‘Built with strong foundations, shaped by care and connection’: qualitative findings about the therapeutic relationship from the helping suppOrt individuals pregnant after experiencing a stillbirth (HOPES) study

Background: Individuals pregnant after a loss want healthcare providers to be knowledgeable, kind and empathetic. The quality of the therapeutic relationship healthcare providers develops impacts psychological well-being as well as the overall experience of maternity care. The experience of the therapeutic relationship and attributes of massage therapists that are important to women receiving massage in a pregnancy after stillbirth are unknown. Aim: To explore how women who received massage therapy during pregnancy after stillbirth experienced the therapeutic relationship, including the therapist attributes and relational elements they valued, and how these contributed to their perceptions the experience of care. Methods: Mixed methods incorporating semi-structured interviews in a sub-sample of the Helping support women in a Pregnancy after Stillbirth (HOPES) participants (n=33) and the Consultation and Relational Empathy (CARE) questionnaire data. Interview transcripts were analysed using an inductive thematic approach and the CARE data were tallied and reported. Findings: An overarching theme of ‘built with strong foundations, shaped by care and connection' was derived. The average CARE score was 47.2 out of 50 ± 4.7 (n=68). Conclusion: Study findings highlight the central role of the therapeutic relationship in shaping HOPES study participants’ experiences. The physical environment and technical skill of the therapist provided structure, and the qualities of care, presence, and emotional connection transformed the massage treatment into one of meaning and support.