The Orange Grove: A stillborn baby still is born

It runs counter to our experience and intuitions about the way things should be: the ending before the beginning; death before life; sorrow instead of joy; silence instead of laughter; a funeral instead of a christening.

Stillbirth, the death of a baby from the 20th week of pregnancy up until full term, is surely one of life's bitterest disappointments. But it is not one of life's rarest. Stillbirth occurs in about one of every 114 births, around 30,000 per year in the United States, and 3,300 in California.

Usually, such personal tragedies are beyond the purpose and purview of public policy, and there is nothing the law can do to assuage the suffering of the bereaved. But not always.

For example, California some years ago amended state law to allow the relatives of homicide victims to give victim impact statements at the killer's sentencing. Not only have these statements proven cathartic for the victims' families, they have also given the courts and the public a more humanely accurate and comprehensive understanding of the gravity of what has taken place.

Legislation that can serve a similar purpose regarding stillbirth is currently wending its way through the California Legislature. Conceived by an Arizona-based group called MISS (Mothers in Sympathy and Support), the "MISSing Angels Bill (Senate Bill 850)" sponsored by State Sen. Abel Maldonado, R-Santa Maria, allows for the elective issuance of a "Certificate of Birth Resulting in Stillbirth" (CBRS) for all stillborn babies. Similar bills have passed in 17 states, including Arizona, as well as five other countries.

Currently in California, the parents of a stillborn baby receive only a "certificate of fetal death," along with notification that state law requires them to arrange for their baby's burial or cremation. The CBRS, issued at parents' request, at their sole expense and in addition to the state-mandated certificate of fetal death, brings potential consistency to the law. As of now, if a baby born at, say 19 weeks, breathes but then dies, he or she is issued a birth certificate and is counted in official infant mortality rates. Yet, a 40-week, full-term baby who dies during birth results only in the issuance of a certificate of fetal death and is not counted in official infant mortality statistics.

This is both a bureaucratic contradiction and biological nonsense, and the result is an inaccurate picture of fetal and infant mortality, as well as, perhaps, obstetrical challenges.

A CBRS resolves such contradictions, and will help standardize statistics regarding stillbirth, allowing for a systematic analysis of similar cases, documented causes, and various circumstances, thereby aiding research efforts into understanding and prevention. And these efforts are much needed, since in nearly half of all stillbirths no definitive cause is ever medically established, an ambiguity that compounds the parents' sense of helplessness and confusion. The CBRS will also bring needed publicity to stillbirth, which, because of the horror that the very idea brings, is a seldom-discussed matter. Thus, most people don't know that stillbirth takes the lives of more infants than SIDS and all other causes combined.

A final virtue to the CBRS is that it affirms legally for women what they have traumatically experienced: the birth of a baby who was dead. From the permanent changes to her body from a full-term pregnancy, to her bitter memory of labor pains knowing only death awaits, to the breast milk her body will still produce – not to mention every awkward personal and social encounter the months to come will bring – every mother of a stillborn baby knows she has been a mother.

Orange County resident Kirsten Pert suffered the sudden stillbirth of her full-term daughter, Emma, last year. She's one of several Southern California women lobbying legislators for passage of this bill. "Losing my baby seemed like a surreal nightmare," she said, "But as I came to grips with the reality of what had happened, I realized that the law is looking the other way, just like so many well-meaning people I meet who know I lost my baby but don't really know what to say, so they just seem to shrug their shoulders. I think public policy should do better than that."

The option of a Certificate of Birth Resulting in Stillbirth is a psychologically humane, medically reasonable and epidemiologically purposeful first step toward facing the tragedy of stillbirth.