A difficult issue

The Human Tissue Authority has today published new guidance for hospitals and clinics on the way they manage the disposal of pregnancy remains after pregnancy loss.

The guidance contains much to be welcomed. However, it fails to fully address the issues raised when hospitals deal with pregnancy remains.  You can read our press statement here, but we write more fully below.

Some of you may remember headlines last year about the way in which hospitals managed the disposal of pregnancy remains after pregnancy loss.

Most people would rather not think about this subject at all.  If you’ve been affected by pregnancy loss, though, it might matter very much, even years later.  You may want to know that the remains were disposed of disposed of with respect and sensitivity, even if you don’t want the details.

Sadly, this is not always the case.  Even though previous guidance has recommended that hospitals arrange for pregnancy remains to be cremated or buried unless parents want to make their own arrangements, some pregnancy remains are still disposed of along with clinical waste.  This is not illegal, but it’s certainly not the respectful ending that many bereaved parents would prefer.

That was highlighted in press reports last year, and especially in the Dispatches programme, presented by actress Amanda Holden.

Upsetting though that programme was in parts, it led to government ministers agreeing that it was time to improve the way that hospitals manage the remains of pregnancies lost before 24 weeks’ gestation.  The Human Tissue Authority was tasked with drawing up new guidance for hospitals and clinics and we made sure that the M.A. was one of the organisations that they consulted.

We felt this was an opportunity to drive up the standard of care in this sensitive area – just as Scotland has done.  There, hospitals must cremate or bury all pregnancy remains unless parents choose to make their own arrangements.

The new guidance

The guidance, published on 25 March, contains much to be welcomed. However, it also really disappoints, as it fails to fully address the issues raised when hospitals deal with pregnancy remains.

What we welcome  

It’s good to see that the guidance emphasises the need for pregnancy remains to be treated with dignity, sensitivity and respect, however early in pregnancy that loss occurred.  They have considered the varying needs, concerns and sensitivities of the women involved.  They also recognise that staff who provide information to patients need to be well informed, trained and supported.

All of that can help women to make a very difficult decision at an unhappy time.  If they cannot decide or even think about it at that time, they will have several weeks to let the hospital know their decision.  If they don’t make a decision, the hospital will decide.  And here is the first problem.

Where the guidance disappoints

If the woman does not express a preference, hospitals are allowed to dispose of the pregnancy remains along with clinical waste.  We feel this is wrong.  It seems to assume that not making a decision means not caring and doesn’t take account of the distress and difficulty that many women go through in having to make this decision.

We believe that the ‘default’ option for women who don’t decide should be cremation.  That offers respect and dignity and perhaps comfort too, whether a decision has been made or not.  This is what should be in place.

The second major problem is that the guidance refers to ‘sensitive incineration’.  This is virtually impossible to guarantee, since almost all incineration of clinical waste takes place away from the hospital.  Unless there is someone there who can ensure that these remains are incinerated in a dignified way, completely separate from clinical waste, we believe that this description is simply untrue and shouldn’t be used.

We hope very much that the government ministers responsible for this area will reconsider, and follow the admirable lead of the Scottish government.  In the meantime, we can only hope that hospital managers will themselves decide to practise the best possible standards in this sensitive area.