Cooling in the Context of Perinatal Bereavement Care
CuddleCot Statement on Cooling in the Context of Perinatal Bereavement Care
The use of cooling devices within bereavement care is fundamentally parent-focused and aims to support families in spending valuable time with their baby following death. The emphasis should always remain on informed consent, compassionate communication, and shared decision-making, ensuring parents understand both the benefits and limitations of cooling technology.
From a physiological and forensic perspective, it is well established that all human bodies undergo post-mortem change following death as a result of autolysis, bacterial activity, and microbial decomposition. The rate at which these changes occur is influenced by numerous variables, including gestation, infection, environmental temperature, underlying pathology, and the condition of the body at the time of delivery.
Whilst cooling does not stop decomposition entirely, reducing body temperature is widely recognised to slow metabolic, enzymatic, and microbial activity associated with post-mortem deterioration. This principle underpins standard mortuary practice worldwide, where bodies are routinely transferred to refrigerated environments following death in order to preserve tissue integrity and delay decomposition.
Current forensic and scientific literature consistently demonstrates that lower temperatures retard post-mortem change and slow decomposition processes. Therefore, statements suggesting that cooling has “no effect” on post-mortem deterioration are not aligned with established physiological and forensic understanding.
Within the context of perinatal bereavement care, cooling devices such as the CuddleCot are not intended to provide preservation in the traditional mortuary sense, but rather to gently slow post-mortem changes sufficiently to support memory making, parental bonding, cultural and religious practices, and enabling time together as a family. Importantly, the duration of use will vary depending on individual clinical circumstances in conjunction with parental wishes.
Factors including gestation, presence of infection, congenital anomalies, trauma, and the length of time since death in utero, may also influence how effective cooling is in slowing perinatal post-mortem changes . As such, regular assessment, honest communication, and individualised care planning remain essential throughout the use of any cooling device.
It is important that parents are fully informed about the limitations and practical considerations associated with cooling devices so that expectations can be managed sensitively and realistically. Whilst cooling may help to slow post-mortem changes, it does not stop the natural processes that occur following death, and changes in the baby’s appearance and condition will still occur over time.
Parents should also be gently prepared for the fact that their baby’s skin and body will feel cold to touch whilst using a cooling device. For some families this may be unexpected or emotionally difficult, particularly as warmth is often closely associated with comfort and life. Healthcare professionals should provide compassionate explanation and ongoing support to help families understand why cooling is being used and what they may experience during their time with their baby.
Cooling devices can play an important role within trauma-informed bereavement care by giving families additional time, choice, and control following the death of their baby. This aligns with Continuing Bonds Theory, which recognises the importance of maintaining connection and creating memories after death. Qualitative studies have shown that many parents value the opportunity to hold, care for, and spend meaningful time with their baby, helping them process the reality of the loss and create lasting memories. Healthcare professionals have also reported positive experiences, describing cooling devices as supportive in facilitating compassionate, family-centred care and reducing the pressure families may feel to say goodbye too quickly.
We conducted a review of the literature surrounding the use of cooling devices following perinatal loss in 2025, which is inlcuded below as a separate document for further reference.
Skin to Skin contact
Skin-to-skin contact can still be facilitated while using a CuddleCot, with the cooling mattress remaining in place against the baby’s back and covered with a blanket or protective layer to avoid direct contact with the parent’s skin. For many families, the opportunity to hold their baby close in this way is a profoundly important aspect of parenting, bonding, and memory-making following their baby’s death.
Healthcare professionals should sensitively explain that prolonged skin-to-skin contact may lead to some variation in temperature and could contribute to the progression of post-mortem changes. However, these discussions must remain balanced, compassionate, and centred on the needs and wishes of the family. The possibility of minor temperature fluctuation should not automatically prevent families from accessing meaningful experiences that may become deeply treasured memories.
Within trauma-informed bereavement care, the role of the HCP is not to direct how families choose to spend time with their baby, but to ensure they are fully informed, supported, and empowered to make decisions that feel right for them. When offering skin-to-skin contact as an option, we would like to reiterate that open, honest communication, informed consent, and shared decision-making should remain central to care, recognising that for many families, the emotional significance of skin-to-skin contact may outweigh the clinical implications of slight temperature variation.
Supporting Evidence: The Effect of Cooling on Post-Mortem Change
- Temperature is a pivotal factor influencing the progression of the decomposition process of a human cadaver and thus its post-mortem changes. Fluctuations in temperature and humidity have been identified as factors that greatly influence the rate of decomposition. It is anticipated that rising global temperatures and increasing humidity levels, as consequences of climate change, will result in a substantial decrease in the time required for complete skeletisation.
The observation that higher initial body temperatures result in more pronounced post-mortem changes is in agreement with prior research. Elevated temperatures promote decomposition by enhancing enzymatic activities, bacterial growth, and insect activity, thereby accelerating the progression of post-mortem changes. Conversely, lower temperatures reduce the rate of enzymes and denature and destroy the essential enteric bacteria required for the process of putrefaction.
PH value, temperature, moisture, and partial pressure of oxygen are four key variables that determine the progression of post-mortem changes. Among these, temperature is recognized as a pivotal factor in the process of decay, although the exact proportion of this component has not yet been conclusively clarified. Megyesi et al estimated the influence of temperature and elapsed time on the decomposition process at 80%, while others arrive at controversial results between 25% and 94%.’
Lanzinger, N., Verhoff, M.A., Birngruber, C.G. and Lutz, L. (2026). Factors influencing the progression of post-mortem changes between scene and autopsy. Scientific Reports. [online] doi:https://doi.org/10.1038/s41598-026-35786-x.
2. ‘A body undergoes complex and intricate changes after death. These postmortem changes depend on a diverse range of variables. Factors such as the ambient temperature, the fat content of the body or sepsis/injuries postmortem, affect the rate at which post-mortem changes occur in a cadaver.’
(Rutwik Shedge, Krishan, K., Warrier, V. and Tanuj Kanchan (2023). Postmortem Changes. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK53974)
3. ‘Decomposition rates are highly heterogenous and depend on modifying variables such as the storage temperature’
Krassner, M.M., Kauffman, J., Sowa, A., Katarzyna Cialowicz, Walsh, S., Farrell, K., Crary, J.F. and McKenzie, A. (2023). Postmortem changes in brain cell structure: a review. PubMed, [online] 4. doi: https://doi.org/10.17879/freeneuropathology-2023-4790
4. ‘Results suggest that decomposition rates may be significantly slower in cold weather regions’
Da, K. (1998). Decay rates in a cold climate region: a review of cases involving advanced decomposition from the Medical Examiner’s Office in Edmonton, Alberta. Journal of forensic sciences, [online] 43(1). Available at: https://pubmed.ncbi.nlm.nih.gov/9456526/
For more information please contact info@cuddlecot.com