National Committee on Infant Cremation: 2017 annual report

7. Updated Guidance On The Cremation Of Pregnancy Losses

In 2012, the Scottish Government Chief Medical Officer and Chief Nursing Officer issued revised Guidance to the NHS in Scotland, notifying them that incineration of pregnancy losses (i.e. losses that occurred before 24 weeks’ gestation) was no longer acceptable, and that shared cremation was now the minimum standard. All fourteen territorial Health Boards confirmed in 2013 that they were meeting that new minimum standard.

An early piece of work for the National Committee, largely via its Shared Cremations Sub-Group, was to ensure this Guidance was updated to reflect the Bonomy recommendations. The revised version was submitted to Scotland’s Chief Medical Officer and Chief Nursing Officer, and was subsequently issued to all NHS Health Boards in June 2015.

It is worth noting that one of the changes introduced, a requirement to ‘discuss’ all available burial and cremation options with the individual who had experienced the loss, caused concern to some medical professionals working most closely in this area, who felt that in certain circumstances this would cause additional distress to patients. Although the Bonomy recommendation is based on sound principles of ensuring informed consent / authorisation, and despite the option for the patient to decline all discussion, there is a continuing view that actively discussing all options may still be a step too far in some instances, particularly in the context of very early pregnancy loss.

The originally intended update to the CMO letter was postponed to ensure that the updated letter could take account of the changes in practice that will emerge from the new legislation. The chair of the National Committee issued a letter in January 2016 providing a progress update about the work of the Committee.

Throughout the period of this report significant work has been undertaken with NHS Scotland and others to design and deliver new statutory pregnancy loss authorisation forms. These forms will be used by health care providers to record a mother’s wishes for the burial or cremation of her pregnancy loss or stillborn child. The introduction of the forms will be accompanied by guidance for health care professionals and sufficient time will be built into the process for staff training. In addition, an updated CMO letter will be circulated to health boards in due course which will provide an update on the new legislation.