---
title: "Mental health support needs of NHS staff after patient pregnancy and neonatal loss: qualitative fi"
id: "plos-one-22-examining-the-mental-health-support-needs-of-nhs-staff-exposed-to-patient"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-22-examining-the-mental-health-support-needs-of-nhs-staff-exposed-to-patient"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358321"
published_at: "2026-09-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Mental health support needs of NHS staff after patient pregnancy and neonatal loss: qualitative fi
## Provenance & Clinical Metadata
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- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358321)
- **Published At:** 2026-09-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative study explored how 20 NHS clinical, allied, and non-clinical staff experienced exposure to **pregnancy and neonatal loss** and what support they perceived, used, or wanted. - Semi-structured online interviews were conducted with purposively sampled staff from a single large UK NHS Trust providing maternity, fetal medicine and neonatal services across two sites (≈5,000 deliveries/year). Interviews were audio-recorded, transcribed verbatim and analysed using reflective thematic analysis. - Six themes emerged: (1) staff felt **unprepared** for the emotional and communication challenges of loss; (2) cumulative exposure could lead to a **tipping point** where resilience was overwhelmed; (3) **peer support** was accessible and valued but organisational support was inconsistent and underused; (4) reliance on informal support networks was common, especially among junior, allied and support staff; (5) bereavement teams and multidisciplinary input could buffer stress; (6) a “one size does not fit all” conclusion emphasising the need for tailored, visible and equitable support. - Exposure varied by role in type, frequency and intensity; junior, allied and support staff often reported lower levels of preparation and less access to formal support. - The authors conclude a proactive, multidisciplinary approach is required to provide visible, equitable, and role-sensitive mental health support for staff exposed to patient pregnancy and neonatal loss. - Ethical approvals were obtained; data are not publicly available due to confidentiality, though anonymised excerpts may be requested through the University of Bristol. Funding sources included the Bristol and Weston Hospitals Charity and NIHR ARC West; authors report no competing interests.
## Clinical Analysis & Structured Key Points
Examining the mental health support needs of NHS staff exposed to patient pregnancy and neonatal loss: A qualitative study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Background Pregnancy and neonatal loss, including miscarriage, stillbirth, termination for fetal abnormality, and neonatal death, affects a substantial proportion of pregnancies in the UK. Although the impact on patients is well documented, less attention has been paid to the experiences of NHS staff providing care during these events. Study aims To explore staff experiences of exposure to pregnancy and neonatal loss, perceptions of available support, support previously used, and needed or wanted. Methods This qualitative study used a reflective thematic approach. Semi-structured interviewed were conducted with 20 purposefully sampled clinical, allied and non-clinical staff from a single UK NHS trust. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using thematic analysis, with themes mapped to the study aims. Results: Six themes were identified: (1) nobody prepared me for this (2) reaching a tipping point; (3) peer support versus inconsistent organisational support; (4) reliance on informal support networks; (5) bereavement team and multi-disciplinary support buffer the stressful effects of loss; and (6) one size does not fit all. Exposure varied in type, frequency, and intensity across roles. Many staff, particularly junior, allied and support staff, felt underprepared for the emotional and communication challenges of pregnancy and neonatal loss. Participants described reaching a “tipping point” where resilience was compromised. Peer support was the most accessible and reliable resource, whereas organisational support was underused despite being valued. Conclusion The emotional demands experienced by NHS staff are inconsistently supported. Findings highlight a “tipping point” where cumulative exposure to pregnancy and neonatal loss can overwhelm coping capacity, particularly among staff in junior, allied and support roles who often report lower levels of preparation and access to formal support. A proactive multi-disciplinary approach is needed to provide visible and equitable support tailored to diverse staff needs. Citation: Johnson D, Newell S, Family H, Holland M, Westby M, Franks E, et al. (2026) Examining the mental health support needs of NHS staff exposed to patient pregnancy and neonatal loss: A qualitative study. PLoS One 21(9): e0358321. https://doi.org/10.1371/journal.pone.0358321 Editor: Dorothy Serwaa Boakye, University of Education Winneba Faculty of Science Education, GHANA Received: April 14, 2026; Accepted: August 27, 2026; Published: September 17, 2026 Copyright: © 2026 Johnson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The qualitative datasets generated and analysed during the current study are not publicly available due to ethical restrictions and participant confidentiality. The dataset comprises in-depth interview transcripts from a single NHS organisation with a small and identifiable workforce, meaning that even anonymised data carry a risk of deductive disclosure. Therefore, full data sharing is restricted. Requests for access to anonymised excerpts may be considered on reasonable request, subject to appropriate governance approvals. Data access requests should be directed to the University of Bristol Research Governance Team ( research-governance@bristol.ac.uk ), which is the study sponsor. Requests will be considered in line with applicable ethical approvals, participant consent, and institutional data governance procedures. Funding: This research was funded by the Bristol and Weston Hospitals Charity (BWHC-2024-01) and supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), the NIHR Health Protection Research Unit (HPRU) in Evaluation and Behavioural Science (EBS) at the University of Bristol in partnership with the UK Health Security Agency (UKHSA). The views expressed in this article are those of the authors and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: No authors have competing interests. Introduction Pregnancy and neonatal loss, encompassing miscarriage, stillbirth, termination for fetal abnormality, and neonatal death, affects a substantial proportion of pregnancies in the United Kingdom (UK). Miscarriage alone is estimated to occur in one in four recognised pregnancies, while around 1 in 250 births results in stillbirth and thousands of families each year experience neonatal death or termination for fetal abnormality [ 1 ]. Although the impact on patients is well-documented [ 2 , 3 ], less attention has been given to the experiences of National Health Service (NHS) clinical (e.g., nurses, midwives, obstetricians, gynaecologists) allied (e.g., sonographers, theatre) and support staff (e.g., administrators) who provide care during these events [ 4 – 7 ]. A wide range of staff working in Obstetrics and Gynaecology (O&G), encounter pregnancy and neonatal loss as part of their day-to-day work. Such exposure has been associated with emotional distress, burnout, compassion fatigue, perceived professional failure, reduced job satisfaction and staff absence. Staff working in high-stress settings, such as Neonatal Intensive Care Units (NICUs) may be particularly vulnerable [ 8 – 10 ]. The relational nature of perinatal care, combined with repeated or unsupported exposure to loss, may heighten the risk of psychological trauma and secondary traumatic stress, especially for those with personal experiences of loss [ 11 – 14 ]. In the UK, supporting the mental health of NHS staff is highlighted in several national and regional policy initiatives. The NHS staff survey [ 15 ] and the Bristol, North Somerset, South Gloucestershire (BNSSG) mental health and wellbeing strategy [ 16 ] identify stress, anxiety, and depression as key contributors to staff sickness absence. Similarly, the Royal College of Midwives ‘Caring for You’ campaign highlights the need for improved mental health support for maternity staff [ 17 ]. Evidence also points to the value of targeted education, training and emotional support for staff [ 18 ]. Despite this, research on staff experiences remains limited, with much of the existing evidence focusing on clinical staff. Little attention has been given to allied and non-clinical staff who also encounter patient pregnancy and neonatal loss. Furthermore, there is a lack of research examining the availability and effectiveness of organisational support. While support interventions such as debriefing, supervision and peer support exist, their availability and effectiveness remain inconsistent [ 19 ]. Consequently, further research is needed to examine mental health support needs, and to determine what support is most beneficial. This study aimed to examine: 1) experiences of exposure to pregnancy and neonatal loss; 2) perceived support available; 3) support previously used; and 4) support needed or wanted Materials and methods Design and setting This qualitative study used a reflective thematic analysis approach to explore staff experiences of pregnancy and neonatal loss. Semi-structured individual interviews were carried out with staff working in a large NHS Trust in the UK. The Trust provides maternity, gynaecological, fetal medicine, neonatal and ultrasound services across two hospital sites and conducts around 5000 deliveries annually. It also provides tertiary maternal and fetal medicine care for patients across some of the most socio-economically deprived areas in England. This means that staff frequently provide complex, high-risk maternity and neonatal care and may be more likely to come across pregnancy and neonatal loss. Participants and sampling Healthcare professionals, allied and support staff were eligible to participate if they were over 18 years of age and had interactions with patients experiencing pregnancy and neonatal loss as part of their role. A recruitment email was sent to all staff in relevant departments and recruitment posters were placed in staff areas from 20.07.2025 to 09.02.2026. Prospective participants could register their interest by completing a short online questionnaire or by contacting the research team directly. Purposive sampling was used to arrange interviews with a diverse group of staff across departments and employment roles. Interviews took place across eight months to enable an iterative approach to each interview allowing both revision of the topic guide and further sampling of participants. As data collection progressed, emerging findings also informed decisions about recruitment, with additional staff groups identified as important to include in order to further explore developing themes and ensure adequate representation across relevant roles. For example, later interviews prompted further sampling of allied staff and refinement of interview prompts to explore areas such as preparedness and access to informal support in greater depth. Given the remote interview format participants were asked to provided verbal informed consent prior to participation, which was approved by the National Health Service, Health Research Authority, Research Ethics Committee (25/HRA/2520 IRAS: 357165) and the University of Bristol Faculty of Health Sciences Research Ethics Committee (FREC) (REF: 25063), Participants were sent a participant information sheet in advance of the interview and had the opportunity to ask questions before consent was obtained. Verbal consent was obtained by DJ at the start of each interview and was audio-recorded as part of the interview recording, thereby providing a documented record of consent. Consent recordings were stored securely on encrypted institutional servers, separately from anonymised interview data. Participants were reimbursed with a shopping voucher as a thank you for their time. The reporting of this study was guided by the Standards for Reporting Qualitative Research (SRQR). The completed SRQR checklist is provided as Supporting Information ( S1 Checklist ). Semi-structured interviews Interviews were carried out online (MS Teams) by DJ (a research associate with a background in health research including topics related to pregnancy, breastfeeding and perinatal mental health in addition to previous midwifery experience). A flexible topic guide, informed by the aims of the study, was developed and adapted appropriately for the participant’s job role. Reflexive consideration was given to how DJs positioning may have influenced participant responses and interview dynamics. Data management and analysis Interviews were audio recorded and transcribed verbatim by a professional transcription service. NVivo software (QSR International Pty Ltd.,) was used to manage and analyse data using thematic analysis [ 20 ] following an iterative interpretive and reflexive approach. Transcripts were read several times for familiarisation, and initial codes were generated inductively by DJ to capture meaningful features of the data. CH (a behavioural scientist with expertise in sexual and reproductive health) independently read and coded a substantial proportion of the transcripts, contributing alternative interpretations, supporting reflexivity and the development of a richer, more nuanced analysis. Throughout the analysis, DJ and CH regularly met with SN (Consultant Obstetrician and Subspecialist in Fetal/Maternal Medicine), MH (Lead Neonatal Nurse for Bereavement), HF (Psychologist and Behavioural Scientist with expertise in qualitative research) to reflect on assumptions and discuss analytic decisions while considering how differing perspectives and backgrounds may have shaped interpretation of the data. Sub-themes were developed iteratively through close engagement with the dataset and were generated from patterns identified across participant accounts rather than being predetermined by the study aims. Subthemes were further refined and organised into broader overarching themes. Deviating from Braun and Clarke’s approach to reporting findings the themes were organised in relation to the aims of the research to support coherent presentation and interpretation of the findings which are intended to inform future intervention development. Results Recruitment outcome A total of 49 staff members volunteered to be interviewed with 20 purposefully recruited to participate in the interviews. Interviews lasted between 42 and 84 minutes. Interviewees included: Doctors (Consultants, Residents and rotational) from O&G, Fetal Medicine Unit (FMU) and NICU (n = 5); Nurses and Nursing Assistants (Bands 3, 6 & 7) from Early Pregnancy Clinic (EPC), Gynaecology, and NICU(n = 6); Operating Theatre staff (n = 2) Sonographers (n = 2); Administration staff (n = 1) and Midwives (bands 5, 6 and 7) from continuity of carer team / rotational staff and Delivery Suite (n = 4). Exposure to loss The type, frequency and intensity of exposure to patient pregnancy and neonatal loss varied by job role and department (see S1 Table ). Staff working in Gynaecology, Sonography and FMU reported frequent exposure to early pregnancy loss, often managing multiple cases daily. In contrast, late-gestation or neonatal loss occurred less frequently and the larger midwifery workforce in the Delivery Suite enabled more careful allocation of cases to minimise repeated exposure. Midwives also appeared to have more flexibility to ‘opt out’ of caring for patients experiencing a loss. In comparison, sonographers and doctors across all grades reported greater and more frequent exposure to a wide range of pregnancy and neonatal loss scenarios, where their roles can involve direct management of more complex cases, terminations for fetal abnormalities and occasionally, feticide. The smaller number of medical staff also reported limited opportunities to step back from such cases, even when individuals feel emotionally overwhelmed, resulting in fewer opportunities to mitigate the cumulative burden. Six themes, each with a set of sub-themes, were generated and have been synthesised narratively below according to the aims of the research: 1) Experiences of exposure to patient pregnancy loss, 2) perceived support available, 3) support previously used, and 4) support needed or wanted. Illustrative quotations are provided. Within illustrative quotations the use of […] indicates part of the quotation was not presented because it was not relevant, whereas (text) indicates additional text added for clarity. Quotes are followed by participant identifier and number. To protect anonymity, we have categorised doctors, midwives and nurses as ‘clinical’, sonographers and theatre staff as ‘allied staff’, and nursing/theatre assistants and administrators as ‘support staff’. Experiences of exposure to patient pregnancy and neonatal loss Theme 1. Nobody prepared me for this: staff across roles described exposure to pregnancy and neonatal loss as ‘stand-alone’, distinct from other clinical trauma. 1.1. Missed opportunities: Introductory training was often brief, general and insufficiently tailored to preparing staff for the emotional, and communicative challenges they might encounter. Junior medical, allied and support staff members in particular described feeling underprepared and highlighted missed opportunities during recruitment and induction processes that could be used to alert them to, and discuss, the potentially distressing nature of loss related care. Although medical, nursing and midwifery staff described having built up resilience through their professional experience others found the lack of preparation daunting and expressed a need for improved introductory and ongoing training that began earlier in the employment process to prepare them for the specific emotional demands and communication needs of pregnancy and neonatal loss: “So, yeah – I do feel like maybe you should be briefed – when you’re first coming into the job (on Gynaecology ward/dealing with terminations & miscarriages)– that, this is what you can see – and the babies can be moving – and they can still be alive” (108 Support staff) 1.2. Emotional unpreparedness: Inadequate job preparation also led many staff to report a lack of emotional preparation for loss related care, with some describing having to find their own way when encountering bereavement care for the first time: “W e’ve never had any training on how to, for us to cope or how to help the patients themselves manage that situation you know, and we just have to try and find our way” (111 Allied staff) 1.3. Training disparity: S ome HCPs benefitted from training. However, formal preparation to manage pregnancy and neonatal loss varied both across and within staff groups with some reporting their learning was through experience only: “I think sometimes you just have to deal with it there and then and just if that happens and there’s no one else to deal with it, you just have to get on and do the job and then kind of process what you had to do afterwards” (120 Clinical staff) Theme 2. Reaching a tipping point: Pregnancy and neonatal loss was found to be emotionally challenging for all staff. Long, intensive shifts with little or no time at work to process their experiences and decompress, exacerbated emotional distress and reduced resilience. 2.1 Cumulative exposure: Staff described difficulty recovering between distressing cases and described emotional overload following shifts involving cumulative exposure to pregnancy and neonatal loss: “ I had three shifts in a row where I had FMU patients (losing their babies) that affected me because it was just continuous ” (113 Clinical staff) “When they’ve had a morning like that where everybody has lost their baby […] it’s very difficult to switch off” (101 Allied staff) 2.2. Personal loss: Emotional distress was further intensified for staff navigating their own pregnancy, fertility issues or having experienced their own pregnancy or neonatal loss: “There was a lot that was really hard to navigate, for example, being pregnant and having a visible bump and then going and looking after women or telling them that they had lost their child” (116_Clinical staff). “Somebody triggered me talking about that they buried their... I wasn’t allowed to bury my baby because my baby was only 16 weeks, and so at that point it wasn’t recognised, and […] I found that really triggering. So you don’t know what’s going to trigger you if you’ve been through loss yourself and then you come back into work too quickly” (101, Allied staff) 2.3 Resilience: Although staff described developing professional resilience to patient pregnancy and neonatal loss, nearly all described moments where the cumulative burden of exposure reached a “tipping point” where resilience felt compromised. At these times, their usual coping strategies felt insufficient, and they needed a break or extra support. Senior staff with greater experience in obstetrics, gynaecology and neonatal care, although reporting a greater sense of resilience, highlighted cumulative emotional fatigue that developed over years of repeated exposure or exposure to particularly distressing cases, such as unexpected late-gestation losses or complex fetal conditions and the impact it could have for their resilience: “I h
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