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📖 Deep dive: How to Explain Autopsy and "What Happens to My Baby's Body" in Plain Language

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📖 Deep Dive

How to Explain Autopsy and "What Happens to My Baby's Body" in Plain Language

This is one of those conversations nobody prepares you for in nursing school.

A family has just received the most devastating news of their lives. And within hours, you — or someone on your team — has to bring up autopsy.

It can feel impossible. But families want this conversation. They want information. And the way you show up in that moment matters more than you might think.

When Should You Offer an Autopsy?

The short answer: The short answer: every time there is a stillbirth — in the U.S., that means a baby who dies at or after 20 weeks’ gestation or weighs at least 350 grams.

ACOG recommends that fetal autopsy be offered for all stillbirths as one of the most useful diagnostic tests in determining cause of death.

The yield is highest when dysmorphic features, growth restriction, structural anomalies, or hydrops are present — but even when none of those are there, autopsy still provides useful information.

One important data point: placental pathology is useful in about 65% of stillbirth cases, and fetal autopsy is useful in about 42% in identifying a possible cause or contributing factor.

And yet, only about 20.9% of stillbirths in the United States undergo fetal autopsy according to a national analysis of fetal autopsy rates.

That gap exists partly because of cost, partly because of access to pathologists, and partly because nurses and providers feel unprepared for the conversation.

That’s where you come in.

What Varies Hospital to Hospital

Before you walk into a room and offer an autopsy, it helps to know how things actually work where you practice.

Every hospital is different. Before you talk with families, try to have clear answers to:

• Who performs the autopsy at your hospital? (In‑house perinatal pathologist vs. transfer to another facility.) (Learn more about this here)

• How are results delivered — phone call, portal message, or a dedicated in‑person visit?

• What does it cost at your hospital? Is it covered by the hospital, billed to insurance, or self‑pay?

• What are your state’s fetal death reporting requirements after 20 weeks? A summary of state-by-state laws is available here. (heavens gain)

Knowing these details ahead of time turns a scary conversation into a calm, grounded one for families.

What Actually Happens During an Autopsy

Here’s a clear breakdown to help you and the family understand the full process.

Most of what follows is drawn from RCPath’s 2024 fetal autopsy guidelines and US stillbirth management guidance from ACOG.

Step 1 – External examination
The pathologist carefully examines the outside of the baby. They take measurements (weight, length, head circumference, foot length) and photograph the baby for the clinical record.

Step 2 – Imaging
A full‑body X‑ray is usually taken. In some centers, MRI or CT imaging is also used, and can be offered as part of a less invasive approach.

Step 3 – Placenta examination
The placenta, umbilical cord, and membranes are always examined. Placental pathology alone explains or contributes to cause of death in a large proportion of stillbirths and can be done even if the family declines a full autopsy.

Step 4 – Internal examination
If the family consents to a full autopsy, internal organs are examined. Standard incisions are usually T‑ or Y‑shaped on the chest and abdomen. Importantly, incisions are not made on the baby’s face, which helps maintain appearance for viewing or an open casket.

Step 5 – Tissue samples
Small tissue samples are taken from key organs for microscopy and, when consented, for genetic testing.

Step 6 – Reconstruction and return
The baby is carefully reconstructed and prepared before being returned to the family. Incisions on the head (if any) can be covered with a hat or headband. Families can still hold, dress, and see their baby.

The RCPath guideline notes that detailed autopsy reports can become an important part of a family’s grieving process and planning for future pregnancies.

What About Limited or “Less Invasive” Options?

Full autopsy is not all‑or‑nothing.

Options that can be discussed include:

• External examination only (with photographs and measurements)

• Partial autopsy (for example, chest and abdomen only)

• Placenta examination only, with or without genetic testing

• Imaging‑based approaches (MRI or CT) with targeted biopsies

• Imaging only, for families who do not want any incisions

In one study, about 54% of bereaved parents said yes to traditional autopsy, but 91% said yes to at least one less invasive option when it was explained clearly.

So even when a family declines a full autopsy, it’s still worth offering placenta-only evaluation, imaging, or other partial options.

Preparing for the FAQ: What Families Will Ask You

Research with bereaved parents shows the same themes and questions coming up over and over. Below are common questions and short scripts nurses can adapt.

You’ll recognize a lot of this from Horey et al., “Decision influences and aftermath: parents, stillbirth and autopsy”.

“Will this hurt my baby?”

What’s underneath this: pure protection. Parents are still parenting.

You might say:
“Your baby will not feel any pain. The pathologist who does this work specializes in caring for babies, and they approach this examination with the deepest respect and gentleness.”

“Can I still have an open casket?”

What’s underneath this: fear of seeing their baby “cut” or “changed,” but also a desire for ceremony.

You might say:
“The incisions are not on your baby’s face. Any incisions on the head can be covered with a hat if you’d like. Families can still have an open casket and spend time holding and seeing their baby.”

“What if they don’t find anything?”

Parents worry that they’ll go through all of this and still end up with a blank page.

The literature (including ACOG stillbirth guidance and Marsden et al. 2025) shows that autopsy and related investigations identify a cause or major contributing factor in a substantial proportion of cases, but not all.

You might say:
“Honestly, sometimes we don’t get a clear answer. But even when there isn’t one specific cause, that still tells us something. It can rule out infections, genetic conditions, or anything related to something you did. That information can really matter for your peace of mind and for any future pregnancies.”

“How long will it take to get results?”

What’s underneath this: they’re bracing for another wait.

ACOG and RCPath both describe a staged reporting process.

You might say:
“There are usually two steps. The first, or ‘preliminary’ findings, can come back in a few weeks. The final report — including the microscopic and genetic testing — often takes about 6 to 8 weeks, sometimes a bit longer. We’ll make sure you have a follow‑up appointment so someone can sit down with you and go through it, not just call you quickly.”

Note: This can vary between hospital so be sure to confirm this information.

“What if I decide later that I wish I had done it?”

Horey et al. found that parents who declined autopsy were more likely to report regret later than those who consented, even when no clear cause was found.

You might say:
“You don’t have to decide this minute, and there isn’t a ‘right’ or ‘wrong’ choice. What I do want you to know is that this is a one‑time window — we can’t go back later. My goal is just to give you enough information now so whatever you decide, you feel as much peace as possible with that choice.”

“How much does this cost?”

Gibbins et al., “Addressing Barriers to Autopsy and Genetic Testing in Stillbirth Workup” highlight cost as a major barrier in the US.

You might say:
“I’m really glad you asked, because this matters. Every hospital handles this a little differently. Here, [fill in your hospital policy: e.g., the hospital covers the cost / it’s billed to insurance / there may be an out‑of‑pocket amount]. When it isn’t covered, private autopsies can cost in the range of a few thousand dollars. Let’s find out exactly how it works here so there are no surprises.”

“Do we have to decide right now?”

What’s underneath this: shock + decision fatigue.

You might say:
“No, you don’t have to decide this second. Autopsy is typically done within the next 24–48 hours, so there is a window of time. I’ll come back and check in with you after you’ve had a chance to talk, and you can ask me anything in the meantime.”

“We have religious or cultural concerns.”

Studies show that respect, flexibility, and alternatives (like imaging or placenta-only exams) can help families balance beliefs with medical information needs.

You might say:
“Your beliefs and values are always respected here. There is no pressure. If you’d like, we can connect you with our chaplain or spiritual care team. There are also alternatives to a full autopsy — like examining just the placenta or doing imaging — that some families feel more comfortable with.”

When Is Autopsy Legally Required?

For most stillbirths in the US, autopsy is not legally required. It is the family’s choice. Read more on this here from ACOG.

A coroner or medical examiner may become involved if there is: suspected abuse or trauma, a maternal death, or other suspicious circumstances. In those cases, they may order their own evaluation.

Separately, fetal death reporting laws after 20 weeks vary by state. A useful overview is available here. Your hospital’s policies and your state’s statutes will guide the paperwork, but parental consent is still required for a hospital (non–medical examiner) autopsy.

How to Have This Conversation

Horey et al.’s qualitative study of parents after stillbirth and autopsy, “Decision influences and aftermath: parents, stillbirth and autopsy”, is full of quotes that sound like the patients you see every day.

Parents said they needed:

• Factual, plain‑language information about procedures

• Acknowledgment of their fear of being blamed

• An environment of trust

• Professionals who felt prepared and not rushed

Some practical moves that align with the research:

• Bring up the option more than once, when possible.

• Sit down. Slow your voice. Leave pauses.

• Name the fear of blame out loud: “Many parents worry this might show they did something wrong. It almost never does — and even if it did, this isn’t about blame.”

• Offer written information and a chance to revisit the decision.

• When results are back, schedule a dedicated, private visit, not a rushed phone call.

Please rate the impact of today’s deep dive:

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👍 Helpful, mostly a good refresher

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👋 That’s a Wrap!

Before you go: Here are ways we can help your hospital

Education: Please share our newsletter with your co-workers. Our priority is empowering nurses with the tools to support patients with modern, evidence-based bereavement education.

Bereavement boxes: Our bereavement boxes were designed out of a need for a modern high quality solution for families suffering from miscarriage, stillborn, or infant death.

Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.

These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.

Until next week,

Trina and Jay
Co-founders of Forget Me Not