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61 Maternity and Obstetrics T he vast majority of babies at the NMH are born healthy and well, but we are acutely aware of the great tragedy that is the death of a baby, whatever the circumstance. Over the past number of years, we have been working to develop a comprehensive holistic service for bereaved families attending the National Maternity Hospital. The Bereavement Midwives at care for women who experience 1st trimester loss, stillbirth or neonatal death and couples who have Medical Termination of Pregnancy in the case of life limiting conditions or maternal interest. Central to the running of the service are the Clinical Midwife Specialists (CMS) in Bereavement, Brenda Casey, Sarah Cullen and Debbie Tarleton Bereavement Midwife (CMM1) who co-ordinate bereavement care for women, their partners and families. Arrangements are made for follow-up in specialised miscarriage and stillbirth clinics which are run by the Bereavement Midwives, senior medical personnel, special interest nurses and midwives. There are four bereavement clinics: Dr Stephen Carroll met with 27 couples in the Stillbirth Clinic in 2020. 28 couples attended the late miscarriage clinic with Dr Cathy Allen. Follow up was also arranged with individual consultants for a further 47 couples with a significant amount of time invested in organising time frames for those that require joint obstetric and paediatric appointments.The recurrent miscarriage clinic remains busy with a high demand for appointments. 89 women attended the recurrent miscarriage clinic . A new Preterm Bereavement Clinic was set up facilitated by Dr Siobhan Corcoran and the Bereavement CMS. 17 couples were counselled following the death of their baby following a preterm birth with a clear and comprehensive plan put in place for future pregnancies. A new clinic, facilitated by Dr Cathy Allen, was launched in July to provide extra support in the 1st trimester to women who are pregnant following recurrent miscarriages. The psychological impact of pregnancy following multiple loss requires special care; 53 women have attended so far. Women value the additional reassurance and psychological support. Clinics provide an opportunity to ascertain how parents are coping with grief and loss and if further support is required. Women are counselled and medical information, obtained through investigations including Bereavement haematological, microbiological, sonographic, radiological and histology is shared. The MRI scanner at the Hospital assists in this specialised area and images are reviewed by Dr Gabrielle Colleran. Clinics are supported by Consultant Pathologists Drs Paul Downey and Eoghan Mooney, who provide valuable information through postmortem examination. Dr Willie Reardon, Consultant Geneticist, provides expertise and sees couples in those cases where genetic assessment is required. COVID-19 has impacted on how clinics are facilitated: Dr Allen's miscarriage clinics are telephone consultations which have been well received by women and their partners. Our face-to- face counselling support service had to be suspended due to COVID-19, however telephone support is provided for women and couples by request. The Miscarriage Support Group commenced monthly meetings in January with positive feedback. The group is currently held monthly virtually due to restrictions. This initiative is the first midwifery led, hospital based support group in the country. The Bereavement Midwives arrange all hospital burials in the Holy Angels plot in Glasnevin Cemetery. Burials were organized for 68 babies following early or mid-trimester miscarriage. We believe time invested in preparing babies for burial with respect and dignity is one of the most important aspects of our work. The Annual Remembrance Service has grown to be a large event with some 1,000 people attending annually. It is a most important day in our hospital calendar. COVID-19 restrictions impacted on the service however, the event was marked virtually by a candle lighting ceremony. Support, information and advocacy continues to be provided to women who have experienced the death of a baby at any stage throughout pregnancy. We plan to continue educational input with staff and student midwives within the hospital and UCD. The Hospice Friendly Hospitals standard of care initiative continues. The Irish Hospice Foundation education programme "Dealing with Loss in Maternity Settings" will be facilitated by CMS: this is an education programme aimed at supporting hospital staff involved directly or indirectly in bereavement care. We continue to work with colleagues in UCD on research in relation to bereavement care and education. NMH Annual Rep t | 2020