Information for Families

Having a post-mortem after the loss of your baby

Please be aware that the following information may be distressing to some readers.

We offer our heartfelt condolences if you, or someone close to you, has suffered the loss of a baby. We understand that the loss of your baby is a painful time, so we’re committed to supporting and caring for you and your family as you navigate this difficult experience.

The loss of your baby may raise important questions that can affect your grieving process as well as have implications for future pregnancies. The decision to have an internal examination of your baby’s body is a personal one. Research, and our experience in assisting hundreds of families, shows that some parents have later regretted not having the information that a post-mortem examination may provide. Rarely do they regret having this information.

A post-mortem examination is a detailed internal examination of your baby and is usually performed by a pathologist within 48 hours after birth. Some parents understandably find this request overwhelming at such a difficult time. It can be daunting to make the decision to have an autopsy performed as there is some fear about the process, or concern that your baby will be returned to you disfigured.

Please be assured that the examination will not compromise your ongoing contact with your baby, nor any pastoral, spiritual or religious needs related to your family. The post mortem examination will be performed carefully in such a way that you will still be able to hold your baby following the completion of the examination.

More detailed information about the post-mortem process is available in the drop down menu below. Please take your time in reading this information and understanding the options available to you.

Creating memories

The memories that you create with your baby can play an important part in helping with your grief. While in hospital, there are a number of ways that you can spend time with your baby and create everlasting memories, including:

  • Seeing, holding or dressing your baby
  • Bathing your baby
  • Photographs and hand and foot prints
  • Naming or other personal rituals
  • Creating a memory folder and keeping special mementos, such as teddies or blankets.

Our perinatal pathology staff are available to assist you with organising some of these mementos for miscarriage, stillborn or neonatal babies, even if your baby is not having a post-mortem examination. We store these indefinitely and they may be collected at any time by you. 

Arranging a viewing

We have a quiet room for you, your family and other people important to you, to spend time with your baby when you have left the hospital. The quiet room is available from Monday to Friday from 8am to 3pm even if your baby is not having a post-mortem examination.

Access to the quiet room may be arranged by phoning:

  • Perinatal Pathology department: (08) 6458 2730
  • Paediatric Pathology department: (08) 6458 0281.

Comfort, support and more information

Aside from your family, friends and the health professionals involved in caring for you and your baby, there are agencies that can offer you support, including: 

  • SANDS: provides support and information to families who experience miscarriage, stillbirth and neonatal and infant death
  • Red Nose Grief and Loss: a 24-hour bereavement support and counselling service to families who have experienced stillbirth or the sudden and unexpected death of a child, regardless of the cause
  • Bears of Hope: ongoing comfort, support and counselling to families who have experienced the loss of a baby during pregnancy, birth and infancy
  • Heartfelt: a volunteer organisation of professional photographers who provide photographic memories to families. All services are provided free of charge
  • Lifeline: a national charity providing anyone experiencing a personal crisis with access to 24-hour crisis support and suicide prevention services
  • Centrelink (Family Assistance Office): provides financial assistance including maternity allowances and bereavement payments
  • Registry of Births, Deaths and Marriages: the registry records and maintains births and death registrations in Western Australia and issues certificates.

 

Frequently Asked Questions

This is an examination performed after death to provide as much information as possible to explain what happened to your baby and why. An examination can only be performed with your consent. The examination is performed by a medical specialist called a Paediatric and Perinatal Pathologist who is experienced and trained specifically in this area.

It’s entirely up to you the type of examination you give permission for the pathologist to perform. The examination will be tailored precisely to your wishes. These should be written on the signed consent form so that the pathologist knows exactly what is required, but also what you do not permit.

Full post mortem examination

This will allow the pathologist to give a very detailed report of any external or internal abnormalities, organ growth and structural defects. To perform the autopsy, incisions will be made in order to examine the organs. These are made along your baby’s chest and tummy and another is made at the back of his/her skull. These will be delicately repaired and will not be visible to you when your baby is returned to you carefully redressed and wrapped. The examination will include an x-ray and placental examination.

Limited post mortem examination

This is where restrictions are placed on the examination, such as:

  • Examination of the abdominal and chest organs but no head incisions
  • Examination of chest organs only
  • Examination of abdominal organs only
  • Examination of head only.

To perform a limited autopsy, an incision is made as determined by the Pathologist. This will be carefully repaired and will not be visible to you when your baby is returned to you carefully redressed and wrapped. The examination will include an x-ray and placental examination.

External post mortem examination

This is where only the outside of your baby’s body is examined. No incisions are made and no internal organs are studied. The examination will include an x-ray if required and placental examination.

A more complete examination allows the pathologist to provide a more informative final report. If we’re able to provide more information to the doctor or counsellor involved in your care, they will be better able to explain what happened to your baby and whether this could affect future pregnancies or other family members. Your doctor or midwife will be able to give you more information about the post-mortem procedure and answer any questions you have.

Genetic, microbiology, virology or other laboratory tests may help detect infection or genetic problems. Small specimens will be sent for tests if the pathologist thinks it necessary at the time of the post mortem examination.

The results of these additional tests are included in the final report.

PathWest has a formal policy that all organs are returned to the body and whole organs are never kept without the specific consent of the parents. Please be aware that some organs, such as the brain, cannot be examined satisfactorily without chemical treatment (this is called ‘fixation’). Without this examination, the amount of information will be reduced so you may be asked before the examination for permission to allow us to keep the organ for a little longer.

If permission has been granted and an organ has been retained for fixation, the options include:

  1. Delay cremation or burial until examination is complete (this may take up to two weeks)
  2. Proceed with cremation or burial and have a separate interment later.

This is entirely up to you to decide. Your post mortem coordinator or doctor will be able to offer advice and support.

Following the post mortem examination, the pathologist writes a report for the doctor who cared for you and your baby, detailing their findings.

A provisional report will generally be available within 2-3 working days and a final report will be issued within 6-8 weeks, when all test reports are known.

The information gained from this report will allow your healthcare professional to counsel you if your baby had a genetic condition or discuss why your baby died and what the risks are for future pregnancies. We can also prepare a report for you in non-technical language for discussion with your healthcare professional. This report, called the Plain Language Report, can be requested when signing the post mortem examination consent form.

The post mortem coordinator or your doctor will be able to discuss all your questions about the post mortem examination with you.

No, you don’t. It’s important to reach decisions you are comfortable with and we understand that this may take some time. No examination of your baby will be performed without your consent.

The post mortem examination takes place at PathWest’s Paediatric & Perinatal Pathology department at Perth Children’s Hospital (PCH).

Your baby is kept in Perinatal Pathology at King Edward Memorial Hospital (KEMH). If your baby requires an examination, he/she will be transferred to the PathWest Paediatric & Perinatal Pathology department at Perth Children’s Hospital (PCH). Your baby will always be accompanied by the Perinatal Pathology staff. Before leaving KEMH, an x-ray of your baby is done to assess bone development. On arrival at PCH, the pathologist will perform an examination in the specialised state-of-the-art autopsy suite. Measurements and photographs are also taken of your baby to create a permanent record. Your baby will be returned to the Perinatal Pathology department at KEMH the same day.

With your agreement, the pathologist performs a full external and internal examination. Each organ is examined, weighed and a small piece is taken for microscopic examination. These small pieces are kept indefinitely to create a permanent record. The placenta is also examined at this time if available. After the examination, all the organs are returned and the skin surfaces are carefully closed.

During a post mortem examination, a training doctor, midwife, nurse, laboratory technician or specialist may be present as part of their training or to review the findings. Tissue won’t be taken or used for research purposes unless your permission is given on the consent form. Any research that takes place will have the approval of the hospital’s ethics committee.

Please be aware that PathWest’s Paediatric & Perinatal Pathology department is a teaching government agency where any photographs, diagnostic slides or knowledge gained during a post mortem examination may be used anonymously for teaching of clinicians or authorised students.

A small biopsy (roughly the size of a pea) is routinely taken from every major organ for microscopy to detect disease, similar to how biopsies are taken during life to determine if disease is present. This tissue is processed into a paraffin block from which a microscope slide is produced. This material is kept indefinitely. All remaining tissue is returned to the body at the conclusion of the post-mortem.

Unless permission is specifically granted, all tissues are returned to the body at the conclusion of the post-mortem. A pea-sized sample is taken from every major organ. From this, a paraffin block and microscope slide is produced for microscopic examination to detect disease. These are kept indefinitely as part of the patient record and can be referred to at a later stage (e.g if new genetic tests become available).

We are permitted by law to cremate babies that are stillborn and less than 28 weeks gestation, provided we receive parental consent and the correct documentation. If a cremation is requested, parents may choose from two options which need to be indicated on the consent form:

Option A – Interment of Ashes Service

The KEMH Interment of Ashes Service is a memorial service where the ashes are interred in the KEMH Memorial Garden.

The Perinatal Pathology department conducts the cremations for the service towards the end of each month and combines the ashes of all babies to be placed in the garden communally. For King Edward Memorial Hospital and Fiona Stanley Hospital patients, pastoral care will provide service details and a booklet. For those parents whose babies are born at other hospitals, service details and booklet are sent by Perinatal Pathology on behalf of Pastoral Care Services informing them of the details. This service is free of charge.

The service is held on the last Thursday of each calendar month (except for December when it is held on the third Thursday) and is conducted by the hospital’s Pastoral Care Service and welcomes parents of the babies, their family and friends. Where consent has been given, the names of each of babies are read and each parent and their family are encouraged to inter a portion of the ashes in the site prepared within the garden.

The KEMH Memorial Garden was started in 1989. As this is a memorial garden, only ashes may be interred. The garden is for everyone so any personal tributes left in the garden will be removed on a regular basis. The memorial garden will be heritage listed and will remain at this site and will continue to be used for monthly services when the new Women’s Hospital is built.


Pictured: King Edward Memorial Hospital Memorial Garden

Option B: Individual Cremations

An individual cremation means that the baby is cremated singularly and the ashes retained for return to the parents. 

A health care facility or department must be nominated to have the ashes sent to them to return to the parents. We ask that parents collecting ashes produce photo ID. If you nominate another person to collect the ashes, they must have written consent from the parents as well as photo ID.


Pictured: Ashes boxes

The Perinatal Pathology staff prepares mementos of your baby (if possible). This will be done for Miscarriages, Stillborn & neonatal babies only. The mementoes include hand and foot prints and photographs. There is no cost involved with mementos from Perinatal Pathology.

Collection of the mementos can be selected on either the PathWest Consent for Cremation form or the PathWest Consent for Mementos form.

All photographs are stored digitally and are kept indefinitely and may be collected at any time by contacting Perinatal Pathology. Please note the photos will be printed when given.

As only one set of hand and footprints are taken of your baby these are stored until they are collected. If collected, we scan a copy of the hand and footprints into your record which may be printed later however the copies are not ideal.

You will be given the choice to decline mementos if you feel for any reason that you do not want Perinatal Pathology to take photos or hand and footprints of your baby. You can let us know that you wish to decline by filling in this option on either the cremation consent form, if your baby is being cremated by Perinatal Pathology or on the Mementos Consent form if your baby is going for a private burial or cremation.

Name bands may not be given as mementos. It is important that your baby is always identified while in the care of the hospital and Perinatal Pathology staff. It is for this reason that we do not remove the name band.

If you would like to arrange any mementos from companies outside of Perinatal Pathology at your own cost (e.g. Hand and foot moulds, Jewellery imprints or a professional photographer from Heart Felt), it is best to liaise with Perinatal Pathology to make sure that this is done.

The Perinatal Pathology department have photos dating back to 1980 with hand and footprints dating back to 1990. Please note mementos were not taken on all babies before 2005. If you would like to enquire about photos hand and footprints, please contact Perinatal Pathology.

 
Pictured: Hand and footprint cards

For some parents, it is important to spend some time with their baby and family and friends in the privacy of their home or another place of special significance. You can choose to do this if you wish. If you do take your baby outside of your home or to a public place, it is recommended that you take into consideration the appropriateness of the venue and other people’s reactions to seeing a deceased baby.

You can also choose to leave your baby with the hospital if you feel this is the right decision for you and your family. There are no expectations that you will do anything at all. Hospital staff will either facilitate the cremation at KEMH or transportation to a Funeral Director according to the arrangements you have made.

To assist you in making decisions regarding transporting your baby from hospital, the guidelines in this information sheet have been developed to explain the legal requirements you will need to meet and any documents you may need if you wish to take your baby home.

For babies delivered before 20 weeks gestation

If your baby was stillborn before 20 weeks gestation of pregnancy and weighed less than 400 grams, there are no legal requirements. However, when taking your baby from the hospital you will require the Authorisation and release of Human tissue and Explanted Medical Device Consent form

You may choose to have your baby cremated at a public cremation or buried in a cemetery. Alternatively, you may bury your baby in a place of your choosing, providing it is on private property and with the property owner’s permission. It is recommended that when burying on private property that the site be prepared to a depth of at least 1 metre below ground, and that baby’s body is contained in an appropriately sealed container.

For babies delivered after 20 weeks gestation

If your baby was born alive (at any gestation), was born after 20 weeks gestation, or weighed 400 grams

Then your baby must be buried or cremated in a registered place such as a cemetery or crematorium. King Edward Memorial Hospital is registered to perform cremations for babies stillborn at less than 28 weeks gestation.

However, if you choose to transport your baby outside the hospital for a service, a funeral director should be chosen and informed prior to transporting.

You will need the following documents

  • MR295.95 – Permission to Transport Deceased Baby
  • Form 7 – Certificate of Medical Practitioner
  • BDM201 – Medical Certificate of cause of Stillbirth or Neonatal Death

These forms will need to be given to your funeral director. You will need to keep the documents together with your baby at all times. It is recommended that you tuck the forms in beside your baby in the car seat or bassinette. This is particularly important should you have a car accident on route to your destination, as police, paramedics or ambulance staff will need to know that your baby was not alive when the accident occurred.

Transporting your baby

You can transport your baby yourself or choose to have a funeral director arrange transportation for you.

Your baby may travel with you in the car secured in a car seat, bassinette, or other suitable carrier. The important thing is that your baby is secure during the trip. Remember to keep all documentation with your baby. For smaller babies under 20 weeks gestation, the hospital may provide you with a container to carry your baby in, as it is still important for smaller babies to be secured. We do not recommend you carry your baby in your arms.

If you wish to transport your baby by domestic or international aeroplane you will need to engage the services of a funeral director. All airlines require that stillborn babies travel in a casket

or coffin in the hold of the aeroplane and not the cabin, and the funeral director will organise this on your behalf. Babies being transported internationally are required to be embalmed prior to the flight and this can also be arranged by the funeral director.

Caring for your baby at home

The room which you keep baby in must be kept cool and well ventilated. We recommend that you place baby on a bed of ice bricks while you are sleeping or at intervals during the day. Natural changes to your baby’s body will occur; these may include variations in the appearance of baby’s skin, such as peeling or changing in colour and an odour may be noticeable. Keeping baby cool will help to slow down the rate at which any changes will progress.

The Hospital has a Cuddle Cot which may be available; this assists in keeping your baby’s body at a stable temperature.

 

If you would like to take your placenta home, please contact Perinatal Pathology.

WA health have advised that any placenta that may be potentially infectious or has been fixed in formalin should not be released.

We advise that taking a placenta home after a Pathology examination for consumption is not appropriate. Pathology does not use sterile techniques when performing examination.

 

Private cremations and burials involve a registered funeral director and are required by law for babies equal to or over twenty-eight weeks gestation and those babies who, at any gestation, had a heartbeat or breathed at birth. Private funerals are another option for babies who could otherwise be cremated by the Perinatal Pathology Department.

Funerals with a registered funeral director incur a cost. Families should contact the funeral director of their choice directly to make the appropriate arrangements.

It is best that Funerals are arranged as soon as possible. Perinatal Pathology cannot facilitate appropriate care for your baby long term.

KEMH Pastoral Care Services or Social Work departments can assist parents when considering various funeral options and choices. When arrangements are made, the funeral director will contact us to arrange the transfer of the baby into their care.

Please see here for a list of all Funeral Directors for Western Australia.

Last Updated: 01/12/2021