Midwives' competence in perinatal bereavement care: A socio-ecological analysis

Background: Perinatal bereavement, including miscarriage, stillbirth, and neonatal death, poses profound psychological challenges for parents. Midwives are often the primary professionals supporting families through this process. However, many report feeling underprepared, lacking confidence, and experiencing compassion fatigue, which may affect the quality of care. Aim: This study aimed to examine midwives' competence in perinatal bereavement care within the framework of the Socio-Ecological Model, focusing on the influence of individual, interpersonal, and organizational factors, as well as the roles of confidence and compassion fatigue. Methods: A cross-sectional, correlational design was employed in Turkey. A total of 450 midwives participated in an online survey conducted between March and April 2025. Data were collected using a descriptive information form, the Perinatal Bereavement Care Confidence Scale, the Perinatal Bereavement Care Competence Scale, and the Compassion Fatigue-Short Scale. Multiple linear regression analyses were conducted in accordance with the socio-ecological levels. Results: At the individual level, grief support knowledge (β = 0.377, p < .001) and self-awareness (β = 0.300, p < .001) significantly predicted bereavement care competence. At the interpersonal level, grief support skills (β = 0.440, p < .001) were a strong predictor, while compassion fatigue was not significant. At the organizational level, only perceived support (β = 0.074, p = .010) had a weak but significant effect, while clinical unit was non-significant. Conclusions: Midwives' competence in perinatal bereavement care is shaped primarily by self-awareness, knowledge, and grief support skills, rather than demographic or institutional variables. Educational interventions focusing on reflective practice, communication skills, and structured training should be integrated into midwifery curricula. Organizational support remains essential to sustain compassionate care.