Pregnancy and neonatal loss (including miscarriage, stillbirth, termination for fetal abnormality and neonatal death) affects a substantial proportion of pregnancies in the UK. While patient impacts are well described, comparatively less is known about the experiences and support needs of NHS staff who provide care during these events. Evidence associates repeated exposure to loss with emotional distress, burnout, compassion fatigue and reduced job satisfaction, especially in high-stress settings such as neonatal intensive care.
The study aimed to explore four linked areas among NHS staff: experiences of exposure to pregnancy and neonatal loss; perceptions of support available; support previously used; and support needed or wanted.
A qualitative reflective thematic analysis was used. Semi-structured individual interviews were conducted online with staff from a single large UK NHS Trust that provides maternity, gynaecology, fetal medicine, neonatal and ultrasound services across two hospital sites. The Trust conducts around 5,000 deliveries annually and serves areas with high clinical complexity and socio-economic deprivation, increasing the likelihood of staff encountering pregnancy and neonatal loss.
Staff eligible to participate were over 18 and had role-related interactions with patients experiencing pregnancy or neonatal loss. Recruitment ran from July 20, 2025 to February 9, 2026 using trust-wide emails and posters. Purposive sampling sought a diverse mix of clinical, allied and support staff. In total, 20 staff members from relevant departments were interviewed over an eight-month period. Sampling and topic guide prompts were iteratively refined as themes emerged, with additional allied staff recruited to ensure representation.
Interviews were conducted online (MS Teams) by a research associate with health research and midwifery experience. Participants provided verbal informed consent, which was audio-recorded at the start of each interview. Interviews were audio-recorded, professionally transcribed verbatim and anonymised. NVivo software supported data management and thematic analysis. Reporting followed the Standards for Reporting Qualitative Research (SRQR).
Analysis produced six primary themes mapped to the study aims:
Nobody prepared me for this: Many participants, particularly junior, allied and support staff, reported feeling underprepared for the emotional and communication demands of caring for patients experiencing loss.
Reaching a tipping point: Staff described cumulative exposure to loss leading to a point where personal resilience and coping capacity were compromised.
Peer support versus inconsistent organisational support: Peer support emerged as the most accessible and reliable resource. Organisational supports (for example debriefing, supervision or formal mental health services) were valued but inconsistently available and often underused.
Reliance on informal support networks: Informal networks—colleagues, friendships and family—were commonly relied upon, especially by those with less access to formal supports.
Bereavement team and multidisciplinary buffer: Where bereavement teams and multidisciplinary input were available and integrated, participants reported these mitigating some of the stressful effects of loss.
One size does not fit all: Participants highlighted diverse needs across roles and individual circumstances, stressing that support should be tailored rather than generic.
Exposure to pregnancy and neonatal loss varied in type, frequency and intensity across roles. The study reports that junior, allied (for example sonographers, theatre staff) and non-clinical support staff (for example administrators) frequently felt less prepared and less able to access formal support pathways than senior clinical staff. Staff working in high-intensity areas such as neonatal units or fetal medicine described particular vulnerability to cumulative stress.
Participants’ accounts indicate that while staff value organisational support in principle, practical barriers and inconsistent provision limit uptake. The prominence and accessibility of peer support suggests any organisational plan should recognise and strengthen peer-based resources while also ensuring visible, equitable access to formal services. The authors argue for a proactive, multidisciplinary approach offering role-sensitive training, preparation, and a menu of support options tailored to diverse needs rather than a single standard intervention.
Ethical approval was obtained from the NHS Health Research Authority Research Ethics Committee and the University of Bristol Faculty of Health Sciences Research Ethics Committee. The qualitative datasets (full transcripts) are not publicly available because of confidentiality and the risk of deductive disclosure in a single-organisation sample; anonymised excerpts may be considered on reasonable request via the University of Bristol Research Governance Team. Funding was provided by the Bristol and Weston Hospitals Charity and supported by NIHR ARC West and the NIHR HPRU in Evaluation and Behavioural Science. The authors declare no competing interests.
The study finds that emotional demands from repeated exposure to pregnancy and neonatal loss are inconsistently supported within the NHS trust studied. A cumulative “tipping point” was described where coping capacity becomes overwhelmed. Junior, allied and support staff were particularly likely to report under-preparedness and unequal access to support. The authors recommend a visible, proactive, multidisciplinary and tailored system of support to meet diverse staff needs. Data-sharing restrictions and specific operational details were described in the source; additional quantitative measures of prevalence or effectiveness of specific interventions were not reported in the article.