By Darren Smith, Weekend Contributor
There is a disturbing and somewhat macabre report out of Great Britain where the bodies of thousands of aborted and miscarried fetuses were incinerated as clinical waste, with some even used to heat hospitals, an investigation has found.
Ten National Health Service (NHS) trusts have admitted burning fetal remains alongside other rubbish while two others used the bodies in ‘waste-to-energy’ plants which generate power for heat. Department of Health issued an instant ban on the practice which health minister Dr Dan Poulter branded ‘totally unacceptable.’
At least 15,500 fetal remains were incinerated by 27 NHS trusts over the last two years alone, according to British news agencies.
Investigations found that parents who lose children in early pregnancy were often treated without compassion and were not consulted about what they wanted to happen to the remains. One of the country’s leading hospitals, Addenbrooke’s in Cambridge, incinerated 797 fetuses below 13 weeks gestation at their own ‘waste to energy’ plant. The mothers were told the remains had been ‘cremated.’
Another ‘waste to energy’ facility at Ipswich Hospital, operated by a private contractor, incinerated 1,101 fetal remains between 2011 and 2013. They were brought in from another hospital before being burned, generating energy for the hospital site. Ipswich Hospital itself disposes of remains by cremation.
“This practice is totally unacceptable,” said Dr Poulter. “While the vast majority of hospitals are acting in the appropriate way, that must be the case for all hospitals and the Human Tissue Authority has now been asked to ensure that it acts on this issue without delay.”
Sir Mike Richards, Chief Inspector of Hospitals, said: “I am disappointed trusts may not be informing or consulting women and their families. “This breaches our standard on respecting and involving people who use services and I’m keen for Dispatches to share their evidence with us. “We scrutinize information of concern and can inspect unannounced, if required.”
Ipswich Hospital Trust said it was concerned to discover that fetal remains from another hospital had been incinerated on its site. A spokeswoman said: “The Ipswich Hospital NHS Trust does not incinerate fetal remains.” She added that the trust “takes great care over fetal remains”
A spokesman for the Cambridge University Hospitals NHS Foundation Trust said that trained health professionals discuss the options with parents ‘both verbally and in writing.’ “The parents are given exactly the same choice on the disposal of fetal remains as for a stillborn child and their personal wishes are respected,” they added.
This certainly speaks volumes of the need for greater oversight of what constitutes medical waste and dignity for human remains and the row controversy is surely guaranteed to address the issue. What is important to recognize in the United States as to what constitutes patient wishes should be carried out, especially with regard to a miscarriage.
One issue that might come to bear is that status of fetuses aborted voluntarily by mothers for the purposes of family planning. What would constitute the responsibility on behalf of hospitals where mothers are wanting to separate themselves from the events of the surgery and do not wish to have any decision in the burial or cremation of the fetus? Should hospitals also be required to treat a fetus in this regard the same as would be the case with an unclaimed person who died in the hospital?
What do you think?
By Darren Smith
Sources:
The Telegraph
National Health Service
Wikipedia
The views expressed in this posting are the author’s alone and not those of the blog, the host, or other weekend bloggers. As an open forum, weekend bloggers post independently without pre-approval or review. Content and any displays or art are solely their decision and responsibility.
I had one young 14 year ld mother who had a 16 week miscarriage of twins. We asked of if she wanted to see them and she said yes despite the fact that the head of one of the babies was no longer connected. She wanted a picture of the twins, so we put the head on the torso, washed the babies up and wrapped them up securely in a baby blanket and she was comforted by seeing them and go her picture. She didn’t want to take the remains with her and they were sent to pathology IIRC.
Darren,
I will take that question. Been there and done that. The short answer is there is no consistent answer. Some OB/GYN docs have no interpersonal skills and a tin ear for their patients. Others are sensitive and caring. As varied as there are people. My recommendation is to listen carefully to the patient and her family, and try to “read” what they want. Some mothers who miscarry in late term want the full meal deal, name the “baby” and have a formal funeral. Others don’t want to see it, think about it or make any decisions. No matter the decision, it is an emotionally traumatic time for any woman who has the smallest amount of maternal instinct. Oftentimes the father and rest of the family are devastated as well.
Best answer: It all depends. It should never be the doctor’s or the hospital’s decision, much less a bunch of meddling busybodies in the state capitol.
Thanks Annie
If she having a later miscarriage she would be going to the ER and have a D&C and the fetal remains would most likely be saved and she would be asked if she would like to view them and take them for burial or cremation. Sometimes they are in pieces, sorry for being graphic. If its an earlier miscarriage she would either see her OB in the office or go to the ER later and those remains would most likely end up on a disposable pad in bed and discarded in medical waste. The fetus is sometimes so small it can’t be distinguished, from the rest of the tissue. Things may have changed since in the last few years, bu that is how I recall it.
Annie:
How does a medical professional approach the woman who has miscarried in the later terms of pregnancy about what to do with the remains? Trying to respect what her wishes might be. I don’t know what the procedures are for this and was curious.
Rafflaw, I can’t think of anything worse than a woman having to “save” fetal remains in order to satisfy some insane law. The Virginia bill was chilling, shades of “A Hamdmaids Tale”, report your miscarriage in case it was really an abortion?
annie,
I think if anyone knows a relative or friend or spouse who has had a miscarriage, they should understand the emotional grief involved and how insensitive laws like the one in Michigan really are.
Thanks Rafflaw.
http://jonathanturley.org/civility-rule/
Great links annie. The Michigan law reminds me of the voter id laws passed to cure a problem that does not exist.
Spinelli, I think you are walking a fine line and if you aren’t careful, you may fall off it. It may take only so much as a breath to do it. You think you are invincible here, I think you kid yourself.
I have known for a long time.
Everyone has.
Good, I hope you’ve learned something.
I’ve bookmarked this thread.
http://www.minnpost.com/second-opinion/2013/05/failed-virginia-bill-miscarriages-reveals-ignorance-about-womens-health
Failed Virginia bill on miscarriages reveals ignorance about women’s health.
CC/Flickr/Tony Fischer
The bill was unanimously voted down by the Virginia State Senate after women’s health advocates made it clear that the bill would place an enormous emotional burden on women.
As I’ve written here before, the medical ignorance of some politicians — particularly in regard to women’s reproductive health — is a continual source of astonishment.
Another one of these incidences hit the news this week. While searching through the legislative history of Virginia state Sen. Mark Obenshain, now running on the Republican ticket for his state’s attorney general position, reporters found that he had authored a bill in 2009 that would have required all women in Virginia to report miscarriages to police or risk legal penalties, including as much as a year in jail.
Specifically, the bill required that within 24 hours of “a fetal death” that occurs without “medical attendance,” the mother or someone acting on her behalf must report that death, the location of the fetal remains and the name of the mother to local police. Furthermore, the “remains” could not be disposed of without police authorization.
The bill was unanimously rejected by the Virginia State Senate, thank goodness — apparently after women’s health advocates made it clear that the bill would place an enormous emotional burden on women.
Obenshain’s office issued a statement Tuesday which said that the senator never intended to target every woman who miscarries, but only women like the 20-year-old Virginia college student who in 2008 delivered a stillborn baby in her dormitory’s bathroom and then placed the body in a dumpster. She received, under current Virginia law, a 30-day suspended jail sentence and a year of probation. Press reports say she also underwent considerable counseling.
That apparently that wasn’t enough of a punishment for Obenshain. So he drafted his failed bill. What struck me, however, was how that bill’s language reflected such a underlying lack of knowledge about miscarriages — how common they are, how they occur, and how intrusive and emotionally burdensome it would be to ask women to report them to police.
To get the medical facts about miscarriages, I spoke Tuesday with Dr. Carrie Terrell, an ob-gyn and chief of staff at the University of Minnesota Medical Center. A condensed version of that interview follows.
MinnPost: What is a miscarriage?
Carrie Terrell
Carrie Terrell: A miscarriage is spontaneous abortion. It’s generally defined as the expulsion of an embryo or fetus weighing 500 grams [about one pound] or less. We usually use the word fetus for gestations that are greater than 10 weeks and embryo for gestations less than or equal to 10 weeks.
So, in general, a miscarriage is a loss of any pregnancy prior to viability — [when] the fetus could potentially be resuscitated in a hospital setting with the proper equipment. That’s generally considered 24 weeks.
MP: What is the difference between a miscarriage and a stillborn birth?
CT: A stillborn is not a medical term, so it’s not something that we have a definition for. But generally it means a fetus that is born dead past that term of viability.
MP: What are the key causes of miscarriage?
CT: For the vast majority, their cause is spontaneous and unknown. Only in rare cases can we identify the cause. It can be a maternal factor, a paternal factor, a genetic factor, an exposure factor, or an anatomy problem. A maternal factor might be some set of antibodies [the mother has], or some kind of blood [clotting or bleeding] disorder that causes abortion. A paternal factor could be a genetic component. The chromosome inherited from the sperm could be somehow mutated.
MP: Miscarriages are very common, aren’t they?
CT: Absolutely. The rates that we quote vary, but we generally say that anywhere from 8 to 20 percent of pregnancies — those that have been documented in some way — result in miscarriage.
MP: Do women always know they’ve had a miscarriage?
CT: Women don’t always know. Today, for good or for ill, women often know they’re pregnant quite early. A lot of home pregnancy tests can show that you’re pregnant four to six weeks from the last period, which is how we date pregnancies. So a woman will often get a positive pregnancy test [and then bleed and miscarry] before we can even identify anything on an ultrasound, before anything can be clinically documented.
That’s one thing that happens. The other thing is that sometimes the fetus or the embryo dies, but the body doesn’t necessarily recognize that it is no longer pregnant because there’s still gestational pregnancy tissue in the uterus, the hormones are still at a very high level, and the body hasn’t recognized that the hormone levels are starting to decline. The women still feels pregnant. They still have a positive pregnancy test. They come in for verification and their ultrasound reveals that either the embryo has stopped growing at some point or is no longer viable. Yet they haven’t had any cramping or bleeding. We’re not doing ultrasounds on everyone all the time, so that could have gone on for several more weeks before the body realized, oh, those hormone levels are dropping so it’s time to start cramping and bleeding.
MP: So in previous generations, before early pregnancy testing and ultrasound technology, women would have been less likely to even know they had experienced a miscarriage.
CT: Yes. It would have been considered a late menses usually.
MP: It’s very common therefore for women to miscarry without a doctor or other health professional present.
CT: Absolutely. Frankly, even if they’re under medical care, even if I diagnose a miscarriage because I’ve done an ultrasound on someone and deemed the embryo is not viable or not growing and the pregnancy is not progressing, the woman most times will opt for natural intervention. She’ll just opt to wait and see what happens. She doesn’t necessarily want to have the surgery or medication. She’ll just go about her business, and at some point she’ll cramp and bleed.
I haven’t read [Obenshain’s 2009 bill], but if they’re saying [that all women need to be under medical care for] the passage of the embryo, well that’s not going to happen. Even the ones that we’re managing, even the ones that we administer medication to help the woman pass the tissue, we’re not there when it happens. So, I think we’re talking voluminous increases in monitoring or surveillance or police calls. I can’t even fathom it.
MP: Most of the time we’re talking about something that just looks like heavy bleeding, correct?
CT: Right. Generally, there’s nothing identifiable. There’s nothing a woman would be able to see with her eyes or separate from the blood or the blood clot in the toilet or on the pad. These early ones are nearly microscopic. There is no fetal growth. There are no parts. It’s just an embryonic sac.
MP: What happens if there is a fetus?
CT: Now we’re talking anything past 10 weeks or above. We technically call that a fetus. There may be something potentially identifiable, but you may or may not be able to find it. As before, if a woman is diagnosed with a miscarriage and she chooses not to have the surgery, she may pass that at home on her own. As the fetus gets larger, passing it at home can be really quite painful and there can be a significant amount of bleeding, so we will encourage women to opt for an intervention, which is most commonly a D&C that is done in the [doctor’s] office or in the hospital.
But women get to make that choice in our society.
MP: In the case that apparently instigated the proposed Virginia legislation, a stillbirth occurred and the woman disposed of the remains in a dumpster. Those cases are extremely rare, correct?
CT: Right. Number one, those pregnancies are generally under some kind of medical care. And with stillborns, we’re talking 23 or 24 weeks and beyond. That’s a large pregnancy. We would generally not recommend that women try to do that at home on their own. Pain and bleeding would be the big concern. We’ve certainly had rare cases where women have used doulas or midwives to birth a stillborn at home, and that can be fine.
In rare cases, maybe the woman doesn’t know she’s pregnant or she knows she’s pregnant, but she doesn’t realize that anything’s wrong. She may have some stomach pain, but she doesn’t think it’s labor because it’s so early. Those cases can sometimes progress rapidly, and a woman may deliver at home. In my experience, 99 percent of the time they call an ambulance. They don’t want it to happen. They’re trying to stop it or figure out what to do about it. It’s a horrible thing to go through.
We have certainly all heard of the cases you’re describing. But they are not the norm.
MP: So what is your opinion of requiring all women to report all miscarriages to the police?
CT: It sounds absurd. From a societal point of view, who’s going to pay for that? Is that going to be a medical expense or a taxpayer expense? Because, again, if we’re saying that up to 20 percent of pregnancies end in miscarriage, that’s an awful lot of phone calls. Because a majority of those aren’t happening in a hospital or a clinic, they are happening at home, even when we’re well aware of them.
MP: It’s also usually a difficult time for women.
CT: Yes, it’s an emotional time for women. It’s also a completely normal and natural event. It would be sort of like having to report every time you had intercourse or your period. It’s a normal part of a woman’ reproductive life.
http://rhrealitycheck.org/article/2011/11/15/fetal-remains-bill-pleases-anti-choice-traumatizes-women-who-miscarry/
“When Michigan anti-choicers claimed they found “fetal remains” in a dumpster at an abortion clinic, state Republicans quickly stepped up to push a bill legislating how products of conception could be discarded.
In the end, it turns out that there was no proof of mishandled remains. But a law was proposed regardless, and because of it, one of the first questions that may be asked of a woman who just miscarried or had a still birth is likely to be “what do you want to do with the fetus?”
Via the Detroit News:
“I think some women will be devastated,” says Joanne Mulhere, who counsels women undergoing loss of pregnancies at Beaumont Hospital in Royal Oak, where about 175 women lose pregnancies through miscarriage or stillbirth annually.
Patients would be handed Kleenex, as well as a form to sign, requesting the remains be cremated, buried or interred.
They’ll be forced to make a potentially emotional choice that will, for some women, redefine how they think and feel.
It’s a “choice” that effectively reframes the way women are supposed to think about early pregnancy, imposing new opportunities for grief where none might have existed.
Unfortunately, Michigan legislators have crafted a bill that’s more sensitive to the needs of tissue that fits in a tablespoon than to grown women who, at vulnerable moments, will face a new form to sign, an unsought, disturbing decision to make.
Yet another thoughtless bill with unintended consequences that will hurt more women.”
Spinelli, quit being a damn drama queen and grow up. What do you think? Do you a expect women to sift through the blood clots and tissue in the toilet bowl? If a woman chooses to do so fine, her prerogative, but it would be cruel to pass judgment on her for flushing the remains. Sometimes you are very childish.
Wow!!!!!
Miscarriage. iPad kept “correcting” it. Strange.