Documentation Requirements

A.        Abortion

1.    Definitions

a.    Abortion:   “Abortion” is defined as “any medical treatment intended to induce the termination of a pregnancy except for the purpose of producing live birth.”[1]

b.    Pregnancy:  “Pregnancy” is defined as “the human reproductive process, beginning with the implantation of an embryo.”[2]

2.    Documentation for Abortion:  Documentation requirements relating to Fetal Death Certificates and Certificates of Still Birth do not apply to an induced abortion.[3]

                    

B.  Fetal Death

1.    Definition of Fetal Death“Fetal death” is defined as “a death prior to the complete expulsion or extraction from its mother of a product of conception irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation, 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.”[4]

2.    Documentation Requirements for Fetal Death

a.    Spontaneous Abortion (Miscarriage) Before 20 Weeks Gestation:  There are no documentation requirements for a fetal death of less than 20 weeks gestation.

b.    Fetal Demise/Stillbirth at or After 20 Weeks Gestation:  A fetal death certificate is required for an intrauterine fetal demise when the fetus is at or after 20 weeks gestation.[5]  The fetal death must be registered with the local registrar of births and deaths within eight calendar days following the event and before disposition of the fetal remains.[6]  A birth certificate is not required where fetal death occurs prior to complete expulsion or extraction.[7]

3.   Note on Certificate of Still Birth

a.    Definition of Stillbirth:  “Stillbirth” is defined as “the delivery of a fetus where there was a naturally occurring intrauterine fetal death after a gestational age of not less than 20 completed weeks.”[8]

b.    When to Issue a Certificate of Still Birth:  A Certificate of Still Birth must be issued by the local registrar of births and deaths in the case of a naturally occurring fetal death at 20 weeks or greater when requested by the mother or father of a fetus.[9]

c.    Certificate of Still Birth is Optional:  A Certificate of Still Birth is not required documentation and does not replace the fetal death certificate.[10]  The information included on a Certificate of Still Birth will not be used for any governmental purpose other than to respond to the request for the certificate from the parent.[11]

 

C.   Spontaneous or Induced Abortion with Evidence of Life

1.    Definition of Live Birth: “Live birth” is defined as “the complete expulsion or extraction from its mother of a product of conception (irrespective of the duration of pregnancy) which, after such separation, 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.”[12]

2.    Treatment:  An infant prematurely “born alive” in the course of an abortion has the same rights to medical treatment as an infant of similar medical status prematurely born spontaneously.[13]

3.    Documentation:  Documentation is the same whether the live birth occurs prematurely or spontaneously or as a result of an induced abortion.

a.    Birth Certificate:  A birth certificate is required for any live birth at any gestational age.[14]

b.    Death Certificate:  A death certificate is required for death following a live birth.[15]

 

D.   General Provisions Relating to Disposition:  Specific policies and protocols relating to disposal of products of conception after abortion or disposition of fetal remains after fetal death will vary based on a variety of factors, such as type of facility and generally applicable institutional policies.[16]

 


[1]   Cal. Health & Safety Code § 123464(a) (2011).

[2]   Id. § 123464(b).

[3]   Id. §§ 102950(b), 103040.1(b).

[4]   Cal. Code Regs. tit. 17, § 916 (2011).

[5]   Cal. Health & Safety Code § 102950(a) (2011).

[6]   Id.

[7]   Id. § 102100.

[8]   Id. § 103040.1(i).

[9]   Id. § 103040.1(a)

[10]   Id. § 103040.1(b).

[11]   Id. § 103040.1(e).

[12]   Cal. Code Regs. tit. 17, § 915 (2011).  Born alive is similarly defined under the Federal Born Alive Infant Protection Act, 1 U.S.C. § 8 (2002).

[13]   Cal. Health & Safety Code § 123435 (2011).

[14]   Id. § 102100, 102400.

[15]   Id. §§ 102100, 102775.

[16]   For general application see Cal. Health & Safety Code § 7054.3 (2011) (“[A] recognizable dead human fetus of less than 20 weeks uterogestation not disposed of by interment shall be disposed of by incineration.”) and Cal. Penal Code § 643 (2011) (“No person knowingly shall dispose of fetal remains in a public or private dump, refuse, or disposal site or place open to public view”).  For application to Abortion Service in Primary Care Clinics see Cal. Code Regs. tit. 22, § 75069 (2011) (governing disposal of infectious waste).