A Move for Birth Certificates for Stillborn Babies

Sari Edber of Los Angeles is compiling a scrapbook of her pregnancy with her son Jacob, who was stillborn. She has joined other parents in lobbying for a law to give parents a birth certificate for stillborn infants.

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By TAMAR LEWIN
Published: May 22, 2007

Last summer, three weeks before her due date, Sari Edber delivered a stillborn son, Jacob. “He was 5 pounds and 19 inches, absolutely beautiful, with my olive complexion, my husband’s curly hair, long fingers and toes, chubby cheeks and a perfect button nose,” she said.

The sudden shift from what she called “a perfectly wonderful healthy pregnancy” to delivering a dead infant was unfathomably painful, said Ms. Edber, 27, who lives in Los Angeles with her husband, Daniel.

“The experience of giving birth and death at the exact same time is something you don’t understand unless you’ve gone through it,” Ms. Edber said. “The day before I was released from the hospital, the doctor came in with the paperwork for a fetal death certificate, and said, ‘I’m sorry, but this is the only document you’ll receive.’ In my heart, it didn’t make sense. I was in labor. I pushed, I had stitches, my breast milk came in, just like any other mother. And we deserved more than a death certificate.”

So Ms. Edber joined with others who had experienced stillbirth to push California legislators to pass a bill allowing parents to receive a certificate of birth resulting in stillbirth.

In the last six years, 19 states, including New Jersey, have enacted laws allowing parents who have had stillbirths to get such certificates. Similar legislation is under consideration in several more, among them New York. More than 25,000 pregnancies a year end in stillbirth, generally defined as a naturally occurring, unintentional intrauterine death after more than 20 weeks of gestation. A cause for the death is usually not determined.

To thousands of parents who have experienced stillbirth, getting a birth certificate is passionately important, albeit symbolic.

“It’s dignity and validation,” said Joanne Cacciatore, an Arizona woman who started the movement after her daughter, Cheyenne, was stillborn 13 years ago. “It’s the same reason why we want things like marriage licenses and baptismal certificates.”

But politically, the birth-certificate laws, often referred to as “Missing Angels” bills, occupy uncertain territory, skirting the abortion debate while implicitly raising the question of fetal personhood.

Many antiabortion groups say the laws fill a need for parents. But some abortion rights supporters see the push for these laws as a barely disguised political move to undermine abortion rights.

In some states, local chapters of abortion rights groups have opposed the legislation. But at the national level, some abortion rights groups are comfortable with the laws, if they are drafted carefully to cover naturally occurring fetal death and not late-term abortion.

“At a level of great abstraction, there are probably some people who worry that recognizing a nonviable fetus as a person would in some way be a seed that could sprout into a threat to abortion,” said Roger Evans, a lawyer for the Planned Parenthood Federation of America. “But I don’t think we see it that way. We recognize the tragedy and loss of stillbirth, and as long as these laws are medically accurate, and the certificates are optional and commemorative, they’re a way to recognize that loss.”

Last month, Gov. Bill Richardson of New Mexico vetoed legislation that would have granted stillborn birth certificates. Mr. Richardson, a Democrat who is running for president, did not mention abortion, but said “confusion and potential fraud” could result from creating two documents — the fetal death certificate and the birth certificate resulting in stillbirth — for the same event.

Those who support the stillbirth certificates say fraud would be impossible because the certificates make clear that there is no living child.

Generally, the bills are retroactive, so parents can get a certificate even for long-ago stillbirths. Parents who request certificates must pay a small fee, and can record a name or leave the name line blank.

Some counselors who work with grieving parents say the legislation would be unnecessary if hospitals did more to recognize the loss, through informal “memory certificates.”

“Parents want some kind of certificate, something they can frame that physically acknowledges the birth,” said Perry-Lynn Moffit, a counselor with the Pregnancy Loss Support Program of the National Council of Jewish Women in New York City. “Having to sign a fetal death certificate triggers a lot of feelings. As one dad said to me, that’s only half the story.”

Ms. Moffit said she was troubled by the term “Missing Angels,” with its religious overtones suggesting that stillborn babies become cherubs in heaven.

Prodded by Ms. Cacciatore, Arizona was the first state to provide birth certificates for stillbirth. Ms. Cacciatore also founded the M.I.S.S. Foundation, a nonprofit group that coordinates the campaign for these certificates and also advocates for increased research to help prevent stillbirth and infant death.

“I thought about suicide every day after Cheyenne’s birth,” Ms. Cacciatore said. “I loved this baby; I went through all the physical pain of delivering her. I had her baby book prepared, with the place for her birth certificate.”

When the state office of vital records mailed a death certificate instead, she said, “I literally dropped it.” She added, “When I called and asked for my daughter’s birth certificate, the woman asked how she died, and when I told her, she said I didn’t have a baby, I had a fetus, and I couldn’t get a birth certificate.”

Frustrated, Ms. Cacciatore began a support group for mourning parents. She said she received 250 e-mail messages a day through the group, and her foundation has 27 online support groups with 25,000 members.

Yet, the concept of birth certificates for stillbirth raises complicated questions. In heated Web discussions, some people cite the parents’ deep need for validation while others say birth certificates are legal documents, not memory trinkets or prizes for enduring birthing.

“Any way that acknowledges the child is important,” said Catherine Shandler, of Montclair, N.J., who lost her daughter, Emma, three years ago, two weeks before the due date. Emma remains part of the family, Ms. Shandler said, a presence she will someday discuss with her son, Benjamin, 20 months old, and a daughter, India, born Saturday.

It is often hard to know what to say, she said.

“When you say you had a stillbirth, some people can’t wrap their head around the fact that there was a baby,” said Ms. Shandler, who said she supports abortion rights. When people ask if she has children, she said, sometimes she mentions Emma, and sometimes she does not. But, she added, “I want to acknowledge that Emma existed.”

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From the MISS Foundation:

We are grateful to the reporter, Tamar Lewin, for writing this very special story.

Unfortunately, we are also troubled by comments are incongruent with the desires of many families experiencing stillbirth across the nation. Our position is that bereaved families of stillborn babies demand what is rightfully due them, and cannot be assuaged merely by an "informal memory certificate" offered by a hospital. This false assertion serves to undermine all of our efforts. Therefore, we reject this notion on behalf of thousands of stillbirth families around the country.

Further, we reject the characterization of the MISSing Angels Bill as suggesting that stillborn babies "become cherubs in heaven." The bill was named, instead, in honor of the many MISS Foundation children who died before their time, and for many embodies the more secular definitions of 'angel' including goodness, purity, and virtuousness (American Heritage Dictionary, 2007).

The article was well written, and accurately portrayed some of the complex struggles facing women, men, and families affected by the tragedy of stillbirth. We thank the courageous families interviewed in the article, and applaud the efforts of the volunteer lobbyists of the MISS Foundation working diligently in many states to pass this important legislation.

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Letters to the editor...

To the Editor:

Our daughter Caroline was stillborn. Her papers consist of a death certificate and receipts from the hospital, the cemetery and the funeral home. That’s a lot of sad.

When it’s hard to find joy, you realize how important a piece of paper can be. A birth certificate would substantiate in writing what my wife and I believe in our hearts.

Brian Henry
Paris, May 22, 2007

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To the Editor:

In the 16 years that I have been helping family members and others locate stillborn babies buried on Hart Island, New York City’s potter’s field, I have never had anyone complain about not having a birth certificate for a stillborn child. People I help are concerned that burial records from the last 25 years are inaccessible and that going through the prison system to visit a baby’s burial site adds additional grief.

There are a number of ways in which stillborn babies should be acknowledged.

A mother without financial means cannot bury her child and may look for the grave site for the rest of her life. In my experience, the search for a lost child often extends to the next generation when siblings go looking. It seems to me that a birth certificate is one part of an overall grieving process that is generally overlooked for the families of stillborn babies.

Perhaps we as a culture should consider a broad range of concerns regarding support for those who suffer the loss of children. To link these matters to political issues like abortion adds to the general lack of consideration that we pay to bereaved families. In New York City alone, there are hundreds of stillborn babies buried every year within the prison system. Melinda Hunt

Director, The Hart Island Project
New York, May 22, 2007

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