Issuance of a Certificate of Birth Resulting in Stillbirth and the Power of Acknowledgement

By: Terrell Hatzilias, PhD

Content Warning: This article discusses grief, hope, and healing after pregnancy and infant loss. This information may be triggering – please go at your own pace.

“This bill was really about the importance of acknowledging and witnessing – acknowledging the truth that a birth occurred and standing witness to the heartbreak of death”. 

In the fall of 2018, I was blissfully anticipating the birth of my second child, a boy we had already named Kegan Christopher. I was nine months pregnant, just over a week before my due date when we received the devastating news that a blood clot in his umbilical cord had ended his life within minutes. There was no chance to save him, no warning signs of death – one minute he was here, and the next, our hearts were shattered. 

Following Kegan’s death, I was induced and labored twelve hours to deliver my perfect, beautiful, breathless, 6-pound, 10-ounce baby boy. I will never forget the cries of living babies echoing down the maternity ward hallway as I traced the features of the gorgeous, silent boy in my arms. After we had sobbed through our final goodbyes and Kegan had been taken to the morgue, we were immediately inundated with forms to fill out – forms for his death certificate, forms for his autopsy, forms for the morgue, forms for the funeral home, but nothing to acknowledge his birth. Nothing to acknowledge the nine months I had carried him, nothing to acknowledge the hours I had labored to deliver him. 

Washington State requires families to handle all arrangements and legalities for burying their stillborn children, but at the time offered nothing to acknowledge the reality that a stillborn baby had in fact been born. By not acknowledging the fullness of the stillbirth experience, the state was contributing to the shaming, silencing, and stigmatization of women who had already experienced unimaginable trauma. By not acknowledging the reality that a birth as well as a death occurred, the state was perhaps inadvertently but still actively, worsening the trauma of stillbirth.

As we struggled to come to terms with losing our son to stillbirth, I discovered the Star Legacy Foundation, an organization dedicated to stillbirth research and advocacy, and learned that over 40 states in the US offered parents stillbirth certificates of some form. It was at this point that we were connected to other bereaved parents and a legislative lobbyist, and then began the long process of passing a bill to allow Washington to join those states in supporting bereaved families. Previous efforts to pass a bill allowing a stillbirth certificate in Washington had not been successful, so we met with all special interest groups to discuss any concerns. After meeting with the Washington Department of Health and various women’s reproductive rights groups, we settled on language that everyone supported and moved forward. One of the largest obstacles in passing the bill was the fear that by acknowledging a birth occurred, women’s reproductive rights would be negatively impacted. For this reason, it became imperative to both have language that reproductive rights groups approved of and to have the bill tied to the already existing death certificate issued by the state. By tying the bill to an already established vital record, no rights or definitions in statute were, or could be, changed; the only outcome of our bill was that a bereaved mother would be allowed to request a certificate of birth resulting in stillbirth, if she so desired.

 After countless meetings, our bill eventually passed with strong majority, bipartisan support. Through the amazing work of our team of bereaved parents, our lobbyist, and the Washington community we were able to convey to our legislators the enormous impact this would have on bereaved parents’ mental health. This bill was really about the importance of acknowledging and witnessing – acknowledging the truth that a birth occurred and standing witness to the heartbreak of death. Nothing will ever undo the pain and trauma of losing a child to stillbirth – the horror of that day will stay in my mind and heart forever – but we can help each other with the amazing power of witnessing each other’s stories. While we may not be able to heal each other’s pain, we can stop causing further hurt through the simple gift of acknowledgment. In the end, this is really what our bill was about – acknowledging pain, but even more so, witnessing love. 

 For those who would like to obtain a Certificate of Birth Resulting in Stillbirth in Washington State, the application process is currently being drafted by the Washington Department of Health. Certificates will be available to be applied for October 1, 2022, and there is not a retroactive date limit after which the stillbirth must have occurred.

About the Author: Dr. Terrell Hatzilias is committed to relieving suffering in the world in memory of her son, Kegan Christopher Hatzilias. Kegan was unexpectedly stillborn at term, just over a week before his due date, in November 2018.  Kegan left behind his devastated mother, father, and big sister. Since Kegan’s death and birth, Terrell has been working to reduce the stigma and silencing that surround stillbirth. By helping traumatized women have a voice, she is hoping to alleviate the emotional and mental health challenges that frequently follow stillbirth. The entire Hatzilias family hopes to bring light into the world out of their immense suffering.
Kegan Christopher Hatzilias was born November 7, 2018. His gestational age was 38.5 weeks. He was 20 inches long and weighed 6 lbs, 10 oz at birth. He is greatly loved and deeply missed.
Terrell Hatzilias, PhD, testifying at the Washington State Capitol in favor of issuance of a Certificate of Birth Resulting in Stillbirth.