A post-mortem is the examination of your baby’s body to try to work out the cause of death. Soon after your baby is born you’ll be asked if you would like your baby to have a post-mortem examination.
Unfortunately, in many cases the post-mortem of a stillborn baby does not show a clear cause of death, so even after a post-mortem you may not know why your baby died. However, it may help rule out what didn’t cause the death.
A post-mortem also allows researchers to gather data on causes of stillbirth with the aim of finding ways to prevent future deaths.
Post-mortems are carried out very respectfully. The incisions are kept as small as possible and the baby’s face, arms, legs, hands and feet are usually unaffected. When a baby is carefully wrapped in clothes, hat or a blanket, the marks from the post-mortem are unlikely to be visible.
Although post-mortems are the gold standard of investigation and reveal important information in many cases , there are other ways of investigating stillbirth, such as
- non-invasive tests - clinical examination or using MRI to scan the baby.
- minimally invasive tests - maternal and paternal blood tests and placental histological examination.
Who does the post-mortem?
A perinatal or a paediatric pathologist, who specialises in identifying conditions in babies, carries out the post-mortem.
Your midwife, doctor or nurse will ask if you’d like to consent (agree) to a post-mortem. It can’t legally be done without your written consent, unless it has been ordered by a coroner or procurator fiscal.
Should I have a post-mortem after a stillbirth?
Unless it has been requested by a coroner, it is your decision as parents whether or not to have a post-mortem, and it is one of the questions you will be asked after your baby is born. If you say yes, you can still change your mind right up until the post-mortem begins.
You may have lots of questions about how and where it is performed, and what the results might tell you. Talk to the midwife and doctors caring for you about your concerns and questions. There is no pressure either way, unless a post-mortem is ordered by a coroner, it is entirely up to you.
"For us we knew we wanted Arthur to have a post mortem as we knew we needed to have done everything possible to try and find out why he had died. Although we didn’t get a definitive answer I still feel we made the right decision."
Kathryn, who lost her son Arthur at 36 weeks (taken with permission from the book, ‘Life After Stillbirth’ by Sarah Smith)
Although it may be very difficult to think about the future right now, if you decide to try for another baby, there’s a chance your baby’s post-mortem might throw some light on the cause of their death, and this could help doctor’s treat you in a future pregnancy.
There may be religious reasons for not having a post-mortem. If your religion requires that the burial happens very soon, speak to the doctors as you may be able to have the post-mortem brought forward.
You will be able to see your baby right up until the post-mortem begins unless hey are changed to a regional centre.
There are different types of post-mortem. The hospital will be able to discuss with you what’s best for your situation but it is your decision.
What happens during a post-mortem?
A complete post-mortem
This is the most thorough examination.
In a complete post-mortem the pathologist:
- examines the outside of the body for signs of abnormality
- examines all the internal organs
- takes small samples of the organs to look at under a microscope. In some instances, if the organs are very small, the whole organ might be examined under a microscope.
- examines the placenta
- examine tissue and fluid samples, such as blood or urine, for infection.
Afterwards the organs will be carefully returned to the baby’s body, just as if it was an operation.
You can choose to have genetic tests carried out on the tissues samples. The samples can be kept on medical record and can be used for further testing if necessary, or you can choose to have them returned. No samples or tissues will be kept without your consent.
Photographs and x-rays may be taken for medical diagnosis and the medical record.
A limited post-mortem
You can choose to have a limited post-mortem. In this case you decide which internal organs or areas of the body will and will not be examined. This may be useful if an ultrasound has revealed abnormalities in a particular organ. However, a limited post-mortem wouldn’t necessarily show any underlying condition or other problems.
An external post-mortem
The outside of the baby’s body will be examined for any signs of abnormality. The placenta, if it is available, will also be examined. X-rays and medical photographs are taken and kept as part of the medical record.
In an external post-mortem, internal organs aren’t examined and no tissue samples are taken.
The health professional discussing your post-mortem options will be able to explain whether an external post-mortem will be useful. There’s a chance you won’t receive any new information on your baby’s death.
Where is the post-mortem done?
The baby is kept in the mortuary until the post-mortem, which is usually carried out the next working day after the baby arrives there. It can take about a week, depending on which post-mortem you decide on, before the baby is returned for the funeral.
Some babies are taken to a regional centre where the post-mortem is carried out by a specialist. This can take longer.
The baby is transported carefully and respectfully, usually by a funeral director or transport arranged by the hospital.
You can dress your baby in special clothes, wrap them in a blanket and leave a special item with them.
"You may want to ask about carrying your baby to the mortuary. This will give the chance to meet some of the people taking care of your baby while they are in the mortuary."
Vicky Holmes, specialist bereavement midwife
You could also ask if it’s possible for the mortuary to phone you when your baby arrives for the post-mortem, and to let you know when they have been returned to the hospital, if they’ve been transported elsewhere for the procedure.
How long does it take to get post-mortem results?
The time it takes to receive post-mortem results varies depending on the hospital and the tests carried out. It is very difficult to estimate how long this will take – but it could be anywhere between six and 12 weeks.
Getting the results of your post-mortem
You (parents) will be asked to come in to the hospital for an appointment and your consultant will talk through the results.
If you have questions, it’s a good idea to write them down, in case you find it difficult to talk. You can take someone close who can also listen to the information and make notes. You might want to ask, for example, about trying for another baby and whether the results will impact future pregnancies. Or whether your care will change and if there are ways to reduce any future risks.
You can receive a copy of the full post-mortem (ask for it when you are discussing the results) and a copy will be sent to the mother’s GP.
This can be a difficult appointment for parents - so you may want to book an appointment with your GP at a later date to go over everything again.
Helping future research
Some hospitals carry out research, such as that funded by Tommy’s, into the causes of pregnancy complications and loss. You may be asked for your permission as parents to allow researchers to use the tissue samples and other items that were taken as part of the post-mortem. This can give researchers valuable insights into the pregnancy that may help prevent future losses. Your consent, however, is needed for this.