Sensitive Services

The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the earliest times to the present day. In this week’s post Karolina Kuberska investigates the new protocols surrounding pregnancy loss for Baby Loss Awareness Week.

While researching the experiences of pregnancy loss as well as bereavement care pathways in England, I had the opportunity to see a number of funeral services for pregnancy losses occurring before 24 weeks’ gestation. I was also able to talk about these services with bereavement care providers, including bereavement care crematorium and cemetery managers.

Following a number of scandals in the UK related to pregnancy remains, such as Alder Hey Hospital keeping large numbers of sets of pregnancy remains or organs without consent [[1]] or Addenbrooke’s and Ipswich Hospitals incinerating such remains while informing patients that the material would be cremated [[2]], a regulatory effort was made to standardise the disposal of pregnancy remains before 24 weeks’ gestation in England. The Human Tissue Authority (HTA) issued “Guidance on the disposal of pregnancy remains following pregnancy loss and termination” in March 2015; the goal of this guidance included explicitly naming legally acceptable options for the disposal of pregnancy remains [[3]]. Although according to Human Tissue Act from 2004 pregnancy remains under 24 weeks’ gestation have the legal status of “tissue from a living person” (rather than “human remains”) [[4]], the HTA Guidance recognised the sensitivity of this issue and emphasised the paramount importance of following woman’s wishes regarding disposal. Crucially, the HTA Guidance established that

[c]remation and burial should always be available options for the disposal of pregnancy remains, regardless of whether or not there is discernible fetal tissue. Sensitive incineration, separate from clinical waste, may be used where the woman makes this choice or does not want to be involved in the decision and the establishment considers this the most appropriate method of disposal. [[5]]

The HTA Guidance recommended prioritising the woman’s choices regarding the disposal of her pregnancy remains while informing her – if she so wishes – of all possible options. In practice, however, as a recently released report reveals [[6]], women who lose a pregnancy tend to only be informed of options available at the hospital where the loss occurs (rather than all options allowed by the HTA Guidance: individual/shared cremation, individual/shared burial, sensitive incineration or taking the remains home). According to the report, shared cremation is most likely to be the default method of disposal for pregnancy remains (burial is less commonly offered as a matter of routine, while sensitive incineration is rarer still). In other words, if a woman who has lost a pregnancy at the hospital does not make a decision regarding the disposal or selects hospital-arranged disposal, her pregnancy remains are likely to be given a funeral-like service before being cremated.

FB-TW-PROFILE_BabyLossAwareness_-750-x-750-300x300While some of the services I observed were relatively elaborate, a number of crematoria organised simple, typically unwitnessed ceremonies prior to shared cremations of sets of pregnancy remains from early losses. Boxes or small coffins with pregnancy remains would be placed on a catafalque in the chapel, sometimes candles were lit, and a piece of non-religious music would be played. This was followed by an act of committal – either curtains closing around the boxes/coffins or their slight lowering into the catafalque. Most of the time, I was told, the service was attended by one or two of crematorium staff or the hospital personnel responsible for transporting the remains to the crematorium.

It was quite moving to see a consistent delivery of a heart-breaking service in the absence of those whose hearts are probably the most broken, the parents. Crematoria staff who spoke to me emphasised the importance of treating pregnancy remains with the same level of sensitivity and respect given to those who had lived and died. I wondered, given how most of these services are unattended by people who lost these pregnancies, who exactly this sensitivity and respect is for. While it is obvious that it was at least partly aimed at those who had lost pregnancies, it was also directed at the remains. It will be interesting to see whether the widespread practice of offering funeral-like services to pregnancy remains of less than 24 weeks’ gestation will, in the long run, impact their legal status.

Karolina KuberskaKarolina Kuberska is a medical anthropologist with a special interest in maternal and reproductive health. In the past, she worked with highland migrants to lowland Bolivia, concentrating on the relationships between emotions, sociality, and well-being as well as understandings of the body that incorporate traditional and biomedical notions. Furthermore, she also analysed wider socio-politico-economic phenomena, with a particular focus on their impact on the way in which migrant women in the lowland Bolivian city of Santa Cruz de la Sierra understand and access medical care. She has published two articles based on that research: “Sobreparto and the lonely childbirth: Postpartum illness and embodiment of emotions among Andean migrants in Santa Cruz de la Sierra, Bolivia” and “Who benefits from hospital birth? Perceptions of medicalised pregnancy and childbirth among Andean migrants in Santa Cruz de la Sierra, Bolivia”. Currently, she is a member of a research team working on an ESRC project Death before Birth at the University of Birmingham that explores socio-legal intersections of decision-making processes in the experiences of miscarriage, termination, and stillbirth in England.

________________________________

[[1]] The Royal Liverpool Children’s Inquiry Report, 2001, https://www.gov.uk/government/publications/the-royal-liverpool-childrens-inquiry-report

[[2]] Sarah Knapton, “Aborted babies incinerated to heat UK hospitals”, 24/03/2014, http://www.telegraph.co.uk/science/2016/03/15/aborted-babies-incinerated-to-heat-uk-hospitals/

[[3]] HTA, “HTA guidance on the sensitive handling of pregnancy remains”, https://www.hta.gov.uk/policies/hta-guidance-sensitive-handling-pregnancy-remains [date of access 05/10/2017].

[[4]] HTA, “Guidance on the disposal of pregnancy remains”, 2015, p. 2, https://www.hta.gov.uk/sites/default/files/Guidance_on_the_disposal_of_pregnancy_remains.pdf

[[5]] HTA, “Guidance on the disposal of pregnancy remains”, 2015, p. 6, https://www.hta.gov.uk/sites/default/files/Guidance_on_the_disposal_of_pregnancy_remains.pdf

[[6]] Sheelagh McGuinness & Karolina Kuberska, “Report to the Human Tissue Authority on disposal of pregnancy remains (less than 24 weeks’ gestational stage)”, 2017, p. 4, 15–17, https://deathbeforebirthproject.org/research/htareport2017/

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