Having a post-mortem after a neonatal death

A post-mortem (also known as an autopsy) is a medical examination of a body to try to find the cause of death.

The idea of a post-mortem can be upsetting. But they are important because they may:

• find the reason why your baby died
• find something that affects your care in a future pregnancy
• assess the effects of treatments and drugs, and identify any complications
• diagnose and treat conditions in any other children in the family. 

Some parents have told us that having a post-mortem has helped them in the grieving process. However, a post-mortem may not always be able to find out why a baby died.

There are 2 types of post-mortems: a coroner’s post-mortem and a hospital post-mortem.

Coroner’s post-mortem examination

A coroner is a government official responsible for investigating deaths in certain situations. 

In most cases, a doctor or the police refer a death to the coroner. This may happen if:

• it’s unexpected, such as sudden death (sudden infant death syndrome)
• it happens during or after a hospital procedure, such as surgery
• the cause of death is unknown.

Deaths of children and babies, except for stillbirths, must be referred to the coroner by the hospital to establish the cause of death. The coroner will then decide whether it will be necessary to have a post-mortem examination. 

If the coroner decides it is necessary, you won’t be asked to give consent (permission). This is because the coroner is required by law to carry out the examination.

But you should be given an explanation about why the examination has been ordered and what the process will be.

Hospital post-mortem examination

Post-mortems are sometimes requested by hospital doctors to provide more information about an illness or the cause of death. Hospital post-mortems can only be carried out with your consent (permission).

You can also request a hospital post-mortem to find out more about why your baby died. 

The Human Tissue Authority recommends you should be given at least 24 hours to consider your decision about the post-mortem examination. 

You should also be given the details of someone to contact in case you change your mind. 

Who does the post-mortem?

Post-mortems on children and babies are performed by a pathologist. This is a doctor who specialises in children’s medicine and with specialist pathology training (the study of disease). 

Pathologists works to strict guidelines that are set out by the Royal College of Pathologists. Like all doctors, theyare bound by a strict code of conduct and will always treat your baby with dignity and respect. 

Should I have a post-mortem?

If the post-mortem hasn’t been ordered by the coroner, it is your decision as parents whether to have one. If you say yes, you can still change your mind right up until when the post-mortem begins.

A senior doctor or specialist midwife will complete a form with you that records your consent for the post-mortem. You can ask any questions about how and where it is performed, and what the results might tell you. There is no pressure to decide either way. Unless a post-mortem is ordered by a coroner, it is entirely up to you. The healthcare professional will also give you the contact details of someone you can speak with later if you need to.

“We knew we wanted Arthur to have a post-mortem as we knew we needed to have done everything possible to try and find out why he had died. Although we didn’t get a definitive answer, I still feel we made the right decision.”

Kathryn

It may be difficult to think about the future right now. But a post-mortem may find information that affects your treatment in a future pregnancy.

You may have religious reasons for not having a post-mortem.

What happens during the post-mortem examination?

There are different types of post-mortems. Your healthcare professional will be able to tell you what is needed, if you want to know. A post-mortem may include:

• a thorough examination of the outside of the body
• medical photographs and x-rays
• an examination of the internal organs (this may include taking samples for testing)
• an examination of the brain. 

For hospital post-mortems, you can consent or refuse permission for any of these.

Organ and tissue donation

Talk to your midwife or doctor if you want to donate your child’s organs. A specialist nurse for organ donation will visit you to talk to you about it. 

How long does it take to get post-mortem results?

The time it takes to get your post-mortem results depends on the hospital and the tests carried out. It is difficult to estimate how long this will take. Some hospitals estimate this could take between 6 and 12 weeks.  

This will not affect your funeral arrangements as your baby will be returned to you after the post-mortem, but before the report is available.

Can I still plan my baby’s funeral?

You will be able to arrange the details (but not the date) of your child or baby’s funeral, before the post-mortem examination has taken place. Once the post-mortem examination has been completed, either the hospital mortuary staff or the Coroner’s Office should be able to tell you when your baby can be taken to the funeral home or to your home, if that’s what you want to arrange. 

Read more about planning a funeral.

Can I see my baby or child after the post-mortem examination?

You may have questions about how your baby will look after a post-mortem. Each baby is different, but the post-mortem examination will have been done in a sensitive way, with any incisions hidden by your baby’s clothes or hair, so you should not notice these while your baby is dressed. 

You may also notice the normal changes that happen after death, which are unconnected with the post-mortem examination. Your baby’s skin may look dry or flaky and baby’s lips and nails may look redder than previously. You may also notice marks on your baby’s skin that look like bruises. These are not bruises, but marks from where the blood settles when the heart stops beating. 

Find out more about spending time with your baby after a neonatal death. 

Getting the results of your post-mortem

You’ll be given the results of the post-mortem at a hospital appointment with your consultant or with the coroner. They should go through everything with you, making sure to explain any medical terms or details that you don’t understand.

It can be difficult to think straight in stressful situations. It may be a good idea to write a few questions down before your appointment. You could take someone close to you to make notes and give emotional support. 

You can receive a copy of the full post-mortem (ask for it when you are discussing the results) and a copy will be sent to the birth parent’s GP.

This can be a difficult appointment for parents, so you may want to book an appointment with your GP later to go over everything again. At some point, you may want to ask them about trying for another baby and whether the results will affect future pregnancies. It may take time to be ready to talk about this though. 

Registering your child’s death

You will have been given the Medical Certificate of Cause of Death before the post-mortem examination is done, unless the coroner is involved. Once the coroner’s post-mortem examination has finished, the coroner will issue the Medical Certificate of Cause of Death, so you can register your baby’s death. 

Find out more about registering your child’s death. 

Helping future research

Some hospitals carry out research into the causes of pregnancy complications and early neonatal loss. You may be asked for consent (permission) to allow researchers to use samples that were taken as part of the post-mortem. This can give researchers valuable insights into the pregnancy that may help prevent future losses.

Tommy’s is the largest charity carrying out research into pregnancy loss and premature birth in the UK. Find out more about the work we’re doing.

More support and information

• Child Bereavement UK provides specialised support, information and training for everyone affected when a baby or child dies, or when a child is bereaved. It also runs an online forum for bereaved parents.
• The Compassionate Friends is run by and for all bereaved parents.
• Cruse Bereavement Care provides support, information, advice, education and training to help anyone who's been bereaved to understand their grief and cope with their loss. 
• The Lullaby Trust provides specialist support for anyone after the sudden death of an infant.
• Petals provides specialist counselling after baby loss. 
• Sands is run by and for parents whose baby has died, either at birth or shortly afterwards.
• Winston’s Wish supports children and families after a parent, brother or sister has died.