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

West London Crematorium. (Evelyne Conrad/Wikimedia Commons)

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.

Notes

  1. Louise Austin and Sheelagh McGuinness, “Reproductive loss and disposal of pregnancy remains,” Northern Ireland Legal Quarterly, 70(1), 131-153. Return to text.
  2. The Human Tissue Authority (HTA) is a non-departmental public body of the Department of Health and Social Care in England. It was formed in 2005 following a series of events in the 1990s that revealed a culture in hospitals of removing and retaining human organs and tissue without consent. The HTA is responsible for regulating organisations that remove, store and use human tissue for research, medical treatment, post-mortem examination, education and training, and display in public. Return to text.
  3. There is no single reason why hardly any parent attends such a ceremony. I argue elsewhere that it is a combination of parents being told about the ceremony and not wanting to attend or being unable to attend, and parents not being told about the ceremony due to bereavement care staff at hospitals not knowing that they should share this information, staff not knowing how to share this information, or even assuming that they are not allowed to share this information. For more details, please see Karolina Kuberska, “Unwitnessed Ceremonies: Funeral Services for Pre-24-Week Pregnancy Losses in England”, in: Susie Kilshaw and Katie Borg (eds.) Navigating Miscarriage: Social, Medical and Conceptual Perspectives, Oxford: Berghahn Books, 2020. Return to text.
  4. According to the UK’s Human Tissue Act 2004, pregnancy tissue following miscarriage or termination up to 23 weeks and 6 days has the status of tissue of a living person from whose body it came rather than a separate legal status. Return to text.
  5. Sheelagh McGuinness and Karolina Kuberska, “Report to the Human Tissue Authority on disposal of pregnancy remains (less than 24 weeks’ gestational stage)”, University of Bristol, University of Birmingham, 2017. Return to text.
  6. Human Tissue Authority, “Guidance on the disposal of pregnancy remains following pregnancy loss and termination”, 2015. Return to text.
  7. Sands, Pregnancy Loss and the Death of a Baby: Guidelines for Professionals,4th ed. London: Sands, 2016, esp. Chapter 20 “Funerals and sensitive disposal”. Return to text.
  8. Steven Lukes, “Political Ritual and Social integration”, Sociology 9(2), 301. Return to text.

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One Comment

larafreidenfelds

This is fascinating and important research. While I was doing my research on miscarriage in the United States, I assumed that the patterns of sentiment you describe were exaggerated in the US compared to Europe, because of the more contentious abortion debate. But I am learning from you and other scholars that if anything, there is a stronger mainstream consensus that a lost pregnancy is “really a baby no matter how early” in Europe. I am very curious about how this affects the pregnancy experience. Do pregnant people question the official narrative? You describe how those who have lost a pregnancy do not attend these funeral-like services; how do they feel about their existence? I hope you continue to pursue all of these questions. I really do think it’s time to push back a bit on the pregnancy loss narrative that requires a funeral no matter how early the loss, and without genuinely consulting the woman who had the loss.

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