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Death Studies
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Parental Grief and Memento Mori Photography:
Narrative, Meaning, Culture, and Context
a

Cybele Blood & Joanne Cacciatore

a

a

School of Social Work , Arizona State University , Phoenix , Arizona , USA
Accepted author version posted online: 25 Sep 2013.Published online: 11 Nov 2013.

To cite this article: Cybele Blood & Joanne Cacciatore (2014) Parental Grief and Memento Mori Photography: Narrative,
Meaning, Culture, and Context, Death Studies, 38:4, 224-233, DOI: 10.1080/07481187.2013.788584
To link to this article: http://dx.doi.org/10.1080/07481187.2013.788584

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Death Studies, 38: 224–233, 2014
Copyright # Taylor & Francis Group, LLC
ISSN: 0748-1187 print=1091-7683 online
DOI: 10.1080/07481187.2013.788584

Parental Grief and Memento Mori Photography:
Narrative, Meaning, Culture, and Context
Cybele Blood and Joanne Cacciatore

Downloaded by [Cybele Blood] at 08:01 01 February 2014

School of Social Work, Arizona State University, Phoenix, Arizona, USA

Postmortem photography is a widespread practice in perinatal bereavement care, yet
few studies have explored how it affects bereaved parents, or how it might be received
by parents of older children. This study is an examination of the meaning, utility, and
social context of postmortem photography in a sample of 181 bereaved parents. Data
were subjected to both quantitative and qualitative analysis. Photographs were
positively regarded by most parents after perinatal death and several parents of older
children. Other parents rejected postmortem photography for aesthetic, personal, or
cultural reasons. Brief recommendations are offered for healthcare providers.

Bereaved parents endure profoundly painful emotions, significant challenges to their worldview, and a
compromised sense of identity, with risk of negative
psychiatric outcomes (Keesee, Currier, & Neimeyer, 2008;
Lichtenthal, Currier, Neimeyer & Keesee, 2010; Wheeler,
2001). Parents facing early child loss—perinatal death—
suffer no less (Arnold, Gemma, & Cushman, 2005), yet
they face the additional burden that their baby is not
socially recognized as significant (Frøen et al., 2011).
The disenfranchised nature of grief (Doka, 1989) in
perinatal death contributes to a complicated mourning
process for many parents (Cacciatore, 2010; Cacciatore
& Bushfield, 2008; Malacrida, 1999). Dominant ideologies expressed through social, cultural, medical,
legal, religious, and economic institutions may call into
question the validity of their bereavement and the status
of their children as legitimate entities (Cacciatore &
Bushfield, 2008; Lovell, 1983; Malacrida, 1999). Many
bereaved parents resist such devaluation, insisting that
their baby and their parental identities are, in fact,
important and very ‘‘real’’ (Layne, 2000). Bereavement
photography has emerged as a means of psychosocial

Received 20 September 2012; accepted 19 March 2013.
This study is dedicated to the memory of the many children who
died too soon and their parents who mourn in their absence.
Address correspondence to Joanne Cacciatore, School of Social
Work, College of Public Programs, Arizona State University, 411 N.
Central Avenue, Phoenix, AZ 85004-0689. E-mail: joanne.cacciatore@
asu.edu

support for these parents in hospital settings (Harvey,
Snowdon, & Elbourne, 2008).
Postmortem photography, also called memento mori
photography, can be found across cultures both past
and present as an aid to bereavement adjustment
(Hilliker, 2006; Johnson, 1999; Mander & Marshall,
2003). This practice was widely accepted in the United
States during the 19th century for children of all ages
who died, then became relatively obscure (Hilliker, 2006),
and is now reappearing in perinatal death protocol (Harvey
et al., 2008). It is no longer, however, a promoted practice
in the case of older children who die. Gold, Dalton, and
Schwenk (2007) found that in the case of perinatal death,
parents were thankful to have postmortem photos of
their child and only expressed regrets if they did not.
Many parents who initially declined photographs later
changed their minds (Harvey et al., 2008).
Postmortem photography offers an unrepeatable and
possibly sole opportunity to create tangible mementos of
a baby who has died; therefore best practice is warranted.
However, protocols have been established with limited
research on efficacy (Harvey et al., 2008) and scant
mention of cultural competence (Gold et al., 2007). Overall, bereavement photography is considered an ‘‘evolving
practice’’ (Harvey et al., 2008, p. 352).
The present study explores how memento mori
photography affected a large and relatively diverse
sample of parents whose children died. We report the
lived experience of these parents, including concerns

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PARENTAL GRIEF AND PHOTOS

pertaining to cultural norms, so that parents can directly
inform appropriate, compassionate bereavement practice. Quantitative patterns in the data shed further light
on the practice or value of bereavement photography.
In keeping with a modified grounded theory
approach (Annells, 2006; Strauss & Corbin, 1998), we
hoped to derive theory from actual data. Mention of
the a priori theoretical assumptions of the current
authors is in order. The data were explored within
a broad context of primarily constructivist literature
on meaning, identity, narrative, culture, and society.
These five terms, to varying degrees, are imprecise
and used in both lay and academic settings. Especially
problematic is the term identity. The use of this term is
contested and plagued by inconsistent assumptions
(Fearon, 1999; Onuf, 2003). In lieu of a thorough examination of the philosophical assumptions underlying
every cited study, and because this is a substantive and
not a formal theory paper (Eaves, 2001), this study uses
definitions of identity as suggested by cited authors
and with a relatively simple working definition: Identity
can refer to social identity, personal identity, or both
(Fearon, 1999). Social identity can be understood as ‘‘a
social category, defined by membership rules and allegedly
characteristic attributes or expected behaviors’’ (Fearon,
1999, p. 36). Personal identity can be understood as
a set of attributes, beliefs, desires, or principles of action
that a person thinks distinguish her in socially relevant
ways and that (a) the person takes a special pride in;
(b) the person takes no special pride in, but which so
orient her behavior that she would be at a loss about
how to act and what to do without them; or (c) the
person feels she could not change even if she wanted
to. (Fearon, 1999, p. 25)

Fearon (1999) further suggested a complex interaction
between social and personal identities, and that personal
identity informs dignity, self respect, and self worth.

IDENTITY, NARRATIVE, AND RITUAL
Visual imagery helps in the creation of parental identity
when a baby has died (Riches & Dawson, 1998), and
may be especially important for fathers (Draper, 2002;
McCreight, 2004). Photographs also help establish a
social identity for the deceased child (Alexander,
2001). Photographs are props that help parents create
narratives to share with others (Fanos, Little, &
Edwards, 2009; Jones, 2002). Multiple authors claim
‘‘the centrality of narrative to ongoing identity formation’’ (Singer, 2004, p. 439). These narratives are crucial
in coping with grief, helping to reconstruct meaning and
repair existential crises (Bosticco & Thompson, 2005;
Gilbert, 2002; Lichtenthal et al., 2010; Neimeyer,

225

2005–2006). For bereaved parents, this can help achieve
a ‘‘broader acknowledgement of the meaning of [the
child’s] life’’ (Riches & Dawson, 1998, p. 124) and
‘‘construct a public, post-bereavement self’’ (p. 128).
Acknowledging and seating identity change is an
important reconstructive task in bereavement (Gillies
& Neimeyer, 2006) especially for bereaved parents
(Riches & Dawson, 1996). Accepting changes in identity
can be considered part of meaning-making (Park, 2010).
Parents who have difficulty revising parental identity
and otherwise making meaning of their loss report
grief that is more prolonged, intense, and complicated
(Keesee et al., 2008; Lichtenthal et al., 2010).
Symbolic activities help embed painful memories,
thoughts, and feelings into a narrative structure
(Cacciatore & Flint, 2012b). Ritual offers meaning,
validates loss, and mediates transition in identity during
the grief process (Castle & Phillips, 2003; Romanoff &
Terenzio, 1998). Yet, few religious or secular rituals
exist to honor children who have died at or near the
time of birth (Cacciatore & Flint, 2012b; Frøen et al.,
2011; Lovell, 1997). Postmortem photography creates
‘‘emotional artifacts’’ (Layne, 2003, p. 125) that are
imbued with symbolic meaning and often used ritualistically by bereaved individuals (Castle & Phillips, 2003).
Directly participating in postmortem photography gives
parents a reason to see and hold their dead or dying child,
which may serve as a therapeutic farewell-ritual behavior
(Cacciatore & Flint, 2012b; Harvey et al, 2008).

THE PSYCHOTHERAPEUTIC VALUE OF
BEREAVEMENT PHOTOGRAPHY
Photography can be used in various therapeutic settings
(e.g., Krauss, 1983; Weiser, 2004). Photographs invoke
the viewer’s application of internal meaning to an
external subject, creating referents that expand the
viewer’s vocabulary of personal symbolism (Krauss,
1983). Weiser (2004) suggested that photographs may,
as symbolic representations, circumvent verbally coded
defense mechanisms and allow more immediate access
to memories and feelings. In addition, photographs
provide assurance that the subject represented was
‘‘real,’’ while allowing individual interpretations of that
reality to be constructed and applied (Weiser, 2004).
Photographs of deceased loved ones function as transitional objects, simultaneously filling a void and calling
attention to it (Gibson, 2004). Photographs help integrate emotional and cognitive processes (Weiser, 2004)
and may gently help parents accept the reality of their
child’s death (Riches & Dawson, 1998). Such acceptance
signifies accommodation in meaning-making, a process
through which people adjust worldview schemas or
global meanings (e.g., children will not die before

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parents) to fit dissonant new information derived via
situationally appraised meanings (Park, 2010, p. 260).
Many parents report a powerful urge to maintain
bonds with their deceased child and keep the child’s
memory salient (Davies, 2004; Klass, 1999; Ponzetti,
1992; Riches & Dawson, 1998). Although maintaining
an ongoing relationship with a dead loved one was
viewed as pathological in the 20th century by Western
psychiatry (Davies, 2004; Klass, 1999), some immigrant
and minority cultures within the United States and
many indigenous cultures have long valued a bond
between the living and the dead (Johnson, 1999; Laurie
& Neimeyer, 2008; Shapiro, 1995). More contemporarily, grief theorists have recognized value in continuing
bonds (Davies, 2004; Exley, 2004; Klass, 1999), and
photographs can foster this sense of ongoing connection
(Johnson, 1999; Riches & Dawson, 1998).
CULTURE AND CHOICE

Hypotheses and Goals
Postmortem photography for the benefit of parents has
become a common element of hospital bereavement care
in perinatal death (Gold et al., 2007), and these parents
have had limited (or no) opportunities to photograph
their child alive. Thus, we expected that these parents
would more likely endorse bereavement photography
compared to parents of older children. We anticipated
that findings would corroborate and expand on previous
research citing the therapeutic value of bereavement
photography in parental grief. In keeping with grounded
theory, we hoped that conclusions drawn from the
data would ‘‘elaborate on . . . existing theories’’ (Eaves,
2001, p. 655) presented in previously cited constructivist
literature on meaning-making, identity, and grief in
a social environment.
Method
Participants and Procedures

Henley and Schott (2008) urged care providers not to
steer bereaved parents based on providers’ own personal
values and biases. Parents from some cultures or
religious traditions might not want or be permitted to
take photographs of their dead children. Some Native
American tribes, The Church of the Latter-Day Saints,
Old Order Amish, and orthodox Jewish traditions have
proscriptions against postmortem photography, contact
with dead bodies, or both (Chichester, 2005; Stamm &
Stamm, 1999). For example, Navajo traditional
practices dispose of the possessions of the deceased
and discourage narratives about that person (Clements
et al., 2003). In any culture, a person may simply have
a strong personal preference. Individual choice for any
reason is important and deserves respect.
CURRENT STUDY
Approach to the current study was manifold. A modified grounded theory approach (Annells, 2006; Strauss
& Corbin, 1998) was used to explore emergent themes
pertaining to ‘‘meaning’’ (as defined by parents) and
‘‘identity’’ (as defined in previous sections), analyzing
the data in an iterative process to generate theoretical
conclusions. Additional and uniquely telling textural
descriptions of participants’ experiences are offered
verbatim and presented with the intent to allow parents’
lived experiences to inform best practice in bereavement
care. Data analyses proceeded in tandem with data
collection (Eaves, 2001), and as data accrued to
a sufficient n, researchers made a post-hoc decision to
quantitatively explore data for useful patterns, despite
obvious caveats on probabilistic generalization from
a non-randomized sample.

Following Institutional Review Board approval in
late October 2011, invitations to bereaved parents were
posted on several bereavement organization websites
and social media websites and sent via group emails to
members of parental bereavement organizations. The
invitation stated the study was voluntary with no
compensation, focused on the topic of bereavement
photography, and open to all adult parents who lost
children whether or not they had participated in
bereavement photography. The call for participants
was spread primarily in the United States though
parents from other countries were not barred from
responding. Interested parents were directed to an online
survey hosting site. Responses were gathered from
a 15-min survey consisting of demographic information
and mostly open-ended questions regarding their
experiences with postmortem photography. Recruitment
materials and survey questions were carefully phrased to
encourage the contributions of parents all ages, as well
as those who had chosen not to participate in this type
of photography. Participants were not directly questioned
as to their motivation for study participation. Data were
collected until April 2012.
The survey garnered 191 nonduplicate responses
classified as ‘‘complete’’ (subjects had pressed the ‘‘submit’’ button on the survey website). Twenty-four parents
chose not to answer any demographic questions but
otherwise completed the survey, meeting criteria for
inclusion. One case was excluded for lack of answers
to almost all core questions including age of child at
death and questions about photography. Eleven
participants reported pregnancy loss (prior to 20 weeks
gestational age). We respectfully acknowledge that many
parents facing pregnancy loss in the first or early second

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PARENTAL GRIEF AND PHOTOS

trimester feel they lost a baby and suffer psychological
sequelae (Côté-Arsenault & Dombeck, 2001); however,
15 weeks gestational age is the earliest we found
mentioned in literature on bereavement photography
(Jones, 2002) and was therefore adopted as a minimum
age for inclusion in the current study. Five cases of
earlier pregnancy loss were excluded. Four cases were
excluded due to respondents’ identification as grandparents of deceased children. Although grandparental grief
is substantial, under-recognized, and under-researched,
it commonly includes features that are not identical to
parental grief (Ponzetti & Johnson, 1991). Thus, 181
cases comprised the final data set.
Of 158 participants who indicated their sex, 96%
were female and 4% male. Age of participants
(n ¼ 158) ranged from 21 to 74, with the mean age
38.5. Participants (n ¼ 157) lived in rural areas (11.5%),
small towns (19.8%), or major urban centers (68.8%),
and were non-Hispanic White (85.3%), African
American or Black (2.6%), Latino or Hispanic (5.8%),
Native American (2.6%), and Asian (3.9%). Of parents
reporting their religious or spiritual identities (n ¼ 150),
72% identified as a Christian variant. Others reported
no religion, indigenous religion, paganism, Judaism,
agnosticism, or a general spirituality. More than onefifth of participants (22.2%, n ¼ 158) reported having
no surviving children, and 5.1% were pregnant or had
a pregnant partner at the time of the study. The year
of children’s deaths ranged from 1958 to 2012
(n ¼ 179) with 25% of parents losing their child in 2011
or 2012, 50% of parents losing their child since 2008,
and 75% losing their child since 2005.
Qualitative Data Analysis
Data were coded anonymously; respondents were
identifiable only by computer-generated codes. Data were
initially assessed by identifying significant statements and
themes which were then organized into ‘‘clusters of meaning’’ (Creswell, 2006, p. 61). This process is similar to the
open coding and axial coding of grounded theory
(Strauss & Corbin, 1998). Within each parent’s response,
a duplicate in the initial meaning units (Lichtenthal
et al., 2010; Talbot, 1997–1998) was only counted once
for coding purposes. This allowed more accurate weighting of responses amongst parents with different writing
styles. Throughout data analysis, a constant comparison
process was used (Glaser, 1965) that examined overlap
and uniqueness amongst parents’ statements and each
statement’s relationship to emerging themes.

227

into various groupings for purpose of quantitative
analysis. Definitions were drawn from national and
international guidelines described by Barfield and
Committee on Fetus and Newborn (2011). Initial groupings were late miscarriage or stillbirth with fetal age
unspecified (n ¼ 36); perinatal death (27 weeks
gestation–6 days of age, n ¼ 87); neonatal death (7–27
days, n ¼ 15); postneonatal infant death (28–364 days,
n ¼ 13); child death (1–17 years, n ¼ 12); and adult child
death (18þ years, n ¼ 18). Data were accreted to create
sufficient cell count into the following three broader
categories: (a) late miscarriage (15–20 gestational
weeks), stillbirth, and perinatal death; (b) neonatal
and postneonatal infant death; and (c) child or ‘‘adult
child’’ death. This allowed testing of the hypothesis that
the more time the child had alive, the less likely parents
would be to have taken postmortem pictures or to
have had postmortem pictures taken.
Results
Quantitative Results
Chi-square analysis of the three accreted age
categories described above confirmed that the younger
the child at death, the more likely their parents were to
have taken pictures or had pictures taken postmortem,
v2 (2, N ¼ 181) ¼ 67.91, p < .001. Post-hoc comparison
revealed that the three groups were each significantly
different at p < .001.
Of the 41 parents (22.65%) who did not take pictures,
14 parents (34.1%) were not content or had mixed feelings about that outcome. Cross-tabulated data from
parents who did not take pictures reveal that only one
parent of nine (11.1%) experiencing late miscarriage or
stillbirth=perinatal death was content not having postmortem photographs (the gestational age of this child
was unreported); six of the nine parents (66.6%) of
neonatal=postneonatal infants were content not having
postmortem photographs; and 20 of 23 parents (87%)
of children from 1 year of age into adulthood were
content without such photographs. The table was too
sparse to gain robust results with multivariate analysis
but data were promising, suggesting significant results
between the first group (parents of late miscarriage
and stillbirth=perinatal death) and the other two groupings, at p < .001. There appears to be greater discontent
at not having postmortem photographs for parents of
children who were younger at the time of death.
Qualitative Results

Quantitative Data Analysis
Despite the nonprobability nature of the sample, statistical analysis was used to find patterns in the data. The
ages of the children at time of death were categorized

The question of meaning. In Survey Question 10, 113
parents who possessed photographs taken at or after
the time of their child’s death answered ‘‘what this
photograph means or has meant to you, or what these

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photographs mean or have meant to you?’’ Analysis of
their text answers produced 158 distinct and pertinent
meaning units. These ranged from one word to several
sentences long. Thirty-seven distinct meaning clusters
were found amongst these meaning units which were
in turn found to accrete organically into three broad,
higher-order categories: (a) Parents discussed real or
potential functions of the photos in their lives; (b) they
made direct statements of feelings (or otherwise abstract
statements) about the photos; and (c) they discussed
the circumstances around the taking or viewing of the
pictures or spoke of the circumstances around their
child’s death. These three categories were labeled
function, feelings, and circumstance.

Function of photographs. Mentions of the function of
bereavement photographs, the most frequently coded
of the three higher-level response categories, were found
in 173 instances in statements by parents. These statements clustered into 17 meaning themes. The matter of
parental and child identity was addressed by several
response categories. The most frequently coded comment category addressed the value of photographs in
helping parents identify their child as real and share that
reality with others, in opposition to stated or implicit
invalidation of either the child’s existence or the legitimacy of their grief (n ¼ 51): ‘‘People . . . think of our grief
as this weird, abstract loss, and seeing photos makes it
more real,’’ ‘‘The pictures will also help my older daughter and future children know who [she] was, and maybe
someday understand why she is so important to us,’’
‘‘It is so important to me that others recognize him as
our baby . . . it has helped others provide support and love
because they better understand the magnitude of our
loss,’’ and ‘‘These pictures represent that even though he
never took a breath, he was and still is my baby. Here’s
the proof!’’ Several parents said photographs provided
their only record of the child: ‘‘I [was] not issued any form
of a birth certificate because he was not born breathing.
These photos . . . are all I have of my son.’’
Another frequently expressed meaning theme, with
49 coded statements, pertained simply to the role of
photographs in preserving and stimulating memory.
Seven parents specifically said the pictures were the
‘‘only memory’’ or the ‘‘only lasting’’ or ‘‘only tangible’’
memory they had of their child. Many expressed
concern that without the pictures they would have inaccurate memories or no memory at all: ‘‘I was . . . in such
as state of shock that I would not remember what my
daughter looked like if it wasn’t for those pictures.’’
A variety of answers referred to the photos as helpful
to the grieving process: ‘‘help me move forward’’ or
‘‘bring comfort.’’ One parent poetically stated that
‘‘acknowledging and sharing’’ with pictures brought

‘‘dignity to grief.’’ Six parents said the pictures helped
them memorialize or honor their child. Parents additionally stated that pictures helped ‘‘remember that
empty part of my heart was once filled with love,’’
‘‘bring back memory of pride and adoration,’’ and
‘‘bring a surge of love.’’ Seven parents expressed that
photos are a way to be with the child: ‘‘a piece of him
to hold,’’ ‘‘to keep him in our hearts and lives.’’

Feelings about photographs. Parents spoke directly of
their immediate feelings about photographs or made
other abstract statements about meaning in 141 instances,
creating the second broad, higher-order category found
in the data. There were 12 distinct thematic subcategories.
The most common theme, expressed in two identical
phrases by many parents (n ¼ 31), was that the pictures
meant ‘‘everything’’ or ‘‘the world.’’ In addition, 19
parents expressed gratitude, appreciation, or thankfulness
for having the pictures. Thirteen parents described the
pictures as priceless, invaluable, irreplaceable, or very
important; 19 as beautiful, cherished, or precious.
Nineteen parents expressed the desire for more or
different pictures: ‘‘I . . . yearn that I had more’’ and
‘‘Wish I had some pictures with my husband holding
him.’’ Three parents expressed strong fear of losing
their pictures. Five said they would be heartbroken
without their pictures or could not imagine not having
them. Four parents said the photographs are ‘‘painful’’
or ‘‘hard to look at’’ but they still appreciate having
them, whereas one reported ‘‘mixed feelings’’ and
wishes she did not have them. One parent creatively
expressed ambiguous feelings: ‘‘Mix of sorrow and
sense, art, mystery to pics.’’ A number of parents
reported mixed feelings or changing feelings over time.
Eleven parents who reported initial negative feelings
about postmortem photographs (‘‘morbid,’’ ‘‘repulsed,’’
or ‘‘resistant’’) emphasized their shift in attitude. All
reported current feelings of thankfulness and gratitude
to have the pictures.
Circumstance surrounding photographs. The third
broad category that emerged included answers that
discussed context, past or present, in which the pictures
were taken or are now used. For many parents, narrating a context was more pertinent to a discussion of
meaning than sharing abstract feelings or describing
the functions of the pictures. This category, labeled
circumstance, contained 141 coded responses that
accreted into 17 distinct thematic meaning clusters.
The most frequent theme was a statement of confusion,
shock, being unwell, ‘‘drugged,’’ or otherwise physically
or mentally incapacitated when decisions needed to be
made about photographs (n ¼ 19). In a similar theme,

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PARENTAL GRIEF AND PHOTOS

11 parents mentioned how quickly events transpired on
the day of their child’s death, how little time they got to
spend with their child, or how unprepared they were for
the events that unfolded. Two parents mentioned that
they would have never thought of taking pictures and
two said they did not have a camera. Four parents
expressed gratitude for hospital protocol that encouraged bereavement photography: ‘‘I’m so glad this
service was offered . . . . I didn’t know that I was going
to lose the baby . . . I was not prepared’’ and ‘‘I am so
grateful I delivered at a hospital with a very progressive
perinatal loss program.’’ Eleven parents mentioned
the use of either paid or volunteer professional photographers. Several parents commented negatively on the
timing or quality of those pictures taken by nurses or
with disposable cameras: ‘‘His skin color had begun to
change . . . wish we had the option to have a professional
there [and take pictures earlier].’’
As discovered in the ‘‘feelings’’ category, several
parents described a contextual process in which their
relationship to the photos had changed or was changing:
‘‘At first I was repulsed by them and never wanted to see
them again. About six weeks later I chose one to put in
the frame . . . It used to make me so sad and I would
cry . . . Now, I smile and say hello to her in my head every
time I see it . . . I’m seven months out.’’ One parent said
that the postmortem photographs of her child meant so
much to her that she abandoned her law career to pursue
a new career as a professional bereavement photographer.
The issue of consent arose in replies by 10 parents
and proved complex. One reply was from a parent
who did not want postmortem pictures for cultural
reasons:
[In Aniishnabe beliefs] It’s not okay to photograph the
dead—it is said to be bad for myself to have those
photos and bad for the baby’s spirit . . . The photos were
taken without my permission first. I would have declined
the offer. But now that I have them, I have always felt
conflicted about keeping them.

Another parent described a very different experience
with consent: ‘‘Initially I did not want any taken . . . but
the hospital called [the professional photographer]
anyway, and I am forever grateful that they did.’’ Eight
parents reported somebody else encouraged them to
take or allow the pictures though they were initially
resistant: ‘‘I didn’t think I’d want them but my doc
encouraged me to take them. She was so right’’ and
‘‘I was reluctant, but the perinatal counselor suggested
it and I am so thankful I listened.’’ The following parent
spoke on this at some length: ‘‘I was against the photos
being taken . . . when asked by the nurses. My mom
convinced me . . . I couldn’t imagine not having them
now. I would be more heartbroken.’’

229

Bereavement Photography With Older Children
and Adults
Of 30 parents whose children died anytime beyond
infancy (>1 year of age), seven reported having postmortem photographs. Two greatly valued their pictures
of the funeral services for making their child’s death real
and providing a tribute to share with others. Two
parents did not explain their pictures; one more said
she did not look at the pictures; and two elaborated
on why their postmortem pictures were valuable: ‘‘I’m
glad I have them. They will eventually go in a ‘sad
memory’ book . . . of all the painful memories surrounding his death and the aftermath’’ (child died at 19
months), and ‘‘Of course I would want those moments
to be preserved. His life is preserved by many, many
photos so his death should be too . . . . Sometimes the
photos make me cry . . . that is part of grieving and adds
to my healing process’’ (child died at 21 years).
Two parents who did not have postmortem pictures
of their older child wished they had: ‘‘In hindsight,
I think I might have wanted to take some photos, but
I didn’t even think of it during that most stressful time’’
(child died at 26 years), and ‘‘I honestly wish I had
a photo of him today to have forever. I . . . [thought] . . .
the morticians would have taken the picture and had it
on file in the event that I would want it at a later date’’
(child died at 14 years).
Parents Who Did Not Want Photographs of Their
Children at Death
Of the 27 parents in the study who were content not
having postmortem photographs, 22 described either
a violent cause of death or circumstances that disfigured
the child’s body. Some parents elaborated, ‘‘She flew
through a windshield and hit a pole, she was all cut
up. I would not want to have a picture of that’’ and
‘‘He was dead for three days before he was found, and
so we did not even have an open casket.’’
Seven parents stated that the only photographs they
wanted were of their children alive. Several parents’
answers overtly stated that the photographic identity
and the remembered identity were too discrepant: ‘‘It
did not even look like him,’’ ‘‘The pictures made him
look cold and alone . . . We didn’t want to remember
him that way,’’ and ‘‘I said no [to photos at
funeral] . . . The way he looked in his coffin was surreal
and not a true reflection of who he was.’’
Four parents who did not want postmortem photos
described being upset or disturbed by photographs
taken without their permission: ‘‘It was very frustrating
to feel like all these wheels were turning and that I had
no say.’’ For one parent, the thought of preserving
a memento of her child’s death was simply abhorrent:

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‘‘It is unimaginable, why would I want to remember the
most horrific day of my life?’’

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Diversity and Bereavement Photography
Ethnicity was not reported by 25 of 181 study respondents (13.8%). The data frequency table emerged too
sparse for meaningful statistical analysis or percentage
comparisons. Nonetheless, useful data emerged given
the dearth of previous literature on the influence of
ethnicity and culture on bereavement photography.
Amongst White or Caucasian respondents, 35 of 133
did not take memento mori photographs or have them
taken. Ten of these 35 regretted not having such
photographs. One of seven parents identifying as Latino=
Hispanic and one of seven identifying as Asian or
Pacific Islander did not take postmortem pictures; both
expressed a wish for them. One of four African American
parents did not want postmortem pictures due to disfiguration. Parents who did have pictures in the above groups
expressed primarily positive sentiments, as discussed in
previous subsections.
The three parents who identified as LDS or Church
of Jesus Christ of Latter-Day Saints members
(Mormon) endorsed memento mori photography and
had taken pictures of their children when they died.
Three of the four respondents who as identified as
Jewish took and appreciated pictures; the other reported
discoloration due to a medical condition as a reason
against photographs. Native American parents expressed
mixed opinions, with two of four endorsing memento
mori photography. One parent, whose baby died shortly
after birth and whose religion and=or spirituality was
identified as ‘‘indigenous ceremony,’’ kept several dozen
pictures and values them greatly: ‘‘They are a way to
memorialize my son. They are a way to share him. To
be with him and honor him since I cannot do so
physically. To help grieve.’’ Another Native American
parent, whose baby died in the neonatal period and
who identified her religion=spirituality with only the word
complicated, did not have pictures of her baby but felt
positive about postmortem photographs: ‘‘I did not even
know that it was a possibility and would have as I have so
few pictures of my daughter.’’
In contrast, two Native American-identified parents
expressed that postmortem photographs were disturbing. One explained, ‘‘It is against our traditional beliefs
and I personally feel that it is morbid. We are Dine
(Navajo).’’ The other parent had photographs taken
but did not want them:
The photos were taken without my permission . . . . it was
meant in a good way, but due to the fact that my baby
was Native American, I viewed it as culturally insensitive
to assume that I would want that . . . She had been
whisked away and was being washed (a ceremony my

‘‘aunties’’ were supposed to perform), dressed (she was
to be wrapped only in rabbit skin), and photographed.
A triple insult to those traditions.

DISCUSSION
Parents who endured perinatal death were more likely to
have postmortem photographs than parents of older
children who died. They were also more likely to express
regrets if they did not have pictures. Three explanations
emerged repeatedly in the data, the first two of which
were hypothesized: (a) the importance of capturing an
image of a child for whom life course photographs
would never happen; (b) many hospitals continue to
encourage bereavement photography in cases of perinatal death; and (c) a higher proportion of older children
or adult children had violent or disfiguring deaths, often
cited as the reasons parents declined photographs. Still,
several of these parents reported wishing they had such
photographs.
Qualitative content analysis reveals that pictures can
contribute to psychological wellness, ritualizing behaviors, personal and social narrative processes, and the
generation of meaning. This was seen directly in themes
expressed by many respondents (e.g., used as a tribute or
to honor; used as indication of a change over time; used
as a trigger to access emotions; used to create family
bonding; triggered a change in career path). Meaning
can also be meta-textually derived from parents’ during
study use of their photographs as a prompt and vehicle
for narrative construction: 57.1% (n ¼ 112) of parents
included narrative about past or present circumstance
in answer to the survey item asking specifically and only
about their understanding of the meaning of the
photographs. The data suggest that future application
of discourse analysis (e.g., Nikander, 2008) would be
warranted to explore additional meta-textual properties
of parents’ answers to this question of meaning.
From the data emerges an apparent irreducible
intermingling of internal attribution and external
context. The photographs are a record of the physical
existence of the child, a specific time in the parent’s life,
and the biopsychosocial context in the wake of the
child’s death as understood by the parent. Such contextualizing and the narrative-making that ensues can be
a powerful healing catalyst (Bosticco & Thompson,
2005; Neimeyer, 2005–2006). A number of parents
suggested what one parent overtly expressed: ‘‘Pictures
can help such a horrible experience become treasured
moments.’’ Bereavement photographs seem to offer far
more than just a visual memory.
Postmortem photography was crucial for many
parents in establishing and sharing the identity of their
child and their own parenthood. Occupying a liminal
social status (Hockey & Draper, 2005) uncomfortably

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PARENTAL GRIEF AND PHOTOS

outside the control of medical professionals (DavisFloyd, 1990), the child who dies perinatally is deidentified socially (Cacciatore, 2010; Cacciatore &
Bushfield, 2008; Lovell, 1983), leaving the parents to
reconstruct that identity. And if, as Fisher (2008) noted,
disabled children are accorded ‘‘deficient identities’’ (p.
583), then what are dead children, at any age, accorded?
Postmortem photography was found to be an aid to
parents in adjusting to the magnitude of their loss and
clarifying their ongoing identity as parents. Data also
indicate that others’ acceptance and legitimization of
their parental grief were important to mourning. Riches
and Dawson (1998) also found photographs important
as ‘‘concrete evidence’’ that could ‘‘confirm . . . the
parental relationship’’ (p. 127)—especially important
for parents without living children and those who
experienced the death of a newborn.
The fairly high number of participants in this study
(n ¼ 181) and the fact that they were recruited from
different sources provided numerous exceptions to
general trends. Several parents of older children took
or wanted postmortem pictures while several parents
of babies did not want them. Mixed findings from
Native American-identified respondents exemplify the
fact that each case is individual and must be treated
as such. There is no single, evidenced prescription
for bereavement care after child death. Rather the
needs of each individual family must be considered
(Cacciatore & Flint, 2012a; Limbo & Kobler, 2010).
For several parents, postmortem photography was not
helpful and their negative experiences are instructive.
There were several disappointing experiences with photographers (e.g., ‘‘Chose the [four] she liked the best and
deleted the rest’’); several reports of provider discomfort
with postmortem photography (e.g., ‘‘Obvious discomfort of the nurse who snapped the photo’’); and
several reports of provider insensitivity or overt dismissal
of parents’ wishes. These data are a reminder that photographs are symbols of meaning on multiple levels, affirming the importance of appropriately sensitive protocol in
infant and child death.
Still, the great majority of parents who had postmortem photographs after the death of a baby expressed
a great deal of appreciation for them, and many parents
who did not have postmortem photographs expressed
regret. These findings are consistent with existing literature (Gold et al., 2007). Many parents also expressed
regret at not having more photos, better photos, or
different photos. Some parents expressed the complex
nature of feelings evoked by postmortem photographs:
‘‘The photographs are viewed not just with sadness for
what has gone, but also with love, pride and joy.’’ One
parent was unequivocal: ‘‘Thank you!! to the past
research that has gone into photos and holding and
taking care of babies during and after death. This has

231

changed practice and I will forever be thankful to have
photos of my baby!’’
Recommendations for Practice
This study demonstrated that the behaviors of healthcare
providers are related to parents’ attribution of meaning
when they considered photographs of their dead child.
Several authors have reviewed bereaved parents’ overall
experiences with providers and made recommendations
for standards of compassionate care (Cacciatore & Flint,
2012a; Einaudi et al., 2010; Gold et al., 2007; Henley &
Schott, 2008). ‘‘Less emphasis should be placed on . . .
standardization . . . focus should be on relational caregiving that underscores the uniqueness of each patient and
their family, recognizes culture, and encourages affirmative, rather than traumatizing, provider reactions . . .
based on authentic, mutual relationships’’ (Cacciatore,
2010, p. 694). Practice guidelines suggested by the
Pregnancy Loss and Infant Death Alliance (PLIDA,
2008) recommend sensitivity to the unique needs of each
bereaved parent. A recent international collaborative
statement by 18 organizations in infant death calls
for parental consent in the creation of any bereavement
mementos (Warland et al., 2011). Osborne (2000) pointed
out taking pictures or creating other mementos without
consent could be considered negligence.
It is crucial that respect for the various wishes of
parents be built into standards of care, and it is up to
individual practitioners to live up to this ethical mandate
with a mindful and humble presence (Cacciatore &
Flint, 2012a). Promoting postmortem photography
in a manner that will help parents surpass an inhibitory
context of stigma requires sensitivity, awareness, and
clinical wisdom.
Study Limitations
Despite a fairly large sample size and a number of rich
responses offered by fathers and parents with diverse
ethnic identification, the majority of respondents were
White females. This limits quantitative exploration of
data by gender or ethnicity and the generalizability of
findings to all populations. Also limiting generalizability
is the fact that this study utilized a volunteer,
convenience sample and was a non-probability sample.
Other data limitations include that some parents
did not note their child’s gestational age but referred
to ‘‘stillbirth’’ as the age of death; this limited opportunities for quantitative analysis. An online, self-report
questionnaire may have limited narrative expression of
thoughts and feelings for those respondents preferring
in-depth interviews. The above points notwithstanding,
the present study adds a rich body of data to the
scientific literature; communicates bereavement care needs

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C. BLOOD AND J. CACCIATORE

expressed by affected parents; and enhances understanding of the meaning, process, and impact of postmortem
bereavement photography.

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