Law brings healing to families of stillborns

Although one twin was stillborn, Leah Mohr didn't see her delivery as one birth and one death.

The state did, however.

Mohr and her husband, Steve, received a birth certificate for their daughter, Claire Olivia. For Anna Sydney, who was stillborn, the Mohrs were told they could receive a copy of a fetal death certificate instead. It was a jarring blow to the already grieving family.

"I don't need a death certificate; I know my daughter died. But she had a birth," Mohr said.

In July, that will change. The Mohrs and other families of stillborn infants born since 1950 in South Dakota will have the option of receiving a "certificate of birth resulting in stillbirth" by applying at their county's Register of Deeds office.

This year, South Dakota became the 16th state to pass a so-called "missing angels" bill. Eight other states have similar bills pending.

South Dakota's law is retroactive, so stillborn infants born from 1950 - when the state began keeping fetal death records - to today are eligible for the optional certificates.

The effort to bring the legislation to Pierre was spearheaded by Sharon Apa of Rapid City, the grandmother of a stillborn baby.

The law passed easily here, but similar bills have faced controversy in other states from groups who worry about unintended consequences.

"My only concern is, in our desire to help families grieve by recording their loss, that we don't permit it to be used in a manner in which it was never intended," said Kim Gandy, president of the Washington, D.C.-based National Organization for Women.

38 a year in South Dakota

A stillbirth is the birth of a baby that's not alive after 20 weeks. Before the 20-week mark - about halfway through an average pregnancy - it's called a miscarriage.

Stillbirths aren't common, but they happen more than people realize, said Dr. Naomi Wahl, a Sioux Falls maternal-fetal medicine specialist. About six in every 1,000 pregnancies end in stillbirth, and many late-term stillbirths are unexplained. South Dakota averages about 38 stillbirths per year.

Sometimes "we never really can find a cause for it," Wahl said.

That was the case for the Mohr family. Leah Mohr had a normal pregnancy and underwent an emergency Caesarian section when her labor stretched too long.

When the babies - the couple's first children - were born on a Sunday morning in August 1999, Claire was breathing, but Anna was not.

"They took her aside right away," Leah Mohr said.

While the Pierre family was dealing with the loss of Anna, Claire was flown to a Sioux Falls intensive care unit to treat lung problems. Steve Mohr went with Claire, and Leah stayed in Pierre to recover from surgery.

The Mohrs brought Claire home a week later. While the family was happy to be home, it was difficult to face a house that had been set up for twins. Two cribs, two car seats, two sets of baby clothes. And there was a funeral to plan.

"It's hard," Leah Mohr said. "We got to come home with a baby; a lot of people don't get to come home with a baby.

"But at the same time, we didn't come home with a baby."

Important aspect of healing

Apa sees the stillbirth law as another step in her grieving process. Her granddaughter, Andie Jane, was stillborn at a Michigan hospital Dec. 26, 2005.

Apa was inspired by efforts in other states, including Arizona, the first state to approve certificates of birth resulting in stillbirth.

"I think it brings some healing and recognition that their babies do matter," Apa said. "The birth of a baby is a huge event, even if the outcome isn't what we expected or hoped for."

The certificates could be an important part of healing for parents of stillborns born recently and in the past, said Donna Gaspar, a registered nurse and certified bereavement facilitator at Sanford USD Medical Center.

Openly recognizing stillbirths through memorials and certificates is a concept that's taken hold during the past 20 years, Gaspar said.

In the "old days," women often didn't get to see their stillborn babies because it was thought better to forget the birth had ever taken place, she said.

"I know that physicians actually would tell their patients that it was bad for them to see the baby or hold the baby, that it was best just to move on," Gaspar said.

While not everyone grieves the same way over a lost baby, it's not an event easily forgotten, she said.

"I bet most parents who have experienced a loss are carrying around a momento of that," Gaspar said.

Apa said she recently discovered that her deceased grandmother once had a stillborn boy whom she never got to see or hold.

"They used to tell the dads to go home and get her pregnant again so she doesn't have to think about it," Apa said.

Those who care for pregnant women largely have a different view today, even though stillbirth remains a difficult topic to discuss.

"When someone close to us loses a baby, especially during our child-bearing years, it's a reminder of how vulnerable (we) really are," Gaspar said.

Mohr said her family's network of friends and family were supportive and sympathetic. But there were some people who just didn't know what to say or inadvertently said the wrong thing.

"We had someone say to us, "Oh, that happens,' " Mohr said, her voice rising. "I wanted to say, 'Oh, it does? That happens? Because we didn't know that.'

"But that's just what came out of her mouth."

Abortion-rights backers wary

The stillbirths bill passed easily through the Legislature to Rounds' desk. He signed the bill last month.

"There is no harm in the issuance of a birth certificate to the grieving parents of a stillborn child," Rounds said in an e-mail. "The recognition that this is the loss of a human life may offer some solace to the parents in their time of mourning."

But the South Dakota law as well as similar ones in other states concern some abortion-rights advocates who fear the legislation could lend support to abortion opponents.

They worry recognizing stillbirths through official certificates is a step toward giving fetuses constitutional "personhood" independent of pregnant women. That personhood, a major tenet of the anti-abortion movement, has not been defined as such by the Supreme Court.

"It comes down to the underlying issue of trying to have states consider a fetus to be a human being from the moment of conception," said Jennifer Ring, executive director of the American Civil Liberties Union of the Dakotas.

Apa said she took "bits and pieces" from other states in crafting South Dakota's bill and kept these concerns in mind. The legislation includes a provision stating that nothing in the bill can be used to determine when life begins. Another provision says the bill may not influence existing abortion laws.

"I did a lot of research on other states that had (similar laws) and to see what they said," Apa said. "We didn't want to run into problems with the whole pro-choice/pro-life debate."

New Mexico Gov. Bill Richardson sees potential confusion and and misuse in certificates for births resulting in stillbirth. This month, he vetoed a stillbirths bill similar to South Dakota's.

"Having two documents for a single event can lead to confusion and potential fraud, and is not sound policy," Richardson said in his veto statement.

South Dakota certificates, which will be available for $10 each from county register of deeds offices, are to have distinctive markings to show they are not live birth certificates that can be used to obtain Social Security numbers.

Memories matter

Such controversy is largely irrelevant for the Mohrs, who plan to get a certificate for Anna in July. It'll be another step in the family's grieving process.

When the twins were born, a group of friends gave the family a black ash sapling that they planted in Anna's honor in a spot between their home and their church. The Mohrs have watched it grow into a thriving tree.

"I don't know if those folks had any idea the impact that had," Leah Mohr said.

The family makes special efforts to remember Anna on the girls' birthdays and the holidays. "We talk about Anna being in heaven, and we visit the cemetery a lot," Leah Mohr said.

When the certificate is in their hands, maybe the Mohrs will take a walk to the tree, or visit Anna's gravestone and talk to Claire and their other two daughters, Natalie and Sarah, about their sister.

Or maybe they'll all read a children's book that Leah once checked out from the library, a book that opened up fresh wounds but also helped them heal.

"Oh my baby, little one," the book begins. "The hardest thing I do is hold you tight, then let you go, and walk away from you."

Reach Megan Myers at 331-2257.