Last summer, three weeks before her due date, Sari E. 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. E., 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. E. 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.”
[22May07, By TAMAR LEWIN http://www.nytimes.com/2007/05/22/us/22stillbirth.html?ref=us&pagewanted=print