Adherence to Stillbirth Guidelines and Women's Psychological Well-Being: The CLASS (CiaoLApo Stillbirth Support) Cross-Sectional Study

Background: The psychological impact of stillbirth on parents is profound, increasing the need for respectful care. Despite the existence of international guidelines, there has been no clinical confirmation of their efficacy in improving parental mental health outcomes. Methods: This study is a web-based cross-sectional study and part of the OPALE (Observatory on PerinatAL hEalth) project. Participants were selected if they suffered a pregnancy loss after 20 weeks (including termination of pregnancy for medical reasons) in the last 10 years. The survey includes: the CiaoLapo Stillbirth Support (CLASS) checklist, the Perinatal Grief Scale (PGS), the National Stressful Events Survey PTSD Short Scale (NSESSS), and questions on satisfaction with care. Results: 261 participants completed the survey. In a multivariate analysis, higher CLASS scores were correlated with lower PGS and NSESSS scores, suggesting a direct relationship between guideline adherence and better psychological outcomes. Specifically, satisfying over 40 of the 60 checklist items independently predicted greater care satisfaction (OR 2.0, CI 1.1–3.8), higher experiences of respectful care (OR 3.6, CI 1.9–7.0), lower grief (OR 0.08, CI 0.1–0.2), and reduced PTSD symptoms (OR 0.21, CI 0.1–0.5). Conclusions: This is the first study which identifies a correlation between adherence to stillbirth care guidelines and better psychological outcomes, indicating their importance in enhancing parents' mental health.