Stillbirth events create a lot of confusion and errors. It is a birth event that does not result in a live birth so it does not qualify for a birth certificate. It does not qualify for a death certificate because, as defined by State Law, there was no life at the time of expulsion. Therefore, the event has its own vital record certificate.
According to Oklahoma State Statutes, a stillbirth (fetal death) certificate must be filed for registration within three (3) days of the delivery. The funeral director, or person acting as such who first assumes custody of a fetus, shall file the stillbirth certificate. In the absence of such a person, the physician or other person in attendance at or after the delivery shall file the certificate. He shall obtain the personal data from the next of kin or the best-qualified person or source available. He shall complete the certificate as to personal data and deliver the certificate to that person responsible for completing the medical certification of cause of death within twenty-four (24) hours after delivery. The medical certification shall be completed and signed within forty-eight (48) hours after delivery by the physician in attendance at or after delivery, except when inquiry into the cause of death is required by Section 938 of Title 63. (63 OS 1-318)
The stillbirth certificate provides valuable health and research data. These data are also essential in planning and evaluating prenatal care services and obstetrical programs and, when used with data on neonatal deaths, provide a composite picture of perinatal outcome.
To clarify when a Certificate of Stillbirth is required, we must look at State Law. Definition of a live birth (63 OS 1-301.5):
"Live birth" means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation, of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
Definition of a stillbirth, or fetal death (63 OS 1-301.8):
Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception after the fetus has advanced to or beyond the twelfth week of uterogestation. 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.
These definitions tell us which certificate to file at the point of delivery. Any evidence of life requires a Certificate of Live Birth. If the baby then dies, even if just a moment afterwards, then a Certificate of Death is also required.
If, however, there are no signs of life at delivery, then a Certificate of Stillbirth alone is required. No circumstances exist where a stillbirth certificate would be filed in combination with a birth or death certificate. This decision-making process is illustrated in the Stillbirth Flowchart.
The responsibility for filing stillbirth certificates can be found in 63 OS 1-318. Paragraph (b) reads:
"The funeral director or person acting as such who first assumes custody of a fetus shall file the fetal death certificate."
This is almost exactly what the "death certificate law" says. The funeral director is responsible for filing the stillbirth certificate within three days of the event.
HOWEVER, it is the responsibility of the hospital to complete most of the certificate. Many of the items on the top part of the certificate can be, and should be, completed by the hospital at the time of the event. Only two items, Items 9 and 10, are specific to the funeral home. Furthermore, the medical information part of the certificate (the bottom part, also called “the tail”) must be completed by the hospital. This information is similar to that on a birth certificate. Therefore, birth clerks should make sure they collect this information for entry onto the stillbirth certificate.
Effective November 1, 2008, in accordance with 63 OS 1-318.2, a “certificate of birth resulting in stillbirth” became available for the parent(s) of a stillborn child. It is the responsibility of the medical staff treating the stillbirth to notify the parent of the ability to request the certificate. The parent(s) must make application to the Vital Records Division. “This certificate shall not be used as evidence of live birth or for identification purposes.”
One common error is filing a birth certificate with medical indicators identifying an at-risk delivery. These include low birth weight, short gestation, an Apgar score of 0, or other risk factors. Similarly, we may receive a death certificate that has an age recorded as 0. These are indications that the event may actually have been a stillbirth.
Another common error is that we receive a birth certificate and a stillbirth certificate for the same infant. Or we receive a death certificate and a stillbirth certificate for the same infant. Or we may receive a death certificate for an infant, but not have a birth certificate on file, indicating the original birth event may have been a stillbirth.
The most common error is a certificate submitted with blank items, particularly in the medical information section. Only under certain circumstances can a few of these items be left blank. All other items must be answered.
Make sure a proper certificate(s) is filed in accordance with Oklahoma Statutes and rules established by the State Board of Health. Cases should be reviewed carefully. If questions arise about any information contained within the chart, contact the attending physician. If there are still questions, contact Vital Records immediately.
In general, funeral director's duties are to:
- Complete/cause to be completed all required items in the top section of the stillbirth certificate (Items 1 through 12).
- Send certificate to the physician for completion of the Medical Information section (Items 13 through 34) IF the physician did not fill it out beforehand.
- Review entire certificate for completeness and accuracy. Address any omissions, errors, and/or discrepancies.
- File the certificate with the State Registrar.
- Notify the medical examiner of any stillbirth believed to have been an accident, suicide, homicide, or to have occurred without medical attendance. (63 OS 938)
- Obtain and use all necessary permits for cremation or removal of the body from the state.
- Cooperate with the State Registrar concerning any questions on certificate entries.
- Be thoroughly familiar with all Oklahoma laws, rules, and regulations governing vital statistics.
- Call the Vital Records Division for advice and assistance when necessary.
- Use the current Oklahoma Certificate of Stillbirth form designated by the State of Oklahoma. (VS 153 2009)
- Complete each required item.
- Make the entry legible. Use a computer printer with high resolution, typewriter with good black ribbon and clean keys, or print legibly using permanent black ink.
- Avoid abbreviations when possible. If you must use abbreviations, use standard abbreviations (ex. US Postal Service abbreviations for addresses).
- Verify the spelling of names, especially those that have different spellings for the same sound.
- Obtain all signatures. THEY MUST BE ORIGINAL. Rubber stamps or other facsimile signatures are not acceptable.
- Do not make alterations or erasures.
- File the original certificate with the State Registrar. Reproductions or duplicates are not acceptable.
- Refer problems to the Vital Records Division.
Completing the Certificate of Stillbirth
These instructions pertain to the 2009 Revision of the State of Oklahoma Certificate of Stillbirth (Form VS 153 2009).
For all items on the stillbirth certificate, including in the Medical Information section, "unknown" is an entry option. However, please understand that this should be the exception and not the common practice! Every attempt should be made to obtain the information requested for record submission.
All required items must be completed. If there are required items left blank on the certificate, it will be rejected in accordance with Oklahoma Administrative Code 310:105-1-2(1).
Physicians who would like to sign up for ROVER should contact AskROVER@health.ok.gov or call (405) 426-8686.