Archive for the ‘Fetal Death in Utero’ Category

The Grief of Losing an Unborn Child

Wednesday, June 1st, 2011

Image from HopeforParents.org

Fetal Death In Utero. It sounds so clinical, so devoid of meaning. Maybe that is by design. Medical terms have a way of masking the real human suffering that is being described.

Adenocarcinoma instead of cancer. Cerebral hemorrhage instead of stroke…and “fetal death in utero” instead of “losing an unborn child.” The medical terms are necessary, but they don’t capture the essence of the diagnosis. As one woman told me, “I didn’t lose my fetus. I lost my baby.”

For any parent, the loss of a child is the most agonizing experience imaginable. As the father of two, I can’t even imagine being told that your child has died. I can’t imagine the life-long grief that follows. I almost decided not to write about this topic for that very reason – I didn’t know the pain of losing a child so who was I to write on it? But other times I’ve waded into topics despite a lack of personal involvement because the issue has touched those whom I care about. For example, I’m not a parent of a special needs child, but I’ve written on that topic because I am close to people who are raising special needs children. Their experiences deserve to be shared.  The same is true here.

For parents who have lost an unborn child, the sense of grief is no different than if the child had been born and then died. Unfortunately, our society seems less sympathetic to the loss because there is no infant that we have seen and gotten to know. We all recognize the agony of losing an older child. Even if we haven’t experienced it ourselves, we can at least try to understand how sickeningly awful it must be. We can then offer our support and love and condolences to those who have experienced it. With an unborn child, however, it’s different. We have a tendency to minimize the grief associated with losing an unborn child, as if the fact that the child wasn’t yet born makes him or her less real. Even medical providers are guilty of this. I’ve had women tell me that their doctors tend to treat miscarriage or stillbirth as a medical condition, not the loss of a loved one. For the parents of such children, however, the loss is deep and real and long-lasting.

Donnica Moore, M.D., an Ob/Gyn and the author of a book entitled “Women’s Health for Life,” summed it up well when interviewed by the New York Times:

Couples can feel there’s no socially accepted way to grieve. If you lose a family member, people know how to do that, they know how to support you and grieve with you. But this is new territory for a lot of us. It’s a tragedy for people who have gone through it that might not be on the radar of people who have not.

I’ve recently had the pleasure (strange word, I know, given the circumstances) of representing two wonderful families who lost children. One couple lost their 9-year-old son who died of a correctible heart condition that his pediatrician failed to detect, and the other couple lost their unborn daughter when the mother was 37 weeks pregnant after being sent home from the hospital where she had gone complaining of decreased fetal movement. It’s easy to see the grief for the first couple. One day they have a little boy going to school, playing, doing homework, and the next day he’s gone. With the second couple, it’s harder to see the grief, but it’s there. I’ll share their story briefly.

This was the first child for Michelle (not her real name) and her husband. They had already decorated the nursery and picked out a name. One evening (believe it or not, Michelle had just attended a baby shower earlier in the day) she felt that the baby wasn’t moving as much as usual and called her doctor’s office. They told her to go to the hospital, which she did. At the hospital, she and her baby were evaluated and told that everything was OK. She was told to go home and keep her regularly scheduled appointment the next day. When she went to her doctor the next morning, however, the doctor could not find a heartbeat. Her daughter, unfortunately, was gone. To make things even worse, Michelle then had to carry her deceased daughter inside her for another full day before she gave birth.

Michelle did her best to move on with her life. She continued to work. She and her husband had another child. But for the entire time I represented her (to its credit, the hospital approached us about resolving the case early on) there was not a single time I talked to her that she did not start to cry in discussing her first baby – the daughter who should now be three years old. She still grieves for the loss of her daughter, wonders why it happened, wonders what her daughter went through in those final moments. She asks herself whether she did anything wrong, whether she should have been more forceful that night in the hospital. These questions don’t go away for her. They’re the same questions that any mother would ask after losing her child – whether it was an unborn child or an older child.

We all need to do a better job of recognizing that the pain of losing an unborn child – whether by miscarriage or stillbirth – is deep and long-lasting. If you know someone who has lost an unborn child, don’t shy away from him or her. A simple and genuine “I’m sorry for your loss” is a good starter. Be there to offer support and talk just like you would if the child were older. Don’t expect it to go away in a matter of weeks, and don’t assume that a subsequent pregnancy somehow erases the pain of losing the previous child; it doesn’t. Also, try to avoid clichés, e.g., “everything happens for a reason,” “I’m sure you’ll be able to have more kids.” While such sayings are meant well, clichés tend to minimize the degree of loss. If you don’t know what to say, it’s perfectly fine to say, “I don’t know what to say.”

If you yourself have lost an unborn child, you need to treat this loss like you would the death of a loved one. It is a long, slow, painful process that not everyone will fully understand. That can add to the sense of loss because you may get the feeling that people are expecting you to be over it already. Don’t let their artificial time-tables dictate your own personal grieving. You may also experience feelings of guilt, asking yourself if you did something during your pregnancy that caused this (in almost every case, the answer to that question is a resounding no). You may feel resentful toward other parents or children, or find it difficult to be around children, especially those who are the same age as your child would be. You may wonder if you will be able to have another baby. All of these feelings are completely normal, but they will take time to resolve.

Additional Links

Here are some good links to learn more about the grieving process for unborn children.

National Share

AmericanPregnancy.org

Related Nash and Associates Links

Pregnancy-related gingivitis and prematurity

 

 

 

Fetal Pain and Suffering: New Nebraska Abortion Law Sparks Debate – When Does a Fetus Feel Pain?

Saturday, April 17th, 2010

An online article posted yesterday in NewScientist raises some interesting issues that will no doubt be the subject of much debate in days, months and years to come – does a fetus feel pain and if so, when? The true focus of this article was the recent (April 13, 2010) passage of new legislation in Nebraska, which essentially prohibits abortions after 20 weeks.  Ostensibly, Nebraska has become the first state to ban abortions on the basis that fetuses feel and appreciate pain.

The law, according to a report in LifeSiteNews.com, goes into effect on October 15, 2010, and has, at a minimum, the following legal implications:

Abortionists who break the law would face a Class IV felony charge, which carries a penalty of a five year maximum prison sentence, $10,000 fine, or both. Women who obtain abortions of their unborn children would face no criminal penalties.

The bill would allow women and even the fathers of aborted unborn children to sue and seek damages from abortionists who violate the law.    

I say “at a minimum” since there are other civil law implications arising from  the rationale behind this legislation. One of those issues often litigated throughout the various courts of the United States is a parent’s right to sue for conscious pain and suffering for fatal or non-fatal injuries to a fetus.  That analysis is beyond the scope of this blog. What is of present importance is the so-called ‘science’ behind this legislation and the response of the scientific community that may well have far-reaching implications in the field of civil litigation.

Before engaging in this discussion, note well: it is not my intention (or desire) to become embroiled in the abortion issue.  That is not what we do in our firm.  It is the state of  science that intrigues me in terms of how that may have relevance to what we do – litigate civil cases involving matters such as fetal death in utero or death or injuries sustained by fetuses due to the negligence of third persons (e.g. medical malpractice, catastrophic automobile accidents and the like).

Apparently, the ‘scientific basis’ for this Nebraska legislation is the research of Kanwaljeet “Sunny” Anand, a professor at the University of Arkansas for Medical Sciences.  Dr. Anand testified in 2004 on the federal partial birth abortion ban.  He provided his opinion testimony that after 20 weeks gestation, an unborn child would experience “severe and excruciating pain” from an abortion.

Dr. Anand’s opinions are not without numerous critics.  What is significant, however, is that even many scientists, who challenge Dr. Anand’s opinions that 20 weeks of gestation is the point at which a fetus can feel and appreciate pain, do accept the proposition that there is a point in the life of fetus where they can and do appreciate pain and suffering.

Dr. Mark A. Rosen, the Director of Obstetrical Anesthesia at UCSF’s Fetal Treatment Center, in 2005 co-authored an article in JAMA (abstract) that some refer to as the ‘seminal review on fetal pain.’

One of the opinions expressed in that paper defines what is at the center of this discussion – what is meant by ‘perception of pain’?

Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by non-painful stimuli and occur without conscious cortical processing.

In the NewScientist posting, Dr. Rosen provided rebuttal statements to the premise inherent in the Nebraska legislation that fetal pain occurs at 20 weeks of gestation.

Dr. Rosen states, “The first brain pathways associated with pain perception “are not complete before approximately 29 weeks of gestation”, so although fetuses develop brain wiring from about 23 weeks onwards, the connections are not there to enable them to experience pain.”

Whether it is at 20 weeks or 29 weeks, one common principle exists – according to a number of scientists, there is a point prior to birth that a fetus can appreciate pain from a medical-scientific standpoint – the ‘wiring’ is in place. If this is true scientifically, how does this affect the right of recovery by a parent or the estate of an injured fetus in those jurisdictions permitting conscious pain and suffering damages for injuries to a fetus?

For instance, if a fetus is at 35 weeks gestation and by all other accounts is totally viable with ‘the wiring in place,’ does that fetus and/or the parents have a claim for conscious pain and suffering should injury to the fetus occur?

Does any jurisdiction recognize the right of a fetus to recover for injuries sustained in utero?  Absolutely – it just depends which jursidiction(s) you are considering.  For example, the District of Columbia, in 1946, was the first jurisdiction to recognize the right of a fetus to bring a separate cause of action (Bonbrest v. Kotz). This was an action for damages being brought on behalf of a fetus allegedly injured ‘in the process of being removed from its mother’s womb.’ “Under the civil law and the law of property, a child en ventre sa mère is regarded as a human being from the moment of conception.”

In 1984, the D.C. Court of Appeals, relying in large part on Bonbrest, stated:

Although this court has never considered this question, we note that every jurisdiction in the United States has followed Bonbrest in recognizing a cause of action for prenatal injury, at least when the injury is to a viable infant later born alive.

Note the key conditions: “…when the injury is to a viable infant later born alive.

This posting is already perhaps too long – this topic is multi-faceted and more the subject of a treatise, white paper or a law review article, not a blog.  What is apparent (at least to me) is that this new Nebraska legislation will undoubtedly rekindle the fires of fascinating litigation about fetal rights, fetal and parental causes of action and fetal pain and suffering claims. Stay tuned – there will undoubtedly be much more to come.


Fibroids during pregnancy increases risk of stillborn birth.

Tuesday, February 9th, 2010

Fibroids, which occur in an estimated 5% to 20% of women, have been reported by researchers at Washington University in St. Louis, Missouri  to increase the risk of stilborn birth. The study was presented Saturday, February 6th,  at the annual meeting of the Society for Maternal-Fetal Medicine in Chicago.

It is known that many women who have fibroids are without any symptoms.  What is of importance is that women typically undergo sonography at 16 to 22 weeks.  It is at this time that such asymptomatic fibroids can be detected.

This study looked retrospectively at over 64,000 births.  After numerous other factors were excluded and a subgroup identified, the investigators found that women with  fibroids and in whom there was evidence of intrauterine growth restriction (IUGR) were at a relative increased  risk of having a stillbirth (fetal death in utero – FDIU).

“Our results showed that women with a combination of fibroids and fetal growth restriction were at two-and-a-half times the risk of having a stillbirth, though the absolute risk remained rare,” said Dr. Alison G. Cahill, one of the study’s authors. “This may lead to a future recommendation for serial growth scans to monitor fetal growth in women with fibroids.”

One related question remains: will the cost-effectiveness of serial sonograms for this group at risk drive the decision-making on setting a new standard for surveillance?

If you are pregnant and know you have fibroids, this is a subject for discussion with you obstetrician.  If you are unaware of the presence of fibroids and undergo the usual 16-22 week sonogram, it might not be a bad idea to inquire about the presence of asymptomic fibroids when this test is interpreted.  We have been involved in a number of cases of FDIU and the emotional devastation it causes a family when it occurs is simply awful.

Should you be interested in more information about fibroids, the US Department of Health and Human Services has a good FAQ on this topic.