I love what I do for a living. I have been active in funeral service since I was 19 years old and in college, studying something not even related to the death care industry. We all have our reasons for choosing this profession, and even though there has historically been a high dropout rate within the first five years, many of us who have stayed found that the rewards come in many ways. Sure, we have all had those days when we feel we have reached our breaking point and just wish the phone would stop ringing for a minute, or that “Why does this family need to be so difficult?” feeling would go away, but we push through and survive the day because of our passion for what we do. The difference it makes to the families we serve is our ultimate reward.

I have seen quite a few excellent and capable funeral directors walk away from our profession. I often think, “What was the breaking point that made them leave the profession?” We can all think of a laundry list of reasons why one would hang it up and walk away, ranging from being on-call, working holidays, nights and weekends, or the sheer mental stress that we undergo with some of the circumstances that we are called to deal with. I have been there as well, and I remember many of those cases in vivid detail, as if they happened yesterday. It makes you aware that you are mentally stronger than you thought you were.

One of the hardest cases, most funeral directors would agree, is an infant death. Amplify that 10 times when the mother dies at the same time. Whether it be during childbirth or in a car accident, your heart breaks because you think about the families affected and all the future dreams that have now been shattered as a result of this tragedy. Over the decades of my career, I have been called on to perform several mother and child funerals, and I want to share with you one of my experiences and the process I went through in hopes that it will help you when and if you have to deal with a similar situation.

I remember the day that our funeral home got the call. The first call got transferred to me and I found myself on the phone with a distraught father-in-law who was barely able to talk. As I started to piece the minimal information together, I realized that his daughter-in-law and grandson had been killed in a car accident the night before. I also found out that his son, the husband to the mother and father to the child, was also in the accident and was at the hospital recovering from minor injuries and was expected to be released in a few days. After asking several questions, I was able to determine that they were members of a local church where services would take place, they would be buried at a local cemetery where there was a family plot, and that it was going to be a traditional funeral. Other than getting permission to do the removal and embalming, the rest was unknown.

I immediately started making calls. In talking to the church, I was told they were already aware of the tragedy and the ball was rolling on their end. I called the medical examiner to find out about the release time frame and conditions of the bodies, and of course, I called the cemetery.

Our funeral home worked closely with the medical examiner’s office, so I requested to go there and take a firsthand look at the condition of the bodies so I could see what I was up against and would be able to relay any concerns to the family if necessary. To my surprise, besides a couple of minor facial lacerations and a compound fracture of her leg, the mother was in decent shape. However, I learned that the child was actually a newborn infant that was taken from the mother the night before at the hospital via emergency C-section and, unfortunately, was stillborn. While all of this was incredibly sad, it gave me more information to work with going forward. I was able to start a plan to help direct the family with options.

Both bodies were released later that day. We had not heard much from the family at that point. However, the church was calling non-stop. The mother had a full post, but the infant was not posted and was basically full-term in size (about 36 weeks gestation). When we got both bodies back to the funeral home, we immediately started our work. My partner started by getting the mother on the table, opening sutures, and working on setting features while I took care of the little one. Since the infant was large enough, our intent was arterial injection. I started by bathing the infant and disinfecting the mouth, nose, eyes and body with Dis-Spray. For my arterial solution, I used a bottle of Plasdopake (18 index), 8 oz of Chromatech Pink (21.5 index), and a bottle each of Metaflow and Rectifiant to make 1 gallon of total solution. The right iliac artery was my injection point because the incision would be a bit easier to disguise with a diaper. The embalming went perfectly, and I received good distribution and firming, not too firm, which is what I was after. After aspirating, I treated the viscera with a bottle of Spectrum so I could avoid having a strong chemical smell emitting from the body.

As a sales representative, I often get asked about “dipping” for an infant. So, for the purposes of this article, I will take a few minutes to cover that process as well. Dipping, or submersion embalming, is a good way to preserve a fetus if arterial embalming is not an option. I would start by using a clear plastic tub with a snap top lid to monitor the progress of the fetus better and keep any chemical smell to a minimum. Based on the condition of the case, I would start with two to three bottles of Dri Cav or Halt Cavity, two bottles of Proflow and two bottles of Rectifiant and then use water to make enough solution to fully submerge the fetus. If you are dealing with dark tissue or skin slip, adding a couple of bottles of Dryene Basic will help bleach out and cauterize the skin, thus making it more stable going forward. Check the progress of the fetus after four to six hours to see how things are advancing. Typically, you do not need to exceed 12 hours for this process. If the infant is larger and more fully formed, once the submersion process is complete, I would suggest aspirating the cavity and then injecting it with some cavity chemicals. It is also a good idea to inject up to 60cc’s of Dryene Basic into the cranial vault using a 6-inch needle and syringe entering through the cribriform plate. This will ensure that everything not preserved by the submersion is treated properly.

If you can determine the family’s preference for whether the infant and mother will be in the same casket or separate ones, this will help you with positioning, primarily for the mother. Unfortunately, I was not able to establish this beforehand, so my co-worker and I made the decision to embalm with regular positioning and pivot later if we needed to. The embalming for the mother was straightforward, with the exception of treating the lacerations and leg fracture. The lacerations were minor, and I treated them with some Dryene Basic to cauterize them so I could glue and wax later if needed. The compound fracture did limit chemical distribution to the lower part of the leg, so I thoroughly hypo’d the area with Introfiant OTC to ensure proper preservation and then in my post-embalming process, I treated the open skin and tissue with a surface pack using Webril and Dryene Basic.

During the embalming, there was some minor swelling in one of the eyes, so I used a small gauge hypo needle with some Dryene Basic and injected it into both eyelids followed by Webril soaked in water to help reduce the swelling. If you have extreme swelling in an area like an eye or temple, use a hypo needle (without the syringe) to channel the area and then manually push out the fluid with your hand or palm. It is a quick and effective way to remove swelling. It is important to do this immediately after the embalming and before the tissue has a chance to fixate. If you wait until later, it is not nearly as effective.

After meeting with the family and exploring the options that they had, it was determined that the mother would be holding the infant in her arm in the casket. I needed to adjust the mother’s arm positioning to allow her to hold the infant naturally in the casket. Our preparation room had sandbag weights that we would use to help position the deceased. So, I recreated the approximate size of the infant using a couple of knotted-up hospital sheets and then positioned the sheets where the infant would be placed. This new position elevated the mother’s arm a bit, so I used a couple of weights to help the arm stay down and appear more natural for the new position I needed to create.

By the next morning, the arm stayed in the position I needed without any further issues or treatment.

Over the years, I have had families request a variety of ways to hold a visitation and funeral. In the example I am sharing with you, the family requested that the mother and infant be buried together in the same casket. However, I have had requests ranging from the infant being in an infant casket next to the parent, the infant casket being in a separate visitation room, holding an entirely separate visitation and funeral, and even one time where the florist incorporated a spot for the casket to sit and be incorporated into the casket spray of the parent. The families that we serve will have a wide range of ideas; some make sense, and others might be a little bizarre to us, but the key is to remain flexible and try to accommodate their wishes the best we can.

Preparing the infant for viewing was straightforward. The family brought in an outfit along with a diaper and blanket. I used some Softouch Light Flesh for the base and Kalon Pigment Lip Color for the lips when applying cosmetics to the face. The mother, however, had a few issues to contend with. I wrapped the leg with an Ace Bandage and Webril to help keep the shape and plastic wrap to prevent any possible leakage. The eye had come down quite a bit and had bleached nicely. I had to build up the other eye a little to achieve some symmetry, but that was easy enough. The lacerations were dry, so I used Aron Alpha glue to close them the best I could, and with a small amount of wax, I could hide them well. My cosmetic application was mostly routine, and once we got her positioned in the casket, she looked peaceful.

Our funeral home had a policy that whenever we were handling a case where the deceased was under the age of 55 years old, we would offer an opportunity for the family to come in the day before and view the body privately. The reasoning for this is really two-fold. First, a young person, no matter if it is the “case of the month” and they look exactly like their photo, will never look right in a casket. Our brain can’t compute or accept it very well. Young people aren’t supposed to be in caskets. So, by allowing the family to spend some time beforehand with the body, it gives them time to adjust. Secondly, it gives the family an opportunity to give feedback. If the coloring is a bit off or the mouth is not right, we have time to do something about it before the public visitation. Also, when dealing with infants, the family often wants to hold the child, and this private time allows for that to happen.

The visitation and funeral went off without any hiccups, but there are a few things that I want to mention that you should be aware of when making arrangements based on your specific state and cemetery regulations. In Minnesota, a Fetal Death Report is used when an infant is not born alive (stillborn). If the infant was born alive, even if only for a moment or two, then a Birth and Death Certificate will need to be generated and filed. Your specific state might have a different process, so you should be familiar with what steps must be taken.

Also, the cemetery may have rules pertaining to the situation of two bodies being in the same casket. Some cemeteries will require an additional interment fee or second rite of burial fee to allow the burial to take place as intended. Have clear communication with the cemetery of your intentions; they will price it out accordingly and ensure the final bill to the family is accurate. Another thing to consider is the marker or monument. Confirm with the cemetery that you won’t have any issues putting the infant’s name on the stone in the future. Asking these questions now can save a lot of headaches or costly changes in the future and possibly change a positive experience the family had with your firm into a negative one.

Dealing with tragic situations like the death of a parent and child can be extremely difficult and mentally taxing for everyone involved, including you and your staff. Fortunately, these types of funerals are not common, so there are details and circumstances surrounding these cases that don’t happen regularly. Take some time and think through the process, and don’t leave anything to chance or guess. This will help you move forward. Ask questions, lots of questions and obtain the information you need to take the appropriate steps. We all have our reasons for why we chose this profession, but helping a family in the midst of a tragedy is one of the most compassionate things we can do as professionals and as humans.