The death of a baby affects all parents differently but the grief is often overwhelming and prolonged. The intensity of love parents feel for their baby is not measurable in the weeks or months of pregnancy.

 

Miscarriage

Miscarriage is the spontaneous loss of a pregnancy before 24 weeks gestation. Miscarriage affects approximately 1 in 4 pregnancies. 

Stillbirth

Stillbirth is the birth of a baby after 24 weeks gestation who did not show any signs of life after delivery. In the UK, 1 in 200 babies are born dead.  

Livebirth

If there are any signs of life at delivery, at any gestation, this is a livebirth. If a liveborn baby subsequently dies, registration of both the birth and the death is required by law. 

Termination for Fetal Abnormality

If following antenatal diagnosis there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped women have the option of termination of pregnancy.

Communication with parents

The videos below may help you as a healthcare professional if you are involved in the care of parents who have experienced a stillbirth or neonatal death.

Dealing with unsuccessful neonatal resuscitation

Please note that this video deals with issues of death and bereavement and was created for healthcare professionals: caution is advised for viewers who are not healthcare professionals as some may find the themes upsetting.

A transcript of this video can be found here

Downloadable poster: Dealing with an unsuccessful neonatal resuscitation - key messages

This downloadable educational poster outlines some of the key messages to note when dealing with an unsuccessful neonatal resuscitation. 

It will be relevant to all those professionals who are involved, or may come into contact with parents who have experienced the death of a baby.

The Deafening Silence - Stillbirth through a Mother's eyes

This film was created by Abigail's Footsteps as a tool for teaching those who work in maternity services about good and bad practice following a stillbirth or neonatal death.

Visit their website for more information.

Postnatal care

After a baby has died, a mother will still experience the same physical and emotional postnatal reactions. Physical reminders of the loss, such as vaginal bleeding, the production of breastmilk, painful stitches or a caesarean scar may be very distressing. It is important to ensure that mothers have adequate pain relief and postnatal care.

 

Being with baby

Some parents will name their baby but some prefer not to. Be sensitive and ask what parents would prefer. Seeing and holding a baby after death can be frightening for parents. Some may not have seen a dead person before. Prepare them for what to expect. Many parents cherish this memory later.

Memory making

Encourage parents whose baby has died to consider memory making. Parents may feel unsure about this but photos and keepsakes have been described by many as precious in the years to follow. The hospital bereavement team or maternity midwife may be able to help.

Some parents may find it difficult to decide whether to have photographs taken. However, bereaved parents have said that it’s better to have a photo that they may never look at rather than one they don’t have. If photos are taken on a mobile phone, remind parents to download them as soon as possible so that they are stored safely. Many parents value the opportunity to have photos of themselves caring (e.g. bathing or dressing) their baby, as well as photos of them holding their baby.

Many maternity departments in Scotland have digital cameras and memory boxes to help with memory making. 

Termination of Pregnancy for Fetal Abnormality

Parents who make the decision to terminate their pregnancy following antenatal diagnosis of fetal abnormality will not only experience bereavement but also the guilt associated with their decision. It is important therefore that they receive the same level of care and support as any parent following the loss of their baby and should also be offered the same opportunities for memory making.

Multiple births

The loss of one twin or triplet can be very hard and confusing. Parents are grieving for the baby who has died but may also have ongoing concerns for the vulnerable survivor. Having a living baby does not reduce the grief for the baby or babies who have died and a living child’s progress can be a constant reminder of what might have been.

Deciding about a post mortem examination

If a baby dies after birth and the cause is unknown, the case must be referred to the Procurator Fiscal. Whilst this does not require parental authorisation, the reasons for this referral should be carefully explained to parents. Research shows that a post mortem examination may find new and often significant information about the cause of a baby’s death in 60-80% of cases. This may also discover whether there was a problem which could affect future pregnancies.

Post mortem examination can also contribute to important research into why babies die, and therefore potentially help to prevent more neonatal deaths in the future.

Deciding whether or not to have a post mortem can be an incredibly difficult decision to make. Some parents are desperate to know the reason why their baby died and others really may not want an examination.

Written information is available but remember to check reading ability and understanding. Allow time for parents to decide and ensure that regardless of the decision, parents know that their baby will be cared for at all times.

 

Types of post mortem examination

There are different types of post mortem: complete, limited or external only. It is important to go through the authorisation form carefully. Parents often have high expectations of a post mortem examination but sometimes there is no clear reason why a baby died. Even where a definitive cause of death is not identified, the examination can still yield useful information for families. 

Results are usually available within 8 to 12 weeks but can take longer if specific tests are done on tissue samples. However, the funeral can take place once the main post mortem examination has been completed.

Parents should be offered an appointment to discuss the results of a post mortem examination.

Discussing Post Mortem Examination

This video aims to help healthcare professionals sensitively discuss authorised (hospital) post mortem examinations with families after a stillbirth or neonatal death.

Please note that this video deals with issues of death and bereavement and was created for healthcare professionals: caution is advised for viewers who are not healthcare professionals as some may find the themes upsetting.

A transcript of this video can be found here.

Bereavement following a termination of pregnancy

It is important to note, that women who have had a termination of pregnancy, for whatever reason, may too experience feelings of grief. For more information on abortion, including a support service directory visit NHS Inform.