Unlike most mothers, Estelle Goh’s pregnancy journey did not begin with a giddy search for cots and strollers. Instead, she found herself up in the wee hours desperately searching for a funeral service provider.
In 2018, at around nine weeks of pregnancy, Goh miscarried. Her dilation and curettage (D&C) procedure to remove the foetal remains was scheduled for the next day.
Devastated, she wanted to give her unborn baby a proper cremation. But the five or six funeral providers she contacted turned her down. They only arranged cremations for stillborn babies at or after 24 weeks’ gestation.
At 2am, Goh finally found a funeral provider willing to take the job – Harmony Funeral Care.
The next day, she underwent the D&C. After that, she was handed a plastic bottle containing her foetal remains and other pregnancy tissue.
She placed the bottle in a tiny coffin, along with her pregnancy test kit, ultrasound scan and baby clothes, and watched as the coffin was pushed into the cremation chamber.
Estelle Goh with her husband holding the ultrasound scan of their baby when they found out about the pregnancy in 2018. (Photo: Estelle Goh)
This process helped her grieve better. “It made the pregnancy loss feel real – the foetus was not just an unnamed thing in my body that was purged and thrown away along with other things. It was a life, a child that my husband and I were blessed with,” said the 32-year-old.
One reason Goh struggled to find a funeral provider was because such rites are relatively uncommon for first trimester miscarriage
In Singapore, stillbirths – pregnancy loss at or after 24 weeks’ gestation – are registered at the Immigration and Checkpoints Authority. Parents may also choose to register the baby’s name and are issued a digital stillbirth certificate for funeral arrangements.
But when it comes to miscarriages, practices surrounding the claiming of foetal remains are less standardised.
Dr Seet Meei Jiun, head and senior consultant, Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), said that it is standard protocol to inform patients that they may request the release of foetal remains following both first and second trimester miscarriages.
This has been a longstanding practice at the hospital, added Jocelyn Chng, assistant director of nursing at KKH.
At Singapore General Hospital (SGH), its head of Obstetrics and Gynaecology, Dr Jason Lim Shau Khng, said that patients are explicitly informed of their right to request the release of foetal remains – also a hospital practice for many years.
However, “the ability to claim remains depends on the method of management used and the identifiability of the remains,” he said.
“For first trimester cases, remains can typically be claimed after a surgical procedure. For second trimester miscarriages, patients may claim remains following a medically induced labour,” Dr Lim explained.
However, “in some early first trimester losses, the pregnancy tissue may already have been completely expelled prior to medical or surgical treatment, resulting in minimal or no identifiable remains available for claiming. In such situations, claiming may not be possible,” he said.
In other cases, “foetal tissue may not be clearly formed or identifiable from other pregnancy-related tissue. Hence, this can make the physical claiming of remains technically challenging, or in some cases, not possible.
“Whereas, in the second trimester (miscarriages), the foetus is more developed and physically formed, making it generally more feasible to facilitate a request for private burial or cremation,” Dr Lim said.
Goh’s ultrasound scan of the baby she lost at nine weeks of pregnancy. (Photo: Estelle Goh)
At National University Hospital (NUH), it is standard practice to inform patients of the option to claim foetal remains in mid-trimester pregnancy loss and stillbirths. But for early miscarriage before 12 weeks’ gestation, “providing information to patients on the option to claim foetal remains is not a routine practice,” said Adjunct Associate Professor Arundhati Gosavi from the Department of Obstetrics and Gynaecology.
“Requests to claim foetal remains following a first trimester miscarriage are relatively uncommon, and we would facilitate them on a case-by-case basis,” she added.
Under the Healthcare Services Act, the Ministry of Health (MOH) requires healthcare institutions to take effective measures to ensure the safe and proper disposal of foetal remains. But healthcare institutions are allowed to manage this according to their own protocols, said MOH.
At SGH, unclaimed foetal remains are mass cremated, said Dr Lim. At KKH, they are either buried
Dr Douglas Ong, an obstetrician and gynaecologist at Mount Elizabeth Medical Centre, recalled the first time a patient who had suffered an early miscarriage asked: “What are you going to do with my baby?”
That was more than 10 years ago, and Dr Ong said there were no established protocols for claiming foetal remains for first trimester miscarriage at Mount Elizabeth Hospital and Mount Alvernia Hospital where he was delivering. The standard answer was that the hospital would dispose of the remains, he said.
In fact, when he conveyed her request to the hospital, they were unsure how to even give the foetal remains to her, since it was mixed with blood clots and tissue.
But Dr Ong believed it was important. About one in five pregnancies end up in miscarriage, and around 80 per cent of miscarriages occur in the first trimester, Dr Ong noted.
In such cases, parents often have to deal with the loss privately and move on, he added.
“You have surgery and a few hours later, you go home, no longer pregnant. The next week, you go back to work. It can feel so empty,” he reflected. “People may say, don’t worry, you’ll have another one, but it doesn’t cure the grief.”
Harmony Tee, funeral director at Harmony Funeral Care, collecting first trimester foetal remains at a hospital. (Photo: Harmony Funeral Care)
“As a parent myself, I want to give dignity and respect to that embryo who had no name, no face, but represented everything to the parents,” he said.
Dr Ong spent a year developing a process for his practice and now offers every parent who suffers an early miscarriage the option.
Should parents wish to claim foetal remains, it will be presented in a bottle, along with blood clots and tissue. The bottle is wrapped and placed in a small bereavement box.
Dr Ong also adapted existing hospital forms used in later-stage pregnancy losses to support parents who wished to arrange cremation and provides them with contacts of two bereavement companies who cremate early-miscarriage foetal remains – Harmony Funeral Care and Holy Spirit Bereavement.
Tee transporting foetal remains from a hospital in a coffin. (Photo: Harmony Funeral Care)
Some families arrange for religious rites, such as prayers by a monk or priest, before cremation.
Because ashes from foetal remains are far smaller in volume than for adults, Dr Ong approached Pearl Yang, a potter from LimeLite Studio, to create baby-sized urns, which he provides to grieving patients without charge.
Some choose to keep the urn in a niche. Others scatter the ashes at designated sites or take them out to sea for burial.
Grace (not her real name) suffered two miscarriages in 2019 – a spontaneous miscarriage and an ectopic pregnancy, where a fertilised egg implants outside the uterus.
In both cases, there was no option to claim foetal remains. And in hindsight, even though they were painful losses, the 33-year-old said they felt “very unreal”.
“It was like it didn’t happen, it didn’t matter, it’s forgotten,” she told CNA Women.
In 2021, Grace gave birth to a healthy baby, but in 2023, she experienced a third miscarriage at 11 weeks’ gestation. Dr Ong, her gynaecologist, offered her the option to claim foetal remains after the D&C.
She agreed, and for the first time, she was able to see her foetus. “There was other tissue, but I could see tiny hands and legs,” she shared.
Grace holding her baby’s urn. “We treat miscarriage like a process. It is not. It is losing a child. You’ve lost someone who could be someone,” she says. (Photo: Grace)
After cremating foetal remains from her third miscarriage, Grace named all three babies she lost to miscarriages, and said the process gave her peace. (Photo: Grace)
The couple kept the cremation ceremony small – inviting only a friend and a Catholic priest to pray for the baby. Grace said the process made things a lot more real and gave her a lot of closure.
Goh, who described her miscarriage as “earth shattering” also said that being able to cremate the foetal remains helped her and her husband “grieve a bit more tangibly”.
Harmony Tee, founder and funeral director of Harmony Funeral Care, told CNA Women that cremation for first trimester miscarriage is becoming
These cremations typically take 30 minutes. Some, like Grace and Goh, opt for smaller and simpler ceremonies than adult cremations. However, Tee said one first trimester cremation had 80 to 100 attendees.
Goh with her baby’s urn outside Mandai Crematorium. (Photo: Estelle Goh)
“A lot of people downplay the loss of a foetus. But in reality, the grief can be just as deep,” Tee reflected.
“Parents are not only grieving a life lost, but also (the loss of) the future they had envisioned – the milestones, memories, and moments that will never come to be,” she said.
She added that some parents may also have tried very hard to conceive, including undergoing multiple in vitro fertilisation (IVF) cycles.
Not all patients choose to claim or cremate remains.
“The frequency often depends on factors such as culture and religious beliefs. Specific burial or cremation rites may also be required for some religions,” said SGH’s Dr Lim.
Both Goh and Grace were influenced by their Catholic faith. “My faith believes that life begins at conception. Throwing away the foetal remains is the last thing we want,” said Goh.
“For some parents, claiming the remains is a vital step in acknowledging their child’s life and finding a sense of peace,” Dr Lim noted.
Goh, now a mother of two, takes her seven-year-old daughter to visit her unborn brother’s niche. (Photo: Estelle Goh)
Dr Ong, who has supported more than 100 patients to claim and cremate foetal remains from first trimester pregnancy loss, said that a few patients even come out of the process joyful, stronger and more ready to move on.
Grace, who is now the mother of two boys aged five and one, and pregnant with her third child, has since named the three babies she lost to miscarriages Hope, Faith and Peace. She places her baby’s urn in a small pouch bearing all their names and tells her eldest son about them.
“The whole experience gave us peace,” she said.
Goh and her husband named their unborn baby Jeremiah and placed his urn in Mandai Columbarium.
“That helped me in the days and months when I was recovering. Every time I missed him, I had a physical place where I could be with him,” she said.
Now the mother of two children aged seven and one, Goh takes her eldest daughter to visit Jeremiah on his death anniversary.
“I tell people I have three children, one in heaven, two on earth. It is not just some medical ailment I went through. It is a chapter of our lives, not one that has been forgotten or written off,” she said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
In 2018, at around nine weeks of pregnancy, Goh miscarried. Her dilation and curettage (D&C) procedure to remove the foetal remains was scheduled for the next day.
Devastated, she wanted to give her unborn baby a proper cremation. But the five or six funeral providers she contacted turned her down. They only arranged cremations for stillborn babies at or after 24 weeks’ gestation.
At 2am, Goh finally found a funeral provider willing to take the job – Harmony Funeral Care.
The next day, she underwent the D&C. After that, she was handed a plastic bottle containing her foetal remains and other pregnancy tissue.
She placed the bottle in a tiny coffin, along with her pregnancy test kit, ultrasound scan and baby clothes, and watched as the coffin was pushed into the cremation chamber.
Estelle Goh with her husband holding the ultrasound scan of their baby when they found out about the pregnancy in 2018. (Photo: Estelle Goh)
This process helped her grieve better. “It made the pregnancy loss feel real – the foetus was not just an unnamed thing in my body that was purged and thrown away along with other things. It was a life, a child that my husband and I were blessed with,” said the 32-year-old.
AFTER EARLY PREGNANCY LOSS
One reason Goh struggled to find a funeral provider was because such rites are relatively uncommon for first trimester miscarriage
In Singapore, stillbirths – pregnancy loss at or after 24 weeks’ gestation – are registered at the Immigration and Checkpoints Authority. Parents may also choose to register the baby’s name and are issued a digital stillbirth certificate for funeral arrangements.
But when it comes to miscarriages, practices surrounding the claiming of foetal remains are less standardised.
Dr Seet Meei Jiun, head and senior consultant, Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), said that it is standard protocol to inform patients that they may request the release of foetal remains following both first and second trimester miscarriages.
This has been a longstanding practice at the hospital, added Jocelyn Chng, assistant director of nursing at KKH.
At Singapore General Hospital (SGH), its head of Obstetrics and Gynaecology, Dr Jason Lim Shau Khng, said that patients are explicitly informed of their right to request the release of foetal remains – also a hospital practice for many years.
However, “the ability to claim remains depends on the method of management used and the identifiability of the remains,” he said.
“For first trimester cases, remains can typically be claimed after a surgical procedure. For second trimester miscarriages, patients may claim remains following a medically induced labour,” Dr Lim explained.
However, “in some early first trimester losses, the pregnancy tissue may already have been completely expelled prior to medical or surgical treatment, resulting in minimal or no identifiable remains available for claiming. In such situations, claiming may not be possible,” he said.
In other cases, “foetal tissue may not be clearly formed or identifiable from other pregnancy-related tissue. Hence, this can make the physical claiming of remains technically challenging, or in some cases, not possible.
“Whereas, in the second trimester (miscarriages), the foetus is more developed and physically formed, making it generally more feasible to facilitate a request for private burial or cremation,” Dr Lim said.
Goh’s ultrasound scan of the baby she lost at nine weeks of pregnancy. (Photo: Estelle Goh)
At National University Hospital (NUH), it is standard practice to inform patients of the option to claim foetal remains in mid-trimester pregnancy loss and stillbirths. But for early miscarriage before 12 weeks’ gestation, “providing information to patients on the option to claim foetal remains is not a routine practice,” said Adjunct Associate Professor Arundhati Gosavi from the Department of Obstetrics and Gynaecology.
“Requests to claim foetal remains following a first trimester miscarriage are relatively uncommon, and we would facilitate them on a case-by-case basis,” she added.
Under the Healthcare Services Act, the Ministry of Health (MOH) requires healthcare institutions to take effective measures to ensure the safe and proper disposal of foetal remains. But healthcare institutions are allowed to manage this according to their own protocols, said MOH.
At SGH, unclaimed foetal remains are mass cremated, said Dr Lim. At KKH, they are either buried
HELPING PARENTS CLAIM REMAINS
Dr Douglas Ong, an obstetrician and gynaecologist at Mount Elizabeth Medical Centre, recalled the first time a patient who had suffered an early miscarriage asked: “What are you going to do with my baby?”
That was more than 10 years ago, and Dr Ong said there were no established protocols for claiming foetal remains for first trimester miscarriage at Mount Elizabeth Hospital and Mount Alvernia Hospital where he was delivering. The standard answer was that the hospital would dispose of the remains, he said.
In fact, when he conveyed her request to the hospital, they were unsure how to even give the foetal remains to her, since it was mixed with blood clots and tissue.
But Dr Ong believed it was important. About one in five pregnancies end up in miscarriage, and around 80 per cent of miscarriages occur in the first trimester, Dr Ong noted.
In such cases, parents often have to deal with the loss privately and move on, he added.
“You have surgery and a few hours later, you go home, no longer pregnant. The next week, you go back to work. It can feel so empty,” he reflected. “People may say, don’t worry, you’ll have another one, but it doesn’t cure the grief.”
Harmony Tee, funeral director at Harmony Funeral Care, collecting first trimester foetal remains at a hospital. (Photo: Harmony Funeral Care)
“As a parent myself, I want to give dignity and respect to that embryo who had no name, no face, but represented everything to the parents,” he said.
Dr Ong spent a year developing a process for his practice and now offers every parent who suffers an early miscarriage the option.
Should parents wish to claim foetal remains, it will be presented in a bottle, along with blood clots and tissue. The bottle is wrapped and placed in a small bereavement box.
Dr Ong also adapted existing hospital forms used in later-stage pregnancy losses to support parents who wished to arrange cremation and provides them with contacts of two bereavement companies who cremate early-miscarriage foetal remains – Harmony Funeral Care and Holy Spirit Bereavement.
Tee transporting foetal remains from a hospital in a coffin. (Photo: Harmony Funeral Care)
Some families arrange for religious rites, such as prayers by a monk or priest, before cremation.
Because ashes from foetal remains are far smaller in volume than for adults, Dr Ong approached Pearl Yang, a potter from LimeLite Studio, to create baby-sized urns, which he provides to grieving patients without charge.
Some choose to keep the urn in a niche. Others scatter the ashes at designated sites or take them out to sea for burial.
WHY SOME PARENTS CHOOSE CREMATION
Grace (not her real name) suffered two miscarriages in 2019 – a spontaneous miscarriage and an ectopic pregnancy, where a fertilised egg implants outside the uterus.
In both cases, there was no option to claim foetal remains. And in hindsight, even though they were painful losses, the 33-year-old said they felt “very unreal”.
“It was like it didn’t happen, it didn’t matter, it’s forgotten,” she told CNA Women.
In 2021, Grace gave birth to a healthy baby, but in 2023, she experienced a third miscarriage at 11 weeks’ gestation. Dr Ong, her gynaecologist, offered her the option to claim foetal remains after the D&C.
She agreed, and for the first time, she was able to see her foetus. “There was other tissue, but I could see tiny hands and legs,” she shared.
Grace holding her baby’s urn. “We treat miscarriage like a process. It is not. It is losing a child. You’ve lost someone who could be someone,” she says. (Photo: Grace)
After cremating foetal remains from her third miscarriage, Grace named all three babies she lost to miscarriages, and said the process gave her peace. (Photo: Grace)
The couple kept the cremation ceremony small – inviting only a friend and a Catholic priest to pray for the baby. Grace said the process made things a lot more real and gave her a lot of closure.
Goh, who described her miscarriage as “earth shattering” also said that being able to cremate the foetal remains helped her and her husband “grieve a bit more tangibly”.
A RISE IN CREMATION REQUESTS
Harmony Tee, founder and funeral director of Harmony Funeral Care, told CNA Women that cremation for first trimester miscarriage is becoming
These cremations typically take 30 minutes. Some, like Grace and Goh, opt for smaller and simpler ceremonies than adult cremations. However, Tee said one first trimester cremation had 80 to 100 attendees.
Goh with her baby’s urn outside Mandai Crematorium. (Photo: Estelle Goh)
“A lot of people downplay the loss of a foetus. But in reality, the grief can be just as deep,” Tee reflected.
“Parents are not only grieving a life lost, but also (the loss of) the future they had envisioned – the milestones, memories, and moments that will never come to be,” she said.
She added that some parents may also have tried very hard to conceive, including undergoing multiple in vitro fertilisation (IVF) cycles.
Not all patients choose to claim or cremate remains.
“The frequency often depends on factors such as culture and religious beliefs. Specific burial or cremation rites may also be required for some religions,” said SGH’s Dr Lim.
Both Goh and Grace were influenced by their Catholic faith. “My faith believes that life begins at conception. Throwing away the foetal remains is the last thing we want,” said Goh.
“For some parents, claiming the remains is a vital step in acknowledging their child’s life and finding a sense of peace,” Dr Lim noted.
Goh, now a mother of two, takes her seven-year-old daughter to visit her unborn brother’s niche. (Photo: Estelle Goh)
Dr Ong, who has supported more than 100 patients to claim and cremate foetal remains from first trimester pregnancy loss, said that a few patients even come out of the process joyful, stronger and more ready to move on.
Grace, who is now the mother of two boys aged five and one, and pregnant with her third child, has since named the three babies she lost to miscarriages Hope, Faith and Peace. She places her baby’s urn in a small pouch bearing all their names and tells her eldest son about them.
“The whole experience gave us peace,” she said.
Goh and her husband named their unborn baby Jeremiah and placed his urn in Mandai Columbarium.
“That helped me in the days and months when I was recovering. Every time I missed him, I had a physical place where I could be with him,” she said.
Now the mother of two children aged seven and one, Goh takes her eldest daughter to visit Jeremiah on his death anniversary.
“I tell people I have three children, one in heaven, two on earth. It is not just some medical ailment I went through. It is a chapter of our lives, not one that has been forgotten or written off,” she said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...