Disposal arrangements for fetuses lost in the second trimester

Communication following a stillbirth or neonatal death: room for improvement

OBJECTIVE

To assess the extent of knowledge which mothers had about a previous stillbirth or neonatal death, their satisfaction with the information and advice given them, and their degree of anxiety during a subsequent pregnancy.

DESIGN

Personal interview.

SETTING

Antenatal clinic of a British military hospital in Germany.

SUBJECTS

Forty-eight caucasian, pregnant women, 28 of whom had had a previous stillbirth (Group A) and 20 a neonatal death (Group B).

RESULTS

Over half (25/48) the women had a poor or confused knowledge of the events surrounding the death, only 29% were satisfied with the information they had received, and nearly 40% became pregnant within six months of the death despite medical advice against conceiving soon after such an event. The mothers of stillborn babies were significantly less likely to know the birthweight than the mothers of babies who died after birth (60% vs 95%), and 40% had not given the baby a name. Over a third of the mothers were admitted to hospital because of anxiety about the current pregnancy.

CONCLUSIONS

Dissatisfaction with the quality of information given by hospital staff, rapid conception despite medical advice to the contrary, and anxiety in a subsequent pregnancy were common after a previous stillbirth or neonatal death. A poor or confused knowledge about the baby's death was more likely if the death had been intrauterine and unexplained, or associated with maceration, a lethal abnormality, an emergency delivery resulting in stillbirth, or a preventable cause.

An end to D-I-Y cremation?

This article examines whether to be lawful a cremation must be carried out in accordance with the Cremation Acts. It argues that it need not be but points out that any lacuna in the Acts will be plugged if and when the new consolidated Cremation Regulations are passed. It then considers the implication of this reform for the disposal of babies born dead before the legal age of viability.

The loss of a baby at birth: the role of the bereavement officer

OBJECTIVE

To illustrate and emphasise the role of the Bereavement Officer in the management of perinatal death, as recommended and envisaged by a report of the Royal College of Obstetricians and Gynaecologists in 1985.

DESIGN

A description of the training and responsibilities of the officer and an account of her involvement with all perinatal deaths within a given period.

SETTING

Perinatal deaths in the 12 months, 1 October 1989 to 30 September 1990 from a regional neonatal intensive care unit within a maternity hospital.

SUBJECTS

A total of 59 registerable deaths, three late terminations (severe fetal abnormality) and 12 late mid-trimester miscarriages were dealt with by the Bereavement Officer in this 12 month period.

RESULTS

The introduction of this service to our unit has led to an improvement in our management of both perinatal and fetal deaths.

CONCLUSION

The service has justified fully the recommendations made by the Royal College of Obstetricians and Gynaecologists. Reducing parents' distress will facilitate their grieving and any subsequent bereavement counselling.