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Stillbirth and fetal death reporting

A. Stillbirth and fetal death (greater than 20 weeks gestation)

1. Mandatory report of deaths to medical examiner: 

1. Fetal deaths that fall under medical examiner jurisdiction s. 406.11 Florida Statutes 
2. Stillbirth, infant and maternal deaths which fall under the Midwife Practice Act, Ch. 467 Florida Statutes (non-hospital settings) 
3. Fetal deaths and stillbirths that are to be cremated must be reported under s. 406.11(1)(c) Florida Statutes via the signed death certificate and cremation approval form. 

2. Deaths not required to be reported to medical examiner: 

1. Fetal deaths that do not fall under s. 406.11 Florida Statutes 
2. Stillbirth, infant and maternal deaths that occur in a hospital unless some provision of s. 406.11 Florida Statutes, is indicated. 
3. Related statutory regulations 

a. Midwives are often used at "birthing centers" which fall under the Chapter 383 Maternity and Infancy Hygiene. 

  • "(1) "Birth center" means any facility, institution or place that is not an ambulatory surgical center or a hospital or in a hospital in which births are planned to occur away from the mother's usual residence following a normal, uncomplicated, low-risk pregnancy. (Emphasis added to show that hospitals are excluded from this definition, s. 383.302 Florida Statutes, Definitions).

b. The only definition specifically listing stillbirth in Florida Statutes is contained within the Midwifery Practice Act: 

  • " (2) "Certified nurse midwife" means a person who is licensed as an advanced registered nurse practitioner under chapter 464 and who is certified to practice midwifery by the American College of Nurse Midwives." 
  • " (7) "Midwife" means any person not less than 21 years of age, other than a licensed physician or certified nurse midwife, who is licensed under this chapter to supervise the birth of a child." 
  • " (8) "Midwifery" means the practice of supervising the conduct of a normal labor and childbirth, with the informed consent of the parent; the practice of advising the parents as to the progress of the childbirth; and the practice of rendering prenatal and postpartum care." 
  • " (15) "Stillbirth" means the death of a fetus of more than 20 weeks gestation." (s. 467.003 Florida Statutes, Definitions) 

c. Other terms also have a bearing, however, especially fetal death: 

  • " (5) "Fetal death" means death prior to the complete expulsion or extraction of a product of human conception from its mother if the 20th week of gestation has been reached and the death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles." 
  • " (9) "Live birth" means the complete expulsion or extraction of a product of human conception from its mother, irrespective of the duration of pregnancy, which, after such expulsion, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, and definite movement of the voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached." (Emphasis added, s. 382.002 Florida Statutes, Definitions) 

d. Duty of reporting death to the medical examiner: 

  • " (3) Each maternal death, newborn death, and stillbirth shall be reported immediately to the medical examiner." (s. 467.019 Florida Statutes, Records and reports. [Midwifery Practice Act - excludes hospital deaths]) 
  • " (1) In the case of any death or fetal death due to causes or conditions listed in s. 406.11, … or where there is reason to believe that the death may have been due to unlawful act or neglect, the funeral director or other person to whose attention the death may come shall refer the case to the medical examiner of the district in which the death occurred for investigation and determination of the cause of death." (s. 382.011 Florida Statutes) 

e. It is important to note that if, after review of the details, the medical examiner determines that no category in s. 406.11 Florida Statutes, applies, then jurisdiction is declined and the hospital or birthing center works with the funeral home to complete the fetal death certificate. 

  • " The funeral director shall retain the responsibility for preparation of the death or fetal death certificate, obtaining the necessary signatures, filing with the local registrar in a timely manner, and disposing of the remains when the remains are released by the medical examiner." (s. 382.011 (3) Florida Statutes) 

f. Final disposition of fetal death remains is regulated by Vital Statistics rules governing funeral homes and direct disposers. They cannot be simply incinerated with biohazard waste as a medical tissue specimen. This requires a second reporting of the death to the medical examiner for the purpose of approving a planned cremation or other method: 

  • "Fetal deaths for which cremation, anatomic dissection or burial-at-sea of the remains is intended must be referred to the medical examiner for investigation. For the purposes of this section, "fetal death" is defined by Section 382.002 Florida Statutes." 
  • "The medical examiner shall keep an accurate record of each such investigation in sufficient detail to allow a review of the circumstances." (FAC 11G-2.001(3)(c)) 

B. Non-Stillbirth Fetal Demise (less than 20 weeks gestation)

1. The other obvious category of fetal demise with which you are probably concerned is the "death" of fetal material, which has not attained the 20th week of gestation. This constitutes neither a live birth nor a fetal death and, therefore, is not technically a "stillbirth." Therefore, no reporting to the medical examiner is required for either a death notification or for a cremation approval. 
2. However, this product of human conception must be handled in a manner consistent with disposal of fetal remains of medical procedures: 
o "(2) The agency may adopt and enforce rules, in the interest of protecting the public health, to ensure the prompt and proper disposal of fetal remains and tissue resulting from pregnancy termination." S. 390.012 Florida Statutes, Powers of agency; rules; disposal of fetal remains) 
3. Funeral directors often faced a dilemma in the past when family or hospital requested disposal of non-stillbirth remains (less than 20 weeks gestation including the product of abortion). They now have authority to act on behalf of the family or other authorized person to dispose of such remains. 

  • "(1) In addition to any other common law or statutory rights a legally authorized person may otherwise have, that person may authorize a funeral director or direct disposer licensed under this chapter to lawfully dispose of fetal remains in circumstances when a fetal death certificate is not issued under chapter 382. A person licensed under chapter 470 is not liable for damages as a result of following the instructions of the legally authorized person in connection with the final disposition of fetal remains in circumstances in which a fetal death certificate is not issued under chapter 382 or in connection with the final disposition of a dead human body." (s. 470.0294, Florida Statutes, Additional rights of legally authorized persons) 

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Volusia County, Florida.