Child Health Policy Group (Chairman’s Women’s Health · 2017-05-02 · OBS/GYNAE/GUID/050 Description of amendments: Updated to new template, changes throughout. Version 5.1 –

Document Type: GUIDELINE

Unique Identifier: OBS/GYNAE/GUID/050

Title: Funeral Options For Pregnancy Loss Under 24 Weeks

Version Number: 5.1

Status: Ratified

Scope: Trust wide

Classification: Departmental

Author/Originator and title: Megan Murray, Bereavement Support Nurse Pauline Canning Antenatal Newborn Screening Midwife

Responsibility: Obstetrics and Gynaecology Directorate

Replaces: Version 4 Funeral for Pregnancy / Baby Loss between 14-24 weeks OBS/GYNAE/GUID/050

Description of amendments: Updated to new template, changes throughout. Version 5.1 – Minor changes including: 3.2 updating the leaflet details. 3.3 updating of the Referral of Fetal / Infant Death Book on Delivery Suite and Burial / Cremation Form for a Private Burial Less than 24 weeks and all Stillbirths after 24 weeks form details. Updating Forms on Appendices.

Name Of: Divisional/Directorate/Working Group:

Date of Meeting:

Risk Assessment: Not Applicable

Financial Implications Not Applicable

Validated by: Child Health Policy Group (Chairman’s Actions Miss June Davies Clinical Director – Risk Lead)

Validation Date: 12/11/2014

Which Principles of the NHS Constitution Apply? Principle 1,2,3 and 4

Ratified by: Women’s Health Departmental meeting

Ratified Date: 12/11/2014

Issue Date: 01/01/15

Review dates may alter if any significant changes are made Review Date: 01/11/2017

Does this document meet the requirements of the Equality Act 2010 in relation to Race, Religion and Belief, Age, Disability, Gender, Sexual Orientation, Gender Identity, Pregnancy & Maternity, Marriage and Civil Partnership, Carers, Human Rights and Social Economic Deprivation discrimination? Initial Assessment

Blackpool Teaching Hospitals NHS Foundation Trust ID No. OBS/GYNAE/GUID/050


Revision No: 5.1 Next Review Date: 01/11/2017

Do you have the up to date version? See the intranet for the latest version

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CONTENTS

1 PURPOSE ................................................................................................................... 3

2 SCOPE ........................................................................................................................ 3

3 GUIDELINE ................................................................................................................. 3

4 ATTACHMENTS ......................................................................................................... 6

5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION .............................. 6

6 LOCATIONS THIS DOCUMENT ISSUED TO ............................................................. 6

7 OTHER RELEVANT/ASSOCIATED DOCUMENTS .................................................... 6

8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS ........................... 6

9 CONSULTATION WITH STAFF AND PATIENTS ....................................................... 6

10 DEFINITIONS/GLOSSARY OF TERMS...................................................................... 6

11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL .............................. 6

Appendix 1: Cremation of Evidence of Conception .............................................................. 7

Appendix 2: Burial / Cremation Form for a Private Burial Less than 24 weeks and all Stillbirths after 24 weeks.............................................................................................. 9

Appendix 3: Monitoring compliance ................................................................................... 10

Appendix 4: Equality Impact Assessment Form ................................................................. 11





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1 PURPOSE To provide guidance for staff involved in caring for and providing information about funerals to parents following stillbirth or neonatal death. 2 SCOPE All staff who work with families who have experienced a baby loss 3 GUIDELINE

“Formal burial or cremation is a legal requirement for all babies who are stillborn or die after birth.” Stillbirth and Neonatal Death Charity (SANDS)

The following guidance is applicable in all cases of stillbirth or neonatal death. 3.1 Parents will be given the funeral information at the most appropriate time following

the confirmation of death. Please note: Some parents may want this information immediately; some will not want it until they feel ready. The need for sensitive and empathetic assessment is crucial. 3.2 Following the verbal discussion, all parents will be given written literature relating

to the different funeral services available to them. The choices of service are detailed in the leaflets, ‘Funeral Options for your Tiny Baby’ and ‘Funeral Options for your Small Baby’. Both leaflet will be available on Delivery Suite or on the Trust Document Library, refer to Section 7.

3.3 Prior to making a decision parents must be advised that if they choose to have

their baby cremated, either privately or by the hospital, no ashes will be available. Bereaved parents must be encouraged to read the information provided to enable them to fully understand the options available, and to make choices appropriate to their individual needs. Parents need time, and may not be able to decide before they are discharged home. Staff must complete all the documents before discharge and record if the parents are undecided. The staff in the mortuary also needs this information documented clearly on the Referral of Fetal / Infant Death Form. This form is located within the Referral of Fetal / Infant Death Book on Delivery Suite.

Forms to be completed:

Referral of Fetal / Infant Death Form – Top copy (green) Mortuary, 2nd copy (Blue) Histology Lab, 3rd copy (yellow) to be placed in medical records, 4th copy (white) to be retained in the book.

NVF1 FORM (Appendix 1).

If requesting a private funeral, complete the Burial / Cremation Form for a Private Burial Less than 24 weeks and all Stillbirths after 24 weeks (Appendix 2).





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3.4 The mortuary must be informed within 14 days of the baby’s death of the funeral

choice. However, parents must also be able to contact their named person for support and early decisions of funerals if required. On discharge parents should receive contact numbers of the professional involved to help aid the decision making process.

3.5 Parents will be informed that, should they wish to do so, they can visit their baby

as often as they wish once the mother has been discharged. They will be advised to telephone the Delivery Suite or the Early Pregnancy Unit (EPAU) and discuss with the staff the time they would like to attend, thus enabling the baby to be brought back from the mortuary for viewing in the Family Room on Delivery Suite or the EPAU. Viewings during the working week (09.00 hours to 17.00 hours, Monday to Friday) and other times can be arranged by contacting the mortuary staff on extension 3583.

3.6 In the event of the parents consenting to a post mortem examination, then no

funeral arrangements will be made by Bereavement Office or the parents until the post mortem is complete. The mortician will inform the named person, bereavement office when the post mortem has been completed. The named person will inform the parents when their baby returns, to allow them to arrange and discuss their funeral with either Bereavement Office or a funeral director of their choice.

3.7 In an early pregnancy loss where the products of conception are incomplete they

are sent to the histology laboratory to be viewed by the histopathologist. These products remain in the laboratory for six weeks before being delivered to the crematorium for disposal. The evidence of pregnancy is sealed in a vacuum packed container with the woman’s hospital patient number and details clearly displayed. The NVF1 form (Appendix 2) must be completed by the doctor, nurse and parent.

3.8 Once the choice has been made to have a hospital cremation, the mortuary staff

can then provide a date. This will allow the parents to visit the crematorium on the day of the service, Crematorium staff must be notified that parents wish to attend, however, it must be explained to them that there will be no formal service and ashes will not be available.

To obtain a date for hospital cremation, staff must contact the mortuary technician Monday – Friday between 09.00 hours and 16.00 hours. At weekends/bank holidays, contact with the mortuary staff must be deferred until the next working day. The mortuary technician will liaise with the bereavement office, the ward or delivery suite with the date, once known. This can then be communicated to the parents if they wish to know

Please note: The cremation will not take place for 2 weeks unless the parents specifically request it earlier.

3.9 In all cases where the baby has shown any signs of life, or lived for a period of

time, the baby must be registered as both a birth and a death. In this instance, the





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parents must be provided with both a Notification of Birth and a Death Certificate (located on Delivery Suite) prior to being discharged home from hospital.

The parents MUST be advised that an appointment at the Registry Office is required, and given the appropriate telephone numbers. They can alternatively use the Trust Registry Office, Tel no. 01253 953699. They must also be informed that they can register their baby’s death in their home town, if they reside elsewhere in England and Wales. They must be advised to take the Birth Notification and Death Certificate to their local Registry Office where a registrar will complete the process. Parents must register their baby in a Registry Office in England, irrespective of their country of residence.

Following the registration of the baby’s death, the registrar will issue a Funeral Certificate, which will allow the funeral service of their choice to then take place. The parents must be advised to forward the certificate to their funeral director, or if the parents wish to have a hospital contract funeral then they will take the certificate to the Bereavement Office.

In any instance where the Coroner has been involved, no funeral arrangements can be made prior to the Coroner releasing the baby’s body. The Coroner will be involved when death has been unexpected or the circumstances suspicious.

3.10 All parents who are unable to make a decision re the funeral arrangements or do

not want to make a decision, will be notified that the hospital will perform a hospital cremation at Carleton Crematorium, but consent on the appropriate documentation will be required. No baby should be cremated without the mother’s written consent.

3.11 Where parents have decided that they want a private service, they should be

encouraged to read the relevant leaflet ‘Funeral Options for your Tiny baby’ or ‘Funeral Options for your Small Baby’, which are available on Delivery Suite.

3.12 Where parents have decided that they want an individual type service they should

be encouraged to read the SANDS Guidance (2014). This information can be found in the Sands booklet ‘Deciding About A Funeral For Your Baby’. (SANDS 2014). There is no prohibited law for parents who wish to take their baby home and make their own arrangements with a cemetery or crematorium, but they should consider.

It must not cause any danger to others.

It must not interfere with any rights that other people may have on the land.

There must be no danger to water supplies or watercourses

There must be no chance of bodily fluids leaking into or onto adjoining land.

The fetal tissue must be buried at a depth of at least 18 inches (45cm).





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4 ATTACHMENTS

Appendix Number Title

Appendix 1 Form NVF1 – Application for Cremation of Evidence of Conception

Appendix 2 Burial / Cremation Form for a Private Burial less than 24 weeks and all Stillbirths after 24 weeks

Appendix 3 Process for monitoring compliance

Appendix 4 Equality Impact Assessment

5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION

Electronic Database for Procedural Documents

Held by Policy Co-ordinators/Archive Office

6 LOCATIONS THIS DOCUMENT ISSUED TO

Copy No Location Date Issued

1 Intranet

2 Wards, Departments and Service

7 OTHER RELEVANT/ASSOCIATED DOCUMENTS

Unique Identifier Title and web links from the document library

Patient Information Leaflet – Funeral Options for your Tiny Baby

Patient Information Leaflet – Funeral Options for your Small Baby

Consent for Hospital Contract Funeral Referral of Fetal / Infant Death Book

8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS

References In Full

“Deciding On A Funeral For Your Baby” SANDS (Stillbirth And Neonatal Death Society) Charity 2014 www.uk.sands.org

9 CONSULTATION WITH STAFF AND PATIENTS

Name Designation

Pauline Tschobotko Head Of Women And Children’s Services

June Davies Consultant Obstetrician

Nicola Parry Associate Director Of Nursing And Midwifery

Joanne Sharples Manager Of Mortuary

Carla Mc Caffery Manager Cell Pathology

10 DEFINITIONS/GLOSSARY OF TERMS

EPAU early pregnancy unit

11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL

Issued By Megan Murray Checked By Dr J Davies

Job Title Bereavement Support Nurse

Job Title Clinical Director

Date November 2014 Date November 2014

http://www.uk.sands.org/





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Appendix 1: Cremation of Evidence of Conception NVF1

Please complete this form in full, if a part does not apply enter ‘N/A. All fields marked with an asterix are compulsory’

Part 1 Details of the crematorium

Name of Crematorium where cremation will take place Funeral Director

Carleton Crematorium

Part 2 Your details (the applicant)

Your full name and address * Telephone number

Part 3 Details of the baby born before the legal age of viability

Name of baby (if known) or Name of mother if not the applicant*

1.

Address *

Telephone number

Number of weeks gestation, if known * Sex

2.

Male Female Unknown

Part 4 The application

1. Are you a near relative of the baby* Yes No

If No, please give the nature of your relationship, full name and explain why you are making the application rather than a near relative.

2. What was the date and time of the delivery of the baby who has died?*

Date Time

Official Use:





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Appendix 1: Cremation of Evidence of Conception

3. Please give the address of where the baby was delivered.*

Address (Legal stamp is acceptable) Telephone number

Part 5. Statement of Truth

I understand the remains of my baby, which was born before 24 weeks of gestation and showed no signs of life, will be cremated at Carleton Crematorium. It is highly unlikely for babies under 12 weeks gestation to recover ashes from the cremation. It is difficult for babies less than 24 weeks to recover ashes. If you require the ashes from the cremation please tick this box.

Otherwise any ashes we recover from the cremation we will hold for a period of 2 weeks from the cremation. If you do not contact us within that time we will scatter any ashes in the Baby Memorial Garden.

Print your name*

Signed* Date *

/ /

Official Use

Part 6. Counter Signed.

Non Viable Foetus The expression of Foetal Remains or baby in relation to this document is used to signify a human foetus of less than 24 weeks gestation that has at no time shown any viable life signs.

Print your name * Designation *

Signed * Date *

/ /

If there is any further information you would like to provide.





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Appendix 2: Burial / Cremation Form for a Private Burial Less than 24 weeks and all Stillbirths after 24 weeks.

CONFIRMATION BY THE MEDICAL PRACTITIONER OR MIDWIFE IN RESPECT FETAL REMAINS: I hereby certify that I have examined the remains of:

(Mother’s name)

(Mother’s address) Delivered on _______________________ at __________________________am/pm Of _____________________ weeks gestation and which at no time showed any visible signs of life I know of no reason why any further enquiry or examination should be made. SIGNATURE __________________________________________________ PRINT NAME __________________________________________________ DATE__________________________________________________________ REGISTERED

Write patient details or affix identification label Hospital Number: Name: Address: Date of Birth: NHS No:





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Appendix 3: Monitoring compliance

Minimum requirement to be monitored

Process for monitoring e.g. audit

Responsible individual/ group/ committee

Frequency of

monitoring

Responsible individual/ group/ committee for

review of results

Responsible individual/ group/ committee for

development of action plan

Responsible individual/ group/ committee for monitoring of action

plan and Implementation

a All bereaved families received the leaflet Funeral choices for your baby?

Audit of 1% or 10 health records (whichever is greater) of women identified stillbirth or when a baby has died soon after birth.

Bereavement support Nurse

Annually The Family Division Bereavement support Nurse

The Family Division’s governance group.

b The woman’s choice of funeral was recorded in the path way.

Audit of 1% or 10 health records (whichever is greater) of women identified stillbirth or when a baby has died soon after birth




c Parents were asked if they wanted to take their baby home with them





d Women were given the opportunity to have an individual service.





e Parents were given a coordinated appointment with the registrar.





Appendix 4: Equality Impact Assessment Form Department FAMILIES Service or Policy OBS/GYNAE/GUID/050 Date Completed: 01/01/15

GROUPS TO BE CONSIDERED Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider community, offenders.

EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic / deprivation.

QUESTION RESPONSE IMPACT

Issue Action Positive Negative What is the service, leaflet or policy development? What are its aims, who are the target audience?

See Purpose

Does the service, leaflet or policy/ development impact on community safety

Crime

Community cohesion

No

Is there any evidence that groups who should benefit do not? i.e. equal opportunity monitoring of service users and/or staff. If none/insufficient local or national data available consider what information you need.

No

Does the service, leaflet or development/ policy have a negative impact on any geographical or sub group of the population?

No

How does the service, leaflet or policy/ development promote equality and diversity?

No

Does the service, leaflet or policy/ development explicitly include a commitment to equality and diversity and meeting needs? How does it demonstrate its impact?

No

Does the Organisation or service workforce reflect the local population? Do we employ people from disadvantaged groups

No

Will the service, leaflet or policy/ development i. Improve economic social

conditions in deprived areas

ii. Use brown field sites iii. Improve public spaces including

creation of green spaces?

No

Does the service, leaflet or policy/ development promote equity of lifelong learning?

No

Does the service, leaflet or policy/ development encourage healthy lifestyles and reduce risks to health?

No

Does the service, leaflet or policy/ development impact on transport? What are the implications of this?

No

Does the service, leaflet or policy/development impact on housing, housing needs, homelessness, or a person’s ability to remain at home?

No

Are there any groups for whom this policy/ service/leaflet would have an impact? Is it an adverse/negative impact? Does it or could it (or is the perception that it could exclude disadvantaged or marginalised groups?

No

Does the policy/development promote access to services and facilities for any group in particular?

No





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Appendix 4: Equality Impact Assessment Form Does the service, leaflet or policy/development impact on the environment

During development

At implementation?

No

ACTION:

Please identify if you are now required to carry out a Full Equality Analysis

Yes No (Please delete as appropriate)

Name of Author: Signature of Author:

Date Signed:

Name of Lead Person: Signature of Lead Person:

Date Signed:

Name of Manager: Signature of Manager

Date Signed: