained, the highest associated modifiable factor is maternal obesity and overweight, comprising of a body mass index (BMI) above 25kg/m 2 ( Flenady et al, 2011 ).

Although a meta-analysis of 96 population-based studies by Gardosi et al (2013) observed an association between nulliparity and stillbirth, they also found a 60% increase in stillbirth risk for mothers with a parity equal to 3 or above. Gardosi and colleagues found no significant increase in the risk of stillbirth with older maternal age, however, it could be argued that this correlation was not found because congenital anomalies were excluded, which are known to be increased in older mothers. It could be argued that women of advanced childbearing age are more likely to experience infertility, therefore they may rely heavily on artificial reproductive techniques, however, the link between these and stillbirth risk is unknown ( McDonald et al, 2005 ). Substantial variations in stillbirth rates have also been found in relation to social status and ethnicity ( Gissler et al, 2009 ). This may be a result of poor accessibility to care, as well as language and cultural barriers from disadvantaged groups.

Stillbirth rates in the UK are among the highest in high income countries ( Flenady et al, 2011 ). Around one baby, out of every 200, at 22 weeks' gestation or more is stillborn. The reason for this rate remains unexplained, although a lack of awareness among health professionals has shown to be a large contributory factor ( Mullan and Horton, 2011 ). The care that families receive during this time is extremely important, yet it is influenced to a large extent by knowledge and education and the midwives' ability to provide individualised care. An analysis of mortality data collated between 2007 and 2012, found that a high uptake of accreditation training and evidence-based protocols in customised fetal growth assessment, contributed to a steep decline in stillbirth rates ( Gardosi et al, 2013 ). Nevertheless, while this is the gold standard for most midwives, it is difficult to implement when faced with a rising birth rate, increased case complexity and minimal staffing, as well as a disparity of training and local restrictions imposed by financial constraints ( Henley and Schott, 2010 ). A survey of 77 maternity units found that regular training in bereavement care was only present in less than half of the units and that, in the majority of these units, training was only optional because of pressures on staff time, training costs and the sensitivity of the subject matter ( Henley and Schott, 2010 ). Despite this, midwives are still expected to interact supportively with bereaved parents ( Cox and Briggs, 2004 ).

Specialist bereavement midwives play an invaluable role in supporting both parents and staff, however, the specialist midwife in our unit was off duty for this particular shift. Therefore, my role as a midwife was crucial in supporting and advocating for Amanda and her partner John. Luckily, as it was a quiet shift, I had the support of my shift leader who has many years of experience in bereavement care.

I first obtained an in-depth handover from the midwife who had been caring for Amanda, before I introduced myself to her and her partner, John. I was informed that a scan 3 days previously had shown a hydropic fetus with a large bowel atresia and an absent fetal heart. Shortly after, I went to see Amanda who was being cared for in one of our specialist bereavement rooms at the far end of the labour ward. The provision of these dedicated rooms has a fundamental impact on couples' experiences ( Henley and Schott, 2010 ). During introductions, my palms began to sweat and my heart beat faster as I struggled to choose the right words to say. Did I need to say anything? I had this feeling in the forefront of my mind that nothing I said could make them feel better, but that saying the wrong thing could have a massive impact on their emotional wellbeing and subsequent mental health. Having a stillborn baby has been associated with an increase in anxiety, depression, suicidal ideation, as well as substance use and marital conflict, which can persist for many years ( Cacciatore et al, 2008 ). Consequently, I felt helpless, unable to offer any form of comfort. Säflund et al (2004) found that midwives felt the need to distance themselves from bereaved parents because they felt unable to deal with the enormity of the parent's feelings of loss. I was so used to caring for women with healthy, term pregnancies and, having been present at well over a hundred births, the expected and automatic cry of a healthy baby. In healthy pregnancies and births, I would speak with couples about parenting, feeding and tending to their babies, and their expectations, yet in bereaved parents these conversations do not exist. Instead I was caring for a woman and her partner who were submerged in grief and sorrow, these parents may experience feelings of guilt as a result of the expectation of a healthy baby. They will not feel the same excitement, joy and euphoria of bringing a new life into the world.

One concern I had was the documentation, which is ever increasing due to prospect of litigation. Failure to fill in the correct form, or sending it to the wrong place will lead to an official reprimand or managerial intervention, and this presents as a genuine fear ( Kenworthy and Kirkham, 2011 ). There are forms to be filled out surrounding the birth as well as the stillbirth certificate that is a statutory obligation after 24 weeks' gestation ( Henley and Schott, 2010 ). It is understandable that feelings of anxiety and stress can impact on the accidental omission of essential paperwork ( Kenworthy and Kirkham, 2011 ). There is information that is only collected by obtaining tissue samples, such as those for cytogenics investigation, as well as a need to prepare the baby for viewing and organising mementos. I feel strongly that had I not had support from my colleagues, the burden of the documentation would have impacted negatively on my provision of care to Amanda and John. This is disconcerting at a time when we may need to console the woman and her family and provide extra support.

Throughout the shift, my priorities were to manage Amanda's pain and monitor both her vital signs and loss per vaginum, following 3-hourly administration of oral misoprostol. Following the second dose, she began to experience abdominal cramps which were somewhat relieved with intramuscular diamorphine, yet as the shift progressed her pain became more intense with increased regularity, and so she began to use Entonox frequently. I anticipated a quick birth due to Amanda's parity and previous precipitate labours, yet I did not say much, I felt like I did not need to. I mopped her brow, gave her sips of water and held her hand. This sensitive support is the most poignant aspect of bereavement care, forming many of the memories that parents will take home with them ( Henley and Schott, 2010 ). Towards the end of the shift, she ruptured her membranes and sighed in relief, expressing gratitude, thinking the worst was over. The whole situation felt so unjust, why should she be thanking us. I felt as though she was being punished in some way; questioning why she should have to endure labour with no joy or happiness at the end. With the next contraction, tears rolled down both her cheeks as the reality of the situation took hold of her. I felt so unprepared to deal with the situation, so vulnerable, but I could not let it show. I knew the upset I was feeling was so minor in comparison. Shortly after she birthed her baby. He was so peaceful and content, so still. His tiny fingers and toes, his bottom lip curled under like he too felt the sadness both his mother and father were experiencing. I gently wrapped him in a towel before asking Amanda and John whether they would like to see and hold him.

Parents often regard holding and seeing their baby as one of their most important memories and Statham et al (2001) found that, of 104 women interviewed, 81% felt they made the right decision to hold their stillborn baby. A further study on over 2000 women, found that fewer anxiety and depressive symptoms resulted if women were able to see and hold their babies following a singleton stillbirth after 20 weeks' gestation ( Cacciatore et al, 2008 ). To separate newly bereaved mothers from their dead babies in order to relieve them of the burden of holding and seeing their baby and taking any responsibility for them was the cultural norm in Britain until relatively recently (Broderick and Cochrane, 2013). We now see the error in this reasoning and know that women and their partners value this time to spend with their babies ( Statham 2001 ; Broderick and Cochrane, 2013). It has been argued that giving parents the opportunity to see and hold their stillborn baby can reduce the risk of depression and anxiety resulting from the traumatic experience (Hughes et al, 2001). Conversely, Statham (2001) found that 50% of women who chose not to hold their baby also felt they had made the right decision, whilst Trulsson and Radestad (2004) argue that forcing parents to see and hold their stillborn baby has potential to increase the risk of negative psychiatric sequelae. It is therefore important that women and their partners are treated as individuals and given the correct information to help them make informed choices—a recommendation further supported by the National Institute for Health and Care Excellence (NICE) (2007) .

‘Giving parents the opportunity to see and hold their stillborn baby can reduce the risk of depression and anxiety resulting from the traumatic experience’

Amanda was reluctant to hold her baby initially as she began to process the situation. Instead John took hold of him and closely studied his baby from head to toe. He then gradually revealed his hands and feet to Amanda before gently placing him in her arms. It was nothing a textbook could prepare you for, those shivers you feel down your spine as well as the lump in your throat as you hear a mothers' grieving sob, or the haunting silence that no guideline or policy talks about. It felt as though the world had come to a standstill. I gently took a step back to allow Amanda and John the precious time with their baby boy.

While caring for Amanda initially brought feelings of anguish and worry, I feel that it was a positive act that enabled me to confront my fears surrounding bereavement and pregnancy loss. Despite the distressing nature of the experience, the opportunity has helped me to develop my midwifery practice in order to incorporate aspects that are imperative to bereavement care. Women are coming into hospital, usually the labour ward, where there are babies and new mothers surrounding them, therefore it is important for us as professionals to prepare ourselves for the myriad of reactions that women and their families will present following pregnancy loss.

There is also an element of self-care that is not widely discussed in midwifery literature. It involves acknowledging that women should not be left alone to grieve, but also balancing this with the appreciation of the emotional burden to the midwife that is offering their support ( Kenworthy and Kirkham, 2011 ). Although some consider bereavement care as ‘part of the job’, midwives, irrespective of their professional status, will carry personal and undoubtedly painful experiences of bereavement themselves, which means support between colleagues is fundamental in order to make a positive difference to the care that women receive, and also to reduce feelings of isolation. This support may simply involve a 10-minute debrief in the midwives office, or an in-depth reflection, both of which I feel impacted positively on my ability to care for Amanda throughout this experience.

Through non-verbal communication, midwives can take cues from individual women and respond accordingly. Simply gauging women on an individual basis and bearing in mind that some will want to talk and others simply want a shoulder to cry on or a hand to hold. Furthermore, a ‘memory box’ made up of various mementos, such as hospital bands, a measuring tape, knitted blanket and photos may be offered. While some research has suggested these are unhelpful in helping parents to feel resolution following bereavement, Davies (2004) argues that they can be beneficial.

It is important to be honest and open with women in a sensitive manner without undermining their wishes or beliefs. She will remember her midwife and although she may feel that her midwife has dealt with many of women in her position, she should feel that every effort is being made to meet her individual needs. This could be achieved, in part, by referring to her baby by their name or sex, acknowledging them as a being, thus making it personal to that woman and her family. But most importantly of all, it involves being empathetic and compassionate. Simply, just letting them know you are there without having to say a word.

Conclusions

This reflective case study is centred on my experience as a midwife at caring for Amanda, and her partner John, following a stillbirth at 27 weeks' gestation. It focuses on the emotional aspects of care that are often overlooked, which during bereavement take precedent over the physical skills we easily take for granted. It highlights simple measures that can be adopted to support bereaved parents, while at the same time supporting colleagues. Stillbirth should not be a taboo subject, considering rates, both in the UK and worldwide, are at alarming levels. While a number of stillbirths are unpredictable and therefore unavoidable, pregnancy supervision for those women at risk should be increased and improvements in research and training considered. This is as well as acknowledging the importance of individualised care, sensitive communication and advocacy, all of which are fundamental principles which we are bound to by the NMC Code (2008) .

‘There is a collective myth… that getting pregnant, staying pregnant, giving birth to a live baby… is simple, despite clear evidence that this is not the case’