Embalming A to Z: Infant embalming procedures, Part 1
Babies are not supposed to die. Well, not in 2006; the brutal fact of death history is that babies used to die all the time. Thanks to the great advances of medical care in the 20th century, for the first time in human experience certain cultures live with the expectation that babies will not die. But, of course, as every funeral director knows, this expectation is not always met.
Each year in the United States, approximately 37,000 children die within the first 28 days of life. Another way to look at this reality is to say that one neonatal death occurs every 15 minutes somewhere in this country. And in some countries, infant mortality rates are still similar to what they were 100 years ago in America.
Embalming babies, infants and even older children is especially difficult and challenging for the professional embalmer, both psychologically and technically, but the value of embalming our "little ones" is enormous.
This value is best attested to by the famous case my friend Glen W. Davidson did many years ago called "Death of the Wished-For Child." Dr. Davidson's pioneering study provided proof of what anyone knows in his or her heart: In cases of infant death, the parents have very special needs.
Some of the findings from Dr. Davidson's five-year study of mothers who suffered stillbirths or lost their babies within 24 hours of birth:
• When an infant dies, the mother and significant people around her become vulnerable and disoriented.
• The mother very much wants to hold the infant.
• A significant number of times, this request to hold the dead infant is denied.
• Parents who were able to see and/or hold their dead infant were able to reorient themselves much more quickly than those who did not do so.
• Parents find it difficult to get the emotional support they need from people close to them when an infant dies.
• Professionals have their own problems or anxieties about accepting the death of an infant, making them less able to help the parents.
• When given little or no accurate information concerning what happened to her and her baby, a grieving mother tends to imagine the worst, creating in her mind the image of an infant horrible in appearance.
• Seeing her dead child almost instantly drives out those horrible images the mother's imagination has conjured up.
• Viewing the body can be psychologically helpful to the people significantly affected by the death as they try to work through their deep grief.
In this series of articles devoted to infant embalming I will cover seven embalming techniques:
1. Fluid pack approach.
2. Heart approach.
3. Thoracic aorta approach.
4. Umbilical vein approach.
5. Abdominal aorta approach.
6. Normal arterial embalming injection approach.
7. Angiocath/syringe approach.
There are two problems embalmers frequently encounter in the embalming of infants. First, they often experience difficulty in securing satisfactory blood drainage because of the minute size of infants' veins. Second, they have to beware of the possibility of and tendency to over-embalm an infant.
Because of these challenges, a careful case analysis consisting of, but not limited to, the following points needs to be made:
• vessel selection,
• body positioning,
• injection cannula size,
• presence of liquid blood,
• size/location of incision(s),
• rate of flow,
• solution strength,
• intensity of refrigeration, and
• unautopsied cases vs. autopsied cases.
The pre-embalming and post-embalming procedures are general and might not be applicable to every technique selected by the embalmer.
In cases where there was no autopsy, any of the seven embalming techniques may be used. If there has been an autopsy, only three of the techniques can be considered: fluid pack, normal and angiocath/syringe.
Before embalming by whatever method, you need to take care of the following pre-embalming measures:
1. Perform a case analysis as outlined above.
2. Wash the infant and disinfect all orifices.
3. Place the infant on a bed of nonabsorbent cotton, as this prevents the flattening of the back, buttocks and legs. Such flattening will feel unnatural if the mother holds the infant. Note: I have filled a small receptacle about half full of water and floated the infant in it while I injected the remains and found that the legs, back, buttocks, etc., fill out naturally from the pressure of the injection.
4. Never remove any facial hair without the written permission of the person exercising the rights and duties of disposition.
5. Set the features. Methods vary, but I usually simply held the mouth while injecting. Sometimes a slight opening of the mouth causes the face to truly resemble how infants look when they are sleeping. Eye caps are unnecessary, massage cream on a small piece of cotton works very well.
6. Use massage cream to prevent dehydration.
Approach No.1: Fluid pack
I am ashamed to admit this, but it's true: When I started embalming 38 years ago, this was the only method used to embalm infants. It did not work particularly well in terms of providing a good appearance, but it did accomplish preservation. It has been my experience that few viewings are held when the fluid pack approach has been used.
Basically the infant is wrapped in several layers of cotton, which is then saturated with a concentrated arterial or cavity fluid solution. Next, the infant might be placed in a closed box or container and covered with embalming powder or hardening compound. This embalming approach is also referred to as embalming by osmosis.
The result of placing the concentrated fluid on an infant's fragile tissues are not desirable. There is usually excessive dehydration, intense wrinkling of the skin and little or no change in the color of blood discoloration. In addition, fluid penetration is usually minimal, so there is a risk of premature decomposition if the body is held for an extended period of time without refrigeration.
Next month: No.2, Heart approach.