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Local Supervising
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Supervising
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IN THE EVENT OF AN UNEXPECTED STILLBIRTH OR NEONATAL
DEATH AT HOME
Guidance for Supervisors of Midwives
Paper copies of this guideline may not be the most recent version. The
definitive version is held at
http://www.nipec.hscni.net/supervisionofmidwives/locallsaguidelines.html
Guideline
Produced by
PHA (LSA in NI) SoM Guideline Development Group with thanks
to South East Coast SoMs who wrote the original guideline
Consultation
process
PHA SoMs Guideline Development Group and all SoMs via the
Contact SoMs mechanism
Approved by
LSA Midwifery Officer and PHA (LSA in NI) Guideline
Development Group
Date
Implementation
date
Review date
January 2011
February 2011
December 2013
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Final version January 2011 Review December 2013
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KEY POINTS
Local guidelines should be available with relevant contact details; this
guidance deals with key points.
In the event of an unexpected stillbirth or NND at home, the Supervisor of
Midwives should be informed by the midwife attending the birth or
immediately afterwards.
The supervisor will need to ascertain:
Who was present?
Was the midwife present at the birth?
Were there any suspicious circumstances?
If a stillbirth was it fresh or macerated?
If a stillbirth what is the approximate gestation of the stillbirth?
Booked or un-booked?
High risk/low risk?
In the event of a stillbirth at home with midwife present
a) Midwife should offer and arrange transfer to hospital for mother and
baby by ambulance.
b) If the mother prefers to stay at home the baby may be removed from the
house by an undertaker only after the Medical Certificate of Stillbirth has
been completed by the midwife (see the Midwives rules and standards,
NMC 2004).
c) In circumstances where the mother may have been involved in an
accident or there are any uncertainties surrounding the death (for example
a neonatal death at home) the coroner must be informed as he may require
a post mortem without the consent of the parent(s). This unusual
circumstance should always be discussed immediately with your Head of
Midwifery and the coroner’s advice and guidance sought.
Coroner: 028 9044 6800
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Unexpected Stillbirth with no Healthcare Professional present
a) With neonatal deaths at home or unexpected stillbirths, the coroner’s
office may recommend police involvement in which case handling of
the baby should be minimal until completion of the investigation.
SoMs should advise midwives to secure the evidence in any case
with coroner or police involvement and if unsure what this means in
practice, should seek advice from the coroner’s office.
b) The coroner’s office will always give advice to Supervisors of
Midwives or a midwife.
c) In circumstances where the midwife arrives after the birth and the
baby has no signs of life the midwife must call a medical practitioner.
d) Where the midwife has arrived after the birth and therefore cannot
confirm that the baby never breathed, the coroner’s officer should be
contacted. In such circumstances the Medical Certificate of Stillbirth
should not be completed by the midwife.
e) The baby and/or placenta should not be removed from the home
without instruction from the coroner and the placenta should be sent
for histology.
f) The unit CMACE co-ordinator should be informed so that a CMACE
perinatal death notification form is completed and sent to the CMACE
Regional Manager.
CMACE Regional Manager: 028 9055 3611
SOM - in cases of stillbirth
When a Supervisor of Midwives informed of an unexpected stillbirth at
home by the attending midwife:
Advise minimal disturbance to baby and immediate environment;
secure the evidence
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Offer to attend to support the midwife
Advise midwife to inform GP
SoM informs HoM
SoM provides support for midwives involved
SoM offers to inform local coroners office
Remind midwife to record all actions and observations
Expected Stillbirth at Home
a) In rare circumstances a mother may choose to give birth at home,
knowing and anticipating a stillborn baby. The supervisor of midwives and
midwives should endeavour to support this decision.
b) This situation is unusual. Rule 6, as defined in the Midwives rules and
standards (NMC 2004), states that where there is a deviation from the
norm which is outside her current sphere of practice becomes apparent a
qualified health professional should be called.
c)The woman’s GP and the obstetrician with whom the woman is booked
should be informed of the arrangement. At the time of labour the on-call
medical practitioner and the obstetrician should be informed.
d) Ensure that the midwife knows the procedure as per local HSC Trust’s
requirements following stillbirth, i.e. documentation, checklist, samples,
storage of baby and placenta, consent for postmortem etc.
e) Where appropriate the arrangements following the birth should be
discussed prior to delivery.
Documentation
Where the mother remains at home the midwife should arrange for the
Medical Certificate of Stillbirth to be issued following the birth.
A notification of birth will be required by the registrar’s office and should be
completed by the midwife in the usual manner.
The supervisor of midwives should have access to a supply of Medical
Certificates of Stillbirth at her local maternity unit.
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The midwife may complete this certificate when she has been present at
the birth and/or had examined the baby and is confident that the baby has
not breathed. This will usually be where there is a degree of maceration or
gross abnormality present.
Disposal of the placenta should be carefully considered in light of the
circumstances. Sending the placenta to histology would be seen as best
practice.
Details on the certificate should be confined to those facts which the
midwife knows. Where the cause of death is unknown this may be inserted
into both the main maternal and fetal cause sections. This should be
discussed with your Head of Midwifery and the coroner’s office.
Wherever possible however the cause(s) should be stated to the best of
the certifier’s knowledge and belief.
The father should be advised to take the certificate to the registrar’s office
to register the stillbirth (usually by appointment) if married, otherwise the
mother must attend. A Certificate of Disposal will be issued.
References:
NMC 2004, The midwives rules and standards, London: NMC
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