Death before Birth: Pregnancy Loss and Funerals in England

A pregnancy loss is a site of tension, situated between waiting for the baby, the unanticipated loss, and the often complicated grieving that follows. Although still often a taboo subject, pregnancy loss has been gradually attracting more recognition as a life event that does not benefit from being silenced. Support for people going through a pregnancy loss tends to center on the emotional experiences of the parents; the lost pregnancy, on the other hand, changes from a tangible baby in utero into a memory of the baby that never got to breathe. In this context, it is worth considering the physicality of that baby – or a dead fetus – as well as the disposal arrangements that accompany pregnancy loss. While often intended as sensitive and respectful, mainstream disposal practices around pregnancy remains reveal a lot about our attitudes about fetal personhood and rights.

That a live fetus can make ideologies clash should not be news to anyone. Yet, a dead fetus opens up a slightly different set of concerns and priorities. The law has the capacity to produce relatively clear-cut advice regarding appropriate disposal depending on the time when pregnancy ended. However, such legal advice does not always match either people’s perceptions of what would be an appropriate manner of disposal or what is actually common practice.¹ England presents an interesting case study in this context: the official guidance from the Human Tissue Authority² allows a variety of disposal methods of pregnancy remains following miscarriage or termination (up to 23 weeks and 6 days of pregnancy), but the most common practice favors shared cremations, preceded by virtually free-of-charge, funeral-like, and mostly unattended ceremonies.³

The situation in England is interesting. On the surface, it very much looks like the issue of the disposal of pregnancy remains has been regulated in an exemplary fashion, swiftly responding to changing perceptions and public pressures (including some scandalous media reports about fetal remains being incinerated with clinical waste, distastefully glossed as “burning babies to heat hospitals”). And, in many ways, the official guidance has addressed these concerns well, explicitly recognizing that people can ascribe a special status to the pregnancy remains and that this ascribed special status might be at odds with the law of England and Wales.⁴ The guidance officially allows a variety of options when it comes to disposal of pregnancy remains, including funerary arrangements in the form of shared or individual cremations, shared or individual burials, sensitive incineration (incineration separate from clinical waste) and private arrangements (e.g. burial in a private garden, while following environmental safety restrictions). What is interesting, however, is how this broad, inclusive guidance led to the domination of one specific form of disposal arrangements, namely, shared cremations with a preceding short funeral-like service held at many English crematoria.⁵ Furthermore, these services usually take place in the absence of parents or people who lost the pregnancies – despite their presence being allowed.

Unwitnessed ceremonies

Many crematoria in England have standing arrangements with hospitals for handling the pre-24-week pregnancy remains that follow a similar set of steps. The hospital is responsible for placing each set of remains in an opaque container and labeling it with a number that can be linked to a patient number. These containers are then put in a larger box or small coffin, and delivered to a crematorium by a funeral director or a member of the chaplaincy on a regular basis – once or twice a month. The crematorium keeps a record of all cremations: in the case of shared cremations of pregnancy remains, they will note the numbers on the opaque containers and the total in each coffin. If there is a cost to the cremation for the hospital, it remains very low, e.g. £20 per box or coffin with multiple sets of remains (an adult cremation at a council-run crematorium costs £400 at the very minimum but is more likely to be in the vicinity of £1000).

Those shared cremations have an assigned regular time slot and resemble funeral services held for people who lived and died, albeit with a few key differences. During field research, I observed a few such ceremonies; similar ones were described to me by many bereavement services managers I interviewed. The coffin with multiple sets of pregnancy remains is brought into the chapel through the front door and placed on a catafalque while gentle music is playing. If present, a funeral director or a member of the chaplaincy team says a few words about babies whose lives ended too soon. What follows is the act of committal, when the curtains close around the coffin on the catafalque. A piece of instrumental music is played again and the chapel is cleared for the next service. The whole ceremony lasts between 5 and 10 minutes and hardly anyone is in attendance – perhaps one or two crematorium staff, a funeral director or a chaplaincy team member. On the other hand, a funeral service for people who lived and died, that may last up to 40 minutes and is likely to include some readings, a eulogy, and – last but not least – mourners.

While it is important to acknowledge that these unwitnessed ceremonies have been designed as respectful and sensitive, the logic that underpins them involves treating pre-24-week pregnancy losses in the same way as post-24-week pregnancy losses. This distinction is crucial because the common law of England and Wales considers post-24-week pregnancy losses (or stillbirths) to be human remains that require a funeral in the form of a burial or cremation. On the other hand, pre-24-week pregnancy remains are considered tissue from a living person (i.e. material that can be disposed of via incineration).⁶ Bereavement services managers I interviewed as a part of a research project often explained that everyone deserves a funeral, no matter how young or old they are and it was clear that making funeral services for pre-24-week pregnancy losses available as part of standard care was considered to be a meaningful improvement in bereavement support following a loss of pregnancy.

For many people who lost their pregnancies, these services are very much needed and helpful; their availability as an option is key to making bereavement care following pregnancy loss better.⁷ Being able to hold a funeral for a much anticipated baby who did not make it through the pregnancy is one way to make their brief existence more tangible for the bereaved parents and their family and friends. But it is perhaps also worth noting that making these services a norm can be oppressive in insidious ways. As funeral services for pregnancy losses become wrapped in the discourse of kindness, sensitivity, and respect, choices outside such funeral arrangements – legal as they may be – become the opposite: insensitive and disrespectful. For instance, those who choose not to hold a ceremonial service following a pregnancy loss, might be perceived as cold, insensitive, or even bad parents.

Steven Lukes noted that “[ritual] helps to define as authoritative certain ways of seeing society; it serves to specify what in society is of special significance, it draws people’s attention to certain forms of relationship and activity – and at the same time, therefore, it deflects their attention from other forms, since every way of seeing is also a way of not seeing”.⁸ In other words, ritualizing the unattended shared cremations by making them resemble funeral arrangements with people in attendance (and by framing them as “sensitive” and “respectful”) normalizes an understanding of the fetus where fetal personhood is taken for granted. And conversely, it undermines and de-normalizes those understandings of the fetus where it is not quite a fully formed human.

Karolina Kuberska

Karolina Kuberska is a medical anthropologist with a special interest in maternal and reproductive health. She received her PhD from the University of St Andrews. She has previously worked with indigenous highland migrants to lowland Bolivia, concentrating on the relationships between emotions, sociality, and well-being as well as understandings of the body that incorporate traditional and biomedical notions. Between 2016-18 she was a member of a research team working on an ESRC project Death before Birth at the University of Birmingham, UK, that explored socio-legal intersections of decision-making processes in the experiences of miscarriage, termination, and stillbirth in England. Currently, she is a Research Associate at THIS Institute at the University of Cambridge where she is involved in a range of projects designed to improve the National Health Service in the UK.

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