Maternity Leaflet: Information for Pregnancy Loss

Information for Pregnancy Loss: This leaflet is designed to give you some practical information you will need leading up to and immediately following the birth.

Leaflet Details

Patient Information

Information for Pregnancy Loss

This leaflet is designed to give you some practical information you will need leading up to and immediately following the birth.

This leaflet is intended to support the information that you will receive from healthcare professionals.

We aim to provide care that will meet your individual needs. If you have any specific needs, please let us know what your requirements are, and how we can help you.

Introduction

We would like to express our sincere condolences to you and your family.

This is an emotional time for you and the feelings that you may experience can vary from shock to disbelief. These feelings may also vary between you and your partner.

When you come into hospital you and your partner will, when possible, be taken to a room off the Labour Ward called the Daffodil Room. Whilst you may feel this is a little isolated, the room is situated away from other women to allow you privacy at this sensitive time. The room has a sofa bed so your partner can stay with you at all times and a call bell is in place for you to call your midwife at any time.

The Daffodil Room is stocked with towels, toiletries, a fridge, and facilities for making hot drinks. Please feel able to use these items which have been generously funded by donations from parents and our local community.

There may be occasions when we will not be able to offer the Daffodil Bereavement Room. In these circumstances we will care for you and your Partner in another room on our Labour Ward. Your Partner will still be supported to stay with you.

Labour and Birth

Whilst the thought of going through a labour and natural birth may be distressing in itself, this is widely regarded as the safest option for you giving birth. Caesarean Section is not usually recommended. The medical and midwifery staff will answer any questions you may have and discuss choices which are available to you. You do not have to make decisions in a hurry.

It can be difficult to predict how long labour or induction of labour and the birth will take. Your midwife or doctor will discuss pain relief with you and an anesthetist is available to ensure you are as comfortable as possible.

Time Alone and Making Memories

Loss and grief are a very personal experience. All parents will have their own feelings about how they wish to make memories of their baby. We aim to ensure you are aware of the choices available so that you can decide what is best for you. After the birth you may wish to see, and if you would like to, hold your baby and you may wish to spend some time alone with your baby. We will support you to do this. However, not all parents wish to see their baby. There are no rights or wrongs, and you may change your mind.

Whatever your thoughts might be, we will ask you about this after the birth as sometimes feelings about these things may change after the birth. This can be a difficult and very individual decision and your wishes will be respected.

Making Memories

You may wish to take photographs of your baby and staff can help you to create these special memories if you choose.

If you don’t feel able to see your baby now, the midwife can take photographs of your baby and give you them on a memory card for you to print when you feel ready to do so. The midwife will need your consent to do this.

Hand and footprints may also be taken, where possible, if you would like them.

Our volunteers provide knitted blankets and items of clothing for our babies. You may wish to take the blanket that has been with your baby home. We call this the memory blanket.

You may also wish to use your own blanket for your baby, and this can stay with the baby.

We provide, if you wish, a memory box for you to take home, to keep your precious mementos of your baby. Many parents find this a great comfort.

The midwife will ask you if you wish to name your baby. In cases of very tiny babies born less than 24 weeks it can be difficult to determine the sex of the baby. In this instance parents often choose a name suitable for either a boy or a girl, or a name that is special to them, perhaps a special name that you called your baby during pregnancy.

This may be a time for you to consider whether you would like to invite family members (including your other children, if you have any) to be with you and your partner and meet your baby. Your midwife can help you with this. We have a selection of books to help explain death and grief to children that you may find helpful.

Registering Your Baby / Babies Birth

Less than 24 weeks of pregnancy at the time baby dies

For babies who die before 24 weeks, currently are not required to be registered. However, as parents you may wish for your baby’s death to be recognized.

Your midwife may ask you if you wish to receive a hospital certificate of remembrance to acknowledge the birth of your baby. The Maternity Bereavement Team can also arrange this for you and can be contacted: 01932 722879.

Official Baby Loss Certificate

If your pregnancy ends before 24 weeks, there is also the option to request a Baby Loss Certificate from the Government in memory of your baby.

It is not a legal requirement and not a legal document, but it is an official document. You do not have to request a certificate if you prefer not to.

The certificate is available for either, or both parents to access.

To apply for a certificate your need to be:

• The baby’s parent(s) or surrogate
   
• At least 16 years old
   
• Your pregnancy ended on or after 1/9/2019 (at the present time)
   
• Live in England (or lived in England when you experienced the pregnancy loss)

You need to apply separately for each pregnancy loss.

To apply and for more information visit:
https://www.gov.uk/

If you need a certificate in a different format or are unable to apply online you can email: This email address is being protected from spambots. You need JavaScript enabled to view it. or telephone:0300 330 9445.

From 24 weeks of pregnancy at the time baby dies

For babies who die after 24 weeks gestation where the baby has either died in the uterus or is born without showing any signs of life, it is a legal requirement to register the stillbirth of your baby with the Registry Office and receive a Stillbirth Certificate from them before any arrangements can be made for your baby / babies funeral.

Neonatal Death

For any baby born at any gestation who shows signs of life and then subsequently dies there is a legal requirement to register the birth and death of your baby prior to making funeral arrangements.

Further information will be provided to you at the time regarding the classification and registration process for your baby / babies.

Registration Procedure

If you are advised that you need to register your baby’s stillbirth or birth and death for babies who were born with signs of life then sadly die, you will need to make an appointment with the Registrar of Births, Deaths, and Marriages. You should ideally do this within the first week after your baby has died as without the registration certificate funeral arrangements will be delayed.

To book an appointment, you will need to telephone the Registrar’s Office on 01483 518248.

You will need to attend the appointment in person.

The Registry Office for Surrey has three offices, in Weybridge, Guildford and Leatherhead. You will be able to book an appointment at the office most convenient for you.

• Weybridge Office:
  Rylston
  81 Oatlands Drive
  Weybridge
  Surrey KT13 9LN
   
• Guildford Office:
  Artington House
  42 Portsmouth Road
  Guildford, Surrey GU2 4DZ
   
• Leatherhead Office:
  The Manion
  70 Church Street
  Leatherhead
  Surrey KT22 8DP

Parents who are not married at the time of their baby’s birth and who would like the father’s details to appear on the certified entry should ask the Registrar to guide them. In these circumstances both parents will need to attend the appointment.

The Bereavement Midwives will usually contact the Registrar within the first week of baby’s death and forward the hospital stillbirth or death certificate in order for you to be able to complete your baby’s registration.

Pastoral care

Our Pastoral and Spiritual Care Team are people of faith offering spiritual care and compassion to all at Ashford & St Peter’s Hospitals. A member of the team is available to provide comfort to anyone regardless of whether you have a specific faith or not.

If you have a particular faith, please let us know and we will try to ensure that your needs are met, or you are welcome to ask your own spiritual leader to visit during your stay.

If you wish, a blessing and / or naming ceremony can be arranged through the Pastoral and Spiritual Care team.

Suppression of Lactation

All women who experience pregnancy loss or a stillbirth from about 16 weeks gestation onwards may produce milk in their breasts following the birth of their baby.

If your breasts feel full it can be physically and emotionally painful.

From 16 weeks gestation you will be offered the opportunity to take medicine, called Cabergoline (subject to any medical reasons why you should not be offered this medication) which in the majority of women will stop the milk from being produced.

Some women may prefer not to take medication and you can choose to allow the milk to be suppressed naturally.

An information leaflet providing more information about these options will be provided.

Post-Mortem Examination

It is not always appropriate to offer a post-mortem examination. Your consultant will discuss with you if they feel it would be beneficial in your case. Generally, if your baby is born after 14 weeks of pregnancy you will be offered a post-mortem for your baby. We have separate information leaflets regarding post-mortem examination for you to read and discuss with the doctor.

This is not something you need to decide in a hurry, and you should feel free to ask any questions you may have. Again, the medical and midwifery staff will respect your wishes. There is also a period of time known as the ‘cooling off period’ which lasts between 24-48 hours following your consent for a post-mortem. During this time, you are able to change your mind by contacting the Labour Ward on 01932 722399 and asking for the Midwife in Charge.

If you choose not to have a post-mortem, or if it is not advised, your placenta can be sent for histopathology (an in-depth examination of the placenta). This may give further information as to why your baby died.

Taking baby home

All parents should be offered the choice as to whether they would like to take their baby / babies home. If this is something you wish to do, you will be given information to support this decision. You may like to discuss this with the midwife looking after you or with the Bereavement Support Midwives.

Occasionally, the circumstances require us to notify the Coroner of a baby death. It should be noted that in these circumstances parents may not take their baby home immediately. It may be possible to consider this after the Coroner has completed a post mortem examination.

How we look after your baby after you have gone home

If you do not wish to take your baby home, your baby will be looked after by the hospital.

After you leave the hospital, your baby / babies will be taken to our hospital mortuary at St Peter’s Hospital to be looked after.

If there is to be a post-mortem examination, after the cooling off period has expired, your baby will be collected and taken to St Thomas’s Hospital by our contracted funeral director. You will be notified when your baby returns, which is usually within 2-3 weeks.

If there is no post-mortem, your baby will remain in the mortuary until collected by your chosen funeral director if you are making your own arrangements or for hospital arranged cremations / burial until they are collected by the hospital’s funeral director a few days before the funeral.

Seeing your baby again after you have gone home

If you wish to see your baby again after you have gone home, it may be possible to arrange this.

If your baby has been collected by your chosen funeral director, you can discuss this with them.

If the baby remains in the care of the hospital, the Bereavement Midwife can guide you: 01932 722879.

In deciding whether to see your baby again it is important for parents to be aware that it is normal after death that there is a normal deterioration in the condition and appearance of the baby.

Funeral Arrangements

You may wish to consider taking your baby home with you initially prior to your funeral arrangements or the hospital can take care of your baby for you.

Your wishes and choices will be discussed with you.

In general:

For pregnancy losses before 24 weeks gestation (where there has been no sign of life at birth):

Options:

• Making your own arrangements
   
• Hospital Arranged Cremation
   
• Hospital Arranged Burial
   
• Sensitive Disposal by the hospital

Making your own arrangements:

You may choose to make your own arrangements for your baby.

You may wish to ask a funeral director or faith leader to help you with a burial or cremation for your baby. Funeral directors generally do not make charges for a baby funeral, but it is wise to check with whoever you choose to help you with your arrangements.

For losses less than 24 weeks where baby has shown no signs of life, you may also choose to bury your baby yourself in a place that is special to you. You should follow the guidance set out in The Taking Your Baby Home Leaflet to ensure that environmental requirements are adhered to.

Hospital Cremation Service (free of charge)

We offer a cremation service at Woking Crematorium for babies born less than 24 weeks with no signs of life. A joint service is held each month for up to four babies, each in an individual coffin and cremated separately, (although we offer for twins or multiple pregnancy babies to remain together). You may attend this service if you wish, and other members of your family are welcome.

As your baby is very small, it cannot be guaranteed that there will be ashes following cremation, however, in the majority of cases there will be a small amount of ashes. You will have the choice to collect your baby’s ashes from the Crematorium later if you wish or they can be scattered in the Lewis Carroll Children’s Garden of Remembrance at the crematorium. Your options and further choices will be discussed with you in greater detail and a consent form will need to be signed.

Hospital Arranged Burial (free of charge)

The hospital can arrange a burial for your baby born less than 24 weeks gestation with no signs of life.

A hospital burial can take some weeks to arrange. Unfortunately, we cannot offer same day or within 24 hours burial services.

The burial by the hospital of your baby will be in an unmarked and communal grave in a local burial ground (this means that you will not be able to place a headstone or other marker at the grave for your baby)

Parents may attend the burial if they wish. There is no service or chaplain present at a hospital burial. The staff at the cemetery will make the arrangements. You may make your own arrangements for a spiritual leader of your choosing to be present if you wish. Our hospital chaplain may be able to offer their services for the burial of your baby on request.

Sensitive Disposal:

For babies born less than 24 weeks gestation with no signs of life, parents can opt for the hospital to sensitively dispose of the baby. This will be by sensitive incineration.

For pregnancy losses after 24 weeks gestation and neonatal deaths:

As a legally registerable birth, you will need to make your own funeral arrangements. This must be an officially recognized cremation or burial. A funeral director of your choosing will be able to assist you with the arrangements. Generally, there are no charges for a baby funeral, but it is wise to check with your chosen funeral director. Charges may vary, depending on your wishes, although most keep the costs to a minimum.

After you go home

Support:

The Bereavement Support Midwives are able to advise and provide support. Bereavement counselling is available, this can be individually or as a couple. Where possible a bereavement support midwife will try to meet you whilst you are in hospital. Should you wish to contact the bereavement support service for advice or support, call 01932 722879 leave a message and they will get back to you as soon as possible.

The community midwifery team and your GP will be notified of your pregnancy loss. The Community Midwife may, where appropriate, contact you and will discuss visits with you after you return home. You should see your GP for a check-up in six weeks or sooner if you have any physical or emotional concerns. You will need to make this appointment yourself.

We will cancel all your future maternity related appointments and scans.

We also understand that future pregnancies may cause huge anxiety. The team are available to offer emotional support as needed in future pregnancy. We can be contacted on the same number 01932 722879.

Time off work and benefits:

• Prior to 24 weeks of pregnancy: If you miscarry before 24 weeks or have a medical termination before 24 weeks there is no entitlement to maternity pay or benefits, including maternity leave.
  
  If you feel you are not ready to return to work immediately, you are advised to talk with your GP.
   
• From 24 weeks or neonatal deaths at any stage of pregnancy: If you are eligible for maternity pay and benefits, you will be entitled to these. If your partner is entitled to paternity leave and pay this still holds.

Consultant Follow-up

Where there has been a post-mortem or other investigations you will be invited in due course to meet with your consultant to discuss the results and plan for future pregnancy (please note: it may take many weeks to complete tests and investigations).

Patient Experience Questionnaire

A few weeks after you go home you will receive a patient questionnaire asking about your care experience during your stay in hospital. This questionnaire has been developed nationally in consultation with bereaved parents to ensure that we are asking about what matters most to parents and that we do so as sensitively as possible. We appreciate that this is a difficult time for you but if you feel able to complete the questionnaire this will help us to continually improve care for bereaved parents. We would be very grateful for your feedback.

MBRRACE-UK (Mothers and Babies Reducing Risk through Audits and Confidential Enquiries in UK)

All pregnancy losses from 22 weeks gestation and all neonatal deaths from 20 weeks gestation are reported to a national organization called MBRRACE-UK.

In addition, MBRRACE carries out national in-depth reviews on particular issues and publishes reports for health care providers that include recommendations to improve care for mothers and babies. It is important that we learn from tragic events. All the information received by MBRRACE for these reports is fully anonymized and all information used by MBRRACE is kept in the strictest confidence. We do not seek individual consent and you will not be informed if your records have been used by MBRRACE-UK. However, you do have the right to opt out of having your information used for these purposes. If you do wish to opt out, you will need to contact MBRRACE-UK by telephoning 01865 289700.

Duty of Candour and PMRT (Perinatal Mortality Review Tool)

As a hospital trust we want to be open and honest with our patients. We call this duty of candour

When a baby dies after 22 weeks gestation, we have a responsibility to review the care during the whole pregnancy to see whether there may be things that can be learned by the organization and any changes that the hospital needs to implement. To carry out this review we use a national review tool, known as PMRT (Perinatal Mortality Review Tool). Parents are invited to submit any questions or concerns they may have about the circumstances of their baby’s death so that these can be addressed in the review process. The results of the review will be offered to parents if they wish to receive it.

For further information:
https://www.npeu.ox.ac.uk/pmrt/information-for-bereaved-parents

Memory Day Ceremony

The Trust holds an annual Memory Day ceremony for babies and children who die at any age, from early pregnancy to adulthood.

The ceremony usually takes place in October each year to coincide with Baby Loss Awareness Week. The bereavement support midwives (01932 722879) or the hospital chaplains (01932 723324) can provide more details.

Donations

Sometimes parents ask whether they can make a donation to the Bereavement Service in memory of their baby.

Whilst this is by no means expected, donations are very welcome as many of the items we offer and use in the Daffodil Room are funded by donations. If you would like to consider this, please contact the Bereavement Midwives on 01932 722879.

Support Organizations and Contact Numbers