Information from a high‐quality postmortem examination is the right of every parent after the death of their child.1 Postmortem examination rates worldwide, however, continue to fall. Much of this decline has been attributed to changing societal views on postmortem examination, recent issues of organ retention, and evidence to suggest that parents or carers are less likely to give consent.2
Having reviewed our own practice, we hypothesised that rather than a decline in parental consent, clinicians were less likely to offer a postmortem examination. In November 2004, we carried out a semistructured telephone interview of 60 consultants from 46 level 2 and level 3 neonatal units in England and Wales. There were three interviewers, and the interview took between 5 and 10 min to complete. Given the several clinical scenarios, ranging from an infant born at 23 weeks' gestation who could not be resuscitated at birth to a term infant with seizures and evidence of grade‐III hypoxic–ischaemic encephalopathy, we asked consultants in what circumstances they would offer parents a postmortem examination. We found that 60% of consultant neonatologists interviewed would routinely offer a postmortem examination in the event of every neonatal death.
Of the 40% who did not routinely offer a postmortem examination, more than half had a clear reason for why they did not (table 1). In all, 35% of consultants were not offering bereaved parents a postmortem examination owing to lack of availability of a perinatal pathologist; 37% of respondents thought that the perinatal postmortem examination seldom provided useful new information about a case (ie, in <25% of cases); 66% of consultants believed that with the new consent process, their discussions with parents were now more difficult because of the explicit nature of information shared from a postmortem examination; and 80% of consultants had received no formal training in obtaining consent for a postmortem examination.
Table 1 Reasons for not offering a postmortem examination to all bereaved parents.
| Reason | Respondents (%) |
|---|---|
| Concern that the result might question your clinical judgement | 2 |
| Being uncomfortable with the postmortem examination process yourself | 4 |
| Recent cases of organ retention | 9 |
| The new consent form for postmortem examination | 15 |
| Concern that it might upset parents further | 20 |
| Availability of a perinatal pathologist | 35 |
Offering a postmortem examination and asking parents for consent after the death of their child is one of the most emotive and challenging areas in which neonatologists work. McHaffie et al4 in their study on parents, 3 and 13 months after the death of their child, showed that the biggest parental reasons for refusing consent to postmortem examination were the dread of the child being mutilated and a feeling that there were no unanswered questions. The perinatal postmortem examination, however, remains the gold standard for investigating perinatal death. With new information available in as many as 40% of perinatal postmortem examination,3 we owe it to the parents of babies who have died and to future infants in our care to be sure that we have the best explanation of why a child died. Our study suggests that 40% of consultants are not offering parents this opportunity. The lack of availability of a perinatal pathologist remains the biggest single reason why clinicians are not offering postmortem examination to all bereaved parents.
Acknowledgements
We thank consultants from neonatal intensive care units around England and Wales for their participation in this study.
Footnotes
Competing interests: None.
References
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