Parents of stillborns often fear autopsy, research finds

Parents who suffer the tragedy of a stillbirth are often reluctant to consent to autopsy for fear of further harm to their child — a legacy of the organ retention scandal and negative TV portrayal of the procedure.

Fear of their child undergoing further invasive procedures is reflected in the poor autopsy uptake rate, with just half of stillborns undergoing a postmortem, despite the valuable information it can give to doctors when managing a subsequent pregnancy.

These are among the findings of a number of researchers who will discuss the topic of stillbirth today at a conference looking at its effects on parents and the doctors who deliver the infants.

Speakers at the inaugural conference of Cork University Maternity Hospital’s (CUMH) Pregnancy Loss Team and the Department of Obstetrics/Gynaecology at University College Cork (UCC), include consultant obstetrician/gynaecologist Dr Keelin O’Donoghue, who set up the pregnancy loss service at CUMH.

Dr O’Donoghue, clinical director of women and children’s services at CUMH, said while clinicians “talk a lot about the benefits of postmortem”, there has been a lot of negative discussion around it in the public arena.

“You’d be surprised at how relevant people still consider the organ retention scandal to be,” Dr O’Donoghue said.

What had emerged from the organ retention scandal and the subsequent Madden Report into postmortem practices, was that there was a need “to clearly spell out” what an autopsy entailed.

“It’s not a nice thing to have to do to bring a consent form to grieving parents, but they must know what’s involved,” Dr O’Donoghue said.

Research on what influences a parent’s decision as regards autopsy found a key reason for those who declined was to protect their child from further harm. Their knowledge of the autopsy process was “acquired primarily” from public discourse, particularly TV, which left a negative perception.

Dr O’Donoghue said people “have images of babies lying on cold grey slabs” derived from programmes such as CSI. The reality was very different she said, with great care taken of the baby and every effort made to return to the child to its parents with minimum signs of examination.

The effect of stillbirth on obstetricians will also be discussed at the conference. For this research, eight obstetricians at CUMH were interviewed. Stillbirth, which affects one in 200 births, was deemed one of the most difficult experiences; described as amongst ‘the most devastating news’. Most consultants stressed the importance of their ‘human response’ to parents following a stillbirth. All stated that bereaved parents should receive direct care from a consultant. However a survey of bereaved parents at CUMH in 2011 found only 47% of parents who suffered a stillbirth met their consultant during their inpatient care, and half felt they did not have a timely postnatal visit to meet a consultant. Dr O’Donoghue said matters have improved since then. Today’s Impact of Stillbirth conference will be of interest to anyone providing care and support to parents after stillbirth and during subsequent pregnancies.

A CUMH-produced DVD “Why did my baby die?”, designed to help bereaved parents consider the sensitive issue of autopsy, will also be launched during the conference which takes place at the Western Gateway Building, UCC, starting at 9.45am.


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