Subject: Fetal Death

POLICY: A fetal death, after 16 weeks of gestation born without signs of life – see attached flow charts, infant may not leave the center before the death certificate is signed by a physician. The required funeral home form will be faxed as required.  Fetal death certificate information will be entered into ROSE as required.

GUIDELINES: 1. The Birth Center staff will call a physician to confirm the death and sign the death certificate at The Birth Center.  The physician will sign the certificate within 24 hours of the delivery of the fetal death.

2. The Birth Center staff will notify the funeral home of the client’s choice of the fetal death within 24 hours of the delivery by faxing the completed form (attached) FUNERAL HOME NOTIFICATION OF FETAL DEATH.

3. The funeral home shall complete the disposition section of the Funeral Home Notification of Fetal Death and fax the completed form back to the hospital designated representative within 24 hours for receipt.

4. The Birth Center staff shall enter the fetal death certificate information in ROSE within 5 days of delivery.  This process shall include the editing and marking of the electronic record for registration purposes.

·         Do not mark the record unless you are ready to fax the completed certification for cause of fetal death form

·         When completing the cause of death screens, 1,2 and 3; these screens must match the cause of death form exactly  with the exception being that if the attendant has marked “Unknown” for the cause in both Initiating and Other Significant Conditions.  If they cannot be entered to match then the physician must re-do the form.  One item ONLY may be marked and entered into the Initiating Cause screen

·         Edit and mark the record.

5. Upon completion of step 3 The Birth Center staff shall immediately, with cover sheet, fax the completed Certification for Cause of Fetal Death form to 801-536-0499.  If a Voluntary Declaration of Paternity has been signed it shall accompany the faxed Certification for Cause of Fetal Death form.

·         If there are problems with the form we will be contacted.

·         Make a copy of the form for The Birth Center records.

·         Mail the original form to VR to the attention of Debbie Davis, VR P> Box 141012, SLC, UT 84114-1012.

·         This is the record that is given to parents if they request a copy of the Fetal Death Certificate – do not place patient information on the form, do not punch holes on the form or otherwise mar the form.

5. Parents will be treated with tenderness and respect for their beliefs and desires.  They will be provided clothing and grieving information as is available (see loss package).  Angle Watch can be contacted, free grieving assistance for Utah births.


·         Flow charts for determination of fetal death or infant death

·         Funeral home notification of fetal death

·         Removal of remains statues

·         Transit report for fetal remains

·         Angel Watch information

·         Certification for cause of fetal death form