Having a post-mortem after a neonatal death

Information and support about deciding whether to have a post-mortems after a neonatal death.

A post-mortem (also known as an autopsy) is a medical examination of your baby’s body to try to work out the cause of death.

If the cause of the death of the infant is unclear a post-mortem is ordered by a coroner or procurator fiscal.

The coroner is a government official whose role it is to confirm and certify deaths in their area. This kind of post-mortem does not require parental consent but the reasons for it should be carefully explained to you so that you understand why it is happening.

If the hospital would like to do a post-mortem that has not been ordered by the coroner, they will need parental permission to do this.

Post-mortems are important because they may tell you why your baby died or give important new information about infant deaths. This could also:

  • help medical research into infant deaths and inform future medical treatments
  • find something that might make a difference to your care in a future pregnancy.

If a baby’s death is unexplained after a post-mortem, the death is usually registered as ‘Sudden Infant Death Syndrome’ (SIDS), or unascertained (unknown).

Unexplained deaths make up 9% of all infant deaths.

Parents have told us that having a post-mortem has been helpful to the grieving process. Knowing why their baby dies is important.

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.

Should I have a post-mortem?

If the post-mortem has been requested by a coroner your consent is not needed but they should explain the reasons for it to you. If it hasn’t been ordered by the coroner it is your decision as parents whether or not to have a post-mortem. 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. There is no pressure. Unless a post-mortem is ordered by a coroner it is entirely up to you.

‘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

Although it may be very difficult to think about the future right now, it’s worth being aware that your baby’s post-mortem might find some information on the cause of death that could help doctors treat you in a future pregnancy.

You may have religious reasons for not having a post-mortem.

You will be able to see your baby right up until the post-mortem begins unless they are brought to a regional centre.

How long will a post-mortem take?

A postmortem could take as little as 24 hours, but it depends on a few factors. It is usually done the day after the baby is brought to the mortuary. If it is the weekend, this might happen the following Monday.

The length of time it takes depends on:

  • where it is done – some post-mortems happen in your hospital but others are done in regional centres where they can be carried out by a specialist perinatal pathologist. If this happens it means there will be a short delay while your baby is carefully transferred back and forth. This is done by the funeral director or by special transport organised by the hospital.
  • what type of post-mortem is being done – you can read more information on the different types of post-mortem below.

A post-mortem may delay the funeral if you are having one. The length of the delay depends on how long the post-mortem takes. 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.

What happens during a post-mortem?

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.

A complete post-mortem

A ‘complete’ post-mortem’ is the most thorough examination.

The pathologist will:

  • examine the outside of the body
  • examine all the internal organs
  • examine the placenta if it was an early neonatal death
  • examine tissue and fluid samples, such as blood or urine.

Afterwards any organs that were removed 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. These are done to look for genetic abnormalities. 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.

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.

How long does it take to get post-mortem results?

The time it takes to get your post-mortem results depends 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 6 and 12 weeks. This will not have an effect on your funeral or service arrangements however as the body will be returned to you when the post-mortem is completed.

Read more about planning a funeral

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 early neonatal 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.

Read stories

Sources

  1. NHS Choices, ‘Stillbirth - Afterwards’ http://www.nhs.uk/Conditions/Stillbirth/Pages/Afterwards.aspx Page last reviewed: 03/02/2015 Next review due: 01/02/2018
  2. Writhington, Wigan and Leigh NHS Foundation Trust ‘Post-mortem examination on babies or children, including stillbirth’ https://www.wwl.nhs.uk/Library/All_New_PI_Docs/Audio_Leaflets/Bereavement/PostMortem_Exam_Paeds/bs003_post_mortem_exam_babies_child_stillbirths317v3.pdf Date produced: March 2015 Date reviewed: March 2017

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Last reviewed on October 4th, 2018. Next review date October 4th, 2021.

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