By Dr. Robert Thorson

A legal certificate is issued for each live birth. Should one also be issued to the grieving parents of a stillborn birth? Yes, as a gesture of human support and as clinical documentation of a natural event.

Stillborn deaths often happen mysteriously, with no apparent cause. What we must keep in mind is that stillbirth is about reproduction, which is about nature, which has no morality. Nature is not immoral. It amoral.

The key word is ontogeny. It refers to the growth and development of an individual organism through all development stages, from the moment of conception to full adulthood. This includes the zygote (fusion of sperm and egg), embryo, fetus, late fetus, infant, child, adolescent and sexually mature adult. Biologically, this is a seamless unfolding of genetically coded instructions within the developing individual.

Physical birth — whether through the birth canal or being “untimely ripped” (the quote is from Shakespeare’s Macbeth) — is external to the pre-programmed unfolding. But what do we mean by “untimely?”

If you are a mammal, it depends on whether you are a placental, marsupial or monotreme, the group of animals to which the platypus (Ornithorhynchus anatinus) belongs. Placentals such as humans retain the fetus inside the womb until the new organism is viable with parental care. Marsupials such as kangaroos divide this process into two stages, the first inside the womb, and the second in a protected, nippled pouch. Monotremes lay eggs, which hatch like those of birds. All three strategies are equally timely. Fetal death can come at any time, whether in uterus, pouch or egg, respectively.

The most ancient reproductive method is the egg. In this case, the “fetus” is nourished and hydrated by pre-packaged yolk and white and protected by the shell. This was the original condition for the common ancestor for all early mammals, one that the platypus retained.

The marsupial and placental patterns are evolved alternatives. In the marsupial strategy, the young are “hatched” inside the body as tiny fetuses, which then crawl to the nearest available nipple: they are protected by the pouch. The placental mammals evolved the strategy of retaining the fetus inside the womb long as possible, nourishing it via the placenta and protecting it inside the water- filled amniotic membrane.

With respect to the birthing process, the living human baby breaking out of its amniotic sac before being physically delivered through the birth canal is like the platypus breaking through its amniotic sac before scratching its way out of the eggshell. The stillborn baby who didn’t survive the physical transformation is — reproductively — like the platypus that never hatched. In contrast, the very premature human baby follows the marsupial pattern. The incubator of the hospital’s neo-natal intensive care unit is equivalent to the pouch of the kangaroo where non-viable fetuses cling to life while being fed fluids externally and being physically protected.

Now, my point. The physical mechanism of birth has little to do with the ontogeny (biological unfolding) of the individual. Rather, it’s a dangerous threshold event that must be survived. The human strategy is a naturally evolved tradeoff between delivering too early (too many risks and not enough brain growth), and delivering too late (an unsuccessful breakout). Cases of maternal and infant death (or both) are thus unavoidable consequences of a statistically successful reproductive strategy as a species.

A full-term baby who dies on one side of the birth canal is no more and no less human than one who dies on the other side. An optional certification of that human existence is clearly warranted. But it must be kept in mind that what’s being certified is a natural reproductive event (the stillbirth), rather than a moral decision.

In fact, from the perspective of nature, the human animal (body and brain) is merely the genome’s way of making another genome. Usually the human genome succeeds. Sometimes it doesn’t. This is a sad, but completely amoral fact.

Do not interpret this column for its moral content. It has none.