After the death
Aim to provide continuity of obstetric and midwifery care, and to jointly and sensitively lead the discussions about investigations and processes following a stillbirth.
Families tell us it is difficult and confusing to have different staff at different times discussing investigations and processes, especially any staff they have not met before.
What do we need to do?
- Introduce and explain the need for the following as far as possible with the same obstetrician and midwife providing continuity of care:
- registration processes
- post-mortem
- funeral arrangements
- clinical follow-up
- Perinatal Mortality Review.
- Ensure local guidelines set out clearly who should lead these discussions and how staff in these roles should achieve continuity.
- Plan at least an hour for this discussion and ensure it takes place in a quiet, private place.
- This is complex and challenging information for families. After you have explained, check families have understood what is involved by, for example, using the Teach Back method from The Health Literacy Place. Remember you may need to revisit the conversation.
- Document the discussion in the mother’s maternity record.
- Try to summarise in written information the processes and forms the family will need to engage with.
- Begin to discuss arrangements for discharge and find out the family’s wishes.
- Explain a previous stillbirth form could be added to the woman’s record, if she wishes - a template form is available.
Registration and certification
- Provide parents with the medical certificate certifying stillbirth having carefully checked that
the information is accurate. - In addition to providing written information, sensitively explain the national registration process, including where and how to register.
- Ensure parents have any other information the registrar will need.
Post-mortem examination
- 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.
- Sensitively explain why a post mortem is recommended. You may find the NES video for professionals Discussing Authorised (Hospital) Post Mortem Examination after Stillbirth or Neonatal Death useful preparation.
- Tell the parents if the post-mortem examination will take place in a different hospital and explain where and why.
- Explain that all transport arrangements and handling of the baby will be respectful and caring and who will be responsible for this.
- During the authorisation process, inform parents of the likely timescales for the return of the baby’s body and the results.
- Identify a named contact within pathology and maternity who will be responsible for following up on results.
- Ensure any small objects or keepsakes such as a hat or cuddly toy that parents sent with the baby are returned following the investigation.
- Ensure that you are aware of relevant statutory death review processes and that these link with your Board’s internal processes – e.g. morbidity and mortality [M&M] meeting, Adverse Event Review, Perinatal Mortality Review – and inform parents as appropriate.
Funerals
- Provide parents with information around the legal requirements and options.
- Discuss what is available through the Board and other local options. Allow the parents time to make their decision. They may wish to consider options at home.
- Verbal and written information should include:
- choices they have if they want the hospital to make arrangements and the costs, if any
- financial support payment available to families on low income via Social Security Scotland
- choices they have if they want to manage the arrangements, including information on local funeral directors if available
- time frame for making and communicating that decision
- hospital process if they do not make or communicate that decision within that time frame.
- Bear in mind and facilitate where possible different personal, religious and cultural needs and do not make assumptions.
- Discuss the options for urgent burial and cremation with parents where appropriate.
- Offer to refer parents to the spiritual care/ chaplaincy team.
- Record all decisions made by the woman in her record, including where information is declined or no decision is made.
Clinical follow-up
- Explain the purpose and timing of clinical follow up, both what parents can expect, what the follow up does not cover, and who can attend. Ensure enough time has been allowed for this appointment. Maintain continuity of obstetric and midwifery care at this appointment.
Perinatal Mortality Review
- Inform parents about the process of perinatal review and invite them to become involved
in the review process and refer to parent engagement. See Parent Engagement Materials on the Perinatal Mortality Review Tool (PMRT) website. - Explain that the key contact will remain in touch with them during the review process. Give them information on the review process.
One of the midwives took the time to write a checklist - these are the things that you need to think about, general guidance. We were in shock, your brain is all over the place and it helped to have someone sit down with you – e.g. do I want a post-mortem? Do I want the hospital to make funeral arrangements?
The midwife came in and sat cuddling her and warmed her for me. I didn’t want to hold her for a final cuddle, as she was cold and I didn’t realise what the midwife was doing while she was chatting to me. I will be forever grateful to her. It was very personalised care – the midwife holding her, it was really clear that woman really, really cared.
How will we know we have achieved our aim?
All families tell us they felt the right person spoke to them, in the right way, and they understood what the processes were, why they happened and the choices they had.
Staff will say they feel confident and competent when discussing investigations and processes after death.