Pregnancy Loss Certificates: A New Initiative in England

February 2024 was a landmark month for pregnancy loss in England. The government started a new, voluntary scheme issuing certificates for pregnancy loss before 24 weeks of pregnancy. As a result, bereaved parents affected by early pregnancy loss, including a miscarriage, ectopic pregnancy, molar pregnancy, or early termination for medical reasons, have the option to apply for one.

This certificate has helpfully not been made into a legal document. Hence, the choice of applying for a certificate and what information to include lies with the parent. The certificate may include the date and place of the loss, the baby’s name and gender, and the name of the second parent. It is also possible to backdate the certificate to register a past loss.

In England, 24 weeks is the cutoff for the minimum number of weeks of pregnancy before the death of a baby is officially registered and recognised as a stillbirth. Thus, this new certificate scheme represents an attempt to transform our society’s response to bereaved parents experiencing pregnancy loss before the official cutoff point. Almost a decade of campaigning, originally initiated by Zoe Clark-Coates, preceded the launch of the scheme. The introduction of a loss certificate is among the many recommendations made in the Independent Pregnancy Loss Review recently published by the UK government.

Source: Photo by Joanna Kosinska on Unsplash

A government certificate for a loss that happens behind closed doors

This social recognition of pregnancy loss through a certificate can be deeply meaningful for those affected. This is because the grief surrounding pregnancy loss is a prime example of disenfranchised grief (Doka, 1989). This term refers to a grief response that is not socially acknowledged or distinctly mapped out. This response often follows from an ambiguous loss — a loss not clearly defined (Boss, 2000).

Pregnancy loss, particularly an early one, is ambiguous for several reasons: There is no shared language to describe what is being lost. The term miscarriage often emphasises the physical process of the body getting rid of the pregnancy rather than the loss of a new life. Parents may think of this being as their “dear baby”, while doctors may call it an “embryo” or “foetus”. This new life is not automatically recognised as a living person. In Sara Martel’s words, “the personhood attached to the unborn child is conditional and withdrawn if the baby is not born alive” (Martel, 2014).

Further, there are often no clear physical markers of an early pregnancy loss. When a miscarriage happens naturally, it is like a heavy menstrual cycle. The unborn child may not yet have developed a body. There are no photos to look back at. There are also no clear cultural norms and rituals to mark the loss and help facilitate the mourning process. Families often experience an early pregnancy loss behind closed doors and grieve in silence.

Acknowledgment and something tangible help grieving

Before my fifth pregnancy loss, I had not fully grasped how the absence of physical markers and social acknowledgment weighed on my perinatal grief. As described in a previous post, I had experienced four early miscarriages by this stage. This fifth pregnancy was a life-threatening ectopic (baby developed outside the womb). It required an emergency operation and a two-week recovery period. Following my operation, the waves of grief hit me harder than ever. However, despite their crashing effect, I paradoxically experienced some relief.

This perplexing sense of relief came from the urgency that the medical management of my ectopic pregnancy had required. Its urgency mobilized a notable caring and sympathetic response in those supporting me. The necessary medical intervention equipped me with a sickness certificate, time off work, and two physical marks left from laparoscopy on my body. This fifth loss, unlike my four previous early miscarriages, felt more visible.

Although a certificate is not comparable to my emergency operation, they share similar functions. In both instances, the loss is acknowledged and something tangible is there. After my operation, I felt that I finally had the full right to grieve. This made my grief more palpable, and it allowed me to grieve not only for this baby but also for the four previous babies lost silently.

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Grief is a social process. How our support systems respond to a loss can contribute to our internal capacity to mourn for what is lost (Worden, 2018). In disenfranchised grief, the world around us gives the message that our loss is not significant. The bereaved individual often internalises these messages, which hinder, delegitimise, and disapprove of grief. Hence, they interference with the bereaved’s attempts to grieve their loss (Attig, 2004).

Considering the potentially disruptive impact of disenfranchised messages, the pregnancy loss certificates in England intend to repair some of the damage caused. These certificates are not only a piece of paper; they send a clear and loud message to bereaved parents: This newly formed life is precious and the grief for a baby lost early or mid-pregnancy is valid. They also encourage a different societal response. Eliciting compassion within significant others and systems supporting a bereaved family can facilitate a smoother adjustment to the loss for those grieving.

Grieving for pregnancy loss when a certificate is not available

Many countries around the world have yet to offer an official way to mark early pregnancy loss. However, grief for an unborn child is legitimate no matter what the messages are from those around us. There are plenty of ways to help bereaved parents grieve, honour their babies’ memories, and find solace, even without a certificate.

Tangible and collective ways to grieve can be particularly meaningful. It could be anything from a small pair of socks carried in a handbag, a poem written on a piece of paper, or a tattoo on someone’s body. Lighting a candle during the global Wave of Light can also help remember the little soul that did not fully make it into the world.

Like many other bereaved parents, I had to find ways to remember and honour my pregnancy losses. Living in England, I now also have the option to apply for a loss certificate retrospectively. Will I do this? I am not sure. However, I think that I would have appreciated it if the certificates were available at the peak of my grief and I am delighted that they are available to families in England from now on.