Autopsy and investigations about why your baby died
PLEASE BE AWARE THAT THE INFORMATION SUPPLIED HEREWITH MAY BE DISTRESSING TO SOME READERS.
I can’t decide if my baby should have an autopsy. What should I do?
There are a number of tests that are recommended following a stillbirth to try and establish the cause of a baby’s death. These include blood tests collected from the mother, examination of the placenta, and tissues sent for chromosomal analysis. One examination that you will be offered is a post-mortem or autopsy.
An autopsy or post-mortem is a detailed and thorough external and internal examination of your baby, and is performed by a pathologist usually within 48 hours after birth. Some parents understandably find this request overwhelming at such a difficult time. It can be daunting for parents to make the decision to have an autopsy performed as there is some fear about the process or what is involved, or you might be concerned that your baby will be returned to you disfigured.
However, be assured that the examination is performed in such a way that you will still be able to hold and nurse your baby following the completion of the post-mortem. There is also the option of having a partial or limited autopsy performed where you can select which procedures are performed or organs examined on your baby, and which ones you would rather weren’t performed. This should be discussed with your doctor.
If you consent to the conducting of an autopsy, your baby will be taken for review by a perinatal pathologist. Sometimes, your baby might be transported to another hospital to see the pathologist. Please know that the perinatal pathologist will treat your baby with the greatest of respect. They are people too and are always saddened and upset that a baby has died.
Your baby will arrive dressed and wrapped to the pathologist and, at the conclusion of their investigation, your baby will be redressed and wrapped, and returned to either the hospital or sent to the funeral home. Autopsies are performed in such a way that incisions are made to examine your baby’s organs; one along your baby’s tummy and another at the back of his/her skull. These will be carefully stitched closed and will not be seen when your baby is dressed.
Ultimately, it is important to understand that the decision for the autopsy examination is entirely voluntary and there is no pressure for you to agree to this request. It is equally important to understand that you should be offered this opportunity to discover more information about the possible cause/s of your baby’s death. Therefore, we strongly urge you to think carefully about whether or not you would like an autopsy as you will never again have the chance to gain even the smallest insight into the possible reason for your baby’s death.
Even though experience shows that a post-mortem examination adds important information in up to 40% of stillbirths, results may be inconclusive. This can be disappointing but it’s important to view that this can itself be an answer that there was nothing you or anyone could have done to prevent it. If some clue is given as to the nature of your baby’s death, this too can help your doctor come up with ways to prevent stillbirth from happening should you decided to have another baby in the future.
More detailed information about the autopsy process is available below. Please take your time to consider if you wish to read this information, as you might find parts of the description confronting, particularly when you read this in relation to your own baby.
We have been offered an autopsy for our baby. What is the autopsy process?
An autopsy can be performed to better understand why your baby has died. In 40% of the cases, a reason is never determined.
There are 4 steps to the autopsy process.
The first step in an autopsy is an external examination of your baby. Your baby will be undressed and photographed. His/her weight will be recorded, along with measurements of his/her length, head circumference, and foot length. A full inspection of all features will be made, including looking at his/her fontanelles (i.e. the spaces between the bones of the skull), eyes, ears, fingers, umbilicus, and any malformations or oddities noticed with your baby. The extent of maceration (i.e. how much your baby’s skin has begun to breakdown) will be ascertained, as will the presence (or absence) of meconium staining (this is a fluid which can stain a baby’s amniotic fluid, placenta, umbilical cord, skin or nails), and an estimate of your baby’s gestational age will be made.
During the second step, an incision will be made down the centre of your baby’s chest and tummy so that his/her lungs, heart, liver, kidney and pancreas can be examined. The organs are removed and their weight recorded. Tissue samples will be placed in small blocks for assessment under the microscope but organs will not be kept unless this has been discussed and consented to by you. Through an incision at the back of your baby’s head, his/her brain will be inspected, weighed and again a small tissue sample will be taken to be viewed under a microscope looking for any disease or condition which may have contributed to his/her death.
In the third step, your baby will be x-rayed and sometimes additional blood tests may be performed if necessary. These may include tests to check for viral or bacterial infection, genetics or other disease such as abnormalities of the blood.
In the final step, the placenta is also examined, measured and weighed. Its general condition is assessed and any abnormalities are noted. The sections of the placenta and umbilical cord are carefully examined under the microscope for any disease or condition that may have contributed to the death of your baby.