Read standard 11: Loss and bereavement

Maternity standards
Healthcare Improvement Scotland

Standard statement

Women who experience pregnancy or baby loss have compassionate, person-centred, trauma-informed care and support.

Rationale

The loss of a pregnancy or baby can have a profound impact on women/birthing people, care partners and the wider family.33 More than one in six pregnancies in the UK end in loss each year.34 In addition, there is a higher risk of pregnancy or baby loss during a multiple pregnancy.2

It is important that women, care partners and families (including siblings) are supported at all stages of pregnancy and baby loss. Women should receive continuity of carer and support that is compassionate, person centred and trauma informed (see Standard 1). This includes offering opportunities to make memories and mark their loss. Communication, support and decision making should be in line with the principles of care described in Standard 1 and Standard 2.

NHS boards should implement the national bereavement care pathway for pregnancy and baby loss, the miscarriage framework and relevant guidance. There should be timely clinical intervention, referral for specialist mental health support and support for the management of subsequent pregnancies, as appropriate. Information should be appropriately shared with members of the woman’s care team, including her GP.

NHS boards should have an identified strategic maternity specific bereavement lead to provide oversight across the maternity pathway. The lead will ensure services work together to deliver co-ordinated bereavement care at all stages of pregnancy and postnatally. This should include management of early pregnancy loss and palliative care for newborn babies. The lead should ensure partnership working with social care, third sector and spiritual and faith groups and services.

Staff should receive training in bereavement care and support and be able to deliver person-centred and trauma-informed care to women and their care partners and families. Women should be supported to understand what has happened and should be given the opportunity to have supported discussions with appropriately trained staff. Where there is an investigation or review of the pregnancy or baby loss, women, and where appropriate, care partners and wider family, should receive trauma-informed support and care.

Maternity units should provide dedicated trauma-informed spaces that are private, comfortable, psychologically safe, non-clinical and avoid contact with other women and their babies. Services should be designed collaboratively with people with lived experience to support the psychological safety of women, care partners and families, including siblings.

Staff should be able to access support for their own mental health and emotional wellbeing, including vicarious trauma (see Standard 5).

Criteria

11.1

Women who experience pregnancy or baby loss can be confident that they and their baby will receive compassionate, dignified and respectful care. Care and support should be responsive to the individual needs, belief, culture and preferences of the woman and her baby (see Standard 2).

11.2

Women are supported to mark their loss and make memories, including spending time with their baby whenever possible, either at home or in hospital.

11.3

Women can access person-centred, trauma-informed support in a private, comfortable, psychologically safe and non-clinical environment that actively avoids or minimises contact with other women and their babies.

11.4

NHS boards ensure that all care and support for pregnancy or baby loss is of the same high quality wherever and whenever someone experiences pregnancy or baby loss. Women will continue to receive continuity of midwifery and obstetric case, as required.

11.5

Women who have experienced the loss of one or more babies in a multiple pregnancy, including miscarriage or stillbirth, receive timely, compassionate and specialist bereavement support.

11.6

Women are supported to make informed decisions about suppressing lactation, or donating breast milk, if appropriate.

11.7

NHS boards ensure that all care and support for women who have experienced pregnancy loss aligns with the national miscarriage framework and the national bereavement care pathway for pregnancy and baby loss.

11.8

NHS boards ensure that all care and support for women who have experienced baby loss aligns with the national bereavement care pathway for pregnancy and baby loss.

11.9

Women who have experienced stillbirth are supported to make informed decisions about:

  • care before and during birth
  • when to have their baby
  • birth options, including waterbirth
  • analgesia.
11.10

Women have their physical health assessed, with referral, where appropriate, for immediate obstetric care, clinical interventions or investigations.

11.11

Women have their emotional health and wellbeing assessed with appropriate referral for specialist emotional and mental health support, for example, bereavement care and support, counselling or trauma services.

11.12

Staff providing support for women who have experienced pregnancy or baby loss:

  • take time to understand and respect the experiences of the woman and her baby
  • are appropriately trained and skilled in bereavement care and support
  • ensure women have person-centred, trauma-informed, compassionate and culturally-sensitive care and support
  • are enabled to access supervision, psychological support and time for reflection
  • can access services to address any emotional strain or challenges or vicarious trauma they may experience (see Criterion 5.13).
11.13

Women are provided with tailored information and practical support to:

  • register their loss and contact funeral and cremation services, where appropriate
  • make informed decisions for post-mortem examination, if required
  • contact Specialist Perinatal Pathology services, if required.
11.14

Women are supported to access ongoing care and support at a time and pace that meets their needs:

  • from health visiting teams
  • from relevant community, social care, third sector and spiritual and faith support services
  • for follow-up bereavement care and support
  • for future pregnancy planning.
11.15

NHS boards appoint a strategic maternity specific bereavement lead to provide consistent, high-quality care for women and families who have experienced loss. The lead:

  • has oversight of all settings where pregnancy or baby loss may occur
  • works in partnership across health and social care
  • ensures learning from investigation or review is shared appropriately, including with all relevant care teams.
11.16

NHS boards ensure processes and procedures for the investigation and review of pregnancy or baby loss:

11.17

NHS boards ensure women (and, where appropriate, care partners) can access timely post-mortems and are supported when they receive the results.

11.18

NHS boards ensure that care partners and wider family members, including siblings:

  • feel welcomed by the service and are enabled to attend
  • receive person-centred, trauma-informed, family-centred and age-appropriate information and support from compassionate and skilled staff
  • can mark their loss and make memories
  • have their wellbeing needs assessed, with referrals made for follow-up, as required
  • are signposted to specialist support, where appropriate.

What does this standard mean for...

What does the standard mean for women and their babies?

  • You and your baby will be treated with dignity and respect.
  • You will be supported to spend time with your baby, if that is possible.
  • You will receive clear and sensitive information about the loss of your pregnancy or baby even if it has not been possible to find a reason for your loss. You will be supported to understand what has happened and given time and space to ask questions.
  • Staff will support you with any practical arrangements you may need to make.
  • You will be able to access specialist staff and services to support your health and wellbeing.
  • You can involve your chosen care partner as much as you wish and they will also receive the support that they need. If you have other children, they will be offered support, if that is right for them.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • provide compassionate and respectful support to women (and their care partners and families), including supporting women to spend time with their baby, if possible
  • are trained and knowledgeable in the provision of care and support for women experiencing pregnancy or baby loss, which is in line with national bereavement care pathway for pregnancy and baby loss and miscarriage framework
  • ensure relevant health and wellbeing assessments are undertaken, including referral or signposting to appropriate specialist support
  • have access to support for their own health and wellbeing
  • are supported to take part in investigations and reviews, where required
  • work in partnership with local strategic maternity bereavement lead, where required.

What does the standard mean for the NHS board?

NHS boards:

  • have systems and processes to provide timely bereavement and support services in line with clinical guidance, the national bereavement care pathway for pregnancy and baby loss and miscarriage framework
  • ensure referral pathways are in place for specialist palliative or bereavement support
  • have policies and processes for undertaking investigations and reviews, including post-mortems
  • ensure continuity of care and support is provided to women (and their care partners and families, where appropriate) who have experienced pregnancy or baby loss
  • ensure women who wish a post-mortem or to be involved in any review or investigations are supported by trained and compassionate staff
  • ensure staff have time and resources to deliver appropriate care and support
  • enable staff to access supervision, psychological support and time for reflection
  • support staff to take part in investigations or reviews
  • have a strategic maternity specific bereavement lead
  • learn from reviews and investigations and use this learning to support continuous improvement
  • provide dedicated, accessible, trauma-informed spaces that are physically separated from those used by other women and their babies.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the size and scale of the service or NHS board or delivery model

11.1

Feedback from women, their care partners and wider family members about their experiences at each stage of their bereavement care.

11.2

Availability of memory-making equipment (for example, handprint kits, photography support, blankets and memory boxes).

11.3

Provision of a dedicated space for women experiencing loss that is separated from facilities used by other women and their babies.

11.4

Capacity and resource planning to provide support, including access to facilities, specialist services and a nominated bereavement lead.

11.5

Feedback from women demonstrating that they received timely, compassionate and specialist bereavement support.

11.6

Evidence of accessible information for women on lactation suppression and managing milk supply safely.

11.7

Action and improvement plans supporting the implementation of the miscarriage framework.

11.8

Action and improvement plans supporting the implementation of the national bereavement care pathway for pregnancy and baby loss.

11.9

Evidence of tailored support for women who have experienced stillbirth.

11.10

Monitoring complications following pregnancy or baby loss (including vital signs, blood loss, infection rates and emergency attendances).

11.11

Review of patient records demonstrating timely access to specialist care, such as palliative perinatal care or Maternity and Neonatal Psychological Intervention Services.

11.12

Data on staff training in bereavement care, communication, support and supervision.

11.13

Local pathways for registration of loss and for guidance on offering information about funeral options.

11.14

Referral and signposting to social care, spiritual and third sector support agencies, such as Hospital to Home or Held in our Hearts.

11.15

Evidence of appointment of a maternity bereavement lead, with organisation charts showing the lead’s position and reporting lines.

11.16

Evidence of learning from investigations and reviews of pregnancy or baby loss.

11.17

Evidence of timeliness of post-mortems.

11.18

Feedback, including compliments and thank you cards, from care partners and wider family members that show they felt welcomed, informed and supported.

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project team.