| dataset_desc |
The “Signs of Life – Guidance Visual Summary (v1.2 The “Signs of Life – Guidance Visual Summary (v1.2)” is a clinical guideline for healthcare professionals to determine whether a live birth has occurred before 24 weeks of gestation in cases where—after discussion with parents—active survival-focused care is not appropriate. It provides clear, compassionate instructions for identifying signs of life, documenting birth and death, communicating with parents, and delivering palliative and bereavement care.
signs-of-life-guidance-visual-s…
The guidance is designed to reduce uncertainty, ensure legal accuracy, protect families from additional trauma, and support parents through one of the most emotionally sensitive experiences in healthcare.
Core Components
1. Determining a Live Birth
A live birth is diagnosed when one or more persistent visible signs of life are observed:
Easily visible heartbeat
Visible pulsation of the umbilical cord
Breathing, crying, or sustained gasps
Definite, purposeful movement of arms or legs
signs-of-life-guidance-visual-s…
Not signs of life:
Brief reflexes—such as transient gasps, chest wall twitches, or short muscle movements only in the first minute after birth—do not constitute live birth.
signs-of-life-guidance-visual-s…
Clinicians are instructed to observe respectfully, often while the baby is held by the parents. A stethoscope is not required, and parents’ observations may be included if they choose to share them.
2. Actions After a Live Birth
Once a sign of life is seen:
A doctor (usually an obstetrician) must be called to confirm and document the live birth.
The doctor may rely on the midwife’s account and is not always required to attend in person.
Accurate documentation avoids legal complications when issuing a neonatal death certificate.
signs-of-life-guidance-visual-s…
Comfort care must then follow a perinatal palliative care pathway, addressing the baby’s needs and the parents’ emotional and physical well-being.
3. Communication With Parents
The guidance places strong emphasis on sensitive, trauma-reducing communication.
Parents should be gently told that:
Babies born before 24 weeks are extremely small and typically do not survive.
Babies who die just before birth may briefly show reflex movements that are not signs of life.
Babies who survive may show signs of life for minutes—or occasionally hours.
signs-of-life-guidance-visual-s…
Clinicians should:
Listen actively
Use the parents’ preferred language
Respect whether parents want the experience described as a “loss,” “death,” “end of pregnancy,” or “miscarriage”
signs-of-life-guidance-visual-s…
Each situation is unique and must be handled with individualized sensitivity.
4. Bereavement Care (For All Births)
Bereavement care is required in every case, regardless of signs of life.
The guidance instructs staff to:
Follow the National Bereavement Care Pathway
Provide privacy, time, and space
Support memory-making
Offer choices around burial, cremation, or sensitive disposal
Inform parents of support services and ensure follow-up with community care, GP, and mental health teams
signs-of-life-guidance-visual-s…
This ensures parents receive compassionate, individualized support during and after their loss.
5. Documenting Birth and Death
Documentation follows strict legal requirements:
If signs of life are present
A doctor and midwife must confirm and record the live birth.
A neonatal death certificate must be completed by a doctor who witnessed the signs—or the coroner must be informed.
Parents are required to register the birth and death.
signs-of-life-guidance-visual-s…
If no signs of life are present (miscarriage)
Document the miscarriage.
No legal registration is required, but offer a certificate of loss or certificate of birth.
signs-of-life-guidance-visual-s…
6. Included and Excluded Births
Included
In-hospital spontaneous births under 22+0 weeks
In-hospital births at 22+0 to 23+6 weeks where survival-focused care is not appropriate
Pre-hospital births under 22 weeks (same principles apply)
signs-of-life-guidance-visual-s…
Excluded
Medical terminations
Uncertain gestational age
Spontaneous births at 22–23+6 weeks where active neonatal care is planned or unclear
signs-of-life-guidance-visual-s…
Conclusion
The “Signs of Life – Guidance Visual Summary (v1.2)” is a clear and compassionate roadmap for clinicians caring for families experiencing extremely preterm birth where survival-focused care is not appropriate. It ensures:
>accurate identification of live birth
>consistent legal documentation
>sensitive communication
>high-quality palliative and bereavement care
respect for parents’ emotional needs and preferences
Its ultimate purpose is to provide clarity, compassion, and consistency during a profoundly difficult and delicate moment.... |