This is the first of our two part series about baby loss. It was recorded ages ago but we’ve delayed publishing it again and again. We just thought there’s too much heartbreak at the moment to add something else to the mix of 2020.

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But this is a much requested topic and we realised that it is needed. There are parents coping with the loss of their baby every day.

This is for them but it also for everyone else so we can all be better supports for our friends, family and strangers.

It will be hard for some, probably most, and we have compiled a list of resources for everyone to access who may have experienced pregnancy and baby loss and for people who may need support after listening to our podcast.

(Sorry if we have missed any)

Organisations like:

@pinkelephantsupport
@bearsofhope
@pandanational
@cope.org.au

And of course we are @grow_my_baby in our DMs to chat.

Little babies. Held in our hearts. ❤️

“Rhyla Eve” Born and Died June 22, 2020

Brigid: [00:00:36] Well, hello everyone. This is episode 39. We’re going to be talking about when a baby dies and it’s a difficult topic. Isn’t it, Pat?

Dr Pat: [00:00:45] Yeah. In today’s podcast, we’ll be discussing the subjects of stillbirth and neonatal death.

And please be aware that these issues obviously will be upsetting for some people.

Brigid: [00:00:55] Yeah. And we hope that everybody listens to these episodes because, uh, you know, it sort of helps to normalize the concept of death. It’s a really tricky idea. So what we want you to make sure is that you’ve got your supports in place, and that might mean that, you know, you either listen to it with your partner or you know that you’ve got someone on the end of the line.

If you need to call somebody or if it gets to a certain point where it’s too much, just stop it. Go for a walk outside, breathe, do your breathing exercises,

Dr Pat: [00:01:26] Return to it later. Yep. Hopefully this is something that will never affect you directly. Yeah. But it’s still important to learn something about this if only to be a more effective support for others.

Brigid: [00:01:37] Yeah, absolutely. Yep. So we’ve done it in two parts. So episode 39 will be all about sort of the medical part of when a baby dies. And then the second part in episode 40, we’ve invited in Pat’s sister actually. Who is a funeral care director.

Dr Pat: [00:01:56] Yeah. Funeral director and expert in death care. Who’s going to give us some really amazing insight into the incredible work she does.

Brigid: [00:02:04] Yes. She really focuses her business on babies and supporting families. Alright, so we’ll get straight into it. Pat, what do you think? You already mentioned stillbirth and neonatal. There’s some terms like this is that’s the thing, isn’t it. So if somebody, all of a sudden at 25 weeks or whatever is told that their baby has died, they are bombarded by all these new terms that maybe they don’t know

Dr Pat: [00:02:32] that’s right.

And I think that it’s worthwhile as covering quickly what the common terms used are as a relatively simple classification in this situation, perinatal death, that term report refers to all of the babies that died around the time of birth and

Brigid: [00:02:48] including at birth?

Dr Pat: [00:02:49] Yes. Yep. And that’s divided into stillborn babies, which are babies born after 20 weeks of the pregnancy with no signs of life.

At birth. Yeah. And that makes up about three quarters of the perinatal deaths. And then there’s the other quarter, which are neonatal deaths and that’s babies that are born alive anytime after 20 weeks born alive and die within the first 28 days of, of life.

Brigid: [00:03:16] Right. Okay. I didn’t know that it’d go like a whole month after the actual birth.

Dr Pat: [00:03:21] That’s the period too, yeah.

Brigid: [00:03:23] Okay. So is it worthwhile if we sort of start talking about the differences between, say stillbirth and neonatal death.

Dr Pat: [00:03:30] Yeah. So if we look at stillborn babies, this is about, as I said, three quarters of the babies that die around the time of birth it’s babies born after 20 weeks of gestation, 20 weeks of pregnancy with no signs of life and.

You know, this is not rare. Of  women who reach 20 weeks of pregnancy. One in 137 of those women will have,

Brigid: [00:03:54] That’s a really high statistic.

Dr Pat: [00:03:56] It is. Yeah. It’s, it’s an area of healthcare that right throughout the, even the developed world with the fanciest technology, we’ve still got a bit to go and we haven’t made massive inroads into that figure much in the last 20 years when care, for example, for babies born alive, but extremely premature has rocketed along. The number of stillbirths is still a problem.

Brigid: [00:04:19] And, you know, with the black lives matter, I’ve become so aware of some indigenous health care stats. And it’s worse for indigenous people. Isn’t it?

Dr Pat: [00:04:27] Yeah. It’s much worse. Um, so in Australia, indigenous women and other people living in conditions of significant disadvantage, the still birth rate can be up to double the right for the non-indigenous population.

Brigid: [00:04:42] So I’m just going to get that right. So that means like 1 in 70 women. Indigenous women.

Dr Pat: [00:04:47] Yes, who reach 20 weeks. Will have a still born baby.

Brigid: [00:04:50] Oh my God. Okay. Uh, so you know, that is heartbreaking

Dr Pat: [00:04:55] time, isn’t it? Yes. Obviously it’s not just the loss of that baby and that baby’s life and potential. It’s the damage that this does to families and communities and the woman herself goes through an enormous amount of grief plus also associated problems of depression and anxiety.

Problems with her general health, following that experience and problems with anxiety in future pregnancies, if she becomes pregnant again, and you know, it’s an important cause of all of those problems, plus there’s an additional problem. Of a certain stigma that still surrounds this issue. The problem seems to be that everybody else isn’t terribly comfortable discussing stillbirth so that the families that are experiencing this, and we’re talking about 2,200 Australian families a year.

They report not getting the support that they need in general from family and friends, because. They feel that those other people don’t have the language or aren’t comfortable discussing it.

Brigid: [00:06:02] Right. And I’m going to put my hand up here. I remember in our friendship group, in my mid twenties, one of my friends had a, uh, recent sort of relationship with a woman.

And I didn’t know that woman. And it’s funny if you are friends with the guys in the group, sort of, you know, it’s, it’s automatically assumed you’ll start being friends with the women in the group and we just didn’t gel. And I feel bad even thinking about it because what actually happened was this girl, Sam, she ended up having a stillbirth at 20 weeks.

And I would say that I was, I just didn’t know how to handle that. And I thought that actually she was, I didn’t see her pain and I couldn’t empathize. And I probably would hope that I’m an empathetic person. I’ve learned a lot since my mid twenties, but you know, to go back to that time, I would just do that all differently.

So why does stillbirth happen? What, what do we know about it?

Dr Pat: [00:06:57] Well, we need to know a lot more, but what we do know is that a lot of them are explained by what we call congenital abnormalities. So these are babies with structural problems, perhaps with the heart or the brain. And then there are a number of other conditions that might’ve developed during the pregnancy, such as pregnancy conditions like gestational diabetes, preeclampsia, and there are some related to maternal health issues like smoking and obesity.

And there’s still a good number that are completely unexplained, as many as 20%. Well, that’s a lot too. That’s particularly problematic. Not only because it’s seems particularly tragic, but also because it’s very difficult to advise that woman accurately about perhaps, what to do next time. And people find, I think that the grief even more difficult to manage if there’s no explanation at all.

Brigid: [00:07:52] What about cord accidents?

Dr Pat: [00:07:54] Yeah, sure. So cord accidents are in those figures. Yeah. That’s if a baby becomes twisted up in its own cord or cord multiple times tied around the neck.

Brigid: [00:08:02] Now we talked about that in the umbilical podcast. So a pop back and have a listen to that too. I just want to go back to the congenital abnormality.

So is that discovered at the 20 week scan or when, when does that become apparent?

Dr Pat: [00:08:16] Uh, yes. So some of these will be discovered at the 20 week scan. And for example, we might have evidence on a, a 20 week scan that there’s some major problem. And then that woman might be sent to a tertiary hospital in a big city for a special scan and an opinion to confirm the presence of that major problem.

And some of those will be, will be fatal abnormality.

Brigid: [00:08:41]. And yes, I suppose we’ll go on to what then the decisions are that that woman has to make. But I also wanted to just, you know, you, you mentioned obesity and smoking, so what other risk factors? Like? Can somebody do something to prevent stillbirth?

Dr Pat: [00:08:56] Yes. So risk factors are important. This is a problem that could theoretically happen to anybody, but there are some risk factors that we know make a stillbirth, perhaps more likely. Yeah. And there are some of those that we can do something about. And some we can do less about, but the ones that we know about are decreased fetal movements.

So that’s at the top of the list because there’s tons we can do about that.

Brigid: [00:09:21] Yeah. I’m going to stop because we’ve done a podcast on that. It’s a, what can your baby movements tell about your pregnancy? That may not be the title, but it’s pretty close and I think it’s episode 11

Dr Pat: [00:09:31] so the most important take home message from that podcast is about prevention of stillbirth.

That’s what it’s for and monitoring the fetal movements. And if you listen carefully to that podcast, it’s often about the pattern of fetal movements. It’s so important

Brigid: [00:09:46] yeah. And you start monitoring after about 25 weeks.

Dr Pat: [00:09:49] Well, from when you start getting regular fetal movements. Yeah. So might not be as late as 25, might be 20.

And if they’re regular, then once you start feeling them every day, then you should keep feeling them every day.

Brigid: [00:09:58] Yep. Are there any other risk factors that we’re looking at?

Dr Pat: [00:10:00] Yeah. So the other big modifiable one is smoking. So we know smoking has a very powerful effect on fetal size and on placental function.

And it’s not news to people that we shouldn’t be smoking in pregnancy, but we’ve still got a little bit of a way to go.

Brigid: [00:10:16] Yeah. We still got a problem with smoking and pregnancy. Yeah,

Dr Pat: [00:10:18] yeah, yeah. Other conditions like diabetes, people think of diabetes sometimes as being a condition where they’ve got too much sugar, so they might make a great big fat overweight baby.

And that can be part of it. But just as often with diabetes, the problem is growth restriction. A baby that’s too small and sick because it’s too small and that’s a definite risk factor for stillbirth. One of the reasons while we take diabetes, so seriously have the diagnostic criteria set so tightly.

And monitor those women very carefully. And that is the way diabetes can cause stillbirth through growth restriction is part of a broader classification of stillbirth risks related to IUGR out, which is intrauterine growth restriction.

Brigid: [00:11:03] We’ve got a podcast coming up about that.

Dr Pat: [00:11:05] Yeah, so IUGR baby’s that are too small for how big they should be based on the number of weeks pregnant we are. And one of the things that we can really do and are trying to improve in preventing stillbirth, is improving our diagnosis of IUGR. So identifying more babies that have IUGR and then putting in place sensible management plans to monitor those babies very carefully up until the point where they’re better off out than in and delivering them early before.

Brigid: [00:11:37] Yeah. So stay tuned because we’re going to really go into depth about IUGR.

Dr Pat: [00:11:41] Yup. Yup. Other things that we know increased risk of stillbirth is maternal hypertension. So high blood pressure in the mother, obesity.

 Prolonged pregnancy is a difficult one. When I first started at the Royal women’s many years ago, they had a, you know, a point at which pregnancy shouldn’t go pass, which is different to now.

So there is data. Data changes opinion, but certainly in my practice now, I don’t like anyone to go over 41 weeks. Yeah. And yes, there can be some risks involved in inducing people at 41 weeks, but all things covered those risks in induction at 41 weeks are probably less than the risk of keeping on going.

And there are some other things like advanced maternal age, sleeping flat on your backs. Another difficult one that the data on that’s pretty clear that placenta works. Better if you sleep on your side.

Brigid: [00:12:28] Yeah. And I know that panics a lot of women because they go, Oh my God, I’ve woken up now I’m on my back.

And then they start feeling stressed and anxious.

Dr Pat: [00:12:35] Yeah. I’m sure the guys who discovered that were probably worried about exactly that, whether they  we’re going to cause more good than harm, but it is possible to train yourself, to go and sleep on your side if you’ve previously been a back sleeper.

Yeah. That’s just, the advice needs to come with some common sense that if you wake up and you’re on your back, there’s nothing you can do about that. You turn back on your side and try again.

Brigid: [00:12:52] Yeah. Yeah. And also it’s the one offs that are, might be okay, but it’s the prolonged sleeping on the back.

Do you think that that makes a difference?

Dr Pat: [00:12:59] What seems to be most likely is that this business about the way that you sleep, it may not actually be terribly important for a woman who’s got a big healthy baby on the 65th percentile. Who’s totally fine. That baby can probably cope with you sleeping on your back.

The official advice is because you don’t know exactly how big your baby is, but a really healthy baby maybe it’s probably not troubled by it, but if your baby’s a growth restricted baby, then you need all your little 1% to go, right? Yeah. Yeah. your ducks in a row and sleeping position is one of those.

Yeah. So it may be very important to a baby that needs everything to go. Right.

Brigid: [00:13:33] Yep. And I’m going to pick you up on the advanced maternal age, because like, you can’t help it. You have your baby when you can have your baby

Dr Pat: [00:13:39] that’s

right. Yeah. That’s why there’s nothing you can do about that. Other than, I guess if you are over 40 at the time of your pregnancy and some additional monitoring is recommended, then that may be well worthwhile.

Brigid: [00:13:51] Yeah. Go to all your antenatal appointments.

Dr Pat: [00:13:54] Yep. Yep.

Brigid: [00:13:55] And one other

Dr Pat: [00:13:55] that we haven’t discussed, which is super important. It’s a previous stillbirth. Yeah. So if you’ve had a previous stillbirth, then that’s a risk factor for another one, whatever might’ve caused the previous one. Yeah. Might be something that is still going on and, you know,

Brigid: [00:14:11] Especially if it was unexplained,

Dr Pat: [00:14:13] Yes by definitiod we don’t know what caused the previous one. So we don’t know exactly what the risk status is for this one, but let’s say for example, the previous one was from, was contributed to by your preeclampsia and well, of course you would risk getting preeclampsia again. So those women need very careful pregnancy management to make sure that we do everything right.

And reduce the chances of that tragic outcome happening again.

Brigid: [00:14:36] So we might go on to management, but first I just, I’m a bit confused. What is neonatal deaths then?

Dr Pat: [00:14:42] That’s the three quarters of those babies lost at the time of birth are from a stillborn babies. And one quarter of babies that are born alive, but will die within 28 days.

And those that’s about, that’s less, that’s about 2.3 per thousand. Yeah. So not, not a common thing to happen, but again, those babies. It’s usually much less of a mystery, so there’ll be some syndromic baby that we’re born alive, but not expected to survive for very long and extreme prematurity.

Brigid: [00:15:12] Yeah.

Dr Pat: [00:15:13] And the other thing that’s still going on in 2020 in that group B infections.

Yeah, a small, but a small but important number of babies are born with serious infections. And that’s what that GBS swab at 36 weeks is all about. And even with the best swabbing in the world, and even with antibiotics, a small number of babies will still get, you know, severe, early onset. GBS sepsis and die from that infection.

Brigid: [00:15:37] And again, that comes down to management, but I suppose that those babies need to be very monitored as, as when they born. Is that?

Dr Pat: [00:15:44] Yeah. So this, this area is really more for the paediatrician, so the obstetricians less directly management are involved in the management of these babies that are born alive and then taken over by the pediatricians, but may have problems that from which they don’t survive.

Brigid: [00:15:59] And we talked about insufficient or, um, shortened cervix. That’s a problem with neonatal

Dr Pat: [00:16:05] death as well. Yes, sometimes. I mean, insofar as it’s a cause of extreme prematurity for some babies, so that insufficient cervix might be a reason why labor comes too early and you know, the typical call story of, of insufficient cervix is a quick and painless delivery in the second trimester.

So some of those babies would be less than 20 weeks and not covered in this classification and some would be still born in some neonatal deaths.

Brigid: [00:17:48] So Pat through our work and your work, we’ve become very interested in that whole nine months program. That’s run out of WA.

Amazing. And they’re doing some amazing work on trying to reduce perinatal deaths, both stillborn and neonatal. So what, what are the main things that we can do to. Prevent that.

Dr Pat: [00:18:10] Yeah. Look, I think this is something that’s covered everyday in obstetric because what can we do to help? We can attack smoking.

That’s that’s one thing that’s still there as a problem. And it’s not just saying don’t smoke. It’s about supporting people. To smoke less. So yeah, the things that have been shown to help are to take a couple approach to it. Most women who smoke in pregnancy, their partner smoking as well, and any supports that we can bring in and arming women with information like which of the medications you can use to help you stop smoking are suitable for use in pregnancy, which can be used while you’re breastfeeding.

And this is information and that information. Can get through to people and hopefully drive behavioral change, improving awareness of that safe, sleeping position stuff. That’s important. That’s sort of newish information, but it’s definitely real.

Brigid: [00:19:00] And maybe like, just a point on that. So if you are a back sleeper and you sort of find yourself flipping back, like putting a bolster behind you,

Dr Pat: [00:19:08] Yeah, I think, yeah.

I advise people to

Brigid: [00:19:10] do that. Yeah. You can’t roll. You physically can’t roll or the act of you trying to roll onto your back, wakes you up

Dr Pat: [00:19:17] will make you more uncomfortable in your way come. Yeah, that’s right. Yeah. We’ve got to improve decision making about birth timing, and that’s something that’s, that’s an in house issue within obstetrics that, so that we are trying to get better at identifying IUGR babies in particular, putting in place management programs that monitor those babies very carefully and then make sure that we pick the time with the perfect balance between wanting to get the baby more fetal maturity, but not waiting so long that the stillbirth occurs.

Brigid: [00:19:51] Cause it’s optimal. Like the whole nine months talks about it being optimal time is 39 weeks to have your baby to have your baby.

Dr Pat: [00:20:04] Yeah. So for example, a severely growth restricted baby might not get anywhere near 39 weeks. The appropriate time for that baby to be born might be 32 weeks, but we’re trying to get better as a specialty at working that out.

And planning it appropriately. Then the last one of course is we want to improve them message getting through to people about decrease fetal movements. yes. Yeah. That’s a no brainer. So yeah, still from time to time, have some people who I don’t think of have taken that message on as well as I’d like. Yeah.

And, you know, we’ll perhaps call me on a Monday and say, I haven’t felt the baby moving. Maybe since Saturday. If you haven’t felt the baby moving on Saturday. Then that’s a, that’s a phone call for Saturday night.

Brigid: [00:20:45] Oh, absolutely. So I’m just, um, quickly just making sure that it is episode 11. Yes.

Episode 11. What a normal baby movements. Like we highly recommend you go back and have a listen to that.

Dr Pat: [00:20:56] Yeah. So the whole point of that is, is decreasing stillbirth. Right? If we look at why still birth happens, it’s still very likely that that woman would have experienced decreased fetal movements in the previous two days.

So we’re now much stricter on our messaging. That we don’t go to sleep on absent, fetal movements. Baby hasn’t moved all day and previously it had moved several times in the day. Then that’s not normal needing ultrasound. And then what we have to do at that hospital is not make people feel like a goose for ringing.

So, uh, you know, the assessment center at the hospital is open. You come in, we’ll have a look, we’ll trace the baby’s heart. We’ll have a listen on ultrasound and ah, Exactly and, and, and take it seriously.

Brigid: [00:21:37] Yeah. So what happens when a woman and her partner, they sadly find out that their baby has died and they might be, I don’t know, 32 weeks or earlier, anything from 20 weeks, what actually happens then?

Dr Pat: [00:21:51] Yeah. So that’s, I mean, this is something that’s part of obstetric practice, tragically enough, it’s something that might happen two or three times a year in our units where. Somebody comes in, for example, for routine antenatal visits, 32 weeks reports, perhaps that the fetal movements, they haven’t felt the baby move that day and on ultrasound, the baby has died.

And let’s take, for example, a situation where that’s truly unexplained, tragic situation. The first thing we have to do is tell the woman and her partner that that’s happened. And that’s obviously one of the hardest parts of our job. It’s something you can’t really get training in other than by doing it.

And we try and do it well, people’s immediate question is how could this possibly have happened? And often at that point, we just don’t know. So. In those early hours and days. One of the first things that needs to be done is providing compassionate care to that couple, supporting their emotional and mental health, but also making a nuts and bolts plan for the delivery of that baby.

And we do have to move reasonably,  it’s not an emergency, but reasonably quickly on with a plan to get that baby born. And now this is a super difficult time for people because they’re grieving, but they also have some short term medical needs that need to be met as well. Apart from rare circumstances, most of these babies would be born by induced vaginal birth.

Brigid: [00:23:21] At what week do you have to have an induced vaginal birth?

Dr Pat: [00:23:25] Oh it’s complicated, but there are a number of things you would have to take into consideration, but typically, you know, like a surgical curate is for pregnancy loss under about 10, 11, 12 weeks and pregnancy losses. After that time tend to be born by induced vaginal birth.

So we commonly use a drug called misoprostol, which is a tablet that goes in the vagina. We keep on giving doses of that for four to six hours until labor comes. And unfortunately, that process can take a long time. It can take a day. Which is again, upsetting and distressing for people. So if we take our 32 weeker that we were discussing, that woman might need several doses over the course of a day.

And typically nothing much happens with the first few doses, but then there’s this cumulative effect. And suddenly she’ll come into, into strong labor. And the very strong part of the labor tends to be some very strong contractions, but it will progress quicker than a term delivery of a live baby. And then the baby will be born and the placenta come out afterwards in the, in the usual way.

Brigid: [00:24:35] I remember when we, my first experience, you know, when early in our days when we were together and my first experience of one of your patients having to go through this, and my question was then like, why don’t you just do a Caesar, like so cruel to have to go through a labor.

Dr Pat: [00:24:52] Yeah, it, it is. I mean, we can certainly help people with pain relief.

Um, and in fact, when the baby has died, the pain relief options are broader. We can give more drugs at higher doses because we don’t have to worry about the effect of those drugs on the baby. But yeah, it’s definitely a distressing experience for people. The reason why we don’t do a Caesar is, is there are many factors behind that.

The main one is the Caesar is an operation with risks of its of its own. And looking back from afterwards, people are usually please they didn’t have a caesarean. Sections done at early gestations are complex, technically difficult. And more dangerous. So it’s much harder for example, to do a Caesarean section on a 25 week stillborn baby than a term baby, much harder.

The uterus is very small and the bit of the uterus that’s easy to cut into, the lower bit hasn’t formed yet. So you have to cut into the upper bit and that’s very technically difficult and yeah. More dangerous. And also we’ve got to think of future pregnancies. Yeah. So, uh, it would be much better for that couple next time.

For example, if we do a Caesarean section for a stillborn baby, come back next time with nice, healthy. Pregnancy everything’s going great, but suddenly we’re in a VBAC situation, which we could have avoided if the first, if there stillborn baby had been born vaginally. So taking that into consideration in general terms, it’s much better to have the, uh, the stillborn baby born by induced vaginal birth.

Brigid: [00:26:23] And then what happens? We’ll go into probably the care of the baby and the mum. When we talk with Libby, but medically, like does every baby have to have a post-mortem?

Dr Pat: [00:26:34] No, that’s entirely up to the parents. Um, yeah. Yeah. And we tend to, well, it’s up to the parents in so far as you you’re well, within your rights to say don’t want one, we tend to recommend them in cases where we think there’s something to be learned by them.

Post-mortem that can help us prevent poor outcomes in the future.

Brigid: [00:26:55] Yeah, right, I just didn’t realize that. I thought maybe that all had to have a postmortem just to nut it out

Dr Pat: [00:27:01] well, no, for I’ll give you an example. If I’m the 20 week ultrasound, there was clear evidence of a known syndrome. Which was confirmed on amniocentesis and in the subsequent fortnight, when that was all being discussed, the baby was actually found to have died, then there’s no mystery to solve.

Yeah, it would seem very clear that the baby had, had almost certainly died as a direct result of that syndrome and that the postmortem was very unlikely to add anything. But in the unexplained cases, I definitely recommend post-mortem. And of course the pathologists who do the postmortems do them incredibly respectfully.

And the idea of course, is that the postmortem examination may reveal a hidden diagnosis. That’s got a recurrence risk, and we would need to know about that to counsel those people about next time

Brigid: [00:27:53] this week, was it this week or last week? We’ve had some very happy news. In that one of your patients actually has gone on and had her baby after loss

Dr Pat: [00:28:03] Oh. After, yeah. After a neonatal death last time. Yeah, that’s right.

Brigid: [00:28:07] Yeah. And you know, it was just

Dr Pat: [00:28:09] unbelievably joyous, joyous, but also, you know, a good example of  you’ve got to pull out all stops in that second pregnancy and get everything lined up so that we can. Absolutely maximize the chances of things going well.

Yeah.

Brigid: [00:28:23] So how does that work? Like when somebody is ready, when can they start thinking about their next baby or what happens?

Dr Pat: [00:28:31] The first thing the baby’s born. And then in those early days, the focus is on the present. For example, in my hospital is on collecting some momentos of that baby for the family.

So we get the photos. And some, even if a stillborn baby is born in poor condition, like for example, the baby might have died a few weeks before that. Detected then you can usually get something photos of the baby, a part of the baby that’s in good condition. So a hand or a foot, for example, and little hand and footprints are made and they go into a thing called a memory memories folder that stored at the hospital forever.

And of course the beauty of that is that some times if people have a stillborn baby and they say, no, no, I don’t want to have a funeral. I don’t have a, I don’t want a burial or, or whatever they might just say, I want the hospital to make those arrangements, then that can be done.

But that same person may return many years later and saying ‘did you keep for me in the way of photographs or hand prints or whatever’?. So that’s done. And then there’s a bunch of tests that need to be done to try and work out what happened. And we’ve covered post-mortem there’s analysis of the placenta. And that can be very valuable, especially in conditions like preeclampsia , where we may not have thought that the woman’s preeclampsia was that bad, but the placenta might show changes in the, in the arteries and veins that suggest more established disease than we believe there was. It might show evidence of infection where infection wasn’t clinically obvious. So for example, woman seemed fine.

Didn’t have a fever, but there’s germs in the placenta. And we do some complex tests on mother’s blood, including looking for rare blood clotting conditions and other things that can really help show us a better way of managing the next pregnancy. Yeah. And then there’s a follow up with the results and some more counseling, referrals too.

Mental health services, grief services. And then at that point, some discussion about next time will, will come up. And the question about when to try again is  complicated. It’s how long is a piece of string? There’s too many variables and it has to be highly focused on that couple. Yeah. But the things to take into consideration, uh, the mental health and grieving recovery primarily.

Brigid: [00:31:01] Hmm, I didn’t mean to ask about the next baby straight away. I’ve done that thing that you know is often exactly what somebody that has experienced a loss of a baby says that, you know, people go well, there’s always next time.

Dr Pat: [00:31:15] Yeah. That can be a tricky thing to say at the start. Um, there’s more and more actual data being collected, which is amazing and wonderful where they’ve asked people this experience, looking back, what have we been doing wrong and how did you want us to speak to you. And one of the things that’s coming out of that is that people have said that a term, like, I’m sorry for your loss is all you need to say. And that suggestions like, yeah, we’ll be right next time are less useful because they downplay the significance they’re in right now. And so, and into the future, before that couple’s ready to turn to the future.

Brigid: [00:31:52] And you say a nice thing, which is, they just didn’t want any baby. They wanted that baby, you know, that baby needs to be remembered and named and

Dr Pat: [00:32:00] yeah. Yeah, that’s right. That’s right. So yeah. It’s no point in thinking of another one. That’s not a replacement for this one. No. Yeah,

Brigid: [00:32:05] yeah. So I’m sorry about that.

It was just because I was thinking that we were going to cover that with our next podcast.

Dr Pat: [00:32:12] Yeah. Well, the work that people like Libby provide for families in this situation is incredible because they really leading the way in doing this in the way that people have been through it.

And perhaps it wasn’t managed terribly well, the way that if I had the time again, I would want it managed better. Yeah.

Brigid: [00:32:29] Alright. Well, I think. We’ve covered lots in this podcast. I hope everybody’s gone. Okay. And, and now you might need to have a little breath and a little walk outside or something like that.

Get a bit of fresh air before you go onto part two. We’re going to release it in the same week. And part two, we will be talking to Libby. Libby’s the founder and managing director of natural grace and they help lots of families who have lost their baby. And she does it in a very sensitive and complete way doesn’t she?

Dr Pat: [00:32:58] Yeah. Amazing work. So tune in for the next one.

Brigid: [00:33:01] Bye everyone