Appendix E

Discussion with Parents About Their Stillborn

Parents and their families experiencing the loss of a baby will have a great sense of loss as with any death. It is natural for them to grieve deeply for the death of their baby and their hopes and dreams. In looking for an explanation they may blame themselves. They will have a lot of questions about "why did my baby die?" and "will this happen again?"

What can help?

Acknowledge the birth of their stillborn baby and validate their grief. Provide them with as much information as possible about the circumstances around their baby's death. Express sympathy and allow them the opportunity to talk about their baby. Use the baby's name and let them know you are interested in hearing about their experience, the loss of their hopes and dreams, as well as concerns about future pregnancies.

Provide parents with as much information as they need to make informed decisions about investigations, making memories (holding, bathing, photographs, etc) and burial options. Let them make their own choices and support them in whatever they choose. Refer them for perinatal loss support in hospital and in the community.

  • Refer to the Perinatal Grief Management Form (#HS001-129).

What should discussions about investigations include?

At this time they will have a lot of questions about why their baby died. You will need to talk about an autopsy and other studies that may determine the cause of death and assist in planning for another pregnancy.

Important information in determining the cause of death can be obtained from the medical and obstetrical history, family history, blood studies from the mom, placenta and cord studies and physical and autopsy examination of their baby. In some cases, genetic studies on both parents will be requested.

The following is done on all stillborn babies:

  • Complete physical examination
  • Cord or infant blood studies
  • Examination of the placenta by a pathologist and placenta tissue studies

Consent is requested for:

  • Full autopsy
  • Limited autopsy: If consent is not given for a full autopsy, ask the parent to consider a limited autopsy, which can include any or all of the following:
    • External examination by pathologist/clinical geneticist
    • Medical photographs
    • X-rays
    • Internal examination limited to brain and/or spinal cord; chest organs or abdominal organs as appropriate
    • Removal of small samples from skin or organ for DNA analysis, cytogenetic studies and cultures

Follow-up for results: Discuss how and when you will contact the parents for a follow-up appointment to discuss results of any investigations and any referrals for genetic or follow-up counselling.

You may wish to let the parents know that information on all stillborn babies is sent to the Alberta Medical Association Committee on Reproductive Care. This committee studies all baby deaths for the province. The information collectively obtained from these studies tells us more about why babies die and helps determine what can be done to prevent future deaths. All published information from these studies will not reveal their identities.