After the loss
Aim to sensitively provide information about examinations and tests which may be recommended or can be offered, and about options for certification and cremation or burial.
Women and partners tell us they didn’t always understand the benefits and limitations of the examinations and tests. They were not always given the option of certification and the explanation of cremation or burial was not always clear or given at a time and in a format that is right for them.
Post-mortem examination and histology
- 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 post mortem is offered.
- Ensure staff discussing post mortem examination with the woman and partner are trained to do so and are fully aware of the protocol for offering a full or partial post mortem and any other tests available including examination of the placenta.
- Make sure the discussion about post mortem takes place in a quiet and private place, at an appropriate time and is not rushed.
- Inform the woman and partner if the post-mortem examination will take place at 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 women and partners of the likely timescales for the return of their baby and the results and be realistic about these.
- Make sure anatomical pathology technicians and/or pathologists are aware of any specific cultural or religious requirements or special requests from the family.
- Ensure any small objects or keepsakes such as a hat or cuddly toy that accompany the baby are returned following the investigation.
- Identify named key contacts within pathology and maternity who will be responsible for following up on results.
Registration and certification
- Offer to provide a ‘certificate of loss’ from the hospital - template certificate is available.
- If delivery occurs at home following the initial stage of the medical termination, refer to the Miscarriage Association's Guidance for miscarriages that occur at home.
- If the baby is stillborn after 24 weeks’ gestation, provide the women and partners with a medical certificate of stillbirth.
- If a baby was born after 24 weeks’ gestation but it is known or can be proven that the baby died before 24 weeks, the death cannot be recorded or registered as a stillbirth.
- Explain that if a baby is born alive following a termination of pregnancy at any gestation and subsequently dies, both the birth and death of the baby must be registered. Sensitively explain to the woman and her partner that the cause of death will be recorded as termination of pregnancy for fetal anomaly.
Cremation, burial and funerals
- Explain that the minimum standard for sensitive disposal of pregnancy loss under 24 weeks is shared cremation. Individual cremation or burial may also be considered. The woman and her partner may also make private arrangements outwith the hospital including burial at home.
- Provide the woman and her partner with information about their options but recognise that some people will not want to read or discuss it or to make decisions. In this situation they may authorise someone else to make the decision or authorise the hospital to make the arrangements.
- If the woman and her partner do not want the information, explain that they can get back in touch if they change their minds and provide the time frame for doing so.
- Verbal and/or written information should include:
- The choices they have if they want the hospital to make arrangements and the costs, if any.
- The choices they have if they want to manage the arrangements, including burial at home and information on local funeral directors if available.
- The time frame for making and communicating that decision.
- The 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 where appropriate.
- Offer to refer the woman and her partner to the spiritual care/chaplaincy team if contact has not already been offered.
- Record all decisions made by the woman in her maternity record, including where information is declined or no decision is made.
- See also Scottish Government guidance on the sensitive disposal of pregnancy losses up to and including 23 weeks and 6 days gestation and Miscarriage Association's guide Talking about sensitive disposal and RCN guidance on managing disposal of remains.
How will we know we have achieved our aim?
Women and partners will tell us information was sensitively and clearly given, at a time and in a format (written or verbal) that is right for them.
Staff will say they feel confident and competent in providing information clearly, sensitively and able to do so at an appropriate time and in a suitable format.