BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J. Kuehl, Chair
BILL NO: SB 850
S
AUTHOR: Maldonado and Correa
B
INTRODUCED: February 23, 2007
HEARING DATE: April 18, 2007
8
REFERRAL: Health and Judiciary
5
FISCAL: Appropriations
0
CONSULTANT:
Moreno/
SUBJECT
Birth certificates: stillborn births
SUMMARY
This bill enacts the "Missing Angels Act" and requires a
local registrar of births and deaths to issue, upon
request, a "certificate of birth resulting from stillbirth"
(CBRS) on a form approved by the State Registrar of Vital
Statistics for each fetal death occurring in this state
after the 20th week of uterogestation.
CHANGES TO EXISTING LAW
Existing law:
The State Registrar of Vital Statistics is required to
administer the registration of births, deaths, fetal
deaths, and marriages. Each fetal death in which the fetus
has advanced to or beyond the 20th week of uterogestation
is required to be registered with the local registrar of
births and deaths of the district in which the fetal death
was officially pronounced within eight calendar days
following the death and prior to any disposition of the
fetus.
Continued---
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
Page 2
This bill:
SB 850 requires a local registrar of births and deaths to
issue, upon request, to the mother or father of the fetus,
or his or her designee, a certificate of birth resulting
from stillbirth (CBRS) on a form approved by the State
Registrar of Vital Statistics for each fetal death
occurring in this state after the 20th week of
uterogestation. The bill further requires any certificate
of birth resulting in stillbirth that is issued to comply
with all of the format and filing requirements governing a
certificate for a live birth.
FISCAL IMPACT
Unknown. The author states that the certificates will be
fully funded through fees.
BACKGROUND AND DISCUSSION
Need for the bill
According to the author, between 25,000 and 30,000 babies
are stillborn in the U.S. each year, which is one in 100
pregnancies. The author states that most occur at or near
full term involving otherwise apparently healthy babies.
The author states that a Certificate of Live Birth is
issued for a baby born pre-viability who has taken a
breath. However, for a baby born closer to full-term who
dies prior to birth, only a death certificate is issued.
The author states that there is already a death certificate
issued for stillbirths of fetuses at 20 weeks gestation and
over. The author states that a CBRS will not replace the
fetal death certificate, is optional for parents, will
require a fee, and will not be proof of a live birth.
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
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Stillbirths
Stillbirth is a common term for the death of a fetus while
still in the uterus, also called intrauterine fetal death
or demise. According to the March of Dimes, stillbirth is
caused by a number of things, including birth defects,
placental problems, poor fetal growth, infections, chronic
health conditions in the pregnant woman, and umbilical cord
accidents. According to a study of the causes of
stillbirth published in the June 1998 Journal of Obstetrics
and Gynecology, upon examination of the placenta, a
significant abnormality was detected in 30 percent of the
cases. When an autopsy was performed, only 31 percent of
fetal deaths were unexplained; however, when no autopsy was
performed, 44 percent were unexplained. Overall, 36 percent
of stillbirths still remained unexplained despite a
thorough evaluation in most cases. According to DHS, there
were 2,929 fetal deaths of 20 weeks or more gestation in
California in 2002.
The National Institute of Child Health and Human
Development (NICHD) established the Stillbirth
Collaborative Research Network in 2003 to understand the
epidemiology of stillbirth. The specific aims of this
five-year study are: 1) to obtain a geographic
population-based determination of the incidence of
stillbirth defined as fetal death at 20 weeks gestation or
greater; 2) to determine the causes of stillbirth using a
standard stillbirth postmortem protocol that includes
review of clinical history, protocols for autopsies and
pathologic examinations of the fetus and placenta, and
other postmortem tests to illuminate genetic, maternal, and
other environmental influences; and 3) to elucidate risk
factors for stillbirth.
Other states
According to the sponsor of this bill, the Mothers in
Sympathy and Support (MISS) Foundation, 17 states currently
issue a CBRS (Arizona, Arkansas, Florida, Indiana,
Louisiana, Maryland, Massachusetts, Minnesota, Mississippi,
Missouri, New Jersey, South Carolina, South Dakota, Texas,
Utah, Virginia, and Wisconsin). Legislation is pending in
nine states, including California.
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
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Fetal death certificate
In California, a Certificate of Fetal Death is issued for
each fetal death occurring after the 20th week of
uterogestation. Much of the information contained in this
certificate is substantially similar to that contained in a
Certificate of Live Birth. Confidential information,
collected for "public health use," and not contained in the
Certificate of Live Birth includes the "estimated time of
fetal death" (dead at time of first assessment, no labor
ongoing; dead at time of first assessment, labor ongoing;
died during labor, after first assessment; or, unknown time
of fetal death). In addition to information collected
related to prenatal care, employment, the race and
education of the mother and father, and previous births,
both certificates contain the following information related
to the pregnancy: method of delivery, complications and
procedures of pregnancy and concurrent illnesses,
complications and procedures of labor and delivery, and
abnormal conditions and clinical procedures related to the
fetus/newborn.
Prior legislation
AB 1929 (Runner) of 2002 would have required any person who
prepares a certificate of fetal death to also prepare a
certificate of birth resulting in stillbirth upon the
request of a parent of a stillborn child. AB 1929 was
referred to the Assembly Judiciary Committee, but was not
heard.
Arguments in support
The MISS Foundation and numerous supporters of this bill
write that California law already issues a mandatory death
certificate and requires that grieving parents be held
responsible for the burial or cremation of their child.
Supporters contend that the government recognizes that a
death has occurred and that final disposition is required;
yet, it is unwilling to acknowledge the birth process.
Supporters argue that this bill will offer many bereaved
parents some solace and comfort after their devastating
loss. The Capitol Resource Institute writes that current
law does not recognize the heartbreaking birth process the
mother must undergo when delivering a stillborn child and
that this bill would give the mourning mother some
consolation that her loss is recognized.
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
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Arguments in opposition
Oppose unless amended
Planned Parenthood Affiliates of California (PPAC), writing
with an "oppose unless amended" position, states that this
bill raises considerable concerns regarding vital
statistics and a woman's right to choose. PPAC contends
that the impacts of this complicated bill are too
significant and have yet to be adequately identified to
rush this bill through committee this year. Therefore,
PPAC recommends that this bill be held for a more thorough
review and discussion until next session. The American
College of Obstetricians and Gynecologists, District IX,
and the American Civil Liberties Union write that given the
highly sensitive nature and complex nature of the law
surrounding fetal death, abortion, as well as the legal and
public health purposes of various documentation and
certifications, it is critical to have time to determine
how the bill might be amended to give them confidence that
this well-intended bill does not have unintended
consequences for millions of women. The California Medical
Association is concerned the impact of a state-issued
certificate for stillbirth and suggests that an unofficial
certificate provided by hospitals would be a solution.
COMMENTS AND QUESTIONS
1.Bill was heard on April 11: SB 850 was heard and
testimony was taken in this Committee on April 11, 2007.
The bill was put over at the request of the Chair to
allow more time for the author and opponents to come to
resolution on language. Discussions between the author,
the sponsors of this bill, and opponents have taken
place, but at the time of the writing of this analysis,
consensus on language has not been reached.
2.Clarification needed: It appears that the information
that would be included in the CBRS is substantially
similar to the information currently included in a
Certificate of Fetal Death. From a public health
standpoint, any data collected and reported for the CBRS
will not enhance or improve information that is already
collected through existing certificates. Additionally, a
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
Page 6
birth certificate and a death certificate for the same
fetus cannot be issued by a registrar of births and
deaths. In line with the author's intent, this bill
should be amended to clarify that the CBRS is not a
certificate of birth or death, but rather a commemorative
certificate issued in addition to the Certificate of
Fetal Death, as follows:
103040.1. (a) The local registrar of births and deaths of
the district in which a fetal death has occurred, where
in which the fetus has advanced beyond the 20th week of
uterogestation , shall issue, upon request to the mother
or father of the fetus, or his or her designee, and in
addition to a certificate of fetal death, a certificate
of birth resulting from stillbirth, on a form approved by
the State Registrar of Vital Statistics. for each fetal
death occurring in this state after the 20th week of
uterogestation.
(b) A certificate of birth resulting in stillbirth
issued pursuant to subdivision (a) shall not be
considered a certificate of live birth for any purpose,
but rather is a commemorative certificate issued upon
request and in addition to the certificate of fetal
death. comply with all of the format and filing
requirements governing a certificate for a live birth
contained in Article 2 (commencing with Section 102425).
3.No provision for collection of fees: The author states
that this bill will be funded through fees collected for
each CBRS, but the bill contains no provisions related to
the amount of a fee for each CBRS or the method of
collection of fees. The author may wish to amend this
bill as follows:
a. On page 2, between lines 15 and 16, insert the
following and renumber accordingly: (b) The local
registrar of births and deaths shall charge a fee for
the certificate issued pursuant to subdivision (a)
that does not exceed the costs to the registrar of
issuing the certificate.
POSITIONS
Support: MISS Foundation (sponsor)
Baby Kick Alliance
STAFF ANALYSIS OF SENATE BILL 850 (Maldonado and Correa)
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Capitol Resource Institute
Grief Recovery Institute
Healing Hearts Share
Helping After Neonatal Death
Share Pregnancy and Infant Loss Support, Inc.
Sidelines
Five individuals
Oppose: American Civil Liberties Union
American College of Obstetricians and Gynecologists,
District IX (unless amended)
California Medical Association (unless amended)
Planned Parenthood Affiliates of California (unless
amended)
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