No parent expects to face the death of their baby or child - it goes against the natural order we expect life to follow. Coping with the unfamiliar prospect of a postmortem can be overwhelming and distressing at what is already a very difficult time, bringing with it the added possibility of discovering facts that may be upsetting. 

It is likely you have many questions and concerns, and this resource seeks to answer some of these. However, it is advisable to speak to your consultant, bereavement nurse/midwife, or bereavement support worker who will be able to provide you with guidance based on your particular circumstances.

What is a postmortem?

A postmortem is a series of investigations, carried out as soon as possible after your baby or child has died, that can help to find out why someone died. It may identify conditions that might have contributed to their death, and may also help to identify anything that might be a potential issue in the future for other members of the family, often through genetic testing. Sadly, some postmortems are inconclusive meaning that no reason for death is found. 

The type of postmortem that is suggested will depend on the circumstances of the death. A hospital doctor might suggest a postmortem to find out more about an illness or the cause of death, while a Coroner will ask for a postmortem if a cause of death is unknown or following a sudden or unexpected death. This might include sudden and unexpected death in childhood, sudden infant death syndrome, or death due to an accident or injury.  

While a postmortem can be a very difficult thing for parents to contemplate, having answers about why their baby or child has died can help some families move forward in their grieving.

Some families we have supported at Child Bereavement UK have told us that it can be comforting to know that the results of the postmortem might help other babies or children, as findings are sometimes used in medical research. 

What is the role of a Coroner?

In England, Wales and Northern Ireland, the Coroner is a specialist judge who is authorised to investigate certain kinds of deaths, for instance where the cause of death is unknown or is not clear. A Coroner gathers information about how someone died and about their medical and social background with the support of other professionals such as doctors and in some cases the police, as well as their family and friends. 

If the Coroner decides from the information they are given that someone has died by natural causes, they will issue a Coroner’s notification which means the death can be registered and a death certificate issued. A Coroner may decide, however, that a postmortem is required. The Coroner does not need the consent of the family to order a postmortem, however the family will be informed and supported throughout the process including being advised of any findings. 

In some cases, the Coroner may order an inquest which is an inquiry to find out how, when and where a person died. If a postmortem is ordered or the Coroner decides an inquest should be held, funeral arrangements cannot be finalised until the Coroner has authorised that the body of the person who has died can be released for burial or cremation. 

The government has produced a guide to Coroner services for bereaved people that you may find helpful. 

In Scotland, the role of The Crown Office and Procurator Fiscal is broadly similar to that of the Coroner. You may find it helpful to view this short film which explains their role.

Can a postmortem only take place with my consent?

If the hospital where your baby or child died recommends a postmortem, you are entitled to refuse consent or to ask for the examination to be restricted to non-invasive procedures. Consenting to a postmortem can be daunting and you may feel an understandable, overwhelming need to protect your baby or child. When asking for your consent to carry out a postmortem, your doctor or bereavement nurse or midwife can help you to understand why a postmortem might be helpful, give you information about what will happen, and provide reassurance that your baby or child will be treated with care and respect.  

In the case of a Coroner’s postmortem, you will not be asked for your permission but you should be supported, told why the Coroner thinks it is necessary and be informed about any results or findings. 

If you have any religious concerns or objections around what will happen, let the Coroner’s office know as soon as possible. While the Coroner is not required to ask for your consent for a postmortem, they are required to consider your views. In some circumstances it may be possible to carry out a non-invasive postmortem, however the Coroner will sometimes need to order a full postmortem in order to investigate the cause of death fully. 

Where does a postmortem take place and who carries it out?

A postmortem of a baby or child usually takes place in a hospital mortuary and is carried out by a paediatric pathologist. This may take place at the hospital where your baby or child died, or your baby or child’s body may need to be taken to another hospital where there is a specialist paediatric pathologist. 

What happens at a postmortem?

What happens at a postmortem will depend on the tests and investigations that the pathologist decides to carry out. Whatever they decide to do, your baby or child will be treated with care and respect. 

Some postmortems are non-invasive which means they may involve x-rays or scans only. Others may involve the pathologist looking inside your baby or child’s body in the way a surgeon might when operating on someone. 

The pathologist may take samples to analyse and they may need to take some of your baby or child’s organs to look at. No organs will be removed unless absolutely necessary and this will only be done with your written consent. Any tissues or organs that are removed from your baby or child’s body will be returned to them, if this is your wish.

If the pathologist needs to look inside your baby or child’s body, afterwards they will use stitches or glue to close any incisions and will wash or bathe them.

Will I be able to see and hold my baby or child after a postmortem?

After the postmortem you will be able to see your baby or child, if you wish. If your baby or child is dressed, any incisions made will not normally be visible, although incisions on the head may be visible if your child or baby has only a little hair. Your baby or child’s face, hands and feet will usually not be affected by the examination, however you may see a change in their skin tone and temperature, both of which are natural and expected consequences of death.

If you are concerned about what you might see, speak to your consultant, bereavement nurse/midwife or funeral director who can give you guidance on what to expect.

In most cases you will be able to hold your child after a postmortem but if you have any concerns, your bereavement nurse or midwife can advise you. 

See our resource for more on saying goodbye to your baby or child.

When will I be able to arrange a funeral for my baby or child?

In most cases, the postmortem and any tests take about a week to complete and after this your baby or child can be returned by a funeral director to your chosen funeral home or to the hospital they travelled from so that you can arrange their funeral. 

However, sometimes your baby or child may need to be transferred to another hospital for the postmortem, which may delay their return to you. 

Some tests can take several weeks and this may delay a funeral if you have requested that tissues and organs are reunited with your baby or child’s body.  

At all times you should be kept informed as to where your baby or child is and what is happening. 

How can I explain postmortem to my children?

As adults, our instinct is to protect children from the difficult things in life and it may be tempting to withhold information about the postmortem, but children may overhear conversations or they may be aware that something is happening and be curious. Children need information in age-appropriate language to help them make sense of things that are happening around them. If they ask, avoid going into too much detail or anticipating questions they haven’t asked. You might say: 

“The doctors  are doing an examination of Oliver’s body to try and understand why he died.’ 

That may be sufficient to answer their question, but if your child asks further questions, you can check their understanding by saying something like, ‘What do you think happens at a postmortem?’ so you can find out if they have any misconceptions or are worried about anything. See our resource for more on explaining death and dying to children.

When will I receive the result of the postmortem?

The results of a postmortem can take some time to be completed and it may be up to 12 weeks after your child or baby’s death. Your consultant will then contact you to talk through the results, if you wish. You can request a copy of the report, however it’s important to be aware that this will be written in medical language and may contain details you might find distressing.  If you wish, a copy of the report can also be sent to your GP so that you can organise to go through the results with them.

If a coroner has carried out the postmortem, you may be sent the results directly before your paediatrician has had an opportunity to read through them. This can be unsettling as you may be faced with difficult and impersonal medical language and upsetting details. It can help to let your paediatrician know when the results have arrived so that you can go through them together.  

In some cases, the results of a baby or child’s postmortem are inconclusive. Not knowing why your baby or child has died can be a very difficult thing to cope with and you may experience a number of different emotions - you may feel despondent, physically and mentally fatigued, disappointed and let down that the postmortem didn’t give you the answers you needed, or angry at yourself or hospital staff. Not having any answers can feel like yet another blow after the death of your baby or child and can potentially make you conscious of your own vulnerability and that of any other children in the family. 

It’s natural to want answers and to be upset and frustrated when answers are not available; it can help to talk to someone you trust about how you are feeling, whether that’s friends and family or a professional such as a bereavement support practitioner, your GP or a bereavement nurse or midwife. 

Looking after yourself

Finding ways to look after yourself is important to helping you have the resilience to cope at such a difficult, unsettling and distressing time. Ways to care for your physical and mental wellbeing might include eating a balanced diet, getting sleep when you can, gentle exercise, and accepting help and support from others.