BEST PRACTICE GUIDANCE
01494 568900 www.childbereavementuk.org
For families who wish to take their baby home after death
It is anticipated that each NHS Trust will adapt this guidance to their own local circumstances, adding in
the relevant practical necessities e.g. contact numbers. This guidance is for the doctor, midwife or
whoever is caring for the parents and their baby around the time of death. Many different professionals
may be involved but no one person is better placed to care for the grieving family than another. We each
have something unique to offer – we offer ourselves.
The term ‘parents’ is used throughout; however it is recognised that there may only be a single parent or
indeed a complex family dynamic involving new partners etc. to consider.
AIMS
1. To ensure parents are fully aware of and understand all the choices open to them
2. To ensure that the baby’s body is treated with care, dignity and respect
3. To support parents at home to carry out their wishes, within legal requirements
4. To ensure all relevant staff are informed and in agreement about policy concerning the removal of a
baby’s body from hospital premises
5. To keep an accurate record of the whereabouts of the baby’s body at all times whilst within the care of
the hospital trust
6. To fulfil the necessary legal certification procedures
7. To ensure the hospital environment is adequate and appropriate
© Child Bereavement UK 2011
Registered in England and Wales: 1040419 and Scotland: SCO42910
1. To ensure parents are fully aware of and understand all the choices open to them, and are
supported to make the right choice for them
•
Explain that parents may take their baby home from the unit unless a post mortem examination is
required by the coroner or a consented post mortem examination has been agreed. After the post
mortem examination the body can be released to the parents at home with appropriate
explanations of suture lines, changes that are likely to take place, and any special care needed.
Parents should be offered this as a choice, with no pressure either way, and may need some time
to reach their decision
Parents may not be aware that, unless a coroner’s post mortem examination is required, there is
no legal reason why they cannot have their baby at home. Sometimes it is, for parents, a more
appropriate place to say goodbye to their baby and also makes it more possible for other family
and friends to pay their last respects
•
Inform parents of the possibility of either collecting their baby from the hospital unit or mortuary, or
of their baby being brought home by the funeral director.
The physical act of taking their baby home may be important to parents. Additionally, they may
find collecting their baby from the unit a comfort since they will meet staff they know. However, if
they choose to do this it is important to make them aware that this may raise unexpected emotion
and it may be better to bring along someone else to drive for them. Alternatively, they may wish to
authorise another family member or friend to act on their behalf.
•
Ensure the parents know that they may transport their baby home in their own car. However they
may prefer to ask their funeral director to do this. Explain to parents that funeral directors may
charge for this service.
Parents need to make a choice whilst knowing all the facts. When the responsibility of transporting
their baby seems hard, a funeral director is able to help.
•
Explain to parents that if a hospital or coroner’s post mortem examination is required, they may be
able (subject to the coroner) to return to collect their baby from the hospital afterwards.
Alternatively the funeral director may bring the baby to their home before the funeral.
Parents may assume that if a post mortem examination is required, their baby will not be able to
come home. Some parents may like their baby to leave for the funeral with them, from their home.
•
If parents are taking their baby home themselves, provide them with a letter stating that their baby
has died and they are transporting their baby’s body home.
This affords the parents protection in the unlikely event of them being in an accident or being
stopped by the police.
2. To ensure that the baby’s body is treated with care, dignity and respect
•
Ask parents if they have named their baby and, whenever possible, refer to their baby by name. If
they have not yet chosen a name, refer to ‘your baby’.
The use of ‘the baby’ is impersonal. The mother and father are likely to want their child
acknowledged and them affirmed as parents. Staff can acknowledge their baby’s importance to
them in this way.
•
If the parents take their baby home from the unit, they can use anything they feel is right, carry
cot, car seat etc. They may like to carry their baby in their arms or alternatively they may prefer
you to carry their baby for them.
© Child Bereavement UK 2011
Registered in England and Wales: 1040419 and Scotland: SCO42910
Parents need to know that everything possible is done and feel as comfortable as possible with
the way in which they take their baby home after death.
3. To support parents at home to carry out their wishes, within legal requirements
•
Explain to the parents that they can make their own arrangements for their baby’s funeral if they
so wish, and provide them with details of funeral directors in their local area. They may still wish to
have the hospital chaplain conduct the service for their baby.
It is important for parents to know what choices are available to them.
•
Advise the parents to keep their baby’s body cool at home in a well-ventilated room with heating
turned off. Provide them with information on where to hire a cooler - especially if the weather is
hot, and give them the funeral director’s telephone number in case they need more specific
advice. Some mortuary technologists suggest that the baby’s body is cooled in the mortuary fridge
for 24 hours prior to going home.
Parents may be anxious, especially in hot weather, about how to look after their baby’s body at
home. Funeral directors will collect the baby’s body at any time if the parents have concerns. In
some areas a cooling system can be hired for a few days.
•
Find out if the family wishes to have their baby buried quickly for religious or cultural reasons. For
example, some religions specify that burial should take place within 24 hours if possible.
Exemptions can be made on religious or cultural grounds to provide a ‘Certificate of Burial’ to be
issued before registration of the death so that the funeral may proceed, providing it is not a
coroner’s case, in which case this may affect plans to take the baby’s body home. Cremation is
not permitted prior to registration and medical staff need access to the body for completion of the
necessary forms so these need to be expedited to allow release to take place.
•
Ask the parents sensitively if they are considering having their baby’s body cremated.
If the parents wish their baby to be cremated, you need to ask two independent doctors to sign the
relevant form, one of whom signed the Medical Certificate of Cause of Death. The doctors will
need to communicate with regard to this and it is best done before the baby has gone home, since
the parents should take the MCCD with them.
4. To ensure all relevant staff are informed about the agreed policy concerning the removal of
a baby’s body from hospital premises
•
Make sure that there is an agreed policy concerning the removal of deceased patients from
hospital premises and that all relevant staff are aware of, and have read this policy.
This should ensure that all the staff with whom bereaved parents have contact, are aware of
hospital policy and the choices available to parents in this area.
•
If parents wish to take their baby home, discuss this with relevant health professionals e.g.
manager of the unit and doctors involved, and make a suitable plan, such as what time, where to
park the car, who will accompany them etc.
It is helpful if all the health professionals who have contact with and might speak to the parents
are aware of any of their wishes and staff are agreed about what is unit policy.
© Child Bereavement UK 2011
Registered in England and Wales: 1040419 and Scotland: SCO42910
•
Notify all relevant professional people e.g. bereavement administrator or counsellor, pathology
and mortuary staff.
All hospital staff who may be involved with the family need to know if the baby is to go home. It
may be that some histology tests are required and this will need to be arranged first
•
Telephone or fax the community team: GP, midwife and health visitor if relevant with details of
when the parents are leaving with their baby’s body.
All health professionals who are, or may be involved with the parents should know what has been
arranged in order to offer continuity of care and appropriate support. Parents value liaison
between professionals.
5. To keep an accurate record of the whereabouts of the baby’s body at all times
•
When the parents are ready to take their baby home, write them a letter or ask them to sign a
transfer of care form which states what time they are taking the baby home and whether the baby
will be returned to the hospital or go direct to the funeral director. If the baby is to be returned, the
parents should be provided with contact details for the professional receiving the baby back into
the hospital. If the funeral directors are to make the arrangements for the baby going home, they
will also require the parents to sign a release form.
Either the hospital or the funeral directors need to have a written record of the whereabouts of a
baby’s body and the approximate time of return, if relevant. If parents are travelling out of the
hospital’s catchment it is helpful for staff to have encouraged parents to make contact with a local
funeral director so that they can be on hand to help should the family change their mind at any
point and no longer want the baby at home.
6. To fulfill the necessary legal certification procedures
•
If the baby has died before 24 weeks gestation, ask a doctor or midwife to sign a certificate for
cremation or burial for a ‘baby born before the legal age of viability’ (or NVF form) before the
parents take their baby home..
Although not a legal requirement for babies who die before 24 weeks gestation due to miscarriage
or a termination for foetal anomaly, it is good practice to provide the funeral director with a burial
or cremation form to ensure a respectful disposal. The baby has no legal status so the death does
not have to be registered, but most crematoria and cemeteries will still ask for the NVF form
before they will carry out the funeral.
•
If the baby was over 24 weeks gestation and was stillborn, the doctor (or a midwife providing they
include their NMC PIN) will sign a ‘Certification of Stillbirth’. Again, the parents need this before
they take their baby home
Parents will need the certificate when they go to register the death of their baby. The Registrar will
then issue a ‘Certificate of Burial or Cremation’ allowing burial or cremation to go ahead either
through the hospital or through a funeral director.
•
If the baby was over 24 weeks gestation and showed signs of life, you should complete a birth
notification for the parents. They will also need the Medical Certificate of Cause of Death once it
has been signed by a doctor and seen by the bereavement administrator. This cannot be
© Child Bereavement UK 2011
Registered in England and Wales: 1040419 and Scotland: SCO42910
completed if there is a chance that a coroner’s post mortem examination may be required. In this
case, the baby’s body has to remain at the hospital.
To register the death, a medical certificate of cause of death is required. If the case is referred to
the coroner, the cause of death may change and registration cannot proceed until the coroner has
completed his enquiries.
•
Explain to the parents that it is possible to have their baby at home before registration takes place.
However they will need the Medical Certificate of Cause of Death to register the death and should
have it with them when the baby is at home.
There is a legal requirement for babies who die after 24 weeks gestation to have their deaths
registered within 42 days of a stillbirth or 5 days of a neonatal death. The Registrar will then issue
a ‘Certificate of Burial or Cremation’, which will be needed by the funeral directors. Burial or
cremation, required by law, cannot take place without this certificate.
7. To ensure the hospital environment is adequate and appropriate
•
Ideally, a hospital bereavement suite/room needs to be made available for as long as the parents
want to be in the hospital, before taking their baby home. It should be away from the noise of
other families and their babies and have privacy, yet with easy access to help from professionals.
Other family members such as children and grandparents should be welcomed to be with the
parents.
Some parents may feel more comfortable remaining within the hospital environment with their
baby for a time. They may wish to have some of their family/close friends come to see the baby
there.
•
The room needs to be conducive to grieving families. It should be sensitively furnished with
comfortable seating, a crib and/or bed and preferably en-suite facilities. A telephone, fresh water
system, hot drinks facilities and a toy box are important. An air conditioning unit is very valuable.
(This may not be possible where the only facilities for viewing are in the hospital mortuary)..
The environment in which children see their brother or sister is important as it will become part of
their memories of that time. Touch is important so parents and siblings may value the chance to
hold and perhaps to lie down with their baby. Some people will find this easier if the professional
hands the baby/child to them rather than picking them out of the crib/off the bed, themselves.
They need to feel comfortable there and be able to make sensitive telephone calls in privacy.
Toys are necessary for children who cannot stay with painful feelings for long and need to play as
children do. Air conditioning (as in many hospices) means the family can have their baby with
them for longer, especially in hot weather.
•
Establish a room other than the ward/unit office where staff can spend a little time in privacy and
quiet.
Carers need care and support too, and professionals need to be aware that their own needs for
support are recognised and respected. Support should be made available through peers and
more specialist means. Professionals need to look out for colleagues who need some time alone
or with someone supportive in a separate place away from clinical areas. Providing a suitable
environment for this facilitates staff support.
© Child Bereavement UK 2011
Registered in England and Wales: 1040419 and Scotland: SCO42910