Knowledge, practices, and emotional experiences of Italian midwives and healthcare professionals in termination of pregnancy for fetal anomaly: The RESPeC-ToP Study

INTRODUCTION Termination of pregnancy for fetal anomaly is associated with profound psychological distress for parents and can be emotionally demanding for healthcare professionals. Evidence on professionals' knowledge, practices, and support needs in Italy remains limited. We aimed to examine Italian healthcare professionals' knowledge of legal aspects, bereavement care practices, and emotional experiences related to care in the context of termination of pregnancy (ToP) for fetal anomaly, and to explore factors associated with supportive behaviors. METHODS A cross-sectional web-based survey was conducted among healthcare professionals between September 2022 and December 2023. The survey included sociodemographic and professional characteristics, knowledge of Italian law, bereavement care practices, and professionals' emotional experiences. RESULTS A total of 552 respondents participated of which 84.8% were midwives; 99.4% correctly identified when termination of pregnancy can be performed, while 19.5% were aware that no legally fixed gestational threshold exists; younger and less experienced respondents showed lower levels of legal knowledge (p<0.001). Feelings of inadequacy were reported by 51.4% of respondents, and 71.2% reported the need for debriefing after assisting with a termination of pregnancy. The presence of a shared emotional support protocol was significantly associated with supportive behaviors (p≤0.003). Routine use of memory boxes was reported by 53.0% of respondents, whereas follow-up care was least consistently ensured (37.4%); 97.2% recognized the need for lactation management after termination of pregnancy for fetal anomaly. CONCLUSIONS The RESPeC-ToP Study highlights gaps in legal knowledge and uneven implementation of key bereavement care components. Training and shared emotional support protocols emerge as actionable strategies to standardize supportive practices and strengthen both quality of care and staff support within maternity services.