BOSTON — There are several ways physicians can offer support to parents after a fetal death, Ruth C. Fretts, M.D., said at a meeting cosponsored by Harvard Medical School and Brigham and Women’s Hospital.

She offered several suggestions on how to counsel parents after a stillbirth, including use of a decision support worksheet and a kind of parental bill of rights. (See box.)

The worksheet takes a question-and-answer format and provides space for parents to list their own thoughts and questions. Although answers to the questions may vary by hospital, the questions address general concerns of grieving parents.

The worksheet was originally designed by a social worker in Chicago who had a stillbirth. “When a bad thing happens, all hell breaks loose. It’s hard to even think. This is a checklist for the patient to hold, to look at, and to go through. When your mind is thinking of all of these millions of things, it’s helpful for the patient, and it’s helpful for the providers. And it has a thoughtful approach to the value of an autopsy,” said Dr. Fretts, assistant professor of obstetrics and gynecology, Harvard Medical School, Boston.

Some questions included on the worksheet:

* What are my options for burial or cremation?

* Should we see and/or hold our baby?

* Will pictures of my baby be taken?

* Will my baby have an autopsy or other tests?

* Can we have our baby blessed?

* Will my milk still come in after delivery?

* We have other children. Should we let them see the baby? What should we tell them?

In Australia, a perinatologist or fetal pathologist usually introduces himself or herself to the parents, expresses condolences, and explains that an autopsy may find out exactly why the baby died. The parents are told their baby will be returned to them and that great care will always be taken. The parents are more likely in this scenario to consent to an autopsy, she said.

“When you have a two-page pathology report of all the things that happened before and after, it makes such a difference in counseling that patient,” Dr. Fretts noted. She did acknowledge that not every hospital has a perinatologist or fetal pathologist available, but she still advocated encouraging parents to seek an autopsy while reassuring them great care will still be taken.

The parental bill of rights she discussed was adapted from guidelines by Share Pregnancy and Infant Loss Support Inc., a group created to offer support to individuals who have experienced the loss of a baby through stillbirth, miscarriage, or newborn death.

The term “bill of rights” is something of a misnomer, however. According to a statement from Cathi Lammert, R.N., the group’s executive director, “The term ‘rights’ is not used as a mandate for the bereaved nor as a militant statement of demands. It is an affirmation for parents who wish to be involved with their baby, to make decisions based on informed consent, and to assume the parenting role in meaningful ways despite the tragic circumstances.”

RELATED ARTICLE: Rights of a Parent When a Baby Dies

The following is an abbreviated version of the rights in the Share guidelines, which should be tailored to fit state, local, and hospital polices:

* To be given the opportunity to see, hold, and touch their baby at any time before and/or after death, within reason.

* To have photographs of their baby taken and made available to the parents, or held in security until the parents want to see them.

* To be given as many mementos as possible.

* To name their child and bond with him or her.

* To observe cultural and religious practices.

* To be cared for by an empathetic staff who will respect their feelings, thoughts, beliefs, and individual requests.

* To be with each other throughout hospitalization as much as possible.

* To be given time alone with their baby, allowing for individual needs.

* To be given information about the grieving process and support organizations.

* To have a discussion with the appropriate medical staff on options for an autopsy and other testing procedures.

* To plan a farewell ritual, burial, or cremation in compliance with local and state regulations and according to their personal beliefs, religion, or cultural tradition.