Bereavement support following the death of your baby

The process of induction differs depending on how many weeks pregnant you are or if you have had any surgery to your uterus. The plan of care will be made by a Consultant Obstetrician. Generally labour is induced with doses of tablets which are inserted into the vagina.

Labour can be a painful process and because you may feel emotionally distressed, we want to make sure that you have the pain relief you choose at the right time. We can offer simple analgesia such as:

• paracetamol and codeine
• injections of diamorphine or a morphine drip
• you also have the option of an epidural

You will be offered the option to have blood tests and swabs on yourself and also swabs from the placenta to see if any cause can be identified. The placenta is examined after every birth. There is the option of testing the genetic material in the placenta to investigate whether your baby had anything genetically unusual. You will also be offered the choice of a post-mortem examination (this can be either a full post-mortem or an MRI) which takes place at Sheffield Children’s Hospital. This is the most thorough investigation and it takes about 2 weeks for your baby to be returned to the hospital. We will always let you know when your baby has been returned to the hospital after the post-mortem.

When you are ready to go home from hospital, it can be daunting and emotionally painful as everything has changed since you came into hospital. Some women wish to leave the hospital as soon as they are medically able to; other women prefer to stay a bit longer until they feel more ready. It is usual for your baby to remain in the hospital in the dedicated area. You may want to take your baby home in order to spend time with them in your own surroundings, which also allows your friends and family to spend time with your baby. It may not be possible for you to take the baby home straight away if a post-mortem examination is being carried out.

A Community Midwife will visit you at home within 24 hours following discharge from hospital. If they have not made contact within this time, please call our ward clerk on 01709 427441 or 01709 424491.

We try our best to protect you from baby product companies contacting you but we cannot always filter them all.

If your baby was under 24 weeks gestation and showed no signs of life, you do not need to legally register your baby’s death. However, we can give you a memento certificate of birth and can arrange for a member of the multi-faith chaplaincy team to perform a naming and blessing ceremony if you so wish.

If your baby was 24 weeks gestation or over and showed no signs of life, this is called a stillbirth and your baby needs to be registered as soon as possible to avoid any delays with burial or cremation. You will be given a Stillbirth Certificate and your baby’s NHS number before you leave the hospital. You will need to take these documents with you to the Registry Office. The mother of the baby MUST be present at the registration.

If the staff feel that your baby showed signs of life at ANY gestation, this will be classified as a neonatal death and you will need to legally register the birth and death of your baby within 5 working days. Please take a form of photo ID and a marriage certificate (if applicable) with you.

You will be given a Medical Certificate of Death and your baby’s NHS number which you will need to take to the registry office with you.

It is advisable that you make an appointment with the Registry Office before you go if staff have not already done so for you.

Rotherham Register Office
Riverside House
Rotherham
S60 1QY
Telephone: 01709 823543.

The reality of burying or cremating your baby may be overwhelming and distressing. The decisions you have to make are extremely difficult; the Maternity Team and Chaplaincy Team are here to support you.

Private burial / cremation (any gestation)

If you are arranging a private funeral, the document issued to you by the Registry Office or Maternity Team needs to be shown to the Funeral Director. The Funeral Director you choose can help to guide you through the options available for the burial or cremation of your baby.

Hospital burial / cremation

The hospital will offer to arrange either a private burial or cremation. You will meet with a member from the Hospital Chaplaincy Team to discuss what you would like included in the ceremony, this is not a communal service; it is private for you and your family. You can place items with your baby which will be kept with them.

It will be approximately 2 weeks but may be longer if a post-mortem is taking place. You will be notified when your baby returns from Sheffield following a post-mortem.

Regardless of gestation, you are able to choose whether to attend or not. All funerals organised by the hospital are completely free of charge. Please ensure that you arrive at your baby’s funeral in ample time. The service will go ahead at the scheduled time.

Here are some things you may like to include or think about:

• Photos or videos of your baby or all of you together
• Whether you would like to speak about your baby and whether you would like to ask others to do the same
• Choosing music, a special poem or story you would like to read or tell
• The use of balloons or objects special to you
• Mourners dressing in a special colour
• The Trust also holds an annual memorial service in line with Baby Loss Awareness Week which is an opportunity for families to attend to remember their loved ones. Dates will be confirmed annually. Chaplaincy can be contacted on 01709 424098 for further information.

The uterus will be returning to its normal size, this process usually takes about 10 days. By gently feeling your abdomen, the Midwife will be able to assess whether this process is taking place. If you have any heavy bleeding, pass clots, experience an increase in pain or high temperatures (>37.5°C), this may indicate that the uterus is not returning to its normal size. This could be because you have placental tissue or membranes still inside which can give you an infection and increase your bleeding. If you experience any of these symptoms, you must come into Triage for assessment as you may need treatment.

You will continue to bleed following delivery. Vaginal discharge following delivery is called ‘lochia’, which is a mixture of blood and other products from the uterus. This is bright red at first, and then becomes pinkish then brown before finally turning a cream colour. This loss may last for three to four weeks. If you start losing fresh red blood or clots, have abdominal pain or the loss has an offensive smell, inform the Midwives in Triage.

Passing urine may be a little uncomfortable following birth but it is important that you pass urine regularly. If you are struggling to get to the toilet quickly enough, find that you leak urine when you cough or sneeze or do not realise you have a full bladder until you have an accident, it is important that you contact your GP for a referral to Physiotherapy Services.

Sometimes there is trauma to the area between the anus and the vagina (this is called the perineum), this may have required suturing. If you have had stitches, they can take up to two weeks to dissolve. Keep the area clean and dry, regularly change your pads, do not use scented products and do not douche. If you find the area becomes swollen, is oozing pus or has become very painful, you need to be seen, you can see your GP, attend the walk in centre or contact Delivery Suite.

Most women who have experience the loss of their baby accept a drug called Cabergoline following birth; this reduces the chance of you producing breast milk. You should also avoid stimulating the breasts and take Paracetamol for any pain you have. If you develop any hard red lumps you must seek advice from your GP.

Your pelvic floor muscles are made up of two kinds of muscle fibres which work in different ways. One kind is for strength and if they are working correctly, these muscles should contract automatically when you cough or sneeze. This reflex can be lost after having a baby.

You also have slow fibres for stamina. It is important to do pelvic floor exercises which train both kinds of muscle to maintain normal continence, for sexual intercourse and to support vital organs. As well as pelvic floor exercises you can help the muscles to work correctly by pulling them up before you cough, sneeze, lift or laugh.

Long squeezes

Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, as if you are stopping yourself from passing wind. Now add a squeeze towards the front around your vagina and bladder, as if stopping the flow of urine. Hold the squeeze while you count to four seconds, remembering to breathe normally. Check you aren’t pulling in your buttock muscles by placing your hand on your bottom as you do the exercises. It’s OK if you’re tensing your lower abdominal muscles slightly.

Rest for a few seconds, and then repeat your long squeeze. See how many good quality squeezes you can do before the muscles get tired. Stop when your muscles get tired, you can work to build this up over time.

With these exercises, quality is better than quantity; it’s much better to do a few good squeezes at a time than lots of squeezes incorrectly.

Short squeezes

Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, as if you are stopping yourself from passing wind. Now squeeze towards the front around your vagina and bladder, as if stopping the flow of urine. Let go straight away. This is a short squeeze of no more than one or two seconds.

Rest for one to two seconds, and then repeat. See how many good quality squeezes you can do before the muscles get tired. Make sure that you aren’t squeezing your buttocks, or holding your breath to squeeze.

Postnatal depression is an illness that affects 1 in 10 women, occurs 2-8 weeks after birth and lasts longer than 2 weeks.

Symptoms include:

• anxiety
• panic attacks
• feelings of not being able to cope
• sleeplessness
• loss of appetite
• not able to stop crying
• feelings of hopelessness
• extreme tiredness
• aches and pains
• memory loss and unable to concentrate

It may help to share your feelings with people you trust. Ask your Midwife about local support groups.

Speak to your GP about your symptoms as it is easily treated with talking therapies / medicines.

This is an emergency and needs urgent referral to a specialist.

Symptoms include:

• new feelings and thoughts which you’ve never had before
• new thoughts of violent self harm
• sudden onset or rapidly worsening mental symptoms

A Deep Vein Thrombosis (DVT) is a blood clot that commonly forms in the veins of the lower leg or calf.

The blood clot may break away and travel to the lungs (pulmonary embolus or PE) or the brain and this is very dangerous.

Risk factors include:

• surgery
• previous DVT
• being overweight
• dehydration
• smoking
• immobility
• blood disorders
• contraception
• pregnancy and birth
• increasing age (over 35yrs)

Help reduce your risk by:

• keeping mobile
• drinking plenty and keeping hydrated
• doing ankle exercises when immobile

If you have multiple risk factors further treatment may include:

• blood thinning injections
• anti-embolic (compression) stockings

The following signs require urgent medical attention:

• calf pain (one-sided), any redness or swelling
• shortness of breath
• pain in chest or upper back

You must go to A&E (UECC) for assistance if you have any of the above symptoms.

Contraception is free on the NHS.

Contraception can be arranged by contacting your GP or the Sexual Health team at Rotherham Hospital on C Level, opposite the Chapel. For an appointment at the Sexual Health team, telephone 01709 427777.

There are 13 different methods (some can start 3 weeks after birth).

Choose a method that suits you.

Resume sexual relations when you feel comfortable. Your body needs to recuperate after birth. Sexual intercourse after birth may not be comfortable. If it is painful, stop and try again at a later date.

If problems persist contact your GP or the Integrated Sexual Health Department on 01709 427777.

Bereavement Midwife
Telephone: 07917 243049 or 01709 427274 (if not available please leave a message, in an emergency please contact Delivery Suite / Maternity Triage on numbers listed below.)

Chaplaincy
Telephone: 01709 427015

Maternity Triage
Telephone:01709 427700

Delivery Suite
Telephone: 01709 424491

ARC
Telephone 0845 0772290 / 02077137486
Email: info@arc-uk.org

PETALS
Telephone: 0300 688 0068
Email: counselling@petalscharity.org

BLISS
Email: ask@bliss.org.uk

Child Bereavement UK
Telephone: 0800 028 8840
Email: support@childbereavementuk.org

The Lullaby Trust
Telephone: 0808 802 6868
Email: support@lullabytrust.org.uk

Miscarriage Association
Telephone 01924 200799
Email: info@miscarriageassociation.org.uk

Multiple Birth Foundation
multiplebirths.org.uk

TWINS TRUST
Telephone: 0800 138 0509
Email: helenturier@tamba.org.uk

Bereavement Trust
Telephone: 0800 435 455

Muslim Bereavement Support Service
Telephone: 020 3468 7333

Children of Jannah

Child Death Helpline
Telephone: 0800 282 986

Cruise Bereavement Care
Telephone: 0808 808 1677

Compassionate Friends
Telephone: 0345 123 2304

Wellbeing of Women
Telephone: 020 7772 6400
Email: wellbeingofwomen@rcog.org.uk

The National Child Birth Trust
Telephone: 01709 545760

National Fertility Association
Telephone: 01922 722888

Stillbirth & Neonatal Death Support (SANDS)
Telephone: 0207 4367940
Telephone: 0808 164 3332
Email: helpline@sands.org.uk