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Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Respectful Disposal Of Fetal Tissue and Remains

Reference Number:

738 2009

Author / Manager Responsible:

Alastair Davies

February 2009 Deadline for ratification: (Policy must be ratified within 6 months of review date)

Review Date:

October 2009

Ratified by:

Governance Committee

Date Ratified:

March 2009

Related Policies

Author : Alastair Davies Job title: Senior Chaplin Page 1 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

CONSULTATION AND RATIFICATION SCHEDULE

Name and Title of Individual Mr. David Walker Consultant Obstetrician & Gynaecologist Mrs M Tonge Consultant Gynaecologist Mrs D Dunlop Consultant Gynaecologist Mrs Shirley Brooks Gynaecology OPD Early Pregnancy Assessment Unit Lucinda Payne Johns Pathology Manager Charlotte ward Dr Simon Rose Consultant Pathologist Dr Lynn Hirschowitz Consultant Pathologist Name of Committee Medical Board Surgical board Speciality Board Consultant Pathologist

Date Consulted January 204 January 2004 January 2004 October 2003 October 2003 December 2003 November 2003 November 2003 August 2004 Date of Committee 14 June 2004 June 2004 June 2004 June- July 2004

Author : Alastair Davies Job title: Senior Chaplin Page 2 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

INDEX

Section

Page

Distribution List Introduction Principles of Care

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5 6 6 7 8 8 8 9 9 10 10 10 11 11 11 12

Terminology used in this document 1. Summary of Procedures 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 -

Photography Baby Books of Remembrance Post-mortem Examination Funerals and Remembrance Cremation of Fetal Remains Individual Funerals Follow-up Contact Confidentiality Certification Transfer of Fetuses/Products of Conception to the Mortuary Mortuary Transfer of Fetuses to the Crematorium/Burial Ground -

2. Histology Investigation -

12 13 13 13 14 14 15

3. Surgical Terminations of Pregnancy 4. EPAC and Gynaecology Wards 5. A&E Department -

6. Support Services Department -

7. Parents wishing to take home their baby's body or fetal remains 8. Staff training -

Author : Alastair Davies Job title: Senior Chaplin Page 3 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

9. Policy Review

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15 15 16

10. Further references

11. Appendix 1 Infant Photography Request Form INDEX Continued 12. Appendix 2 Babies Book of Remembrance -

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13. Appendix 3 A Simple Guide of the Post Mortem Examination Procedure

14. Appendix 4 Consent to a Hospital Post Mortem Examination on a Baby or Child 19 15. Appendix 5 Notification of Stillbirth, Miscarriage and Neonatal Death 20

16. Appendix 6 Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains 17. Appendix 7 Forms BCF pursuant to the Cremation Acts 1902 & 1952 18. Appendix 8 Release of a Deceased Infant or Fetus to the Care of a Parent

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21 22 23

Author : Alastair Davies Job title: Senior Chaplin Page 4 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

DISTRIBUTION LIST

E-Mail Distribution Director of Nursing Deputy Director of Nursing Clinical Directors Consultant Obstetricians Consultant Pathologists A&E Consultants Medical & Surgical Board Managers Medical & Surgical Board Nurse Managers Assistant Medical & Surgical Board Managers Senior Nurse Managers General Managers Practice Development Manager Wards and Departmental Managers Midwifery Services Manager Nursing Staff ­ Charlotte Ward, Early Pregnancy Assessment Unit, Theatres, A&E Midwifery Staff ­ Alex & Mary Ward, CDS Chaplaincy Team Facilities

Author : Alastair Davies Job title: Senior Chaplin Page 5 of 27 Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

INTRODUCTION The death of a baby, for whatever reason and at any stage in pregnancy, represents a unique form of bereavement. An early loss is not necessarily a lesser loss. It can affect parents profoundly and they need sensitive, supportive care. It is important to recognise that the needs of individuals and the circumstances of pregnancy loss will differ. Flexibility in the application of this policy is required within the parameters defined by statutory legislation and professional guidelines. · This policy is primarily aimed at providing information and guidance to nursing, medical and technical staff working in A&E, Theatres, Gynaecology OutPatients, Charlotte, Alex, Mary Wards, Central Delivery Suite, the Mortuary and Cellular Pathology Department and the Portering staff involved in the transport of fetal remains. The policy refers solely to the mother, reflecting her unique statutory rights and privileges. This is not intended to be disrespectful to our duty of care to the father and other immediate family members, whether there be mutual agreement or dissent in regard to any action relating to the ending of the pregnancy or funeral arrangements. Information provided to the mother can only be given to her partner or husband with her permission. This policy draws upon the recommendations for best practice from the RCN's guidance on Sensitive disposal of all fetal remains (2001) and the Department of Health's Families and post mortems ­ A code of practice (2003).

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PRINCIPLES OF CARE · This policy is applied in all cases of early pregnancy loss, including spontaneous miscarriage, termination for fetal abnormality and the termination of pregnancy requested solely by the mother. Staff will be aware of the technical, emotional and procedural support provided by the chaplaincy team on a 24-hour basis. Nursing and medical staff will not simply offer the services of the chaplain without a clear explanation of their roles and responsibilities. An on-call chaplain is always available on request to see any mother, partner or relative as well as providing professional or emotional support for any staff member involved in the care of a mother losing her baby.

Date: March 2009 Version: 1 Review date: October 2009

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Author : Alastair Davies Job title: Senior Chaplin Page 6 of 27

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

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Mothers will be informed of the options available for funeral arrangements for their baby. They will be made aware of the options for remembrance and the other resources for support offered by the hospital Chaplaincy team. Staff should understand that the Chaplaincy team offers spiritual, pastoral and advisory aspects of care to mothers of all faiths and of none. Mothers will be fully informed about their own condition and the cause of the pregnancy loss will be explained to them, if this is known. Mothers will be made aware of hospital policy and practice and the options available for burial, cremation and remembrance. Mothers will be informed about the follow-up care and support available to them following discharge from this hospital through professional and voluntary agencies. Family involvement in the death of the baby will be facilitated where the mother requests this. The mother's wishes must determine with whom, and to what extent, hospital staff should facilitate such involvement and what information will be conveyed to other family members. Emotional and psychological support will be made available in order to assist the grieving process of the mother, father or partner and immediate family. The use of language will be sensitive to the needs of the mother and family. The term `baby' rather than fetus will be used in all written information and in discussions with the family, unless an alternative word or name is required. Sensitivity should be shown towards the mother's cultural or religious background; consideration will be given to her traditions and customs for hygiene, diet, ritual cleansing and preparation of the baby in preparation for burial or cremation. All fetuses and foetal tissue will be handled with respect and buried or cremated with dignity. Confidentiality will be respected. The needs of hospital staff will be recognised through: induction and training opportunities for debriefing and/or counselling consultation on the annual review of the procedures and processes defined in this policy

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TERMINOLOGY USED IN THIS DOCUMENT Early Pregnancy Loss - `early Pregnancy Loss' in the context of this policy relates to fetuses/fetal tissue from a pregnancy of up to 24 weeks' gestation.

Author : Alastair Davies Job title: Senior Chaplin Page 7 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Stillbirth - an infant of greater than 24 weeks gestation dying before or during delivery. Neonatal death - an infant dying within 28 days of delivery or when the fetus / baby, had a recordable heart beat at the time of delivery, requiring separate entries in the medical notes of the time of delivery and the time that the heart beat ceased. Fetus/Fetal Tissue - any fetus/fetal tissue or products of conception which are identifiable either visually or by histological examination. Family - any relatives or friends that the mother may wish to involve in her loss. Termination of Pregnancy - the induced loss of a fetus or baby for any reason.

1. SUMMARY OF PROCEDURES

All mothers will be kept fully informed about their pregnancy loss and the present and future consequences for their own health and intended pregnancies. Appropriate advice and health education will be given both in discussions with the mother and in writing before leaving the hospital. Many parents will feel distressed and saddened by their loss and will need emotional support. Staff specifically trained and experienced in such care are the chaplains (available on a 24 hour on-call basis), or the senior nurses working in the Early Pregnancy Assessment and Fetal Diagnostic service. One of these staff members must be consulted in advance of any discussion with a mother in regard to her emotional care and the practical options for respectful disposal of her fetus. In particular, a Chaplain may be appropriately called where there is a need for: counselling discussion over values/ethics obtaining consent for post-mortem examination or providing information in regard to the process and time scales for post-mortem examination religious services, especially Blessing and Naming any form of individual funeral or remembrance arrangements regardless of the involvement of other services or resources organised by the mother or her family Mothers will be offered the opportunity of spending time with their baby in privacy during her stay in this hospital. The mother will be offered the opportunity of a gentle introduction to her baby, giving her the opportunity to decline further sight or contact with her baby for part, or all of her stay in hospital. Mothers will be informed that sight of their baby after they leave hospital will not be possible as a consequence of the post-mortem changes in appearance.

Author : Alastair Davies Job title: Senior Chaplin Page 8 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

1.1 Photography Photographs can be taken for either family use or for medical diagnostic and archiving purposes. Request forms for these distinct photographic purposes are held on Charlotte Ward and Central Delivery Suite (Appendix 1). Photographs for family records must be taken whilst the baby is on the ward: photographs taken days after death in the mortuary are not suitable for family reference. Digital cameras are held by NICU and the Chaplaincy team for immediate photographic records, outside of the normal working hours of the Medical Illustrations Department. 1.2 Baby Books of Remembrance Baby Books of Remembrance are kept in the hospital Chapel and available for viewing at any time. A form offering mothers the opportunity of recording an entry in their baby's name will be provided by the nursing staff (Appendix 2).

1.3 Post-mortem Examination Where a post-mortem examination is requested directly by the mother or judged to be clinically desirable by the Consultant Obstetrician, the mother will be informed of the process for post-mortem examination and the requirement for informed consent. Practices and procedures directed and recommended in the Department of Health's Families and post mortems ­ A code of practice (2003) will be adhered to. Every opportunity will be provided for the mother to express her views, feelings or concerns without undue pressure to conform to the post-mortem request. Information relating to the post-mortem process will be conveyed to the mother by trained and experienced staff, ideally the consultant in charge of the mother's care, a senior member of the nursing staff or one of the full-time chaplains. Only staff sufficiently senior and well informed, with a thorough knowledge of the procedure and trained in the management of bereavement and in the purposes and procedures of post mortem examinations will obtain consent. The process of gaining written maternal consent will be conducted in two stages. Firstly, an explanation as to where the post-mortem examination will be held and the consequential time scales and processes explained to the mother. The document A simple guide to the post mortem procedure ([Dept of Health 2003] Appendix 3) will be offered to the mother along with an explanation as to the specific questions contained within the consent form. Any questions or concerns specific to the post-mortem process raised by the mother or father will be recorded on the reverse of the consent form at this initial meeting. The post-mortem consent form (Appendix 4) will be left with the mother after this initial meeting.

Author : Alastair Davies Job title: Senior Chaplin Page 9 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Sufficient time will be provided after the initial meeting for the mother to seek further information or time for reflection or consultation before a medical practitioner obtains written consent. The mother will be offered the opportunity of having an additional family or staff member present at the time written consent is obtained by the medical practitioner. The medical practitioner will provide a full explanation as to the medical reasons why a post-mortem examination is desirable. 1.4 Funerals and Remembrance Statutory and local regulations for burial and cremation are complex. Mothers wishing to conduct their own funeral arrangements will be referred to the chaplain for assistance and information relating to the funeral arrangements and this hospital's care of her baby prior to release of the body to an authorised funeral director.

Author : Alastair Davies Job title: Senior Chaplin Page 10 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

1.5 Cremation of Fetal Remains In the case of early pregnancy loss, the senior hospital chaplain will assume managerial responsibility for the respectful cremation of fetuses and products of conception at a local crematorium. There will be no religious service at the time of cremation unless specifically requested by the mother. The hospital chaplain, if specifically requested by the mother, can arrange witnessed cremations or the holding of a religious service of committal. Mothers undergoing a termination of pregnancy for social reasons will be informed of this hospital's policy for the respectful cremation of their pregnancy loss on the patient's information sheet. Mothers will be and invited to discuss any questions or concerns that they may have with a member of the nursing staff caring for them at the time of their admission for the termination of pregnancy. 1.6 Individual Funerals Where a mother has miscarried or has had a termination of pregnancy for fetal abnormality, the mother will normally be offered the opportunity of discussing the options for a funeral and the level of funding available to meet reasonable funeral expenses with the on-call chaplain. Where the mother's own minister or family are conducting the arrangements, contact will be made with the on-call chaplain to ensure that adequate provision is made by the hospital for the lawful release of the body and the funeral arrangements. The on-call chaplain will be able to provide information relating to the range of options for funeral services for mothers of different religious, cultural or social traditions. Where a mother clearly states that she does not wish to have any involvement in the funeral arrangements or be notified of the time or day on which the cremation is to be scheduled then the second half of the Notification of a Miscarriage, Stillbirth or Neonatal D Form (Appendix 5) will be completed by the nurse responsible for the care of the mother. Adequate time and support will be provided to allow the mother to change her mind prior to discharge. The contact number for the on-call chaplain will also be offered as a further alternative for the mother to change her mind after discharge. 1.7 Follow-Up Contact Mothers will be provided with a clearly identified staff or ward contact prior to discharge for further practical information and emotional support relating to the loss of their baby. Parents who contact the hospital switchboard directly should be referred to the on-call chaplain. Where appropriate, follow-up outpatient appointments for the mother will be posted to the mother within 2 weeks of her pregnancy loss.

Author : Alastair Davies Job title: Senior Chaplin Page 11 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

1.8 Confidentiality All staff will respect patient confidentiality in accordance with normal hospital practice. All crematorium, local authority and hospital records are governed by rules of strict confidentiality. Only information contained within the Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains will be stored on the Chaplaincy and Crematorium databases along with the date and manner of respectful disposal and the presence of any hospital manager or religious leader. 1.9 Certification The fetus or fetal tissue (less than 24 weeks gestation) will be sent to the mortuary with a completed Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains (Appendix 6). Failure to complete this form will result in the fetus or products of conception being returned to the ward, as funeral arrangements cannot proceed lawfully without this document. Where the presence of a heart beat or respiratory effort at the time of delivery is recorded in the medical notes, the subsequent death of the fetus or infant must be recorded as a neonatal death, regardless of gestational age or development. The attending doctor will complete the Medical Certificate of Death; Part B of the Cremation Form (Appendix 7) will be also be completed by the attending doctor and forward with the body to the mortuary where Part C will be completed by the Pathologist. A medical practitioner will sign these statutory documents. A registered nurse or midwife is not eligible to sign these documents. 1.10 Transfer of Fetuses / Products of Conception to the Mortuary Fetuses or fetal tissue will be transferred from the ward or theatre either to the Pathology Department or the Mortuary. Appropriate documentation will accompany the fetus and transportation will take place in a dignified and respectful manner. No fetuses or fetal tissue will be disposed of as clinical waste. Place the foetus or products of conception in a container with a sealed watertight lid. Ensure that a Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains (Appendix 6) is completed to include: name of patient hospital number date of delivery gestational age signature of Doctor who examines the products of the pregnancy

Author : Alastair Davies Job title: Senior Chaplin Page 12 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

1.11 Mortuary Fetuses and fetal tissue will normally be transferred directly to the Mortuary from wards after the mother has been discharged from the ward. Transfers from the operating theatres will be as soon as possible following surgery. All containers will be carried to and placed in the mortuary fridge with care and dignity. The containers will be stored in the Mortuary refrigerators where a record of the date of receipt is maintained. Any container not accompanied by a Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains or a Certificate of a Medical Practitioner will be returned to the ward by the mortuary staff with an explanation as to which documents have not been satisfactorily completed or omitted. 1.12 Transfer of Foetuses To The Crematorium / Burial Ground Foetuses or foetal tissue will be placed in cardboard or wooden coffins or containers specified for cremation prior to transportation to a crematorium. Either a hospital chaplain or a registered funeral director will conduct all transfers to the crematorium. 2. HISTOLOGY INVESTIGATION The Histology laboratory is only to be sent gestational material under three circumstances. ERPC or tubal ectopics - when the purpose is to confirm the presence of gestational material. Gestational material when there is a genuine clinical suspicion of molar pregnancy or trophoblastic disease (usually a very high HCG or macroscopically abnormal villi). Any babies or fetuses of any gestation that require a post-mortem examination will be sent to the mortuary. The placenta, a full clinical summary, a properly completed post-mortem consent form will be sent at the same time. If more than one container is to be used for each pregnancy then all containers will be clearly labelled with the mother's name and hospital number. Post-mortem examinations will be performed in either Bristol or Cardiff and the mother will be informed of this. The medical and nursing staff responsible for the care of the mother will be responsible for determining the mother's wishes in regard to the disposal of any fetus or unapparent fetal material which might subsequently be found in products of conception (POC) or ectopic pregnancy. The medical and nursing staff responsible for the care of the mother will be responsible for notifying the on-call chaplain if the mother indicates that she wishes to be notified of the time of the cremation or witness such cremation. N.B. In the absence of any specific maternal instructions, the fetus or fetal material will be cremated under the supervision of the senior chaplain (para: 1.5).

Author : Alastair Davies Job title: Senior Chaplin Page 13 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Fetuses not apparent to the clinician but discovered in histology specimens (e.g. in an ectopic) are, in the absence of accompanying written instructions to the contrary, will be cremated under the supervision of the senior chaplain (para 1.5). Any tissue blocks, slides or wet tissue used for histological analysis will be forwarded for cremation under the supervision of the senior chaplain, once a Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains is completed by the reporting Pathologist. The histology report will be amended to indicate that the slide and relevant portion of the block have been released.

3. SURGICAL TERMINATIONS OF PREGNANCY Specimens may result from Suction termination of pregnancy (S.T.O.P) Evacuation of retained products of conception (E.R.P.C) Ectopic pregnancy Hysterotomy Single use small nylon suction receiver tubes (`socks') will be used for each patient. The receiver tube containing the products of conception will be placed in a small polycarbonate screw top container having first removed and disposed of the white suction catheter mount top. The screw top container will be placed in a clear plastic sample transit bag along with the completed Certificate of Medical Practitioner in Respect of Disposal of Fetal Remains (Appendix 6). This package is to be sent to the mortuary for subsequent cremation in accordance with the guidance in section 1.19.

4. EPAC AND GYNAECOLOGY WARDS Every mother will be provided with sufficient information relating to the funeral arrangements for her fetus and resources for medical and emotional support prior to her discharge. All mothers will be counselled and informed on the physical and emotional issues relating to the end of their pregnancy as a result of spontaneous or induced miscarriage. Mothers will also be informed of the options for funeral arrangements in accordance with section 1.15 5. A&E DEPARTMENT

Author : Alastair Davies Job title: Senior Chaplin Page 14 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Any miscarriage occurring within the A&E Department must be notified immediately to either the on-call chaplain or the Early Pregnancy Advisory Clinic so that the necessary procedural and emotional support can be offered to the mother and that any fetal material is collected and recorded in the process defined in Section 1.19.

6. SUPPORT SERVICES DEPARTMENT

All fetal tissue is to go to the Mortuary or Histology Department. No fetal tissue is to be taken from any area for incineration or disposal as clinical waste. Fetal tissue will be transported in sealed containers to either the mortuary or Histopathology Department from either the EPAC Clinic, A&E, Charlotte, Alex or Mary Ward, or the Day Surgery Unit, and in the Labour Ward at Maternity.

7. PARENTS WISHING TO TAKE HOME THEIR BABY'S BODY OR FETAL REMAINS

In recognition of the complex psycho-social needs of a bereaved family and legal requirements regarding the lawful release of a body from the hospital, it is the policy of this hospital that staff will not make an unsolicited offer to parents for them to take home either the body of their child or any fetal remains. Members of the nursing or medical staff will not give consent to such a request or permit the parents to remove their child's body or fetal remains without prior consultation with either the on-call chaplain in conjunction with the consultant and senior nurse manager. Before any arrangements can be made for the release of the child's body or fetal remains from the care of the hospital, the consultant in charge of the child's care must record in both the medical notes and the Release Document (Appendix 8), their assent for such action and that the child's death does not need to be recorded or discussed with the Coroner's Office. All sections of the Release Document details of family will be completed before the body of the child is released to the charge of a member of the hospital staff for transport to the parental home. Fetal remains, still-born infants or any child's body will not be released to a parent or family representative for the purpose of delivering the body to a funeral director or carrying out private funeral arrangements. One copy of the Release Document must be placed in the medical notes and one copy forwarded to the nominated funeral director.

Author : Alastair Davies Job title: Senior Chaplin Page 15 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

8. STAFF TRAINING AND SUPPORT All staff involved in the management of each pregnancy loss will be made aware of this policy and receive training and instruction appropriate to their role. In order to meet this requirement each Directorate and Department will maintain its own Training Policy. Managers will ensure that staff are made aware that emotional and practical support is available from the on-call chaplain either during or after their involvement in caring for a mother with a pregnancy loss. 9. POLICY REVIEW This policy will be subject to evaluation and review. The Surgical Nurse Manager, Gynaecology Manager, the Senior Chaplain and a senior member of the Pathology Department's medical or technical staff will manage all developments or amendments to ensure compliance with national statutory and advisory procedures. 10. FURTHER REFERENCES Many organisations provide information, and a number of documents and articles have been published, about bereavement, post mortem examination, and the retention and use of human tissue and organs. They include: · Pregnancy Loss and the Death of a Baby Guidelines for Professionals (Revised Edition). Nancy Kohner and SANDS (Stillbirth and Neonatal Death Association), 1995. · The Fetal and Infant Post Mortem: Brief Notes for the Professional. Confidential Enquiry into Stillbirths and Death in Infancy (CESDI), 1998. · Guidelines in Autopsy Practice. Report of a working group of the Royal College of Pathologists, September 2002. Available at www.rcpath.org. · Tissue Blocks and Slides. Retained Organs Commission, April 2001. · Guidance on Return of Organs, Tissue Blocks and Slides. Retained Organs Commission, July 2001. · Human Tissue and Biological Samples for Use in Research. Operational and Ethical Guidelines. Medical Research Council (Ethics Series), 2001. · Making and Using Visual and Audio Recordings of Patients. General Medical Council, 2002. Available at www.gmc-uk.org.

Author : Alastair Davies Job title: Senior Chaplin Page 16 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

· Reference Guide to Consent for Examination or Treatment. Department of Health, March 2001. Available at www.doh.gov/consent. · Good Practice in Consent. Department of Health, November 2001. Available at www.doh.gov.uk/consent/index.htm. · Sensitive Disposal of all Fetal Remains. Guidance for Nurses and Midwives. Royal College of Nursing, May 2001. · The Office of Fair Trading published a report of an inquiry into funerals in July 2001, which made recommendations about the information which should be made available about funerals, and the need to ensure sufficient consumer choice. It includes a leaflet prepared in partnership with the National Funerals College. These are available at www.oft.gov.uk/html/rsearch/reports/oft346.htm.

Appendix 1

Infant Photography Request Form Family Photographs Only

Baby photographs taken for family use should be taken as soon after delivery as possible and before the baby has been taken to the mortuary. Complete this form, retain it with the baby and contact the Medical Illustration Department on extension 4134 at the earliest opportunity. Family photographs will only be taken when parental consent has been obtained I confirm that:................................................................................... (Hospital Number:.. ................................................... Has consented to photographs being taken of their baby for personal retention / secure retention* within the Medical Illustration Department until requested (*delete as appropriate).

Author : Alastair Davies Job title: Senior Chaplin Page 17 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Signature of nurse:....................................................... Print Name: ...................................................................... Ward: ............................................................................... Date: ..... / ..... / 200...

Hospital Telephone Number 01225 428331 Chaplaincy Department Direct Line 01225 824039 / 821211 Appendix 2

Dear Parents

Babies Book of Remembrance

Baby Books of Remembrance are kept in the hospital Chapel to enable parents to record the name of their baby who died at or near the time of birth. If you wish to have an entry made for your baby, will you please complete the attached form and either send it directly to the Chaplain's Office, RUH, Combe Park, Bath BA1 3NG or ask the nurse who is caring for you to forward it to us on your behalf. There is no charge for making this permanent record of your baby's birth and death. The hospital Chapel is open at all times for you to use as a place of quiet. If during your visit you wish to speak with one of the Chaplains, please contact the hospital switchboard who will then make contact with the on-call chaplain.

Please return this form to: The Chaplain's Office, Royal United Hospital, Combe Park, Bath, BA1 3NG Baby's Forename(s) (if given): .............................................................................. Baby's Surname: ............................................................................................. Date of Birth:......../....../200.... Date of Death: ...../....../200...

Author : Alastair Davies Job title: Senior Chaplin Page 18 of 27 Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Any brief tribute or expression of love that you wish to make (up to approx 25 words)

...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ......................................................................................................

Author : Alastair Davies Job title: Senior Chaplin Page 19 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Appendix 3

A simple guide to the post mortem examination procedure

A Copy of this document is available on www.doh.gov.uk/pmconsentsimpleguide.pdf/

Hardcopies available from the Chaplains Office extension 4039 or contact via switchboard

Author : Alastair Davies Job title: Senior Chaplin Page 20 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Appendix 4

Consent to a hospital post mortem examination on a baby or child

A Copy of this document is available on www.doh.gov.uk/tissue/pmconsentchildhosp.pdf Hardcopies available from the Chaplains Office extension 4039 or contact via switchboard

Author : Alastair Davies Job title: Senior Chaplin Page 21 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Appendix 5

Notification of Stillbirth, Miscarriage and Neonatal Death

Please notify the chaplain by telephone (Ext 4039 / Bleep 7501or 7704) or radiopage the on-call chaplain via switchboard prior to, or immediately after the birth and then complete this form and send to the Chaplains Office, RUH PLEASE PRINT CLEARLY This is to notify you that Miss / Mrs ......................................................................... Home address: ................................................................................................... ......................................................... Post Code: ............................................

Lost her baby as a result of a Miscarriage / Still-Birth / Neonatal death on ......./...../200.... Date of Delivery: ..../...../ 200..._ Gestation: ................... Gender: M / F / Unknown Mother's Hospital Number: .......................... Ward / Unit: .................................. Nurse / Midwife in charge of mother's care: .......................................................... Signed: ................................ Date: ....../......../200...

The above patient has been notified of the hospital's free provision of funeral arrangements for her fetus and does not wish to be notified of, or be present at, the cremation and agrees to the hospital chaplain making the necessary arrangements on her behalf.

Signed: ________________________ Date: _____/_____/ 200___

Author : Alastair Davies Job title: Senior Chaplin Page 22 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Appendix 6

CERTIFICATE OF MEDICAL PRACTITIONER in Respect of Disposal of Fetal Remains

I hereby certify that I have examined the fetal tissue from Mother's name: ............................................................................... Hospital Number: ............................................................................... Address: .......................................................................................... ....................................................................................................... ....................................................................................................... ................................ Post Code ...................................................... Delivered on ...... / ....... / 200...., of ......... gestation and that at no time was there any sign of life. I have no reason to suspect that the duration of the pregnancy was shortened by violence, poison or any other unlawful act and I know of no reason why any further examination or enquiry should be made. Print name .................................................................................... Signature ....................................................................................

Registered medical qualifications: ....................................................... Date ........ / .......... / 200.......

Address Royal United Hospital, Combe Park, Bath BA1 3NG Telephone 01225 428331

Author : Alastair Davies Job title: Senior Chaplin Page 23 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

This form must accompany fetal tissue to the mortuary and be clearly labelled with the mother's name, date of delivery and marked `For Disposal Only'

Appendix 7

Forms BCF pursuant to the Cremation Acts 1902 & 1952 These forms are statutory. All questions detailed on the form must be answered to enable a lawful cremation to proceed.

Copies are available from the Patient Affairs Office on extension 4315, via the Chaplains Office on extension 4039 or via the on-call Chaplain

Author : Alastair Davies Job title: Senior Chaplin Page 24 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Appendix 8

Release of a Deceased Infant or Fetus to the Care of a Parent

Complete all sections prior to the release of the child's body. The on-call Chaplain is available to assist with the completion of this form and the care of the family. Name of deceased child: ___________________________________________________ Age: _________________ Date & time of death: ____ /____ /200___ @ ________ Hrs Consultant responsible for the child's care: _________________________________ The Medical Practitioner responsible for issuing the Death/Still-Birth Certificate/ Disposal Certificate must complete the following: I confirm that there is no reason for the death of this child to be referred to the Coroner Signed: ________________________ Date: ____ / ____ / 200___

Print Name: _________________________________________________ Name of Parent(s) making request :___________________________________________ Home Address (in full): ____________________________________________________ ________________________________________________________________________ ______________________________________________Post Code _______________ Name and age of other family members residing at the above address ________________________________________________________________________ ______________________________________________________________________ Funeral Director ________________________________________________________ Contact Name ___________________________________________________________ Telephone & Fax Number___________________________________________________

Author : Alastair Davies Job title: Senior Chaplin Page 25 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

If a hospital contract funeral please include the Funeral reference number ____________ Collection of the child's body from the parental home by the funeral director is arranged for: Date ____ / ____ / 200___ @ ___________________ Hours Staff member escorting the child's body to the parental home: ______________________ Signature of staff member: Date of signature: ____ / ____ / 200___ ________________________________

19. Consultation Check list

Author, please attach this to each copy of the policy being sent to a meeting for comments. Dear Chairman, please would you review this policy at your committee and return any amendments / comments to _________________________ by _____ / _____ / ____ Title of meeting Date of meeting Name of policy Name of author ______________________________________ ______________________________________ Respectful Disposal of Fetal Remains Revd Philip Sutton Yes Are there any elements of this policy which present operational issues that require further discussion? If yes, please provide a contact name for the author. ___________________________________ Is the policy referenced? Does the policy include a training plan? If you are the appropriate forum, have the necessary resources been agreed to implement this policy? Is there a plan for policy implementation? Does your meeting recommend further consultation with groups or staff other than listed at the front of the policy? Other comments from meeting. No N/A

Author : Alastair Davies Job title: Senior Chaplin Page 26 of 27

Date: March 2009 Version: 1 Review date: October 2009

Royal United Hospital, Bath NHS Respectful Disposal of Fetal Tissue and Remains

Policy accepted without further comment. (Please circle) Policy needs further amendment. (Please circle) Name of Chair __________________________ Signature ______________________________ For Human Resources Policies only Name of Staff Side Not Applicable

Yes / No Yes / No

Date _____ / _____ / _____

Signature ______________________________

Date _____ / _____ / _____

Author : Alastair Davies Job title: Senior Chaplin Page 27 of 27

Date: March 2009 Version: 1 Review date: October 2009

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GLAN CLWYD HOSPITAL DGH NHS TRUST

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