Mandatory training for midwives on how to deal with bereaved parents is one of the changes recommended for the NHS in the wake of the Mortonhall scandal.
The report said newly-bereaved parents were rushed into making decisions about their deceased babies without having the options clearly explained to them – and often regretted it later.
Mothers told Dame Elish Angiolini they had been in physical pain or on strong medication when conversations took place about possible cremation arrangements.
The report said: “At a time of deep distress and often shock, parents interviewed for the investigation stated they were under the impression they had to make quick decisions about the final act of care for their baby before leaving hospital.
“A number of parents felt they did not have all the options clearly explained to them and made decisions they later came to regret.”
The report said that midwives – usually the first point of contact for bereaved parents – sometimes told them there would be no ashes recoverable from the cremation of a baby. “This was received wisdom among nursing staff, with no-one able to give the investigation the source of this understanding.”
One mother, who had a stillborn child in 1996, told the probe a midwife said her child “would be cremated and that the cremation would be at Mortonhall and there would be no ashes”.
She added: “She said that either they could arrange it or we could arrange it but there was no choice, it would still be cremation at Mortonhall.
“This conversation took place between two and three hours after the delivery when I had lost a lot of blood. I did not feel able to be making the decisions that quickly.”
In fact, written guidance said they had up to 28 days after leaving hospital to make arrangements.
Information leaflets from 2008 and 2012 told parents: “There will be no retrievable cremated remains of your baby available at Mortonhall Crematorium.” And it advised them if they wished to have cremated remains they should make funeral arrangements at one of the private crematoria, adding they would have to pay “all costs incurred”.
But the report said with only one exception, parents said they were not informed verbally that they could retrieve ashes if they opted for Seafield or Warriston crematoria – neither of which charge for cremations of babies.
Dame Elish said: “There is an urgent need to develop clear and simplified policy and guidance based on better researched material for staff. I understand this process is now under way.
“Staff need to be properly trained in dealing with the difficult circumstances of such a loss and the limitations of parents’ ability to make quick decisions when they may be in a state of profound shock and grief.” The investigation recommended trained members of staff should be identified to deal specifically with support, practical arrangements and paperwork for bereaved parents.
It also called for Scottish Government legislation to make clear parents’ rights and the obligations of professionals in relation to the burial and cremation of non-viable foetuses and stillborn babies.
And it said specialist training on infant cremation should be made compulsory by the two main professional bodies – the Institute of Cemetery and Crematorium Management and the Federation of Burial and Cremation Authorities.
Melanie Johnson, executive nurse director at NHS Lothian, said: “We deeply regret and fully understand any distress that parents may have been caused. We will take Dame Elish Angiolini’s Mortonhall Investigation Report and fully consider the findings and work with our council colleagues to progress any recommendations as a matter of priority.”
‘For many parents there is a profound need to have a focal point for their grief’
Dame Elish Angiolini gave her own personal response to the Mortonhall scandal in her report. Here is what she wrote in full
THE loss of a baby is an extremely distressing and deeply traumatic experience for the mother, father and other close relatives. For the parents of the babies involved in this investigation that distress has now been compounded years later by agonising uncertainty about the existence of ashes following the cremation of their baby and, if such ashes do exist, the whereabouts of the resting place of their baby’s ashes.
The nature and findings of this report will undoubtedly cause further heartbreak and grief to many.
Throughout this investigation I have been conscious that the time period of the investigation spans a number of decades during which social attitudes to mourning and grief in the UK have undergone significant change for many, as has the expectation of the internal and external manifestation of grief of those bereaved.
There has also been a major cultural shift for many in our communities in the ceremonial response to death.
Practices about, and attitudes to, the miscarriage, stillbirth or neonatal death of babies have also altered dramatically over those years with a far greater understanding now of the longevity of the profound grief often suffered for many years by the parents of these babies.
I was struck during this investigation by the sad evidence from a number of professionals I met about mothers in their 60s, 70s and 80s still trying to locate the whereabouts of the resting place of babies lost in such circumstances.
This contrasts with the common expectation in the earlier decades that mothers who experienced loss in these circumstances could recover more rapidly from their loss by having another child as soon as practically possible thereafter.
Arguably that pragmatic and less sentimental approach has been displaced by a more profound understanding of the complexity of grief and the very different individual needs and responses of the bereaved.
It is important to appreciate that in examining the responses of those in the 1970s and even 1980s there is a danger of looking through a contemporary lens and applying the social mores of this decade retrospectively. In doing so there’s a risk of making a social judgement on what may now appear repugnant from a very different societal perspective in 2014.
One of the most striking and tragic features of the very many interviews with the parents of the babies involved in this investigation was the absolute conviction which each of them held that no matter how small a quantity of ashes were actually the remains of the body of their child they would still have wished to have had the right to make a decision about the disposal of ashes.
Many other parents felt that even if it could not be shown that any element of their child was present in the ashes, they would still have cherished the opportunity to have the ashes of the coffin, blanket or toy which had been in contact with the baby or formed part of the baby’s last resting place.
A technical approach, even if it has been shown to proceed on a mistaken premise, fails to appreciate that for many parents there is a profound need to have a focal point for their grief.
The great tragedy of the outcome of the vast majority of baby cremations at Mortonhall is that so many parents were told there would be, and were, no remains following the cremation of their baby and they accepted those explanations in good faith.
The outcome of this investigation will cause more pain and distress for most of the parents of the 253 babies who are subject of this investigation. It cannot be said with any certainty what remains of which babies are interred in the Garden of Remembrance.
The only baby remains that can be said to be in the Garden of Remembrance are those of the non-viable foetuses which were the subject of a communal cremation in 2013. Some others are also there but it is unknown which of the babies are there nor can it ever be known.