The loss of a son or daughter at birth, whether expected or unexpected, triggers an emotional process within the family and can also affect the healthcare professionals caring for them. In this context, neonatologists play a fundamental role, especially when a relationship of trust has been built with the parents and their family members during a prolonged stay in the neonatal unit.

Belén Fernández Colomer, MD, PhD, president of the Spanish Society of Neonatology (SENeo) and a neonatologist at the Central University Hospital of Asturias, Oviedo, Spain, explained to El Médico Interactivo, part of the Medscape Professional Network, that the neonatologist is often one of the family’s primary points of contact. “It is their responsibility to clearly explain what has happened, address any questions, prevent unwarranted feelings of guilt, and help the family say goodbye,” she said.

This care must be multidisciplinary and coordinated. Neonatology, obstetrics, nursing, psychology or mental health, social work, and — if the family wishes — spiritual care must work hand in hand. “It is important that all staff in contact with the parents are aware of the situation, that the information provided is consistent, and that the family does not have to repeat their story over and over again,” she noted.

Current guidelines for grief care emphasize this continuity of care and the need for sensitive communication. Support should not end when the parents leave the hospital either. The opportunity to have a follow-up appointment — to review what happened, learn the results of the tests performed, and ask new questions — is essential.

Buy Time for the Goodbye

In this context, some Spanish hospitals have incorporated resources such as the CuddleCot or cooling cradles, also known as “cuddle cradles.” This device helps maintain the baby’s body at an appropriate temperature for a longer period, delaying the changes that occur after death. Their use makes it easier for families to stay with their son or daughter longer, facilitating the farewell and helping to create memories in an intimate setting.

At SENeo, they believe that cold cribs can be a useful resource within humanized care. “Their function is not therapeutic: they keep the baby’s body at a low temperature and slow down the natural changes that occur after death. In this way, families who wish to do so can have more time to be with their child, hold them in their arms, dress them, introduce them to their siblings or relatives, and say goodbye without the immediate pressure of time,” explained Colomer.

Leading British guidelines recommend the use of cooling systems to facilitate this time of saying goodbye. However, there is no available evidence demonstrating that a cooling crib reduces complicated grief, anxiety, or depression. The evidence comes primarily from qualitative studies and the experiences of families and professionals.

A study conducted in maternity and neonatal units in the UK — one of the countries pioneering their use — analyzed the experiences of 33 healthcare professionals and showed a positive assessment of these devices. According to the participants, cold cribs allow parents to spend more time with their baby and facilitate important grieving practices, such as staying by the baby’s side, participating in their care, creating memories, and maintaining a bond after death without the immediate pressure of bodily deterioration.

SENeo emphasized that cooling cribs should be viewed as just one tool within a comprehensive grief care program and never as an end in themselves. Their use should always be optional and tailored to each family’s wishes.

Tools to Support the Grieving Process

Cooling cribs are part of a broader set of measures that help facilitate the process of saying goodbye. “One of the first steps is to offer parents a private and quiet space, as far away as possible from the noise of hospital staff and other families with newborns,” noted Colomer.

It is also possible — always as an option and never as an obligation — to allow parents to be present at the time of death and hold their child in their arms, as well as to participate in subsequent care, such as holding, bathing, dressing, or simply staying by the child’s side. When the family wishes, the participation of siblings, grandparents, or other significant people can also be facilitated.

Another important aspect is the creation of physical mementos: photographs, hand and foot prints, the umbilical cord clamp, identification bracelets, locks of hair, the crib tag, the blanket, or the baby’s clothing — all of which can be included in so-called “memory boxes.” “Studies show that these mementos can hold great significance for certain families because they allow them to build a tangible memory of a life that, in many cases, has been very brief,” noted Colomer.

Laura González, a volunteer and supervisor of the support team at Umamanita— a pioneering association in Spain dedicated to supporting mothers, fathers, and families facing perinatal and neonatal death — explained in an interview with El Médico Interactivo that, when grief intensifies, these objects can become an anchor for families. “Their four little footprints, a blanket, a little hat, or a stuffed animal take on immense value. Photographs do too — offering the family the chance to take them, even if they initially say no, since they’ll only have that one moment to see their baby’s face,” she said.

True Humanization Depends on the Professionals

“True humanization depends fundamentally on the professionals and the organization of care: on how we communicate, on how much respect we show, on whether we provide privacy, on whether we recognize that baby as a member of the family, and on whether we remain available when the parents return home,” insisted Colomer. She added: “Perhaps the most important message is that when a baby dies, our responsibility as caregivers does not end. We can no longer change the clinical outcome, but we can profoundly influence how that family will experience and remember one of the most painful events of their lives. That, too, is an essential part of neonatology.”

Along the same lines, Carlos De Bonrostro, a gynecologist at Maternal-Fetal Medicine Unit at Miguel Servet University Hospital in Zaragoza, Spain, recalled in statements to El Médico Interactivo: “Chill boxes are a very valuable resource because they allow families to spend more time with their child if they so desire, but they are part of a much broader set of measures for managing perinatal grief. In reality, the most important tool remains the human factor, since no material resource can replace care based on respect, empathy, and effective communication.”

Both Colomer and De Bonrostro agree that humanization does not end when the family leaves the hospital. There must be continuity of care, a designated point of contact whether an individual or a team, and a follow-up appointment. It is also important to avoid painful situations, such as scheduling these parents for a follow-up appointment in a waiting room full of pregnant women or healthy newborns.

In addition, psychological support should be provided when necessary, along with information about family associations and peer support groups, spiritual care according to their beliefs, and a follow-up consultation after the death. “In recent years, significant progress has been made in humanizing care related to perinatal death. Perinatal grief remains, in many cases, an underrecognized form of grief, and this can increase these families’ sense of loneliness,” noted De Bonrostro.

Training on Perinatal Grief

Medical schools and the MIR residency program offer seminars on these issues, as well as specific courses and workshops. SENeo itself has for years incorporated content related to communication, the humanization of death, and neonatal grief into its scientific and educational activities, and in 2021 published a specific model for perinatal palliative care.

“In any case, we must continue moving toward more structured training, beginning during residency and continuing through continuing education. Studies conducted among healthcare professionals also show that dealing with these situations has a significant emotional impact on them, so training must also include tools for self-care and peer support,” concluded Colomer.

Ensuring Quality Care

In Spain, progress has been made in perinatal bereavement care, and an increasing number of hospitals have specific protocols in place, although differences still exist between hospitals and autonomous communities. The availability of resources such as dedicated spaces, psychological support, memory boxes, refrigerated cribs, or follow-up appointments remains uneven.

The goal, as indicated by SENeo, should be to establish common minimum standards throughout the National Health System to ensure that families receive quality care regardless of the hospital where they are treated. Furthermore, protocols must be effectively implemented, with trained professionals, periodic evaluation, and the incorporation of the families’ own experiences.

This story was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.