Honeysuckle Bereavement Leaflets

The leaflet is detailed below, or you can download the 'Following pregnancy loss at any stage of pregnancy and Early Neonatal Death' leaflet in PDF.

The Honeysuckle Team are the dedicated baby bereavement team at Liverpool Women's NHS Foundation Trust. The team consists of 2 bereavement support midwives, Marie Kelleher and Pauline McBurnie, and a bereavement support admin officer, Sarah Martin.

The Team’s office is open Monday – Friday 8am-4pm, you are welcome to contact them either by phone 0151 702 4151 or email honeysuckle@lwh.nhs.uk

The Honeysuckle team are very sorry for your loss, we do not wish to be intrusive at this sad time but we would like you to know that we are here to offer support and advice where we can.

We can offer you and your family practical advice and information, help explain some of the formalities involved and guide you through the choices you may face during this difficult time.

Although we do not offer formal counselling we are here if you wish to talk as it may be helpful to talk with someone outside of the family setting. We can provide you with contact details for outside agencies that specialise in bereavement counselling in your local area.

The Honeysuckle Team run a monthly support group for parents and grandparents, with guest speakers, a library of books, craft table and refreshments provided.

The support group normally meets on the first Tuesday of the month between 6pm and 8pm at

Liverpool Women’s NHS Foundation Trust – for up to date information about the group please contact the Honeysuckle Team.

The Honeysuckle Team are active on social media. We have our own Facebook page Honeysuckle Bond and two private closed Facebook pages one for families and one for Dad’s who have suffered the loss of a baby.  To join one of the private group’s request to join Honeysuckle Community Page or Honeysuckle Dad’s Group.

The Honeysuckle Team arranges an annual remembrance service in October during baby loss awareness week for all of for families to remember their babies. We will contact you with details of the service in the weeks leading up to it – if you would prefer not to be contacted please let us know.

Liverpool Women's NHS Foundation Trust has a special remembrance garden located in the courtyard behind main reception. The garden is open any time day or night if you would like to spend some time there. Within the garden there is a metal love lock tree where families have placed special locks in memory of a loved one. If you would like to order a lock please visit 4Everlocks website - http://www.4everlocks.co.uk/shop/ 

Contact Details for Honeysuckle Team

marie.kelleher@lwh.nhs.uk – 0151 702 4151

pauline.mcburnie@lwh.nhs.uk – 0151 702 4151

sarah.martin@lwh.nhs.uk – 0151 702 4151

Facebook – search Honeysuckle Bond or request to join our closed groups Honeysuckle Closed Community Group or Honeysuckle Dads Group.

Twitter - @honeysucklelwh

Helpful organisations

Child Bereavement UK 0800 028 8840

Child Death Helpline 0800 282 986 / 0808 800 6019

Children of Jannah 0161 480 5156

The Ectopic Pregnancy Trust 020 7733 2653

ept@ectopic.org.uk

The Miscarriage Association 01924 200 799

info@miscarriageassociation.org.uk

Muslim Bereavement Support Service 020 3468 7333

info@mbss.org.uk

SANDs

Stillbirth And Neonatal Death charity 020 7436 5881

helpline@uk-sands.org

TAMBA

Twin And Multiple Birth Association

0800 138 0509

asktwinline@tamba.org.uk

The leaflet is detailed below, or you can download the 'Experiencing a pregnancy loss under 12 week’s Gestation' leaflet in PDF.

Firstly we would like to offer our condolences following your pregnancy loss. We do not wish to cause any additional distress but we do want to assist you in making an informed decision.

Why Ask Me To Read This Leaflet Now?

You have been asked to consider giving verbal consent to a Histopathological examination of your pregnancy loss.  This information together with the discussions that you will have with the clinical staff caring for you will assist you in making the choices that you feel are right for you.

The tissue from your pregnancy is usually made up of placenta, the lining of the womb and blood clots and is medically known as “products of conception”.  It can be important for these tissues to be examined and this is what is known as Histopathology, you may hear staff referring to this as Histology. Although you may have seen a tiny baby on an ultrasound scan a baby will only be identified in around 1 out of 100 early miscarriages. Reasons for this maybe that no embryo had developed, or the baby may have died some time ago and the remains have been reabsorbed.   Also at this early stage of pregnancy the tissues are very delicate and fragment easily.

What Is Histopathology?

Histopathology is the microscopic examination of the appearance of cells and tissues in very fine detail.  A technician at the pathology lab at the Royal Liverpool University Hospital will then look at the tissue under a microscope to confirm the presence of any tissue from your baby and to exclude any abnormalities.

If a tiny baby can be identified visually it will not be necessary for any histopathological examination and would therefore be returned to Liverpool Women's NHS Foundation Trust Honeysuckle Bereavement Team who would then contact you to discuss your options in further detail.

If a tiny baby cannot be visualised the small samples of the tissue sent are placed into a wax block from which a slide for examining under a microscope is prepared.   These blocks & slides are kept as part of your medical record.   You may choose to have these blocks & slides returned to you.

Why This May Be Needed?

Abnormal tissue is rare but can occur when the placenta is developing and can grow quickly whilst producing too much of the pregnancy hormone.  This is known as a Hydatidform mole in other words a molar pregnancy.  This is when the baby and the placenta have not developed properly and if suspected specific follow up would be required. 

So What Happens Next?

If a baby was identified: 

• Liverpool Women's NHS Foundation Trust Honeysuckle Team have an arrangement with a local crematorium. With your signed consent The Honeysuckle Team will arrange for a communal cremation and the ashes will be scattered in the Baby Garden of Remembrance.
• Because of cultural, religious or spiritual beliefs you may wish to make your own arrangements through a funeral director or take personal responsibility. You can discuss this with The Honeysuckle Team.

 If no baby was identified:

• Royal Liverpool University Hospital can make arrangements for respectful disposal of your remaining tissue according to their standard procedure
• You can request to have the remaining tissue returned to the Honeysuckle Team and make your own private arrangements.

Does This Examination Have To Be Performed?

It is your decision whether or not to allow this examination.   Please be aware that results from Histology rarely identify a cause for your miscarriage and we do not routinely contact you with the results unless they are abnormal and results can take up to 3 months.  If unsure discuss it with the Doctor, Nurse or Midwife who is caring for you.  If you decide not to have your pregnancy loss examined with your consent a referral will be made to the Honeysuckle Team.

Contact Information

Honeysuckle Bereavement Team:  0151 702 4151 Mon-Fri:  8am-4pm

Email : honeysuckle@lwh.nhs.uk

Gynaecology Emergency Department (24hr number)    0151 702 4438

References:

Sands Stillbirth & Neonatal Death Charity. Pregnancy loss and the death of a baby: Guidelines for professionals 4^th Edition.

The leaflet is detailed below, or you can download the 'Lactation after Loss' leaflet in PDF.

We are very sorry that your baby has sadly died. One of the most distressing physical symptoms following the death of your baby can be breast pain and the production of breast milk. This leaflet aims to provide you with information on how to stop your breast milk production, with some practical advice to help ease the physical symptoms of breast engorgement that you may experience during this difficult and emotional time.

Natural Milk Production

The amount of milk produced in the breast will vary from person to person, and will reduce naturally over a period of time. If breastfeeding has already been established, your breasts may continue to produce milk for some time.

It is extremely important not to abruptly stop the production of milk if breastfeeding has already been established, as this may increase the risk of severe breast engorgement and mastitis.

Engorgement

Engorgement is when the breasts become swollen, firm and painful. It can happen between 2-5 days after the death of your baby. Your breasts can leak milk and feel uncomfortable for up to 7-14 days. 
This can settle on its own. If severely engorged, your breasts can become hard, shiny, warm and slightly lumpy to touch. Breast engorgement actually helps to suppress the production of breast milk. However, painful breast engorgement is not necessary and can be avoided.

Mastitis

Mastitis is inflammation of the breast, which, if left untreated, can develop into a more serious infection. Symptoms include:

• red, swollen area on the breast that is hot and painful to touch
• breast lump or area of hardness on the breast
• white or blood stained nipple discharge
• flu-like symptoms including fatigue, chills, fever

If you display any of these symptoms it is recommended that you contact your midwife, health visitor or GP as antibiotic treatment may be required.

Relieving Symptoms of Engorgement

There are a variety of methods that can be used to reduce milk production including prescribed medication and a milk reduction routine. These are a few suggestions to help relieve engorgement

• Take regular pain relief
• Wear a support bra all the time
• Use breast pads to absorb leaking milk
• Use cold compresses or gel packs on the breasts
• If your breasts feel very full, hand express a small amount off for comfort
• Apply washed and chilled cabbage leaves to the breasts
• Have a warm bath or shower to allow the breasts to leak naturally (ensure shower water jets are not directly on the breasts)
• Sleep in a semi upright position to avoid pressure from heavy breasts

If You Need To Hand Express

To hand express, hold your breast with your fingers a few inches back from the areola (the dark part around the nipple). Push your hand back toward the chest wall, and then roll your fingers forward toward the nipple, taking care not to slide your fingers over the skin

Reducing Your Milk Supply

If you were expressing regularly for a premature or ill baby you will need to gradually reduce the amount of breast milk produced.  This can be done through increasing the time between hand or pump expressing, over a few days and eventually coming to a stop. We would suggest the following

Day 1  Pump each breast for 5 minutes every 4-5 hours

Day 2  Pump each breast for 3-5 minutes every 6 hours

Day 3  Pump each breast just long enough to relieve discomfort

Medication

Cabergoline (Dostinex) prevents / suppresses milk production by blocking the hormone that is secreted to produce milk. It should be used alongside a milk reduction routine. The dose of Cabergoline is 0.25 mg twice a day for two days. Your midwife or GP will be able to arrange this

Milk Donation

Not every woman wants to stop lactating at this difficult time, and there is the option of donating your milk to the UK National Milk Bank for it to be used to treat premature and sick babies.

Tel: 020 838 33559   www.ukamb.org

The Funeral

Around the time of your baby’s funeral is going to be highly emotional.  This unfortunately can affect your milk production and you may experience engorgement even though you thought things were settling down. If possible, sit down and support your breasts with your arm. Let people know not to hug you too hard if your breasts are painful

Local Support

It is important that you are supported through your bereavement.  The hospital has a dedicated bereavement team called The Honeysuckle Team. Please contact the team on 0151 702 4151 / email honeysuckle@lwh.nhs.uk or search Honeysuckle Team on Facebook.

National Support

Stillbirth and Neonatal Death Charity

www.uk-sands.org

Helpline: 02074365881

Child Bereavement UK

http://www.childbereavementuk.org/

Tel: 0800 0288840

Winston’s Wish

www.winstonswish.org.uk

Helpline: 0845 030405

General enquiries: 01242 51

5157

Childhood Bereavement Network

www.childbereavementnetwork.org.u

Tel: 020 7843 568900

Patient Advice and Liaison Service (PALS)

Your local PALS team is available to help with any of your comments, compliments or concerns and will ensure a prompt and efficient service.

Please ask your midwife or the neonatal nurse that was caring for your baby for details