Scoping review of nature-based interventions in bereavement care: What are the implications for perinatal loss?

Perinatal bereavement, the death of a baby before or around the time of birth, is profoundly distressing and associated with significant psychosocial consequences for parents and families. There is a need for diverse support options for bereaved parents that recognises their continuum of needs, preferences and circumstances. Nature-based interventions have potential as a non-clinical approach drawing on “natural assets” within everyday settings. With limited evidence about nature-based interventions for perinatally bereaved parents, a scoping review was undertaken to determine the types of nature-based interventions, theories of change and key elements in the design of bereavement support interventions. A search of eight academic library databases using a combination of terms to represent nature-based interventions and bereaved grief identified 17 papers for review: the 7 qualitative studies, 3 quantitative studies, 4 case studies and 3 mixed method studies included care farming, gardening interventions and animal-assisted therapy. No studies focused solely on perinatally bereaved parents. Studies were underpinned by various theoretical frameworks but none provided explicit explanation of how theory was used for intervention design. The review findings suggest that nature-based interventions offer a promising approach to complement traditional bereavement care interventions. Reported benefits included the capacity to be personalised to suit a person's preferences and needs, their appeal and acceptability, and participant experiences of comfort and calm. Processing of grief and adaptation to loss were supported through the experience of safeness, and the inclusion of natural elements in processes such as memorialisation, rituals, metaphor and mindfulness. Future research should prioritise co-creation of interventions with bereaved parents, rigorous evaluation, and support options that are implemented in healthcare, community organisation and wider community settings.