Pregnancy Loss, Stillbirth and Neonatal Death

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The intensity of love parents feel for their baby is not measurable in the weeks or months of pregnancy.</h3> </div> </div> </section> <section class="m-def-list row"> <div class="col-xs-12 col-md-11"> <h2> </h2> <p style="text-align: center;"><span><img style="width: 500px; height: 333.23459715639814px;" src="/media/15879/mother-with-baby.jpg?width=500&height=333.23459715639814" alt=""> </span></p> <div class="row"> <div class="col-xs-12 col-sm-4"> <h1>Miscarriage</h1> </div> <div class="col-xs-12 col-sm-8"><p><span>Miscarriage is the spontaneous loss of a pregnancy before 24 weeks gestation. Miscarriage affects approximately 1 in 4 pregnancies. </span></p></div> </div> <div class="row"> <div class="col-xs-12 col-sm-4"> <h1>Stillbirth</h1> </div> <div class="col-xs-12 col-sm-8"><p><span>Stillbirth is the birth of a baby after 24 weeks gestation who did not show any signs of life after delivery. <span>In the UK, 1 in 200 babies are born dead. </span> </span></p></div> </div> <div class="row"> <div class="col-xs-12 col-sm-4"> <h1>Livebirth</h1> </div> <div class="col-xs-12 col-sm-8"><p><span>If there are any signs of life at delivery, at any gestation, this is a livebirth. If a liveborn baby subsequently dies, registration of both the birth and the death is required by law. </span></p></div> </div> <div class="row"> <div class="col-xs-12 col-sm-4"> <h1>Termination for Fetal Abnormality </h1> </div> <div class="col-xs-12 col-sm-8"><p>If following antenatal diagnosis there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped women have the option of termination of pregnancy.</p></div> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <p><span class="h2">Communication with parents</span></p> <p>The videos below <span>may help you as a healthcare professional if you are involved in the care of parents who have experienced a stillbirth or neonatal death.</span></p> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>Dealing with unsuccessful neonatal resuscitation</h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://player.vimeo.com/video/167898800" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p>Please note that this video deals with issues of death and bereavement and was created for healthcare professionals: caution is advised for viewers who are not healthcare professionals as some may find the themes upsetting.</p> <p>A <strong>transcript </strong>of this video can be found <a href="/media/15998/transcript-of-communication-around-unsuccessful-neonatal-resus.pdf" target="_blank">here</a>.</p> </div> </div> </div> </section> <section class="m-downloadright"> <h2>Downloadable poster: Dealing with an unsuccessful neonatal resuscitation - key messages</h2> <div class="row"> <div class="col-xxs-12 col-xs-7 col-md-8 col-lg-9 "> <p>This downloadable educational poster outlines some of the key messages to note when dealing with an unsuccessful neonatal resuscitation. </p> <p>It will be relevant to all those professionals who are involved, or may come into contact with parents who have experienced the death of a baby.</p> </div> <div class="col-xxs-12 col-xs-5 col-md-4 col-lg-3 download"> <a target="BLANK" href="/media/16215/nesd0959-neonatal-resucitation-a5-v3.pdf" > <img class="img-responsive" src="/media/16237/neonatal-resuscitation-2019.png?anchor=center&mode=crop&width=455&height=600&rnd=131991927950000000" alt="" /> <button>Download file <span>1.50 Mb</span> </button> </a> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>The Deafening Silence - Stillbirth through a Mother's Eyes</h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://www.youtube.com/embed/MQolbL6Qcq0" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p><span>This film </span>was created by<span> </span><span><a href="http://www.abigailsfootsteps.co.uk/" target="_blank">Abigail's Footsteps</a></span> as a tool for teaching those who work in maternity services about good and bad practice following a stillbirth or neonatal death.</p> <p>Visit their <a href="http://www.abigailsfootsteps.co.uk/" target="_blank">website</a> for more information.</p> </div> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>Breaking the news of intrauterine death - animated video</h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://player.vimeo.com/video/194018241" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p>Breaking the news of an intrauterine death is one of the most challenging parts of working within maternity settings. It can affect not only the patient but also the doctor and the wider team. This video aims to support healthcare professionals who work in maternity services and those who are involved in caring for patients who have experienced an intrauterine death.</p> <p>A<span> </span><strong>transcript</strong><span> </span>of this video can be found<span> </span><a data-id="2227" href="/media/16069/transcript-of-breaking-the-news-of-intrauterine-death-script.pdf" target="_blank" title="Transcript of Breaking the News of Intrauterine Death Script.pdf">here</a>. A<span> downloadable</span><strong> leaflet </strong>accompanying the video<span> can be found<span> </span></span><a data-id="2432" href="/media/16214/nesd0959-intrauterine-death-a5-v3.pdf" title="Breaking the News of Intrauterine Death">here</a><span>.</span></p> </div> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <p><span class="h2">Postnatal care </span></p> <p>After a baby has died, a mother will still experience the same physical and emotional postnatal reactions. Physical reminders of the loss, such as vaginal bleeding, the production of breastmilk, painful stitches or a caesarean scar may be very distressing. It is important to ensure that mothers have adequate pain relief and postnatal care.</p> <p> </p> <p><span class="h2">Being with baby </span></p> <p>Some parents will name their baby but some prefer not to. Be sensitive and ask what parents would prefer. Seeing and holding a baby after death can be frightening for parents. Some may not have seen a dead person before. Prepare them for what to expect. Many parents cherish this memory later.</p> </div> </div> </section> <section class="m-halfimage border-bottom "> <div class=""> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 "> <img src="/media/15805/neonatal-resus-image-10.png?anchor=center&mode=crop&width=800&height=700&rnd=131516914410000000" alt=""> </div> <div class="col-xs-12 col-sm-6 "> <h2>Memory making</h2> <p><span>Encourage parents whose baby has died to consider memory making. Parents may feel unsure about this but photos and keepsakes have been described by many as precious in the years to follow. The hospital bereavement team or maternity midwife may be able to help. </span></p> <p><span>Some parents may find it difficult to decide whether to have photographs taken. However, bereaved parents have said that it’s better to have a photo that they may never look at rather than one they don’t have. If photos are taken on a mobile phone, remind parents to download them as soon as possible so that they are stored safely. Many parents value the opportunity to have photos of themselves caring (</span>e.g. bathing or dressing) their baby, as well as photos of them holding their baby.</p> <p><span>Many maternity departments in Scotland have digital cameras and memory boxes to help with memory making. </span></p> </div> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <h2>Termination of Pregnancy for Fetal Abnormality</h2> <p>Parents who make the decision to terminate their pregnancy following antenatal diagnosis of fetal abnormality will not only experience bereavement but also the guilt associated with their decision. It is important therefore that they receive the same level of care and support as any parent following the loss of their baby and should also be offered the same opportunities for memory making.</p> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <p><span class="h2">Multiple births </span></p> <p><span>The loss of one twin or triplet can be very hard and confusing. Parents are grieving for the baby who has died but may also have ongoing concerns for the vulnerable survivor. Having a living baby does not reduce the grief for the baby or babies who have died and a living child’s progress can be a constant reminder of what might have been.</span></p> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <p><span class="h2">Deciding about a post mortem examination</span></p> <p><span>If a baby dies after birth and the cause is unknown, the case must be referred to the Procurator Fiscal. Whilst this does not require parental authorisation, the reasons for this referral should be carefully explained to parents. Research shows that a post mortem examination may find new and often significant information about the cause of a baby’s death in 60-80% of cases. This may also discover whether there was a problem which could affect future pregnancies.</span></p> <p><span>Post mortem examination can also contribute to important research into why babies die, and therefore potentially help to prevent more neonatal deaths in the future.</span></p> <p><span>Deciding whether or not to have a post mortem can be an incredibly difficult decision to make. Some parents are desperate to know the reason why their baby died and others really may not want an examination.</span></p> <p><span>Written information is available but remember to check reading ability and understanding. Allow time for parents to decide and ensure that regardless of the decision, parents know that their baby will be cared for at all times.</span></p> <p> </p> <p><span class="h3">Types of post mortem examination</span></p> <p><span>There are different types of post mortem: complete, limited or external only. It is important to go through the authorisation form carefully. Parents often have high expectations of a post mortem examination but sometimes there is no clear reason why a baby died. Even where a definitive cause of death is not identified, the examination can still yield useful information for families. </span></p> <p>Results are usually available within 8 to 12 weeks but can take longer if specific tests are done on tissue samples. However, the funeral can take place once the main post mortem examination has been completed.</p> <p>Parents should be offered an appointment to discuss the results of a post mortem examination.</p> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>Discussing Post Mortem Examination – film for healthcare professionals</h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://player.vimeo.com/video/187025288" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p><span>This video aims to help healthcare professionals sensitively discuss authorised (hospital) post mortem examinations with families after a stillbirth or neonatal death.</span></p> <p><span>Please note that this video deals with issues of death and bereavement and was created for healthcare professionals: caution is advised for viewers who are not healthcare professionals as some may find the themes upsetting.</span></p> <p><span>A <strong>transcript</strong><span> of this video can be found <a data-id="2204" href="/media/16059/transcipt-of-discussing-post-mortem-after-stillbirth-or-neonatal-death.pdf" target="_blank" title="Transcipt of Discussing Post Mortem After Stillbirth or Neonatal Death.pdf">here</a>.</span></span></p> </div> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>Parent to Parent Post Mortem Animation </h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://player.vimeo.com/video/272820256" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p>This animated video was created by Held in Our Hearts.</p> <p>This <a href="https://heldinourhearts.org.uk/post-mortem-animation/" target="_blank">Parent to Parent Post Mortem Film</a> draws on the experience of parents who have been bereaved, in order to comfort and inform others who face the decision of whether or not to proceed with a post mortem examination for their baby.</p> <p>Please visit <a href="https://heldinourhearts.org.uk/post-mortem-animation/" target="_blank">this page</a> for more information on the video.</p> </div> </div> </div> </section> <section class="m-2columnlinks border-bottom"> <div class="row"> <div class="col-xs-12"> <h2>Supporting the professionals</h2> <p><span>Experiencing the loss of a baby within one’s capacity as a professional can also be very distressing. Ensure that you seek support from your colleagues and <a href="/wellbeing/" target="_top" title="Resillience and Wellbeing">other sources</a>. It is normal to think about this event for a long while after it has happened.</span></p> <p><span><span>For the MBRRACE-UK Perinatal Mortality Surveillance Report - UK Perinatal Deaths for Births from January to December 2014, published in May 2016 </span><a href="https://www.npeu.ox.ac.uk/mbrrace-uk" target="_blank">click here</a></span></p> <p><span><span>There are many sources of training and education for those who work with those who have experienced a pregnancy loss, stillbirth or neonatal death - search <a href="#" target="_top" title="Education & Learning Resources">resources page</a>. These include:</span></span></p> </div> </div> <div class="row"> <div class="col-xs-12 col-sm-6"> <p><span>An <a href="http://www.knowledge.scot.nhs.uk/maternalhealth/learning/bereavement-following-pregnancy.aspx" target="_blank">e-learning module</a> for those who work in maternity care services</span></p> <p><a href="https://www.sands.org.uk/professionals" target="_blank" title="SANDS webpage"><span>Sands resources and training for professionals</span></a></p> <p><span><a href="http://www.arc-uk.org/for-professionals" target="_blank">Antenatal Results & Choices organisation</a><span> Support and training for professionals</span></span></p> <p><span><span><a href="https://www.rcog.org.uk/globalassets/documents/guidelines/goodpractice4registrationstillbirth2005.pdf" target="_blank" title="RCOG Good Practice on registration of stillbirths">RCOG Good Practice document</a> on registration of stillbirths and pregnancy loss before 24 weeks</span></span></p> </div> <div class="col-xs-12 col-sm-6"> <p><a href="http://www.sehd.scot.nhs.uk/cmo/CMO(2015)07.pdf" target="_blank">Revised Guidance on the Disposal of Pregnancy Loss Up to and Including 23 Weeks and 6 Days Gestation</a>, Scottish Government, April 2015</p> <p><a href="http://www.gov.scot/Topics/Health/Policy/BurialsCremation/CremationCommission" target="_blank">Infant Cremation Commission</a>, Scottish Government, including Lord Bonomy report, 2014</p> <p><a href="https://www.nbcpscotland.org.uk/" target="_blank">The National Bereavement Care Pathway Scotland Project</a> - E<span>vidence-based care pathways designed for all healthcare professionals and staff who are involved in the care of women, partners and families at all stages of pregnancy and baby loss.</span></p> </div> </div> </section> <section class="m-2columnlinks border-bottom"> <div class="row"> <div class="col-xs-12"> <h2>Practical support for parents</h2> <p><span>Coping with bereavement is a long process and there may be times of extreme distress and emotion. Getting back to daily routines can be very hard and parents often feel completely exhausted. Memories and anniversaries can bring back an overwhelming sense of loss. There are many available sources of advice and support, for example: </span></p> </div> </div> <div class="row"> <div class="col-xs-12 col-sm-6"> <p><span><a href="https://www.sands.org.uk/" target="_blank" title="SANDS">Stillbirth and Neonatal Death Society</a> (Sands), information booklets online offering practical advice and support include </span></p> <ul> <li><a href="https://www.sands.org.uk/sites/default/files/AW%20WABDBLB%20211113%20LR%20SP%20LINKED-%20new.pdf" target="_blank" title="SANDS"><span>When a baby dies before labour begins </span></a></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/SAYING%20GOODBYE%20TO%20YOUR%20BABY%202013%20edition_0.pdf" target="_blank" title="SANDS">Saying goodbye to your baby</a><br /></span></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/160806%20AW7%20POST%20MORTEM%20ADVICE%20LINKED%20v3%20-%2022.06.16.pdf" target="_blank" title="SANDS">Deciding about a post mortem: information for parents</a><br /></span></li> <li><a href="https://www.sands.org.uk/sites/default/files/MAINLY%20FOR%20FATHERS%20THIRD%20EDITION%20LINKED.pdf" target="_blank" title="SANDS"><span>Mainly for fathers </span></a></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/SANDS-RETURN-TO-WORK-BOOK.pdf" target="_blank" title="SANDS">Going back to work after the death of your baby</a> </span><span><br /></span></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/160806%20FAMILY%20AND%20FRIENDS%20LINKED%20v4%20-%2022.06.16.pdf" target="_blank" title="SANDS">For family and friends: how you can help</a> </span></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/%E2%80%A2AW%20SUPPORTING%20CHILDREN%20211113%20LR%20SP%20LINKED.pdf" target="_blank" title="SANDS">Supporting children when a baby has died</a> </span></li> <li><a href="https://www.sands.org.uk/sites/default/files/SANDS-GRANDPARENTS-BOOKLET.pdf" target="_blank" title="SANDS"><span>Information and support for grandparents</span><span></span><span> </span></a></li> <li><a href="https://www.sands.org.uk/sites/default/files/160806%20INFORMATION%20FOR%20EMPLOYERS%20LINKED%20v4%20-%2022.06.16.pdf" target="_blank" title="SANDS">Information for employers: helping a bereaved parent return to work </a></li> <li><span><a href="https://www.sands.org.uk/sites/default/files/ANOTHER-PREGANCY-AFTER-A-LATE-MISCARRIAGE-STILLBIRTH-OR-NEONATAL-DEATH.pdf" target="_blank" title="SANDS">Another pregnancy: for parents whose baby has died</a> </span></li> </ul> </div> <div class="col-xs-12 col-sm-6"> <p><span><a href="http://www.bliss.org.uk" target="_blank">Bliss</a> - Support and advice for families of babies in intensive care and special care, including bereaved families</span></p> <p><span><a href="http://www.miscarriageassociation.org.uk" target="_blank">Miscarriage association</a> - Support and information for those affected by pregnancy loss</span></p> <p><span><a href="https://www.tamba.org.uk/bereavement" target="_blank">Twins and Multiple Birth Association</a> (TAMBA) Bereavement Support Group - Support for families who have lost one or more children from a multiple birth</span></p> <p><span><a href="https://www.miscarriagesupport.org.uk/" target="_blank">Scottish Care & Information on Miscarriage</a> – Support for women and families in Scotland who have suffered miscarriage, stillbirth or neonatal loss</span></p> <p><span><a href="https://heldinourhearts.org.uk/" target="_blank">Held in Our Hearts</a> - P<span>rovide support to families following the death of a baby through specialised bereavement services including befriending and counselling</span></span></p> <p><a href="http://www.moneyadviceservice.org.uk" target="_blank">Money Advice Service</a> - Advice leaflet: Late miscarriage, stillbirth and neonatal death - A guide to the financial help available</p> <p><span><a href="http://www.mpsonline.org.uk/bmpsr" target="_blank">Baby mailing preference service</a> (MPS) - register online to stop or reduce baby related mailings</span></p> <p><span><a href="http://www.arc-uk.org/for-parents" target="_blank">Antenatal Results & Choices</a> (ARC) - Support for families affected by the diagnosis of fetal abnormality</span></p> <p><a href="https://www.nhsggc.org.uk/your-health/health-services/milk-bank-scotland/" target="_blank">One Milk Bank for Scotland</a> - Milk bank hosted by NHS Greater Glasgow & Clyde, covering the whole of Scotland</p> </div> </div> </section> <section class="m-richtext row"> <div class=""> <div class="col-xs-12 col-md-12"> <p><span><span class="h2">Bereavement following a termination of pregnancy</span> </span></p> <p><span>It is important to note, that women who have had a termination of pregnancy, for whatever reason, may too experience feelings of grief. For more information on abortion, please visit <a href="https://www.nhsinform.scot/tests-and-treatments/surgical-procedures/abortion" target="_blank">NHS Inform</a>.</span></p> </div> </div> </section> <section class="m-5050videotext"> <div class=""> <h2>Talking to parents about their decisions around burial or cremation after the death of their baby</h2> <div class="row m-richtext"> <div class="col-xs-12 col-sm-6 pull-right"> <div class="video"> <iframe src="https://player.vimeo.com/video/295358413" width="100%" height="281" frameborder="0" webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe> </div> </div> <div class="col-xs-12 col-sm-6"> <p><span></span><span>This video includes guidance for professionals in Scotland on how to provide families who are bereaved with support and information about their options following the death of their baby. It will be of interest to a wide range of people, including healthcare professionals, funeral directors and crematoria staff.</span></p> <p>A <strong>transcript</strong> of this video is available<span> </span><a data-id="2394" href="/media/16191/talking-with-bereaved-parents-about-their-choices-for-burial-or-cremation-transcript.pdf" target="_blank" title="Transcript of Talking with bereaved parents about their choices for burial or cremation after the death of their baby">here</a>.</p> <p><strong>For more information</strong> on discussing infant burial and cremation please <a data-id="1685" href="/bereavement/funerals-cremation-and-burial/" target="_top" title="Funerals, cremation and burial">click here</a></p> </div> </div> </div> </section> </div> </div> </div> <footer role="contentinfo"> <div class="container"> <div class="row footer-links "> <div class="col-xs-12 col-sm-3"> <div class="footer-logo"></div> </div> <div class="col-xs-12 col-sm-3 visible-md visible-lg"> <h2> Before 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</h2> <ul> <li><a href="/bereavement/communication-with-those-who-are-bereaved/">Communication with those who are bereaved</a></li> <li><a href="/bereavement/pregnancy-loss-stillbirth-and-neonatal-death/">Pregnancy Loss, Stillbirth and Neonatal Death</a></li> <li><a href="/bereavement/maternal-death/">Maternal Death</a></li> <li><a href="/bereavement/death-of-a-child/">Death of a Child</a></li> <li><a href="/bereavement/children-who-are-bereaved/">Children who are Bereaved</a></li> <li><a href="/bereavement/bereavement-following-suicide/">Bereavement Following Suicide</a></li> <li><a href="/bereavement/suddenunexplained-death/">Sudden/Unexplained Death</a></li> <li><a href="/bereavement/funerals-cremation-and-burial/">Funerals, Cremation and Burial</a></li> </ul> </div> <div class="col-xs-12 col-sm-3 visible-md visible-lg"> <h2> Other links </h2> <ul> <li><a href="/wellbeing/">Wellbeing</a></li> <li><a href="/cookies-and-privacy/">Cookies and privacy</a></li> <li><a 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