GREAT FALLS, Mont. (AP) — On a night at the end of November 2011, Beth Morey, 31 weeks pregnant, realized the baby she was carrying had stopped kicking. Worried, she went to Community Medical Center in Missoula to have a doctor check the baby, and there she found out it had died.
The next day, Morey was induced and gave birth to a stillborn daughter she named Eve.
"(Hospital staff) asked if we wanted to have photos or casts of her hands and feet, and they also gave us stuff we didn't ask for, like memory items," Morey recalled.
But Morey left the hospital without knowledge of a certificate that, according to Montana law, she could have received. Called a certificate of birth resulting in stillbirth, the document is meant to provide a level of comfort to bereaved parents.
"I talk to a lot of parents who say, 'We want to leave with something, a piece of paper that says, 'Our child mattered,'" said Morey, of Missoula, who helps facilitate a support group for bereaved parents. "Something tangible means so much when you don't have the baby."
The CBRSB has been in existence for more than six years, but some potential parents and hospitals don't know about it.
Women in Montana tell a similar story — that of unspeakable grief at losing a baby, learning of the CBRSB sometime afterward, then the labyrinth of phone calls, websites and false leads in their attempt to obtain the certificate.
Passed by the Montana state Legislature in 2007, Senate Bill 518, sponsored by former state Sen. Gary Perry, R-Manhattan, allowed for a certificate of birth resulting in stillbirth to be issued within 10 days of a stillbirth should the parents request it. The bill was passed and signed by Gov. Brian Schweitzer in May 2007 and went into effect Jan. 1, 2008.
Prior to the passage of Perry's bill, the only document filed with a stillbirth was a fetal death certificate, which is required to be filed upon the death of a fetus before birth and if the fetus had reached 20 weeks of gestation, or, if gestation period is unknown, if the fetus weighs at least 350 grams. With the passage of SB 518, fetuses that reach the qualifications for a fetal death certificate also can have a CBRSB.
Larisa Barth delivered a son, Asher, in October 2011 at North Valley Hospital in Whitefish. Asher was stillborn after Barth carried him to term. Barth said she and her husband, Jim, were not offered a CBRSB and were told a fetal death certificate was the only document the hospital could issue.
The Barths, of Browning, later learned about Missing Angels bills, which have been passed in several states and allow for a CBRSB, and found out Montana passed such a law in 2007. They attempted to obtain a certificate for Asher from her doctor, from state and local recorders' offices. They received no answers.
"It made us very much aware that if a child isn't born alive, it's like they try to shove it under the rug," Barth said.
Barth eventually got into contact with Perry, but still the Barths struggled to obtain Asher's CBRSB.
After six months, the Barths obtained a request form from the Office of Vital Statistics. There was no option to request the CBRSB, so Jim crossed out the fetal death certificate option and wrote out "Certificate of Birth Resulting in Stillbirth."
That attempt was successful, and finally the Barths received Asher's certificate.
"I couldn't believe how ignorant people were about it and making us feel like we're the bad guy. The point of this bill is to help the family," Barth said.
Karin Ferlicka, the registrar of the state of Montana at the Office of Vital Statistics, said she is unsure where the confusion about the CBRSB has come from. She said in 2008 when the CBRSB became available, that form was added to the certificate of fetal death so that both could be filled out by hospitals.
Perry echoed Ferlicka's confusion, saying he isn't sure where the breakdown has occurred, "But we're at a point now where we can pull this together."
The CBRSB can be produced by either the hospital or funeral home or by the state registrar's office, she said.
"Normally, it is filled out by hospital staff or funeral home. A lot of the information has to come from the hospital," Ferlicka said.
However, the CBRSB is not available from county clerk and recorder's offices, Ferlicka said.
"It's only filed with the state, and we're the only ones who can issue it," she added.
Morey found out about the CBRSB and asked about it several months later after she became pregnant with her son. Eventually, she found a request for the form online.
"I downloaded the form and just never did anything because I thought it would be too gut-wrenching to go and (the staff) not know what I was talking about," Morey said.
Rachael Heilig of Turner tells a similar story. Heilig delivered a daughter, Kenley Faith, at 20 weeks at Benefis Health System in Great Falls in February 2012. She said a CBRSB was never mentioned to her.
"We left with a piece of paper that said, 'Go to the morgue and get your daughter's ashes,'" Heilig said.
Later, Heilig learned of a CBRSB when speaking with Barth, founder of a nonprofit called Held Your Whole Life that provides memorial jewelry to parents of stillborn children, and who herself faced a struggle with obtaining the certificate.
"I didn't even know they existed," she said.
Heilig said she has not attempted to obtain a CBRSB because she does not know how, nor does she know where to begin.
"It would be nice to have one at this point, being two years into it. I'd like to get one but I'd more like to raise awareness for other women so they can walk away with something," she said.
Like Barth and Morey, Heilig too has directed her grief into outward projects. Heilig started Kenley's Empty Arms Project, which distributes teddy bears to parents who have lost a baby.
Even with a state law and instructions sent by the Office of Vital Statistics, many hospitals in Montana cities, including hospitals with neonatal intensive care units where high-risk deliveries occur, either had no knowledge of the CBRSB or reported filing procedures that are not consistent with the state regulations Ferlicka described, according to a Tribune survey.
Ferlicka, who has been with the Office of Vital Statistics for more than 20 years, said information about the CBRSB was sent out to hospitals throughout the state when the law was passed in 2008.
Eleven hospitals in Montana's largest cities, in Great Falls, Bozeman, Kalispell, Whitefish, Billings, Helena, Butte, Havre, Missoula and Miles City, were polled. Of those 11, three (Billings Clinic, St. James Healthcare in Butte and Northern Montana Hospital in Havre) report filling out the form when required.
Bozeman Deaconess Family Birth Center manager Susan Connell said the fetal death certificate is completed there, but "the parent has to request (the CBRSB) from the state."
St. Peter's Hospital in Helena does not prepare the CBRSB, but Lewis and Clark County coroner Mickey Nelson does prepare the document when he receives the fetal death certificate from the hospital.
Kalispell Regional Medical Center, which operates a Level III NICU, reports never having had a request for a CBRSB.
"I don't know that parents know that's an option," NICU manager Rachelle Mertz said.
Four hospitals — St. Vincent Healthcare in Billings, Benefis, Community Health Center in Missoula and Holy Rosary Healthcare in Miles City — reported no knowledge of the CBRSB. Benefis, Community Health Center and St. Vincent Healthcare operate Level III NICUs, where many high-risk deliveries are performed.
"The only form the state is sending is a fetal death certificate," said Karen Ogden, chief communications officer for Benefis Health System.
Both Benefis and St. Vincent report issuing remembrance certificates to parents of stillborn children that are not legal, but hospital-generated, certificates. Community Medical Center reported to the Tribune that after inquiring with the state registrar's office about the CBRSB it would begin issuing it should parents request it.
North Valley Hospital, where Barth's son was born, did not provide information to the Tribune for this story.
While Morey and Heilig express distress that they were not offered the CBRSB at the hospitals where they delivered, both say they received excellent care and experienced compassion from the staffs.
Montana Department of Public Health and Human Services oversees the Montana Office of Vital Statistics, where the CBRSB would be filed. Richard Opper, director of DPHHS, declined to be interviewed for this story.
Jon Ebelt, DPHHS public information officer, said their office recently made contact with all the major hospitals in the state and were told all are aware of the CBRSB and are telling parents it is available.
"We realize that when this unfortunate situation arises, the information may still not be getting to the people who need it most," Ebelt said.
Ebelt said only a few requests for the CBRSB are made each year. In 2012, the last year for which data is available, there were 57 stillbirths in the state. The counties with the highest frequency of stillbirths are Yellowstone, with 12, and Missoula, Hill and Cascade, with six each.
Perry, who no longer serves in the state senate, said he is confident that even six years after the law's implementation, a solution can be found for issuance of the CBRSB, even for people whose children were born years ago.
"I can't see any problem for those who have had a stillbirth child since the law was enacted, and if there is, we can fix it," Perry said.
Ebelt said DPHHS plans to send out about 200 informational packets about the CBRSB, similar to those sent out in 2008, to hospitals, county clerks and recorders, and funeral homes. Employees from Vital Records will also include information on how parents can acquire a CBRSB when they give training to county clerks and recorders on birth and death certificates as well, he said.
The document, a piece of paper, differs only slightly from the fetal death certificate, but the differences are significant. For parents, the fact that legally their child is considered to have been born means a great deal.
Heilig calls the certificate "tangible" proof of their child's existence.
"Recognition of the most brief life of my child is important to me because it validates that I am mourning a real person," she said.