Miscarriage -v- stillborn. (Ummm....kinda gross/weird question)

Great Debates
1

Despite my ultimate GQish question I think this issue belongs here because of the conversation it will most probably raise. I trust the mods to move it to where it needs to be.

WARNING: The following may be upsetting to some!

This morning a woman went to the hospital and had a vaginal birth resulting in a dead 4 1/2 month old baby, a D&C, sepsis, and a whole mass of other issues. I don’t want to go into a whole lot of detail about the “why”, but we had an office conversation about the delineation between a miscarriage and a stillborn birth.

If a woman goes into the hospital at full term and gives birth and the baby is dead or dies soon after, I think (and I wish to be corrected if I’m wrong) it’s a stillborn, the death is recorded on a death certificate, the baby is named, and given a burial according the custom of the parents.

On the other had, if a woman has a violent “bowel movement” (this is where it gets difficult, because we weren’t sure of the proper/correct/moral terminology. The stuff I have here in quotes is just the words coming out of our mouths as we were pussy-footing around the subject. AND I’m trying really hard not to offend anyone.) at six weeks and expels “a mass of cells” or “fetus”, the “result” is a miscarriage, a death certificate is NOT issued, and the “fetus” is either flushed or, in a hospital setting, perhaps incinerated.

To add to this:

Warning: REALLY GROSS!

The retired nurse in on this conversation related a story about a couple who had a late miscarriage/early stillborn. They were both biology teachers and took the “fetus” home to dissect. I don’t know if this is scientifically interesting or morally disgusting or neither or both.

She also related a story about a couple who miscarried in the third month who had the remains cremated, as they were young and didn’t know in which state they would end up - whoever died first would have the child’s remains buried with them. I just thought that was COOL, considering the fact that a distant relative of mine hasn’t seen her daughter’s grave in 50 years because of the whole Hawaii to Colorado trip.

Here’s my GQish question. In this case, the “fetus” is less than full term and more than six weeks, and the mother went through a normal, vaginal birth. Are there guidelines about whether it’s termed a stillborn or a miscarriage? If my initial premise (that a stillborn is issued a death certificate) is true, is there a medically- or state-determined cut-off? Is this a decision made between the parents and the medical professionals? If the “zygote” is at three weeks, does the state issue a death certificate for it?

2

i would think that in order for a death certificate to be issued, a birth certificate must first be issued, (or at least applied for?) implying a live birth, not a stillborn or miscarried fetus.

in my understanding (which is by no means expert) a stillbirth implies a full or near-full term pregnancy where the fetus/child dies during or shortly before delivery, and miscarriage implies a pregnancy aborted before a potentially viable birth

my grandparents had one stillborn, which was not named, though buried in the family plot. i could not say whether a death or even birth certificate was issued, though the fact that no name was given suggests to me that no certificates were issued (this was also well over fifty years ago, and in a quite rural setting, so i don’t know if this helps you at all…)

3

I’m not sure about the US, but here the parents may request the remains to do as they wish with them (usually quiet cremation, but I know of full funeral services and burials).

Most people don’t request anything for first trimester miscarriages, some ask for the remains of second trimester miscarriages, some don’t. Almost everyone asks for the remains of third trimester miscarriages and stillbirths. Some people choose names, some don’t.

There are religious issues about baptism involved in burying stillbornand miscarried babies on consecrated grounds (Ireland being predominantly Catholic), and I’m not sure how these issues are dealt with by the church.

I don’t think it would be helpful to the parents to issue death certificates for first trimester miscarriages, nor do I think it would be helpful to insist on a name or giving remains to the parents. Many miscarriages in the first trimester would not have survived to term, or life outside the womb, it would be pointless to presume differently.

Loss is dealt with differently by different people, and to assume that everyone wants a burial and a death certificate for their 6-week miscarriage is a little OTT. You assume that the reaction to losing a pregnancy at 6 weeks is the same as at 7 months, it’s not.

4

Your story is a bit confusing. By “normal, vaginal birth,” do you mean that the woman went into labor very early? Presumably she went to the hospital, and they looked at her, determined that the baby had already died, and helped her through the miscarriage? If the baby had still been alive, they would have given her a lot of treatment to stop the contractions and so on, in the hope of saving the pregnancy.

The way a miscarraige generally works is that the mother experiences contractions and delivers the embryo/fetus too early, usually because it has already died and the body is taking care of it the only way possible. If it’s early enough, it can feel like a bad period (and is often mistaken for one). The further along the pregnancy is, the more painful, and the more likely the mother will need medical care. When a baby dies in the 7th or 8th month, then there’s no option but to induce labor and deliver the dead child in the usual way. There usually isn’t any way to expel a fetus except to go through labor and give birth; it’s just a question of whether the baby is alive.

You can also have a ‘missed miscarriage,’ in which the baby dies, but the body hangs on to the pregnancy anyway. Really, all this means is that the doctors find out what’s happened before the body takes care of it, but it is possible for the fetus to (TMI HERE) start to decompose and cause infection. I experienced a missed miscarriage in the 12th or 13th week, and two weeks later, once they figured it out, I had a D&E (the next step up from a D&C; I was dilated and everything removed). Perhaps I would have miscarried soon, or maybe I would have gotten sick.

AFAIK death certificates are not issued for any babies not born alive, even full-term ones, but I guess we’d need an OB to ask to really find out. The babies are often, though not always, given to the parents, and it’s up to them what to do in the way of naming, photographing, and burial. For someone in an early pregnancy, they usually have to ask, and until recently, almost anyone had to ask pretty forcefully. It’s only now that people are realizing that it’s better for most parents to have some sort of contact and mourning ceremony; until quite recently they were just sent home alone. People who miscarry at home in early pregnancy often do some sort of private burial or memorial, with (for example) a tiny box buried in the backyard, under a tree. Or they may not. Since it’s so private, it’s hard to know.

Reactions to miscarriage and fetal death vary, and the grieving, naturally, tends to be deeper the further along the pregnancy is. Miscarriage is most common before 12 weeks, so women tend to try not to get too excited until it’s ‘safe.’ This is why many women don’t announce a pregnancy until 3 months; they don’t want to tell everyone the great news and then have to inform everyone that things went badly. But a miscarriage, esp. after maybe 6 weeks, is devastating to most women. You don’t hear about it all that much, but they’re more common than you’d think.

5

I suspect what the OP meant is similar to what happened to me. At 25 weeks, I started to have contractions. I went to the hospital, but by the time I got there (maybe 20 minutes,tops, after the first contraction) it was too late to stop the labor. I delivered about a minute after they got me on the table. There was no birth certificate, there was no death certificate and it was referred to by the doctors and nurses as a stillbirth, not a miscarriage. According to the March of Dimes website, fetal death prior to 20 weeeks is a miscarriage, after 20 weeks is a stilbirth.

6

Well, I had a 21 week miscarriage and a 30 week stillbirth, got both cremated and buried in my part of the family plot FWIW. I also plan on being rendered extra crispy after they harvest and dissect whatever they want on me…that way the hospital actually pays for the cremeation [or so I have been told by the teaching hospital I currently am planning on donating my shell to when I am finished with it.]

7

Paging Cyn to GQ…

8

I had been told a “miscarriage” is a fetus that was too young to have survived outside the womb, and a “stillbirth” is (presumably) third trimester pregnancy loss of a fetus that was otherwise viable.

Scopata Fuori

9

First, let me clarify that the word ‘abortion’ has two uses- one is a medical use and one is a common use. Also, the words "miscarriage’ and ‘stillbirth’ are lay terms. The word ‘abortion’ has a political charge, and is used differently in the everyday world and the medical world.

Medically, 20 weeks is the dividing point, althought viability isn’t until about 24 weeks. There is some grey area between 20 and 24 weeks.

A pregnancy lost before 20 weeks is termed a “miscarriage” in lay terms. Medically, it an ‘abortion’ as in an ‘aborted pregnancy’, and can be further described as voluntary or spontaneous. One might say “she had a spontaneous AB at 18 weeks” or simply “she miscarried”.

A pregnancy lost after 20 weeks is a stillbirth in lay terms. Medically, it is also considered an ‘abortion’ as in an ‘aborted pregnancy’ and could also be voluntary (up to a point) or spontanous. One might say “she had a voluntary AB at 22 weeks” or “the baby was stillborn”. The facility where I work obtains death certificates after 20 weeks.

There are also the terms “VTP” or “voluntary termination of pregnancy” and “spontaneous” that are used to differentiate between the different kinds of losses. The word “loss” is used alot, too- as in ‘she has a history of a 22 week loss’ but that doesn’t really say what kind of loss.

How the loss is handled afterwards is (or should be if it isn’t) generally up to the family involved. Before twenty weeks, some want funeral services of some kind and some don’t (most don’t). After 20 weeks most prefer some kind of service (but some don’t).

We make a bereavement box with momentoes (special gown or blanket, armband, etc. ), foot and/or handprints, and photos (if appropriate) for the family starting around 18 weeks which the family may take or leave behind. Generally, the later the pregnancy, the more we try to provide by way of support and ‘stuff’. Every family is different. It’s more important to find out what they want and try to provide it.

10

I forgot to add the we say “fetal demise” for almost any undesired loss at any time to avoid the conflict of using the dreaded “AB” word.