Dear Dr. Rose,

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Additional Editor Comments:

The authors present an interesting study regarding bereavement practices and staff competencies in managing perinatal loss. Kindly see the comments below to help strengthen the manuscript:

1. It is unclear why the authors label the study as a "pilot study". With the use of survey, a cross-sectional design will be more appropriate. Kindly consider this further.

2. Kindly add the absolute figures to the percentages mentioned in the abstract section.

3. The authors mention 11 questions were removed from the original instrument. It will be helpful, for methodological purposes, to list these questions in a table. Also, was the validity and reliability scores re-evaluated for the modified scale? This is extremely important.

4. The "omission of missing data" could use more details. Does the authors mean all responses that were incomplete were discarded?

5. Did the authors observe any variations across the participants from the L&D and ED? Such nuances, if observed, should be highlighted.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

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Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: This is a well written manuscript with significant findings for improving perinatal loss management in hospital settings as well as highlighting the pressing need for structured training programs and institutional resources to equip staff with the necessary skills to provide compassionate and effective bereavement support.

I have only minor comments for clarification purposes.:

1. On page 4 line 109, could you provide the full meaning of the 'TEARDROP' program described as an interdisciplinary training on perinatal bereavement care, if there is.

2. On page 5 line 128 -129, could you clarify the statement 'This pilot study was conducted after receiving Institutional Review Board review and 'determination as exempt' what do you mean 'determination as exempt'?

3. On page 6 lines 162-164, 'As the questionnaire was originally developed for midwives and nurses in Ireland, some items (11 total) were not relevant to the current U.S. healthcare system and thus removed for the current research.' Could you clarify if these 11 items removed were within the same subscale? If so, as part of this tool development, does the developers allow for each subscale to be assessed as a separate component and thus removing these 11 items does impact on the total outcome score for the tool?

Thank you such important manuscript.

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Reviewer #1: Yes:Mary Abboah-OffeiMary Abboah-OffeiMary Abboah-OffeiMary Abboah-Offei

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Bereavement Practices and Staff Competencies on Perinatal Loss at a Community-Based Teaching Hospital

PONE-D-25-50589R1

Dear Dr. Rose,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

JONATHAN BAYUO, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Thanks to the authors for addressing the comments raised.

Reviewers' comments: