At the time of telling parents that their baby or child has died, explain what steps will be taken next. Parents in shock can feel confused and need your direction and guidance. The same is true for children who experience the death of someone important to them
Information, choices and time
Don’t give information and leave. Let parents know when and where they will see you again, and be specific regarding the place and time agreed.
Parents need to be given the choice to participate as much as they wish in the care of their child after the death. A clear unhurried time needs to be available for them to be with their child before he or she is transferred to the mortuary. Don’t hurry parents; allow them as much time as they need, alone or with grandparents, siblings and friends. This time is vital in their grieving process.
Offering parents choices
It is very important for parents to have the opportunity to choose how they and their child are cared for. In order to make these choices they will need all the information on the options open to them, time to understand this information and time to make their decisions. Below are some of the choices and decisions that parents need to know about:
- Holding their dead baby or child
- Washing or helping to bath their baby or child
- Choosing clothes and dressing their baby or child
- Being involved in all aspects of their baby or child’s care
- Taking photographs of their baby, both dressed and naked
- How long they can have their baby or child with them after the death
- Who they should contact if they would like to return to hospital to see their baby or child before the funeral
- How they may include any other children they have ~(Parents often want to protect their children from these painful experiences and will need help to explain to children that their brother or sister has died, and that they may want to say goodbye)
- How they involve grandparents, other relatives and close friends
- Whether to take the child home before the funeral
- What sort of funeral to have. A funeral is often the only thing that parents can do for their child and it will be a very special memory
- Visiting their child at the funeral director’s
Post mortem examination
With a sudden death, a coroner’s post mortem examination is required because the death is unexpected. It is appropriate to explain this to the parents and to tell them this is a legal requirement. Detailed verbal and written information should be given to parents about the post mortem examination and possible inquest. It is also important to acknowledge that they may find it very difficult having no say in whether this happens. They will need time to absorb, understand and discuss the implications of a post mortem examination and may find it hard to remember what has been said verbally to them. The Human Tissue Authority produces codes of practice that give professionals practical guidance on human tissue legislation.
Leaving the hospital and follow up
Let parents know you will be letting the relevant community professionals know about the death. Speak directly to a member of the primary healthcare team as soon as possible and inform them of the circumstances surrounding the death. This all helps with the continuity of care. When families leave the hospital, offer to walk with them to their car.
Bereaved parents value receiving the written offer of a follow-up appointment with their child’s consultant/s within about six weeks of their child’s death.
It is helpful if the letter sent to parents includes an invitation to bring along another family member or friend, if they wish. Include in the invitation whether they would like their child’s nurse, midwife or other member of the hospital team to be present. Often they wish to see the nurse or midwife present at the time of death. If the child is well known to other wards and health care professionals, then the follow up may possibly be better from them, e.g. the oncology team.
Parents’ agreement should be sought on the acceptability of the venue. Some parents may not yet be ready to revisit the place where their child died.
If parents do not choose to accept a follow-up appointment, they need to be sent written information as to how they may initiate a follow-up consultation in their own time. Provide them with the name and telephone number of a contact person or suggest they ask via their GP.
A follow-up appointment is important because:
It gives the parents the opportunity to ask questions and clarify issues of treatment, their child’s responses to treatment, care given and post-mortem findings, etc. Parents may be harbouring regret or guilt at not having asked certain questions or spoken up on occasions when their child was alive and they may be blaming themselves in some way. Open, honest communication, sensitively given, is likely to deepen parents’ understanding and support the grieving process.
Another opportunity is provided to assess with the family their needs for referral for bereavement counselling and/or emotional support and to address any needs of siblings, such as revisiting and saying goodbye to members of staff, other children, playrooms, schoolrooms, etc, that may have featured significantly in their lives at a critical time.
Feedback to staff from families about care is often helpful to them and helps to increase confidence and self esteem.
The following information sheets may be helpful:
- How we grieve
- Helping yourself through grief
- Coming to terms with grief
- Men, women and grief
- Taking photographs following the death of a baby
- For families who wish to take their baby home after death
- When your baby dies – a particular sort of grief
- Saying goodbye to your baby or child
- When a child dies-a loss like no other
- Returning to work after the death of your baby or child – guidance for employees
- Returning to work when a baby or child has died – guidance for employers
- Care of a family when their baby or child dies in the Neonatal, Paediatric or the Accident and Emergency Units
- Care of a family when their baby dies in the maternity unit