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When a fetal heartbeat is not heard

Aim to share information kindly and clearly when staff suspect there is no fetal heartbeat before birth or during labour and throughout the period until they can confirm that the baby has died.

Families often know when staff are concerned that a baby has died and remember this moment for years.

What do we need to do?

  • Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
  • When you suspect there is no heartbeat explain this straightaway to the family and describe what will happen next.
  • During this challenging time keep language and body language clear, calm and face to face.
  • If the family are not already in a quiet and private place, move to an appropriate room.
  • Ask parents if they would like someone else to be with them.
  • Make sure the family knows what will happen next, give written information about ongoing care and ensure:
    • continuity of obstetric and midwifery care
    • a key contact is identified who will support and coordinate care, including bereavement care, for the woman and couple right through their journey whether they are going home or remaining in hospital – this may be the primary midwife
    • the key contact also provides continuity during the Perinatal Mortality Review.
  • Record the care plan on the mother’s maternity record including planned continuity of care and key contact.
  • Ensure your guidelines on the management of an absent fetal heartbeat include information on how to confirm a diagnosis as soon as possible and by whom.
  • Check that the woman and partner can get home or to the next appointment safely and, if not, help them
  • Explain how support organisations would be able to help and offer contact details.
  • If there is an intrauterine death in a multiple pregnancy, parents face the challenge of simultaneously experiencing ongoing pregnancy and a baby who has died. Support the family by focusing equally on all the babies.

How will we know we have achieved our aim?

Families will tell us they felt they were told what was happening from the first moment they realised staff had concerns and were well prepared for what happened next.

Staff will say they feel confident and competent telling the family when they suspect and confirm there is no fetal heartbeat and explaining what happens next.

Go to Before induction or onset of labour and delivery

They used a Doppler, put on a monitor and said maybe baby was sitting awkwardly – I knew it wasn’t that. Then we went to the scan room - it felt like 30 minutes, but it was only 2 minutes. I was duly plonked in waiting room with everyone sitting with bumps. I was sitting for 15 or 20 minutes howling into my husband’s chest. The scan took ages, they said ‘I’m sorry’ but they had to go and get someone else to confirm. I already knew but they didn’t want to alarm me. We were left a while, then a junior doctor came to speak to us "the consultant is still in theatre, but I can start a few things".
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