Imagine every law enforcement agency, local, state and federal, that collects fingerprints does so on their own forms and that once collected, the forms are kept at the facility that collected them. These fingerprint forms would be useless for the investigation of crimes. Information is collected, but it is practically inaccessible. 

 

Now imagine the current practice wherein stillbirth autopsies are reported on hundreds of different forms, not only inaccessible, but incomparable too.

 

Today in America there is no uniform post mortem protocol at the national, state or local level. Pathologists who perform autopsies do so using their own choice of protocol. While rules for keeping copies and samples exist, they are generally kept either at the hospital or the laboratory where specimens are examined. That brings us to the second reason so little is understood about stillbirth in general.

 

In addition to there being no uniform comparable protocol for stillbirth autopsies, there is no central repository for autopsy findings either.

 

Until there is a uniform protocol, which mandates the minimum tests that must be performed, and specifies the minimum information to be collected, and sets out the format in which it shall be reported, and identifies the agency to which it must be sent, there can be no hope of reducing the number of stillbirths in America. 

 

A Phoenix mother, whose full term baby died on the eve of its scheduled delivery, requested an autopsy be performed. It was done, but significantly, the pathologist never interviewed the mother. When a plane crashes, NTSB interviews survivors. What did they see, hear, smell, and feel before, during and after the crash? Is not the mother a survivor too of a devastating “crash”? Would not her experiences in the days and hours preceding the event be significant?  Just one more example of the inadequacy of current autopsy practices.

 

We had once thought that this was an issue to be addressed at the state level, and indeed some states have done so. New York recently passed a law mandating that a uniform post mortem protocol be designed for unexplained deaths of infants under one year. The National Stillbirth Society is in the process of asking New York to extend the requirement to offer autopsies for all third trimester stillbirths. But the likelihood of getting every state to sign on to a uniform autopsy protocol seems to be remote at best. Therefore, we have concluded that federal action is required.

 

Uniform protocols and a central repository are meaningless unless there is an accompanying requirement that autopsies be offered as a matter of law for all third trimester stillbirths.

 

Is there any reason the OB/GYN attending the birth would suggest to the parents that their stillborn baby be autopsied?

 

Is there any reason the hospital where the stillbirth occurred would suggest to the parents that their stillborn baby be autopsied?

 

Is there any reason the insurance company paying the hospital bill would suggest to the parents that their stillborn baby be autopsied?

 

The possibility the doctor or hospital may have been culpable, plus the certainty that a cost will be incurred, renders the recommendation of an autopsy unlikely by any of the above three. Add to that fact the shock of the parents and the likelihood that they are too emotionally distraught to consider the merits of an autopsy and to demand one be performed, are reason enough to require that parents be offered an Informed Consent Form as proof an autopsy was offered.

 

In summary, here is the autopsy agenda of The National Stillbirth Society.

 

Cause the introduction and lobby for passage of federal legislation to reduce the incidence of stillbirths by creating a centralized repository for findings of autopsies conducted under a national uniform protocol. Require that autopsies be offered at no charge to parents of all third trimester stillborn babies. Make the findings of the uniform autopsies available to research facilities to determine the cause or causes of unexplained stillbirths, and to provide a better understanding the etiology of all known causes, for the purpose of reducing the number of deaths that occur every year with devastating effect upon women and their families.