THE DEATH OF A BABY
Miscarriage, stillbirth and neonatal death
Parents develop a relationship with a child from the beginning of pregnancy, long before birth, and so a dead baby produces enormous shock and ongoing grief. There is profound sadness at the loss of expectations for the future. Early miscarriage is common, late miscarriage, stillbirth and neonatal death less so, but many of us will know family or friends who have experienced these events, and some will want to know what happens around this time. As with all the situations in this book, we firmly believe it is good to talk (and more importantly listen) to the bereaved parents, as well as to one another about this event which has too often been treated without due consideration of the loss.
The three stages of pregnancy
Doctors divide pregnancy into three stages called ‘trimesters’. The times are calculated from the end of the mother’s last period.
The first trimester is up to 13 weeks of pregnancy.
The second trimester is from 14-24 weeks of pregnancy.
The third and final trimester starts from 25 weeks of pregnancy.
This is when a baby dies before 24 weeks of pregnancy. About 1 in 5 pregnancies ends before 24 weeks. This is called a miscarriage, rather than stillbirth, as 24 weeks is the legal age at which a baby is thought to stand a good chance of survival.
Early miscarriage – when a baby dies up to 12 weeks of pregnancy. Early miscarriage is common and sometimes happens before even the mother herself is aware of the pregnancy.
Late miscarriage – when a baby dies between 14 and 24 weeks of pregnancy. Late miscarriage is less common.
Will there be a birth or death certificate after a miscarriage?
After miscarriage, whether early or late, the law does not require a certificate.
Although there is no legal certificate after a pregnancy loss before 24 weeks, some hospitals do provide a certificate for parents to mark what has happened. For many parents this is an important memento.
The Miscarriage Association (MA) has suggestions of how to obtain a certificate if you have not been given one, but would like to have one. Their website details are below. After a late miscarriage, most hospitals offer a simple funeral and either burial or cremation. Some hospitals offer this for all babies, no matter how early the loss and whether or not there is a fully formed body. Hospital practice is improving all the time but sadly not all hospitals treat the remains of an early loss with the respect needed.
What happens to the baby after a miscarriage?
‘I initially declined to hold my baby I was so scared to see how he might look. But a few hours later I changed my mind and a very kind midwife brought him back into the room. I was pleased I had seen my baby who was tiny but perfectly formed.’
Mother after a late miscarriage, MA website
There is no law about what should happen to the body of a miscarried baby.
This is when a baby is born dead at or after 24 weeks of pregnancy. Stillbirth is uncommon but unfortunately, it is not rare. In the UK about one baby in 200 is stillborn.
Holding your stillborn baby
Many parents decide to see and hold their baby after the birth, and nearly all find it helpful. Some do not and this is an individual decision, with no right or wrong way to respond. Sometimes one parent makes a different decision from the other. Both parents need time to think what is best for them.
Should there be a postmortem?
When doctors are unsure about the cause of death, they might ask the parents to consider a postmortem examination and other tests to help to find out. This will only be done with their agreement and written consent.
When the results are available the doctor should arrange to go through these with the parents. More than half the time the cause of death is not found.
The parents can decide to say goodbye to the baby either before or after the postmortem.
A certification and registering of a stillbirth
The doctor or midwife will give a certificate of stillbirth. The stillbirth should be registered within the time given on the UK Government (UK Gov) website below.
Will there be a funeral?
The bodies of babies who are stillborn (that is, born dead after 24 weeks of pregnancy), or who are born alive but then die, must by law be buried or cremated.
A neonatal death is when a baby is born alive but dies within the first 28 days of life. Premature birth, congenital abnormality and infection are the main causes. Whatever the cause, a baby has died and it is a hugely sad time. The death must be registered, the doctors might ask permission from the parent/s for a postmortem examination and burial or cremation will need to be arranged. (See chapter 12.
Sudden Unexpected Death in Infancy
The sudden loss of a seemingly perfect baby, who increasingly became a part of the family as each day went past, is devastating for the parents and those who love them. ‘Sudden Infant Death’ is the term used to describe the sudden and unexpected death of a baby that is initially unexplained. The usual medical term is ‘Sudden Unexpected Death in Infancy’ (SUDI) or, if the baby was over 12 months old, Sudden Unexpected Death in Childhood (SUDC). In spite of following advice on how to reduce the risk of sudden infant death, it can still happen.
‘Parents are shocked, bewildered, and distressed. Parents who are innocent of blame in their child’s death often feel responsible nonetheless and imagine ways in which they might have contributed to or prevented the tragedy.’
Paediatrics, Feb 2001
As well as shock, there is bound to be a feeling of guilt– how could I have prevented it? Although there will be a postmortem, in at least half of cases no cause at all is found. At the time of death, there will be routine questions from medical and judicial teams, which, depending how they are said, can seem intrusive and accusatory. (It is important that the small proportion of deaths where there has been malpractice can be detected.) Only after a thorough death scene investigation, postmortem examination and review of case records, can a diagnosis of SIDS be given as the cause of death.
These procedures might give a reason why the infant died, and how other children in the family, including children born later, might be affected.
For the parents of the approximately 300 sudden and unexpected infant deaths which occur in the UK each year, it is an enormous shock and an event which will have an effect on them for the rest of their lives. How doctors and others deal with them after the death can also have a deep and lasting effect.
How can family and friends help?
In all the situations described in this chapter, it is important for us to remember that no baby can be ‘replaced’.
Family and friends need to be aware of the acute and ongoing pain and loss felt by the parents. Listen rather than talk, send cards and flowers, leave messages, offer specific help. (See chapter 13.)
‘Nobody talks about it, the topic is completely avoided or worse, I am avoided. To me, I lost our baby, the baby who already had its own room and crib, we were thinking about names and how childcare would work. No one seems to acknowledge what has happened. Talk to your friends/ family who have gone through a miscarriage, ask them if they want to talk about it. Sometimes you just need a hug, sometimes you want to get it all out and have a long talk, no responses needed just acknowledgment and comfort.’
Posted by a mum, a month after a miscarriage
Sources for miscarriage, stillbirth and sudden death of a baby support
Miscarriage Association (MA): www.miscarriageassociation.org.uk
Babycentre general: www.babycentre.co.uk/a1014800/when-a-baby-is-stillborn
Babycentre website on how friends can help
www.babycentre.co.uk/x1014809/my-friends-have- recently-lost-their-baby-is-there-anything-i-can-say-or-do- to-help-them
UK Government site https://www.gov.uk/register-stillbirth giving information about registering a stillbirth. At the time of writing this must be done within 21 days in Scotland, 42 days in England and one year in N Ireland.
SANDS Stillbirth and neonatal death charity: www.uk-sands.org
Babyloss gives information about other support agencies www.babyloss.com/index.php
The Lullaby Trust offers confidential support to anyone affected by the sudden and unexpected death of a baby or young toddler. www.lullabytrust.org.uk