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Butterflies and Ribbons: Supporting Families Experiencing Perinatal Loss in Multiple Gestation

Lookup NU author(s): Professor Nicholas EmbletonORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 by the authors. Introduction: In neonatology, multiple pregnancies are common. Unfortunately, it is not rare for one baby to die. Communication with parents in these circumstances has been demonstrated to be sub-optimal. Methods: Two educational programs were evaluated with pre- and post-course surveys, questionnaires administered to participants, and audits. Results: In the online Butterfly project (UK; n = 734 participants), all participants reported that the training exceeded or met their expectations, 97% reported they learned new skills, and 48% had already applied them. Participants expressed gratitude in their open-ended answers: “I feel a lot more confident in supporting parents in this situation”. In the Ribbon project (workshop for neonatal clinicians, Quebec; n = 242), 97% were satisfied with the training and reported feeling more comfortable caring for bereaved parents. Knowledge improved pre–post training. Audits revealed that 100% of cases were identified on the incubator and the baby’s/babies’ admission card, all changed rooms after the death of their co-twin/triplet, and all had the name of their co-twin/triplet on the discharge summary. All clinicians (55) knew what the ribbon symbol meant when asked during surprise audits at the bedside. Conclusion: Different educational strategies to optimize communication with families after the perinatal loss of a co-twin are appreciated and have a positive impact.

Publication metadata

Author(s): Boutillier B, Embleton ND, Belanger S, Bigras-Mercier A, Larone Juneau A, Barrington KJ, Janvier A

Publication type: Article

Publication status: Published

Journal: Children

Year: 2023

Volume: 10

Issue: 8

Online publication date: 18/08/2023

Acceptance date: 08/08/2023

Date deposited: 18/09/2023

ISSN (electronic): 2227-9067

Publisher: MDPI


DOI: 10.3390/children10081407


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Funder referenceFunder name
RSQPAL (reseau Québécois de Soins palliatifs)