Care of the deceased
The death of a woman in childbirth is a tragedy, which requires sensitive and careful management. While this is a rare event it is essential that staff caring for the deceased know how to do so (Figure 62.1). The term ‘last offices’ refers to care of a deceased patient prior to transfer to the mortuary. All legal and cultural requirements must be complied with and all care recorded in the notes.
The Coroner’s Office is informed of the death and any Coroner’s Office instructions must be observed. Staff should refer to local policy for managing a maternal death and handling of the deceased. The procedure of last offices is not carried out until death is verified.
As the body may present an infection risk, careful hand hygiene must be observed and cuts covered. Personal protective equipment must be used when carrying out last offices (Box 62.1). Care must be taken to avoid cross-infection of other patients and not to contaminate the environment. Last offices are carried out before rigor mortis starts (Box 62.2) (2–4 hours after death) and by two members of staff. Avoid actions that may leave long-lasting marks such as binding the jaw. Body orifices are not packed and in the case of a maternal death all venous access and drainage tubes must be left in situ. The site of each device should be marked on a body map, which should accompany the deceased to the mortuary. A label indicating that access or drainage lines are still in situ should also be attached to the outer sheet or cadaver bag.
The personal belongings are checked and recorded by two members of staff. These are returned to the relatives. When recording jewellery or other potentially high-value items it is usual practice to avoid naming gems or precious metals. For example a gold ring would be described as ‘yellow metal’.
The identity of the patient is checked again before transfer. The body is transported to the mortuary in a concealment trolley. Staff should ensure that other patients and visitors are guided away from corridors and other public spaces while the body is removed.
Staff may be involved in care of a deceased baby if there has been an intrauterine death, stillbirth or early neonatal death. The wishes of the parents must be ascertained. Many parents wish to see and hold their baby but they should not be persuaded to do so if they appear reluctant. Staff should remember that in cases of intrauterine death maceration begins within hours. (Maceration means softening by soaking and refers to the degenerative changes that begin after death in utero. The fetal skin may peel and become discoloured. Over time other tissues are affected.)This may affect the appearance at birth. Memory building is important and photographs and other mementoes such as hand and foot prints may be taken. If the parents do not want to keep these at the time they should be stored in the notes. The baby is cared for, washed and dressed in accordance with the parents’ wishes, and must be treated with gentleness and respect at all times. The infant’s name (if given) must be used when speaking of the baby. The baby is usually kept on the ward with the parents and some hospitals have a cold cot, that is, a refrigerated cot, for infants who die around birth. If the baby is transferred to the mortuary a Moses basket or suitably sized transport coffin should be used. Before transfer the baby must be clearly labelled and a label attached to the Moses basket or coffin. Unless this is a Coroner’s case, the parents may take the baby home if they wish. The parents will want an explanation as to why the baby died and they will be asked for consent to a post-mortem examination. They may refuse and their wishes should be respected.
The correct registration procedures must be followed after the death and options for funeral arrangements explained. The woman should be informed that she will start to lactate and simple care/comfort remedies discussed. She should be offered a lactation suppressant.
If there was any sign of life at birth the case is referred to the Coroner, regardless of gestation.
In all cases, whether a mother or baby has died, all conversations and decisions must be recorded in the notes. The Bereavement Officer must be informed. Parents must be offered support and given contact details for groups such as SANDS.