It can be very difficult for parents to contemplate the thought of a post mortem examination on their baby or child. We know from families that parents do not love or care about their child any less because he/she has died. They want as much care taken of their child after death as before.
Parents usually find it helpful to know as much as possible about why their baby or child has died. A post mortem examination can provide families with valuable information.
They take place in a mortuary and are carried out by a pathologist who is a doctor with specialist training. In certain situations, where doctors are unsure about the cause of a baby's or child's death, they have to discuss it with a coroner who will decide if further investigation (which may involve a post mortem examination) is needed. Coroners are independent, legally trained judicial officers who are required to investigate deaths where the causes or circumstances are either unclear, or unnatural. If the coroner (in Scotland, the Procurator Fiscal) orders a post mortem examination, consent from the family will not be sought. Otherwise, parents will have to give their written consent to a post mortem examination being carried out. This can be a difficult decision for grieving parents to make, but the examination may help parents find out as much as possible about what led to the death of their child.
A post mortem examination, or autopsy, involves a careful external and internal examination of the child's body by a pathologist, a doctor with specialist training. The procedure involves a careful external examination of the body, followed by a detailed internal examination at which the major organs are removed, weighed and inspected. Small samples of tissue - usually less than 1cm3 - and fluid are taken for testing. It is possible to consent to donate these samples for research without anything further being taken from the child's body. Specific written consent from parents is needed for anything else to be kept, for example for further study or research, . All tissue and organs that the parents have not agreed can be kept will be returned to the child's body. Some tests may take several weeks, and if tissue and organs are to be reunited with the child's body, the funeral may be delayed. Alternatively, the parents may agree to the hospital respectfully disposing of the tissue or organs after testing is complete.
Photographs, x-rays and digital video images may be taken during the examination to provide a visual record of findings. These are normally kept as part of the records.
Many parents worry about what will happen to their child at post mortem, and whether they will be able to see their child again. There is no reason why parents cannot see their child after post mortem, and if dressed, the incisions made on the child's body and head will not be visible. A child's face, hands and feet will not usually be affected by the examination.
The post mortem examination will be carried out as soon as possible after consent has been given, usually within 72 hours, and is conducted with respect and dignity. A child may be taken to another hospital so the examination can be carried out by a specialist children's pathologist. Results are usually available within six weeks. The consultant or family GP should discuss the results with the baby's or child's parents and ensure they are given full, understandable explanations and an opportunity to ask questions.
The examination may help to identify a cause of death which was unclear, reveal illnesses or conditions that had not previously been diagnosed, or give information about the effect of treatment. While a post mortem examination may still leave some questions unanswered and does not always find a definitive cause of death, it can rule out certain diseases and conditions and provide families and the staff who care for them with valuable information and knowledge for the future.