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The “Signs of Life – Guidance Visual Summary (v1.2 The “Signs of Life – Guidance Visual Summary (v1.2)” is a clinical guideline designed for healthcare professionals managing spontaneous births before 24 weeks of gestation when, after discussion with parents, active survival-focused care is not appropriate. It provides a clear, compassionate framework for determining whether a live birth has occurred, how to document it, and how to support parents through this extremely sensitive situation.
The document defines a live birth as the presence of one or more persistent visible signs of life, including:
an easily visible heartbeat
visible pulsation of the umbilical cord
breathing, crying, or sustained gasps
definite movements of the arms or legs
It emphasizes that brief reflexes—such as transient gasps or twitches during the first minute—do not qualify as signs of life.
The guideline instructs clinicians to observe signs of life respectfully, often while the baby is held by the parents, and notes that a stethoscope is not required. Parents’ observations can also contribute to the assessment if they wish to share them.
After any live birth is identified, a doctor (usually the obstetrician) should be called to confirm and document the live birth. This step is crucial to avoid complications in issuing a death certificate later. The doctor may rely on the midwife’s account and is not always required to be physically present.
The document stresses the importance of perinatal palliative care, focused on the baby’s comfort and the parents’ emotional and physical needs. It guides clinicians to provide sensitive communication, explain what to expect, and acknowledge that parents may prefer different language when referring to the baby, the loss, or the birth.
A major emphasis is placed on bereavement care, which applies to all births in this context. The guidance instructs staff to follow the National Bereavement Care Pathway, offer choices about time with the baby, support memory-making, discuss options for burial or cremation, and ensure ongoing emotional and medical support.
The document also outlines the legal steps for documenting birth and death, including when to issue a neonatal death certificate, when to inform the coroner, and when parents must register the birth and death.
Finally, the guidance clarifies which births are included (in-hospital spontaneous births <22 weeks, or 22–23+6 weeks when active care is not planned) and which are excluded (medical terminations, uncertain gestational age, or cases where active neonatal care is planned).... |