Government consultation into allowing coroners to investigate stillbirths: have your say

[RowanMumsnet]

Hello

The government has announced a public consultation over a proposal to allow coroners to carry out investigations into the circumstances around stillbirths.

The Ministry of Justice says:

"Whilst we have robust and comprehensive systems for establishing the possible causes of a stillbirth and reviewing the care that had been provided, there is room to further strengthen these processes. Although many parents are satisfied with the results of these reviews, others feel they have not always been listened to, or that they have not had access to all the facts. Still other parents are concerned that the lessons revealed in these reviews are not always put into practice."

"Over the years there have been calls from bereaved parents, charities and others for a more transparent and independent process for determining the causes of, and learning from, stillbirths. It is time we considered this important and sensitive issue in detail."

"Some of those calling for change have identified coronial investigations as the way to deliver an improved process, while the Chief Coroner for England and Wales has repeated his call for proper consideration of the question whether or not to give coroners powers to investigate stillbirths."

You can read more about the consultation, and find a link to a survey for responses, here.

We'd be interested to hear what you think.

Thanks
MNHQ

I think we should push for more scans. We are woefully behind other countries in terms of how many scans we get

Rowan Oops, I overlooked the consultation. I will fill it in, but I wonder if others will do similarly. A collated response might be helpful.

I had a stillbirth 8 years ago. I'm in Scotland so the coroner system wouldn't apply in the same way - not very sure what it would be here. Like many, there was no cause identified even after full post-mortem (which I was keen on as I wanted to know why it had happened, although the hospital explained that many people aren't comfortable with the idea). I had been into Triage on the Thursday in early labour (baby's heartbeat checked), went back on the Saturday, triaged again (heartbeat checked) and told to wait, examined again 3 hours later (baby's heart rate not checked), told I had dilated enough to go to the labour ward, where they tried to find the baby's heartbeat and couldn't.

The only possible slight indication was slightly reduced movements - which I didn't pick up on as I was having contractions and she was still moving a bit. Another was that at my 40 week midwife appt, the community MW did the tape measure test and said the baby hadn't grown, got me wiggle a bit, then re-measured and said it was fine. She was on holiday for my 41 week check and the other midwife didn't pick up anything. If she had been there, maybe she would have noticed something - but maybe not. Like many PP have said, the tape measure test is flawed.

I welcome anything that helps to identify causes and possibly increase third-trimester scans.

I think this is a good idea, if it's what bereaved parents want. 💐 to all of you who've had such tragic losses.

Just to say, in my area, third trimester scans are now standard. It's only come in recently, I didn't have one for my three year old but I had my second baby six months ago and they were in place then. All mothers are now routinely booked in for a 36 week scan. My understanding is that this is a measure taken to lower the rate of stillbirths. They do a very thorough check (almost like another anomaly scan in terms of length).

Should be standard everywhere in the UK, IMO.

I think @lunaticfringe’s tragic story perfectly encapsulates the problem with the current system. I can’t think of any other area of medicine - or indeed life - where you’d have the people who were directly involved in an event also being responsible for investigation of that event. It’s just got such unbelievably obvious potential for a conflict of interest.

So I think it’s a good idea although frankly any truly independent review would be better than the current system - it doesn’t have to be a coroner.

The mother had a still birth. It is that that will be investigated, and that includes having to investigate the foetus. It's the mother who has the right to know why she had a still birth.

Also there's already grey areas with 'one class of foetus'. Those over 24 weeks have access to medical care others don't.

Or rather, the mother who is carrying a 24 week old foetus has more medical options when it comes to the health of said foetus.

Those are really offensive opinions

My son was not "tissue". He was a very much a newborn baby, fully formed and fully developed. The only difference between him and any other newborn was that his lungs never were filled with oxygen.

To call him "tissue" is frankly ignorant and offensive. His post mortem listed him as a newborn infant, not "tissue".

I also find this offensive, Gth. Do not forget that many on this thread have suffered terribly because of stillbirth. Their babies died.

We have an abortion limit of 24 weeks, after which foetuses are deemed viable and medical efforts are made to save them. To deny these babies, and their families, answers and, if appropriate, restitution, would be a travesty.

I do not agree that empowering coroners to investigate stillbirths would lead to the outcomes you warn of. It is not beyond the wit of man to come up with a framework flexible enough to avoid this.

I think it will be hard to grant a legal status to one class of foetus, but not others

Abortion week limit does exactly this.

I am very sorry for previous comments. They were not intended to cause distress. I just think that this is a very difficult subject. I would be surprised if the government decide to include this within the remit of coroners.

I realise that this is sensitive for many people, and I know how hard it is to lose a much-wanted child whether before or after birth. It's just that there is a significant difference in law between a live birth, and a still birth, and I do think it will be very difficult to draw up acceptable laws to deal with this.

I just searched, and quickly found a BBC article about assaults on pregnant women leading to the death of the baby. I found a UN committee had produced a contested resolution that unborn babies had no right to life. I also found many articles describing normal activities that can cause harm to unborn babies.

I wonder how parents would feel if coroners had to return findings that the parents' actions had contributed to the harm to the baby.

Gth1234 i think you're raising valid points (as difficult as they may be; this is a complex subject).

I hadn't actually considered the impact of a situation where coroner investigations may lead to situations where a grieving mother may end up being the target of accusations about behaviour prior to the birth, or as a way to e.g. start infringing on the bodily autonomy of pregnant women in case of stillbirth and later investigation by a coroner...

This would have to be fully thought out in more detail, taking on board a lot of detail about the realities of how this would work in practice... I think it's a fair topic to raise, but needs to be handled sensitively. I'm not sure I can imagine (or most people would be able to imagine) where that fine balance between respecting the need of women to not become a blame/human rights limited target vs. the (totally understandable) need of grieving parents to have an option to find out more about what might have happened.

I'm not sure that there is a balance that would suit everyone... but it's a worthwhile discussion to be had.

You are being quite offensive to be honest. The coroner's court is not a criminal court, it is involved in finding the facts in any case to determine what happened and if it was preventable, then if there are actions to be taken to prevent reoccurring.

In my case there were serious failures in my care, however thanks to being in the hospital at the right time I had a live birth, unfortunately baby passed away soon after. If I had been at the hospital a few hours later, I'd probably have had a stillbirth, however the serious failures in care were still there, but wouldn't have been investigated anywhere near so thoroughly, if at all. That is the point of this - some stillbirths are caused by preventable issues that could be investigated and actions put in place, and an impartial office such as the coroners is the best option in many cases.

In the same way that not all adult deaths are referred to the coroner, not all baby deaths are referred either, and that is likely to apply to stillbirths too.

This is a really tricky one. Our first daughter was stillborn at 33 weeks in 2012. We were asked if we wanted a post mortem and our main question was 'would a post mortem on our beautiful daughter potentially stop someone else from going through what we were?' The answer was no.
Ultimately tests on myself identified a clotting disorder, and a subsequent pregnancy with twins was highly monitored with regular scans, blood tests etc along with daily medication for myself. At 35 weeks IUGR was identified and they were delivered at 36 weeks.

So for me - no not an automatic coroner investigation - I think we may start to get into parental blame as in the US.

Yes to third trimester scans for all.

Could there be a way for parents to trigger coroner involvement?

Also @RowanMumsnet it would be great if you could compile a response. I'm a few weeks away from my first daughters 7th birthday and there will be no party. It's always tough at this time and as she had a flowers name, she is not surprisingly represented all over our home, this year is probably the year I have to explain to my 4 year olds why we plant a particular flower on the same day every year🤷🏼‍♀️

Much love to all of you who have been there.

Also, complete understanding to those who haven't, and feel they are approaching this objectively. Don't feel guilty, objectivity in any situation is great, just please remember that when a baby is stillborn - you give birth and there is no sound at the end, you dress a baby, cuddle them and know them, but they don't draw breath.

I'd like it to be an option for people who want it. I know that I would not have wanted it - I wouldn't even want a post mortem if it was a spontaneous stillbirth, because I wouldn't expect it to find anything.

If it was a death during labour, then yes I would absolutely want an investigation of some sort. Wouldn't need to be an inquest - I think I would find that quite upsetting regardless of the outcome.

From some of the comments here it looks like not everyone is clear on the difference between a post-mortem and an inquest. The post-mortem is when a pathologist looks for a cause of death (by taking tissue samples, opening the body to examine the organs, etc). Sometimes a cause will be found (infection, genetics, IUGR), sometimes not.

An inquest is where a coroner, who is often a lawyer, looks at the circumstances surrounding the death to see if there is any blame to be attributed. If the cause of death is unknown from the PM, the inquest won't be able to determine it either. What an inquest can do is point to failings in care. It is run like a court case though, and raking over the circumstances of your baby's death in fine detail six months down the line is likely to be traumatic all over again.

(2nd trimester MC pre-24 weeks, so though I haven't experienced a stillbirth it was similar enough that I know what I would want in the circumstances)

This is a sensitive area, but overall I think it is a good proposal as:

1. information will be gathered that ultimately helps in preventing or reducing stillbirth as we learn more through postmortem (both for the individual parents and women in general)
2. The fetus is given greater legal status - his or her death deemed worthy of investigation, important to many parents who have lived with the fetus for many months
3. It will be a legal requirement so parents don't have to agonise over whether or not to give consent, particularly when they are in early stages of bereavement, and potentially regret their decision later.

The proposals are sound per se but would this mean a long delay in being able to bury babies or would this be a separate process?
Also may I point out that the viability limit and the abortion limit are NOT connected and the RCOG has made this point a number of times. In the UK babies are regularly resuscitated between 23-24 weeks if they are of a good weight and have reasonable chances of survival (some will be too sick in utero to survive). The abortion limit is linked to the 20 week scan and information gathered from that.
Which then brings me to the next point that this consultation will ONLY allow for coroner’s enquiries into stillbirths at 37 weeks, ie full term. I can imagine answers are harder to find but I would imagine there is a grey area between 34-36 weeks when the baby if born would be late pre-term and not having answers at that gestation would be problematic. I can imagine mothers feeling like they had failed their babies in one more way (obviously not true).

Of course stillbirths should be investigated. A baby has died! The parents need to know what happened. The medical world should know what caused each death so docs and midwives can try to avoid it happening again.

I agree about slightly younger babies PotolBabu. Hopefully parents can be made aware of their right to request a hospital post mortem examination in those circumstances.

Although I support this, it will make it harder for parents who do not want a post mortem, as they will have no choice. And there can be a long wait for the inquest which can be difficult.

Just to add, a tiny number of babies are aborted at 20-24 weeks. And these are virtually always because of severe abnormalities uncovered at the 20-week scan.