Talk:Stillbirth

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Stillbirth article.
Please sign and date your posts by typing four tildes (~~~~). Put new text under old text. Click here to start a new topic. New to Wikipedia? Welcome! Ask questions, get answers. This is not a forum for general discussion about the article's subject.	Be polite Assume good faith No personal attacks Be welcoming	Article policies No original research Neutral point of view Verifiability

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
Start	This page has been rated as Start-Class on the quality assessment scale
Mid	This article has been rated as Mid-importance on the importance assessment scale

Contents 1 Conversations without headers 1.1 1 1.2 2 1.3 3 2 General 3 Drugs 4 Legal definition 5 Legal definition of stillbirth 6 Legal Definition of stillbirth in the US 7 New edits 8 2 Reversions in a Row? 9 Definition 10 Contradiction? 11 Undue weight and OR 11.1 UK details 12 European legal definitions 13 Reasons for Reverting 14 LEAD discussion 15 Stedman's Medical Dictionary 16 Womb and Uterus 17 Womb-Uterus debate: central location proposed 18 Quiet birth?

[edit] Conversations without headers

[edit] 1

Stillbirth is more properly defined as the death of a fetus before 20 weeks gestation ~~Bob

No, Bob. Stillbirth is AFTER 20 gestational weeks. Miscarriage is the term for prior to 20 gestational weeks. Please check your facts.

Joanne Cacciatore, LMSW, FT CEO, MISS Foundation http://www.missfoundation.org

—Preceding unsigned comment added by 149.169.184.244 (talk • contribs) 21:40, 11 July 2006

This may be the case in the USA but in the UK it can be a miscarriage up to 24 weeks.Rosenthalenglish

[edit] 2

Anon user at 12.64.66.67 wrote in article (moved to talk by Infrogmation 06:08 May 15, 2003 (UTC)):

Photograph of Breanna Lynn Bartlett-Stewart, Stillborn, September 6, 2000.

I think we should have a link to a picture of a stillborn baby for research purposes...

Perhaps more about bereavement therapy as well???

[edit] 3

I'm surprised we can link to off-site jpg's, I thought that was no longer done. For 12.64.66.67, we generally put comments about articles on the talk page, and the content on the article page. So if you are able to write something about bereavement counseling following pregnancy loss, you could place the information in the article. My impression, for what it is worth, is that photographs of the dead tend to disturb people -except perhaps very special audiences --rather than educate them. -- Someone else 06:25 May 15, 2003 (UTC)

--Photographs of stillborns abound across the Web, and many find them hauntingly beautiful. I think Bree Lynn here fits the latter.

Stillbirth is the delivery of an infant which is dead at birth, regardless of the stage of development.

It's only a stillbirth after 20 weeks. Before 20 weeks, its a miscarriage. ~~Bob

You win more flies by not deleting opinions. Isn't this thing about debate vs ignorance???

--Bob

In fact, I just stumbled on http://www.missingangel.org/ ... It's freakish. ☢ Ҡieff⌇↯ 05:38, 7 January 2006 (UTC)

Stillbirth is defined as 20 weeks in the United States of America.However as this is a worldwide encyclopedia then you should put in that fact,as in the United Kingdom for instance it is defined as 24 weeks.

Rosenthalenglish

[edit] General

I felt the need to give this article a major overhaul for several reasons:

1. The introduction was repetitive, confusing, and some of it was factually incorrect
2. There was a lot of "topic wandering" and the content was not well organized
3. Most of the article appeared to be copied directly from support materials provided by another source
4. The extensive grief data should be summarized here, and expanded in a more appropriate article, as it is essentially a different (though related) topic
5. Most of the material is very heavy POV
6. wikipedia is an encyclopedia, not a grief counselling site...this material in it's current tone is more suited to a wikibook discussing the effects of stillbirth and/or perinatal death, and coping strategies

I've pasted here the material that I felt was not suitable for this article so it can be easily transferred to the appropriate areas

==Perinatal Bereavement: Loss at the time of Pregnancy==
Perinatal death in the U.S. alone can affect as many as 40,000 families.  While the causes may be many, the experience of loss is
nearly universal.  "Perinatal bereavement" is the grief experienced in and around the time of birth, and the initial synthesis
of the grieving process may last two years or more.  Perinatal death includes miscarriages, stillbirths and neonatal deaths.
Sudden Infant Death Syndrome is usually considered to be a separate category.  Loss at abortion may also be considered in this
general area.
At the death of an infant, parental expectations turn upside down. At a time when plans are made to announce a birth, announcements
of the death take place, usually from a hospital.  Reactions to the death early on may include shock and numbness. The reality of
the event is often difficult to assimilate, and may be followed by waves of grief and despondency.   Over the first few weeks,
these opposite waves of feelings of loss, numbness, ebb, and flow, are often followed by depression, and occasionally, rage over
people or events associated with the timing of the infant's death.  Characteristics of all normal grief including perinatal
bereavement include appetite and sleep disorders, stress related symptoms and illnesses, a lowering of the immune system's
function, depression, nightmares, and even having random experiences of the pregnancy in what is termed 'phantom' movement or even
cries.
== Morbid or Difficult Reactions ==
Morbid or complicated reactions include the inability to do such activities as taking down a nursery even after a year or more,
extreme phantom experiences which cause distress, 'replacement child syndrome' in which the next child is saddled with the
expectations of the 'ideal' first child, or 'vulnerable child syndrome' in which all subsequent children are seen as very fragile
and prone to harm or illness.
== Essential Choices & Facilitation of Grief ==
While grief cannot be treated or 'cured' as an illness, there are things which aid families experiencing perinatal loss.  These
include: 1) Choices in making funeral plans, 2) Choices in early hospital arrangements 3) Seeing, holding and saying goodbye to the
infant, which is thought to alleviate experiences of phantom crying and bring closure to the death, 4) Crisis intervention and
effective listening by health care providers and loved ones, 5) Keeping memorabilia to anchor grief such as clothing, hospital
bracelets or footprints/ultrasound photos, and 6)  Freedom to allow for individual differences in relinquishment of the infant in
the grieving process.  There is often a blurr between what is normal and not in perinatal bereavement.
== Negative Consequences ==
When the intense grief of perinatal loss is not dealt with, severe familial reactions may occur including loss of intimacy, sexual
dysfunction, divorce, alcoholism, juvenile delinquency and other difficulties.  Openness and acceptance of the normal process of
grief along with careful listening skills may often bring about the greatest effect.
== Intervention ==
Over the past 25 years, radical changes have been made in in-hospital effectiveness in treatment or intervention with perinatal
bereavement.   International Self-Help Resources include SHARE - for the support of parents experiencing Stillbirth, HAND - for
those experiencing a neonatal death, and The MISS Foundation - a volunteer-based organization committed to providing crisis support
and long term aid to families after the death of a child from any cause.
== External links ==
*The Forgotten Grief: Perinatal Death
*The MISS Foundation
*SANDS The Stillbirth and Neonatal Death Society (UK)

I WOULD like to keep some statistical information in the article - the rate of occurance - but it should not be limited to the US rate. bcatt 09:39, 7 February 2006 (UTC)

Question - should we distinguish between "stillbirth" as essentially "the birth of a dead baby" and "a stillbirth" as essentially "a dead newborn"? It seems to me that we're using the word "stillbirth" as both an event and a "thing", which could be confusing. I vote for calling the baby itself a "stillborn" or a "stillborn baby" and reserving "stillbirth" for the event itself. Ideas here?

I do agree that the event is called stillbirth, while when referring to the baby itself, stillborn would be used, whether it is in a verb or noun sense. For example:

• It was a stillbirth (verb)

  The baby was stillborn (verb)

  The baby is a stillborn (noun)

So, yes, I agree. However, the only part where the infant itself is referred to directly is the photo caption, where she is appropriately referred to as a stillborn...or did I miss something? bcatt 08:23, 18 February 2006 (UTC)

Just curious - but would anyone object to replacing the word 'fetus' with 'unborn child' in the first sentence passage: "A stillbirth occurs when an unborn child, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body."? I think it's generally understood that this article is dealing with the stillbirth of a human being. Not often will you hear a person asking a pregnant mother how her 'fetus' is doing. I think 'unborn child' is a more respectful term. Any thoughts? J.Nevels 21:45, 15 June 2006 (UTC)

[edit] Drugs

why cannabis alone is excluded from "recreational drugs", and on what grounds, i am unsure. this seems to be the result of marijuana advocates, and may therefore violate NPOV. i think that a citation is needed in this case. Whateley23 19:11, 1 April 2006 (UTC)

Cannabis was not excluded from the category of recreational drugs (as many people do use it for this purpose), but rather was excluded as a substance, which may be used as a recreational drug in some cases, which does not cause stillbirth. The grounds for exclusion is that there have been no conclusive studies that can show that cannabis actually causes stillbirth. The reason why it is the only one excluded is that I am not aware of any other substances used as recreational drugs which haven't been conclusively shown to increase the risk of stillbirth...please correct me if I am wrong about this.

a quick google search shows that marijuana use can increase stillbirth risk. I see no reason to leave this uncited, inaccurate claim in the article (from revision history)...

I did an extensive google search before including that note and was unable to find anything that was either based on scientific studies, or did not lump cannabis in with "hard drugs" (as in "cannabis increases the risk of stillbirth when used with cocaine/cigarettes/alcohol/etc..."). In other words, in order to find something accurate, you have to sift through all the anti-cannabis propaganda to find the non-biased studies conducted for the purpose of finding out the truth, rather than to serve an agenda. And the truth is, hard as some people have tried to find and/or create a link between cannabis use and stillbirth, they still haven't been able to do so, except by referring to subjects who also use other substances that are proven to increase risk of stillbirth. Granted, some studies indicate that cannabis use may have other effects on the fetus during pregnancy, but stillbirth isn't one of them. I was away for a few months, otherwise I would have found a citation earlier, but I am back now and this is what I found:

"There is firm evidence that cannabis use during pregnancy is not associated with higher rates of foetal mortality." (Fried, P.A. (2002). The consequences of marijuana use during pregnancy: a review of the human literature.)

which was included in page 18 of this document.I'm going to put the note back in, but I haven't figured out how to work the footnotes, so if someone can put in a footnote with the above citation, that would be great...my thanks in advance. bcatt 00:43, 13 June 2006 (UTC)

[edit] Legal definition

In the UK (I'm not sure about the US) stillbirth has a particular legal definition and requires the birth to be registered. I remembered this vaguely from being pregnant but the research I have just done show there was a UK Stillbirth Definition act in 1992 to define stillbirth as the delivery of a dead at birth infant of over 24 weeks gestation. Before this it is classed as a miscarriage and does not require registration [1]. Does anyone object if I start a "Legal definitions" section as I think it's an important distinction. Does anyone know the US definition or what it is elsewhere in the world? Sophia ^{Gilraen of Dorthonion} 11:39, 4 May 2006 (UTC)

That sounds like a good idea. I do not know the information about the states. I do not believe there is anything national, but some states may have their own definitions and registration requirements. --Andrew c 00:25, 5 May 2006 (UTC)

Here's a first go:

[edit] Legal definition of stillbirth

In the U.K. stillbirths must be registered by law. The Stillbirth Definition Act (1992) requires that any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life be registered as a stillbirth. This must be done within 42 days and a Stillbirth Certificate is issued to the parent(s).[2]

Please tweak as required as I'm not feeling very inspired at the moment. I use the word "parent" as this is the terminology in the uk gov website on filling out the certificate. Sophia ^{Gilraen of Dorthonion} 17:59, 5 May 2006 (UTC)

No one has objected so I'll add it to the article and hopefully others can add other countries legal definitions. Sophia ^{Gilraen of Dorthonion} 17:33, 7 May 2006 (UTC)

[edit] Legal Definition of stillbirth in the US

I've added a bit based on some research I've done here in the United States. Hope it's found to be helpful. J.Nevels 19:45, 9 June 2006 (UTC)

Thank you for helping to fill out this section. It's very interesting to find out how different countries define this very sad event. Sophia 14:03, 10 June 2006 (UTC)

Thanks for the 'thanks'. There is a movement by parents of stillborn children in the United States (through individual actions and through various partental support organizations) to get each state to issue 'Certificates of Birth Resulting in Stillbirth' when a parent's child is stillborn. I volunteer for one of those organizations. My son was stillborn on August 1, 2002. His name was Bump. It's handy to know how an individual state defines fetal death, because that's the definition that state uses for 'stillbirth' - and the states are required to issue a 'Certificate of Fetal Death' (or like wording) for each stillbirth. We recently passed legislation in Texas - and Bump's Certificate of Birth Resulting in Stillbirth was the first to be issued in the State of Texas.J.Nevels 21:02, 15 June 2006 (UTC)

[edit] New edits

Under "Prenatal diagnosis":

• most of the second paragraph repeated the information given in the first paragraph, so I integrated the new information into the first paragraph and deleted the repeated info. (note: the nonstress test article needs a lot of work)

Under "Prenatal maternal treatment":

• "The reason for [vaginal birth being recommended over cesarean] is that it has shown that a woman is better able to prepare emotionally and mentally if she is able to take an active role in her child birth."

  This may be an added benefit, but my understanding is that the reasons center around lower rates of pregnancy-related maternal death with vaginal delivery, and cesarean section increases the risk of future stillbirth (also, vaginal birth triggers the release of hormones that cause the uterus to return to it's normal size and other such physical factors). Additionally, what shows this is not stated...has there been a study on it? If so, it would be good to mention. Otherwise, this is material better suited to a wikibook than a wikipedia article (actually, it's useful info for a wikibook anyway, even if it does stay in this article, so I'll add it to the list below).

• "Younger stillborn children are at further risk of damage to their bodies at birth than full term babies and induction is very rarely used because medications increase the wombs contractions."

  I can't find anything that agrees with this statement. The information I've been able to find states that damage to the body (maceration) increases the longer the fetus remains inside the uterus after death. Further, all the medical sites I have referenced recommend vaginal delivery because cesarean poses a risk to the mother, and because the fetus itself does not have any health or safety risks. My references also state that induction is commonly used in any case where labour does not occur spontaneously, and cesarean is used only if induction fails or there are other complications. Obviously, a person may choose a c-section instead of vaginal birth, but it's not encyclopedic to present a personal choice as a medical recommendation when it is actually the opposite of what is medically recommended

• "It is also note worthy to mention that unless the child is full term the mother rarely goes into labour spontaneously and the child is most often delivered by C-section."

  Again, all the sources I've found say that labour usually begins spontaneously within two weeks (seemingly regardless of gestational age...this part could use some research though), and that induction is recommended before c-section if it doesn't.

• "Many women learn their child has died when arriving at the hospital to deliver and a great portion of those women find that their labour simply stops upon hearing the news."

  I can't find anything supporting this claim (though it seems very likely to be true). However, if it can be cited, it may be an interesting phenomenon to note in the article.

• The third paragraph under this heading addressed things that were covered under the next heading ("Impact on family"), though there were a few new details that I integrated into what was already there. The rest seems more suitable to a wikibook, so I've added it to the list below.

Stuff that is more suited to a wikibook about stillbirth:

*Most often parents learn their baby has passed away when a lack of heart beat is noticed, this is confirmed by the use of
 ultrasound.
*The reason for this is that it has shown that a woman is better able to prepare emotionally and mentally if she is able to take an
 active role in her child birth.
*It has been said that, in the past, women were not allowed to see their child; more recently things are vastly different. The
 parents are offered all the time they need to spend with their dead child. Many bathe and dress their children, taking photos and
 such as it helps to build memories of their child. Most hospitals provide what is known as a Memory Box, blankets and bears
 donated to the hospital mostly by orginizations that are related to child loss and still birth. The blanket is wrapped around the
 child when born and the parents can then take it home when they leave the hospital, often claiming they can 'smell' their baby on
 it for some weeks. The Memory Box is designed to provide a safe and special place the parents can store any mementos from their
 child and the bear is so that the parents don't leave the hospital empty handed.
*The sad fact is that parents come home feeling very confused and alone. Many say they do not fully understand the impact of what
 happened until several months after their child's death. There is a sense of isolation for parents given that most have never met
 or known anyone who lost a child & those who have not can never understand. Support from family & friends is important but rarely
 given when it is truly needed, well after the death. Commonly parents or other family of the bereaved parents step in to take over
 funeral arrangements which in their belief is helping the parents. This is far from what the parents need or want. One of the most
 common complaints mothers have is that they felt out of control, that everyone took over and that her child was long gone before
 they had a chance to fully say goodbye and it is a regret that few get over. Recent studies have shown that this sort of loss
 often leads to post traumatic stress disorder. And the grief they feel has been reported to be far greater than that of parents
 whos children have died of a chronic illness because the suddeness allows no time to prepare.

bcatt 23:46, 13 June 2006 (UTC)

Under "Impact on family":

• I have removed the third paragraph and placed it in the list above, as much of the content is probably useful for writing that wikibook I keep mentioning. The reasons I removed it is that it reads like a commentary on an individual experience of stillbirth, while indicating that this is "the experience" that people have, while the previous paragraphs indicate that the experience varies from person to person, and describes the range of forms this grief may take; it also reads more like a support guide for families than an encyclopedia article; there is some applicable information here, but most of it had already been covered in other parts of the article, and the parts that hadn't, I integrated into the applicable parts of the article.
• The items listed under "Common Reactions After Stillbirth" are also covered in the previous paragraphs, so I have removed this list. I moved the two statistical statements to a new sub heading, though I'm not sure if they belong in the article...if they do though, then there a few others that should probably be added to the list as well.
• I have also removed the lengthly list of "symptoms of grief", as this information belongs in the grief article, which is linked to in the preceeding paragraphs. I have reproduced the items in the list below so it is easy to add any of the items from here if they are missing from the grief article.

  Sypmtoms of Grief: Physical - hyper or hypoactivity, lack of reality, chest and abdominal pain, headaches and nausea, weight loss, change in appetite, tiredness, trouble sleeping, sighing and/or crying, shortness of breath, feelings of loneliness and/or isolation, tight throat; Emotional - confused and numb, sadness, fear, anger, depression, guilt, anxiety, feeling meaningless, longing and loneliness, feeling vulnerable or abandoned; Social - often oversensitive, withdrawn and avoiding others, dependancy; Behavioral - forgetfulness, mental confusion and the inability to think clearly

bcatt 00:26, 14 June 2006 (UTC)

[edit] 2 Reversions in a Row?

Yes, I am aware that I did two rv vandalism edits back to back. Both were done manually and I missed part of the vandalism with the first edit. --Targetter ^{(Lock On)} 16:37, 16 October 2006 (UTC)

[edit] Definition

I recently updated the definition of "stillbirth" at the top of the page. However, this edit was reverted for the following stated reason:

“

Rv politicized redefinition of medical term. See Miscarriage: "A fetus that dies...after about the 20th week...is termed a 'stillbirth'. Defs. should be consistent throughout articles.

”

First of all, there is nothing "politicized" about the edits I made, and I deplore the accusation. I agree that definitions should prefereably be consistent throughout articles, and therefore I would also edit the definition of "stillbirth" in the miscarriage article.

The definition at the top of this page currently says the following:

“

A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb, or during labour or delivery, exits the maternal body.

”

Three references are provided: [A] Thompson, Sharon Roseanne. (2005). Definition of stillbirth. Retrieved January 10, 2007. [B] stillbirth. (n.d.) Medterms.com. Retrieved January 10, 2007. [C]stillbirth. (n.d.). The American Heritage New Dictionary of Cultural Literacy, Third Edition. Retrieved January 10, 2007, from Dictionary.com website.

My experience has been that the term "stillbirth" is synonymous with any fetal death, not just those occurring after the mid-second trimester. Therefore, I researched the matter, and edited the definition to read as follows:

“

A stillbirth occurs when a child or fetus, which has died in the womb, or during labour or delivery, exits the maternal body.[D][E][F] Sometimes, the term is limited to a fetus of mid-second trimester to full term gestational age. [A][B][C] The term “stillbirth” has for decades been the subject of repeated redefinition by various governmental and medical organizations for statistical, reporting, and other purposes.

”

I provided three additional references: [D] The American Heritage Stedman's Medical Dictionary, 2nd Edition (2004) ("1. The birth of a dead child or fetus 2. A child or fetus dead at birth"). Retrieved January 10, 2007. [E] Random House Unabridged Dictionary, Second Edition Newly Revised and Updated (1993) (1. The birth of a dead child or organism; 2. A fetus dead at birth.) [F] Med Student Practice Exams, University of Illinois College of Medicine. Retrieved January 10, 2007.

Please note that I preserved references [A], [B], and [C] that were previously in the article, and I added three new references [D], [E], and [F] to support the edits I made. But then my edits, and my three additional references were summarily deleted, with the accusation that they are somehow politicized. This is absurd. Which of the three references I provided is "politicized"? Stedman's Medical Dictionary? Random House? The University of Illinois College of Medicine?Ferrylodge 22:49, 10 January 2007 (UTC)

A source must state, categorically, that the medical definition of "stillbirth" includes miscarriages before 20 weeks for it to be used to support that claim in this article — otherwise adding the claim is original research. Your sources refer only to a "dead child" or a "fetus dead at birth," which are completely ambiguous as to the stage of pregnancy, and thus cannot be used to infer that stillbirth is medically defined to include miscarriages before 20 weeks. Stillbirth is defined at Miscarriage as "A fetus that dies while in the uterus after about the 20th week of pregnancy." However, the article clarifies that premature births and stillbirths are not generally not considered to be miscarriages, so "stillbirth" is not "synonymous with any fetal death." -Severa (!!!) 23:24, 10 January 2007 (UTC)

I can't imagine a woman who experienced fetal demise and chose to end the pregnancy with a D&C referring to her experience as a stillbirth. To me, stillbirth implies "childbirth", and a fetus still undeveloped enough to have its remains extracted by aspiration doesn't qualify. The cutoff gestation is certainly fuzzy - the miscarriage article says "about" 20 weeks, and specifies that "usage of the terms... may overlap". The stillbirth definition currently in this article is also deliberately vague - it does not specify a week of pregnancy.

But fuzzy definitions are one thing (that I agree with). Implying that the natural demise of a nine-week LMP pregnancy (seven weeks from conception - when the embryo becomes a fetus) is a stillbirth is quite another (that I do not agree with). Lyrl ^Talk _C 00:28, 11 January 2007 (UTC)

I have made a request for expert comment at Wikipedia talk:WikiProject Medicine. -Severa (!!!) 01:01, 11 January 2007 (UTC)

Regarding the medical AND non-medical definitions that I found stating that stillbirth is synonymous with fetal death, it’s exceedingly well-known that there are fetuses younger than five months. No definition of the word “fetus” in any dictionary anywhere says that the fetal stage begins at five months or later. Therefore, the definitions that I found do support the notion that a “stillbirth” can occur before five months.

Lyrl, my goal here is not to find a definition that I like or dislike. The purpose is to write a definition that accurately reflects what the word means, whether I like it or not.

The definition that Severa has been asserting directly conflicts with the most widely accepted legal definition of stillbirth, which is fetal death "prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy." [3]Ferrylodge 01:04, 11 January 2007 (UTC)

Please see WP:NOR. Basically, if a source does not explicity state that a stillbirth can occur before five months, you cannot infer that it does, because that is original research. This is a medical topic, thus the definition in the introduction should be one used generally in the medical community. Also, to suggest the U.S. legal definition is a "common legal and lay definition" is incorrect and undue weight, given that in the "Legal definitions of stillbirth," the U.K.'s definition is said to begin at 24 weeks and Australia's at 20. I don't think that the U.S.'s definition can be taken as indicative of the world at large (WP:BIAS). -Severa (!!!) 01:33, 11 January 2007 (UTC)

Do the words "irrespective of the duration of pregnancy" not explicity state that a stillbirth can occur before five months? You accuse me of "edit-warring", and yet I proposed the following language only once, and you have not explained why the last sentence is problematic at all:

"A stillbirth is usually defined medically as occurring when a fetus, of mid-second trimester to full term gestational age, which has died in the womb, or during labour or delivery, exits the maternal body. [1] [2] [3] Governmental and medical organizations have sometimes used alternate definitions for statistical and other purposes. According to some sources, stillbirth is defined as fetal death irrespective of the duration of pregnancy.[4] [5] [6] [7]"

I don't think a bald accusation of edit-warring is any substitute for a cogent response. Additionally, if a dictionary says that stillbirth is synonymous with fetal death, then it is not "original research" to infer that some sources say stillbirth is synonymous with fetal death irrespective of other factors.

Just because you happen to prefer one of a plurality of medical definitions is no reason to shove it down everyone else's throat, accompanied by accusations of edit-warring and politicization. This article very obviously covers more than just medical issues. And note that Lyrl was not relying on medical sources for her understanding of the term. The definition at the top of the page should not narrowly prefer a particular medical definition.Ferrylodge 02:02, 11 January 2007 (UTC)

Today, I edited the page, and the edit was reverted. See here. Severa's objection is "original research" which I find manifestly implausible. Subsequently, I added yet another reference to the four I have already provided: Wiktionary (“1. The birth of a dead fetus. The delivery of an infant which is dead at birth, regardless of stage of development”), retrieved January 11, 2007. Ferrylodge 23:44, 11 January 2007 (UTC)

This whole argument seems ridiculous to me. There are miscarriages and there are stillbirths. Ignoring the medical definition, in common parlance, these terms are NOT synonymous. If a woman gives birth to a dead baby, then we call that a stillbirth. If a woman is only pregnant for a few months and 'looses' the fetus, we call that a miscarriage (and loosing a fetus is not the same thing as giving birth). There is a grey area for sure, but medically, and commonly speaking, the terms have two distinct meanings. I think editors here need to watch out for WP:POINT. Don't disrupt wikipedia to prove a point. We don't need all those citations one after each other. Discuss it out here, and maybe we can reach a consensus and use the best citation. Ferrylodge, bring your sources here to the talk page, instead of flooding the main article with information more relevant to the content dispute going on here. All that said, I personally do not think the definition ferrylodge is pushing is very common, but I wouldn't oppose a sentence (worded differently) to point out that usage. I'll try my hand at rewording it. -Andrew c 01:40, 12 January 2007 (UTC)

I certainly agree that the argument is ridiculous. There seems to be a concerted effort here to deny and suppress the fact that stillbirth is often defined as fetal death irrespective of the duration of pregnancy.

The definition of "stillborn" does not depend on what you or I think it should be, or how you or I use it in common parlance. It depends on how the word is commonly defined. We should not ignore or suppress how the word "stillborn" is commonly defined, merely because some of us do not like the idea that a "fetus" (i.e. a human being after two months of development) can be "born."

Andrew C, you say that "losing a fetus is not the same thing as giving birth." That is an attitude that you are free to nurse in your own mind, but it should not affect how Wikipedia defines the word "stillborn." You are allowing your own feelings and emotions to interfere with your editing. You say that "stillbirth should not be confused with miscarriage", but who says there is no overlap?

More importantly, why do you deny that stillbirth is often defined as fetal death irrespective of the duration of pregnancy? The intro of this article currently says that the word “stillbirth” should not be used this way. Why shouldn’t it?

The Centers for Disease Control and Prevention’s State Definitions and Reporting Requirements equate stillbirth to fetal death "irrespective of the duration of pregnancy".

Wiktionary likewise defines stillbirth as birth of a dead fetus; delivery of an infant which is dead at birth, “regardless of stage of development.”

Yet, the intro to the present article says that the word “stillbirth” should not be used as the Centers for Disease Control and Wiktionary use it. Who are we to tell them they’re misusing the word?

The American Heritage Stedman's Medical Dictionary defines stillbirth as "1. The birth of a dead child or fetus 2. A child or fetus dead at birth," and Stedman’s dictionary does not make the exception you make regarding fetuses prior to five month’s gestation. Who are we to tell Stedman’s that their definition is too broad?

Likewise, the Random House Unabridged Dictionary defines “stillbirth” as “1. The birth of a dead child or organism; 2. A fetus dead at birth.” Who are we to tell Random House that their definition is too broad?

Med Student Practice Exams at the University of Illinois College of Medicine say that “stillbirth” and “fetal death” are synonymous. Who are we to tell them that they are only synonymous after five months’ gestation?

It violates NPOV to allow your personal view ("losing a fetus is not the same thing as giving birth”) to interfere with the fact that stillbirth is often defined as fetal death irrespective of the duration of pregnancy.

First I'm accused of politicization, then of edit-warring, and now of trying to prove a point, being disruptive and flooding the main page with citations. Instead of making empty accusations, I would appreciate an honest, straightforward discussion. Why should Wikiepdia deny that stillbirth is often defined as fetal death irrespective of the duration of pregnancy, when in fact that is how it is often defined?Ferrylodge 03:20, 12 January 2007 (UTC)

You just admitted yourself what your motivation is, so, sorry, but the shoe fits:

"We should not ignore or suppress how the word "stillborn" is commonly defined, merely because some of us do not like the idea that a "fetus" (i.e. a human being after two months of development) can be "born."

I can see not reason to persistently fight to redefine "stillbirth" other than to promote the view expressed above. Wikipedia is an encyclopedia, not a soapbox, or a place to come to prove something. Regardless, I have requested comment from an expert, so please refrain from revert-warring until that time. Thank you. -Severa (!!!) 04:48, 12 January 2007 (UTC)

Severa, I did not admit anything whatsoever in the quote you cite. Andrew C has been ignoring and suppressing how the word "stillborn" is commonly defined, merely because he does not like the idea that a "fetus" can be "born." That's all I was saying. I never said whether I myself like that idea or not, and of course it's entirely irrelevant whether I like that idea. Our personal views should play no role here.

Your continued accusations are highly inappropriate. I am not trying to use Wikipedia as a soapbox, or to prove anything. I am trying to eliminate falsehoods and falsities, such as the recent false information that you had inserted at "Abortion in the United States."Ferrylodge 05:36, 12 January 2007 (UTC)

I'd highly appreciate it if you would stop speculating on my motivations. I just got here, and you are already saying my purpose is to "suppress" the common definition. I dispute that your POV is "common" sure, but my edit readily admits that the term can be used in the way you are pushing. However, the current article is NOT about that use, and the majority of states, and the UK legally do not agree with you (a minority of states do). This has nothing to with whether I personally like the idea of a 'fetus' being 'born'. This isn't about my personal believe, but instead about the way things are defined medically. I just find it hard to believe that you are surprised that childbirth and parturition mean specific things in the medical profession. That medically, stillbirth and miscarriage are distinct. And that when I point this out, you accuse me of original research/ I find it ironic that you mention "continued accusations [being] highly inappropriate" right after accuing me of things. I'd ask that we all take a step back and a breather and relax.--Andrew c 16:39, 12 January 2007 (UTC)

The CDC report you cite PROVES my point. That most commonly, stillbirth means after 20 weeks, or after 350/500g birthweight. You can count the number of states that define stillbirth and fetal death in this manner. We have Arkansas that uses Miscarriage and Stillbirth and Spontaneous fetal death interchangably, Connecticut and New Jersey that say "irrespective of the duration of pregnancy", Texas uses stillbirth and fetal death interchangably, Delaware and Louisiana are ambiguous in their definition, but only reports after 350g/20 weeks, and that is it. Compare that to all 44 other states, some that specifically define stillbirth as the medical definition. (there are 11 areas that report all periods of gestation as fetal death, however, only the ones listed above use the term "stillbirth" in thier legislation).

Please stop citing wiktionary. It does not meet our WP:RS requirements.Also, please stop citing American Heritage and Random House because they doesn't say "irrespective of the duration of pregnancy". They say 'birth', which I think is very different from having a heavy period. But like you said, what I think doesn't matter. What exactly does "birth" mean... (do we need to get into this?)

You say "It depends on how the word is commonly defined." and that is exactly what I was saying when I said "in common parlance". I thought that was obvious. I guess we disagree upon how it is commonly used. I recognize that there is clearly a difference between miscarriage and stillbirth, or else they wouldn't have seperate entries in dictionaries and encyclopedias (such as this one). We can also look at your CDC citation and analyze it to discover, it is a minority view that stillbirth is used in this manner. We can then go to say the Oxford Concise Medical Dictionary and get "stillbirth n. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception. Under the Stillbirth (Definition) Act 1992, there is a legal obligation to notify all stillbirths to the appropriate authority. The number of such births expressed per 1000 births (live and still) is known as the stillbirth rate. In legal terms, viability is deemed to start at the 24th week of pregnancy and a fetus born dead before this time is known as an abortion or miscarriage. However, some fetuses born alive before the 24th week may now survive as a result of improved perinatal care." or the Oxford Dictionary of Nursing "stillbirth (stil-berth) n. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception. A fetus born dead before this time is known as an abortion or miscarriage." You accuse me of trying to push my personal personal view, and I believe my edit is supported in sources, not personal preference. I'm not denying that sometimes stillbirth and miscarriage are used interchangably, but from my research this is a minority view, and regardless that is NOT what this article is about (we have the miscarriage article to cover the other view). How notable is it? Clearly it is not "often defined" in this manner when only 6 out of over 50 reproting areas in the US use it that way, and when the UK there is a legal distinction between miscarriage and stillbirth and the majority of your dictionary definitions fall on the ambiguity of the term "birth" (which really isn't that ambiguous). I apologize that my compromise was not suitable, but perhaps we can still reach a middle point.-_Andrew c 16:32, 12 January 2007 (UTC)

Thanks for the response, Andrew C. I'll try to focus on it tomorrow.Ferrylodge 02:28, 13 January 2007 (UTC)

I want to apologize. I just read over my posts, and the tone seems a little harsh. I'm not trying to be mean here, but sometimes its hard to project myself over the internet. I believe we can reach a compromise. I think our disagreement is only slight (in how prevalent the different definitions are, because I believe we both acknowledge the different definitions existence), and I believe my attempt at a compromise was worded poorly. I did get a little defensive, and I apologize for that and I'm sure we can work this through.-Andrew c 02:44, 13 January 2007 (UTC)

At this point, we probably all agree that our personal viewpoints and experiences regarding the definition of the word “stillbirth” should not influence the intro to this article. We can all agree that we’re striving here for an objective description that accurately reflects the various definitions (both medical and non-medical) that are used in dictionaries and other authoritative sources around the world. This article deals with both medical and non-medical matters, and there’s no reason to have an intro that emphasizes the medical.

I agree with Andrew C. that we should exclude the Wiktionary definition that was in place from 24 June 2005 until 12 January 2007 (i.e. for over a year and a half). That definition does not meet our WP:RS requirements. However, if we can come to a resolution regarding what the word “stillbirth” means, then we should be able to agree that the change can be made not just in the intro of the present article, but also at Wiktionary.

I also think we should try to define the word “stillbirth” in terms of words that have uncontroversial meanings. Won’t that save us time and effort? We won’t have to argue about the meaning of one word after another. Andrew C. says: “there is clearly a difference between miscarriage and stillbirth, or else they wouldn't have seperate entries in dictionaries and encyclopedias (such as this one).” But dictionaries often have separate entries for words that are synonymous, and encyclopedias often have separate entries for overlapping subjects. I suggest that we leave miscarriage out of this intro to the “stillbirth” article. I have not yet studied the subject in detail, but I am far from convinced that a “miscarriage” may not occur after viability.

Andrew C. says: “please stop citing American Heritage and Random House because they doesn't say ‘irrespective of the duration of pregnancy’. They say 'birth', which I think is very different from having a heavy period.” Many of the sources we have discussed use the word “birth.” The word “stillbirth” is sometimes used in distinction to “live birth,” and I am unaware of any reputable source that limits “live birth” to birth after viability, or after five months. After all, it is well known that a fetus can be born before five months and still survive for a brief time. Therefore, the fact that many of the sources we have discussed mention “birth” in no way implies or suggests that “stillbirth” only occurs after viability, or after five months. On the contrary, “birth” means the process in animals by which an offspring is expelled from the body of its mother, and the very word “fetus” is derived from the Latin word for “offspring.” Expulsion of a fetus (as opposed to an embryo) from a mother has always been considered a form of birth.

Andrew C. cites two Oxford medical dictionaries which both say that stillbirth is medically defined in England as birth of a dead fetus later than 24 weeks after conception. This is inconsistent with the current intro to the present Wikipedia article, which states that exit of a fetus is medically considered a stillbirth in the latter part of the second trimester. Therefore, these two Oxford medical dictionaries buttress the need to fix our intro. Other medical sources (e.g. The American Heritage Stedman's Medical Dictionary, 2nd Edition (2004) and Merriam-Webster's Medical Dictionary) say that any exit during the fetal stage is medically considered a stillbirth. Obviously, these four medical sources are not in agreement with each other or with our present intro, and much less are the non-medical sources in agreement. Our intro ought to reflect the diversity of definitions, without expressing a preference for one version or another.

Andrew C. says: “The CDC report you cite PROVES my point. That most commonly, stillbirth means after 20 weeks, or after 350/500g birthweight. You can count the number of states that define stillbirth and fetal death in this manner.” The CDC Report explicitly says at page 1 that stillbirth is synonymous with “fetal death”, as do various of the other sources we have discussed. The primary CDC definition of “fetal death” is on page 9 of the CDC Report:

“

The 1992 Revision of the Model State Vital Statistics Act and Regulations (1) recommends the following definition of fetal death. This definition is based on the definition promulgated by the World Health Organization in 1950 and revised in 1988 by a working group formed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2). The revision added clarifiers to help determine what is to be considered a fetal death: ‘‘Fetal death’’ means death prior to the complete expulsion or extraction from its mother of a product of human conception, ‘irrespective of the duration of pregnancy’ and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, 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. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. Forty-one areas use a definition very similar to this definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death.

”

Andrew C. argues that not all of the laws of the fifty states equate stillbirth to fetal death according to this definition. Actually, thirty states define “fetal death” substantially according to the primary CDC definition (i.e. “irrespective of the duration of pregnancy of pregnancy”), without suggesting that “stillbirth” means anything different from “fetal death” (some of these states exclude induced terminations from the definition of “fetal death”). Eight more states don’t explicitly say that stillbirth or fetal death is irrespective of the age of the fetus, but they don’t suggest otherwise. Only twelve states place durational or weight requirements on stillbirths or fetal deaths, or use other terms altogether: Florida, Idaho, Indiana, Kansas, Maine, Minnesota, Nevada, Ohio, Oklahoma, Pennsylvania, Utah, and Wyoming.

Given all of these considerations, I suggest a better compromise intro for this article. I hope it meets with everyone’s approval.

“

A stillbirth occurs when a fetus, which has died in the womb, or during labour or delivery, exits the maternal body. Sometimes the term “stillbirth” is defined so that it only applies to a human being that has already developed to a point beyond the point at which an embryo becomes a fetus, or is defined so that it only applies to situations other than induced abortions.

”

As for the footnotes, we clearly should continue to cite to http://dictionary.reference.com/browse/stillbirth which provides a bunch of well-researched definitions; there is no need for us to specify which one we like best. I think the second footnote should be the CDC Report which is packed with definitional material at http://www.cdc.gov/nchs/data/misc/itop97.pdf These two footnotes should be sufficient.

Does all of that sound okay? I’ll tentatively edit this article accordingly, and will tentatively revert the Wiktionary definition to the version that has already existed for a year and a half (until yesterday), pending conclusion of the present intense negotiations.  :)Ferrylodge 02:23, 14 January 2007 (UTC)

I'll try to be brief because these responses are getting quite verbose (and I know that it can be intimidating for other editors to participate when there is so much to weed through). I think we are on the right track. However, you are giving too much weight to what you believe the One True definition of "birth" is. You claim that a bunch of your dictionary definitions state that any exit during the fetal stage is medically considered a stillbirth. However, you are clearly putting words into the dictionary. The definition in question says "The birth of a dead child or fetus" and that is it. It doesn't specifically say "after such and such" and it doesn't specifically say "any state of development". Neither side of the argument can use this definition to support it. It goes back to the definition of "birth". I don't know if we should get into this, but I disagree with you saying any expulsion equals a 'birth'. Furthermore, a major problem with the CDC citation is that, we must equate 'fetal death' with 'stillbirth' for your argument to work. The word "stillbirth" is only used in a limited number of laws, and as we have both pointed out, there is no agreement on what the term actually means legally, from state to state (i.e. Idaho vs. Arkanas).

You then say I have not yet studied the subject in detail, but I am far from convinced that a “miscarriage” may not occur after viability. Now I say that I have spent literally months working on the first paragraph definition of Abortion, and I have read over 20 definitions of abortion, and researched stillbirth and miscarriage, and the consensus of the sources we encountered was that miscarriage is an early termination before viability, where a stillbirth was either an early termination after viability (or a specific weight or gestational age), or a fullterm birth of a dead fetus. Now, I agree that there is a grey area, and you have more than demonstrated that the terms are controversial enough. If I was trying to push my POV, I would argue that the consensus that I found was right, and that any other view was wrong and need not be included. I don't feel that way, but I feel strongly that we should define stillbirth in a manner that reflects the medical definition, and as a side note mention the controversy, as opposed to reframing the whole intro inlight of the controversy while ignoring the medical, and common uses of these terms. I believe we all know why the legal definitions are so different and varried. While this information is important, I don't think politics and legal jargon should color the actual medical definitions. I guess we disagree about the importance of the medical vs. political definitions, and whether there is an actual consensus in the medical community.

Like I said, your edit is a step in the right direction, but I still feel it is problematic for making the term seem much more controversial and undefinable than it actually is. I'll dig up some old sources, and see if I can't propose an improvement to what we have. Thanks for your time.-Andrew c 03:35, 14 January 2007 (UTC)

Andrew C, I appreciate the tone of this conversation, but some greater clarity would be nice. Are you saying that you think live birth can only occur after viability?Ferrylodge 03:49, 14 January 2007 (UTC)

Well, the term "live birth" was coined by the WHO for statistical purposes because it can be "[difficult to distinguish] stillborn infants from those liveborn infants who are extremely preterm (near the limit of viability), asphyxiated, or neurologically depressed and who die soon after birth." [PubMed]. Like I said, the exact cut off point between miscarriage vs. stillbirth is grey. Likewise, there is a grey area between stillbirths and neonatal deaths. Bbecause of this ambiguity, the "perinatal mortality rate" has been used to combine both figures. But generally speaking, the grey areas are the exceptions. Most cases are easily classifiable medically, which is why I don't think there should be so much focus on the grey. Just because there is a grey area, and just because the exact limit cannot be agreed upon does not mean that it is useless to differentiate between a miscarriage and a stillbirth (because my research has lead me to believe that medically these terms are different, and useful for classification purposes). "Jurisdictions differ in terms of the lower limits of gestational age or birth weight for registering a late fetal death (stillbirth) and thereby distinguishing the event from an early fetal death (also referred to as a miscarriage or spontaneous abortion)."[ibid]-Andrew c 04:30, 14 January 2007 (UTC)

The term "live birth" was not coined by the WHO. The WHO coined a particular definition of the term, but the term itself has been around for many centuries. For example, see here. Incidentally, the U.S. Code uses a definition of "live birth" along the lines of the WHO definition.[4]

Even if there is a strong legal and medical and popular consensus that miscarriage only applies to a nonviable fetus, that would say nothing about whether there is any overlap between miscarriages and stillbirths, and would say nothing about how big the overlap is. I agree that there is no overlap between stillbirths and live births; a birth is either one or the other. But I just don’t see how discussing miscarriage in an intro about stillbirth can clarify anything. Obviously, a woman can have a miscarriage of a 3.5 month fetus that results in a live birth followed by fetal demise, so why can’t she have a miscarriage of a 3.5 month fetus that results in a stillbirth instead of a live birth?

You seem to have acknowledged that stillbirth means birth of a dead fetus, and you seem to be arguing that a "birth" can only happen after some point subsequent to the point when an embryo becomes a fetus. Yet, I have no idea when you think that point occurs. Is there any dictionary or encyclopedia or other reputable source that says or implies that “birth” can only occur starting at some point after an embryo becomes a fetus? I am fairly certain that there is no such source saying that “birth” can only occur starting at viability.

In any event, the intro that I have written is sufficiently flexible to embrace whatever unorthodox concept of "birth" you may have. The intro I wrote says, "Sometimes the term 'stillbirth' is defined so that it only applies to a human being that has already developed to a point beyond the point at which an embryo becomes a fetus...." So, if you think that birth can only happen after a point five months from conception, then the intro I wrote doesn't contradict your belief.Ferrylodge 06:22, 14 January 2007 (UTC)

Please keep all proposals to the drawing board until you have reached a solution which is suitable to everyone, as well as WP:NPOV, WP:V, WP:NOR, or WP:RS. Thank you. -Severa (!!!) 07:03, 14 January 2007 (UTC)

Severa, you say that, “A stillbirth is medically defined as occurring when a fetus, of mid-second trimester to full term gestational age, which has died in the womb, or during labour or delivery, exits the maternal body.” Putting aside the very good question of why a medical definition should be preferred to a legal or a layman’s definition, your definition is inconsistent with the following medical authorities:

1. Oxford Concise Medical Dictionary (no stillbirth occurs before 24 weeks)

2. Oxford Dictionary of Nursing (no stillbirth occurs before 24 weeks)

3. Medterms.com (a dividing line between stillbirth and miscarriage is sometimes set at 24 weeks)

4. The American Heritage Stedman's Medical Dictionary, 2nd Edition (2004) (stillbirth is any birth of a dead fetus even if the birth occurs before the mid-second trimester)

5. Merriam-Webster's Medical Dictionary (stillbirth is any birth of a dead fetus even if the birth occurs before the mid-second trimester)

6. Med Student Practice Exams, University of Illinois College of Medicine (stillbirth synonymous with fetal death)

7. The Centers for Disease Control and Prevention’s State Definitions and Reporting Requirements (stillbirth described at page 7 as synonymous with fetal death)

I believe that you are cherry-picking medical definitions, and preferring certain medical definitions to the non-medical definitions. It is easy enough to write an intro that embraces all of the prominent definitions of this term.Ferrylodge 07:20, 14 January 2007 (UTC)

I realized after I hit sent that "coined" was not the best word to have used. I apologize for not changing it to "defined". Next, you are playing word games with birth and the Obviously, a woman can have a miscarriage of a 3.5 month fetus that results in a live birth followed by fetal demise, so why can’t she have a miscarriage of a 3.5 month fetus that results in a stillbirth instead of a live birth business. Please search pubmed and find me an article that describes a "miscarriage" that results in a "live birth"; search pubmed and find me an article that uses the term "birth" to desribe the events of a miscarriage. And while you are searching through pubmed, take note of how these terms are actually used.

Why do I not agree on leaving the LEAD section describing some vague, undefinable, controversial term called "stillbirth"? Because Encarta (delivery of a dead fetus after gestation period of 24 weeks. Fetal death earlier in pregnancy is known as miscarriage.), and MedlinePlus Medical Encyclopedia (A stillbirth is when a fetus that was expected to survive dies during birth or during the late stages of pregnancy.), and the already cited Oxford Reference Online. This term simply is not as controversial as you claim it is. I am not denying that there is a grey area and that there are multiple uses of this term. But we do not have to bend over backwards for this controversy, when we have very reliable sources that don't even mention the politicized use of the term. My proposal is to work with one of my versions from a few days ago that keeps the common definition of a stillbirth occuring later in the pregnancy, with a sentence mentioning the controversy. I see no reason to stay vague when Oxford, or Encarta, or Medline are even more strict than what I am proposing.-Andrew c 21:56, 15 January 2007 (UTC)

Andrew C, thanks for the additional Encarta reference. The Medline reference was already footnoted in the article. As you can see, I've added a section on medical definitions and lay definitions, to supplement the already-existing section on legal definitions. I think you will find that the intro to the article (written by Joie de Vivre) is a fairly good summary of all those definitions, without favoring one over the other. You're correct that we could also peruse PubMed, and do a survey of which articles use which definitions. However, it seems like that would be pretty close to original research. All of the sources that are currently cited in the article would seem to provide an ample basis for writing an intro, IMHO.Ferrylodge 23:19, 15 January 2007 (UTC)

Fetal Death and Stillbirth are not synonymous. While 'Fetal Death' is irrespective of gestational age, 'Stillbirth' (and for that matter miscarriage) most certainly are not. The World Heath Organization (see: http://www.who.int/reproductive-health/publications/interagency_manual_on_RH_in_refugee_situations/a3.pdf ) defines stillbirth as:

“

A fetal death in late pregnancy. At what gestational age (point in pregnancy) a miscarriage becomes a stillbirth for reporting purposes depends on the country’s policy.

”

The CDC publication (used as a footnote in this article - which is now 10 years out of date) indicated that each of the 57 different reporting areas (states and territories of the U.S.) had different definitions. States (and territories of the U.S.) pass laws that legally redefine what 'stillbirth' means in their state or territory every day.

In my opinion, the 'lead definition' this article should be using is that of the WHO, and the "Legal definitions of stillbirth:United States" portion of the article should be edited to show that that states and territories are making constantly making changes to their laws that redefine what stillbirth is for their own state - but the majority of those definitions tend to support the WHO definition. J.Nevels 15:39, 26 January 2007 (UTC)

Thank you for adding your input. Perhaps you could propose some changes to the article? I would suggest you be bold and just take a stab at the article, but with the recent revert history it would probably be best to discuss changes first. However, I do feel that the article could be improved, and your input it cheerfully welcomed by me.-Andrew c 16:00, 26 January 2007 (UTC)

J. Nevels, further definitions can be found [here]. I think it is wrong for Wikipedia to unilaterally adopt one of several competing definitions. There is no reason to treat the WHO as superior to various prominent medical dictionaries, or vice versa. The definition of the WHO that you cite is well within the scope of the present intro to this article. Moreover, "fetal death" is irrespective of the gestational age of the fetus, but the fetal stage itself does not begin until eight weeks after fertilization. Therefore, if some source considers fetal death and stillbirth to be synonymous (which many do), that would not mean that stillbirth is completely irrespective of gestational age. Additionally, the WHO definition you cite is very vague about what it means by "late"; do you think that that WHO definition precludes a country's policy from saying miscarriage becomes a stillbirth when an embryo becomes a fetus?Ferrylodge 16:02, 26 January 2007 (UTC)

Andrew C, thanks for your cheerful welcome - it is much appreciated!

Ferrylodge, I think that there may be some value in including the "Other definitions of stillbirth" section you've provided. It seems NPOV to me - because it shows that different definitions exist and it does not favor any specific definition.

I believe that Fetal Death and Stillbirth are not synonymous. In the World Health Organization source that I've provided, you'll notice that it offers three distinctly different definitions for three distinctly different terms.

Fetal Death: 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.

Stillbirth: A fetal death in late pregnancy. At what gestational age (point in pregnancy) a miscarriage becomes a stillbirth for reporting purposes depends on the country’s policy.

Spontaneous abortion or Miscarriage: A fetal death in early pregnancy. At what gestational age (point in pregnancy) a miscarriage becomes a stillbirth for reporting purposes depends on the country’s policy.

Mindfully taking into consideration that Wikipedia is a world-viewed encyclopedia, definitions provided by the WORLD Health Organization (governed by 193 Member States through the World Health Assembly. The Health Assembly is composed of representatives from WHO's Member States), imho, would seem to be very useful in formulating a 'lead definition'. Futhermore, I think the WHO definition of stillbirth, basically trumps all other definitions in that it was reached by consensus. J.Nevels 17:20, 26 January 2007 (UTC)

J. Nevels, thanks for your further comments. It's useful to keep in mind, I think, that we are discussing the definition of a word in the English language. It's not clear to me that the WHO definition you cite was approved by any English-speaking countries, or even by any countries at all (as opposed to bureaucratic agencies). Don't get me wrong, the definition you cite is worthwhile, and I wouldn't exclude it from a list of various relevant definitions. All I'm saying is that it by no means "trumps all other definitions". And even if it did, still it's a vague definition. Don't you agree that the WHO definition is well within the scope of the present intro to this article? And do you think that that WHO definition precludes a country's policy from saying miscarriage becomes a stillbirth when an embryo becomes a fetus?

By the way, it would be interesting to read the treaty by which the United States and other countries agreed to join the WHO. I doubt if the treaty gave WHO power to govern and alter the language of the member countries. In the United States, not even the federal government has such power. Just some food for thought.Ferrylodge 18:10, 26 January 2007 (UTC)

Thanks for your comments, Ferrylodge. The World Health Organazation's official languages are: Arabic, Chinese, English, French, Russian and Spanish. It's not clear to me how it's actually relevent if any country approves the definition - it is relevent to me that the World Health Assembly (the world's highest health policy setting body - composed of health ministers from 193 member states - and speaking 6 different languages) reached a consensus to define stillbirth the way that they did. I believe the WHO/WHA definition was written to be vague by design - thereby making it a truthful, all-inclusive, and widely-acceptable definition. I don't think that my getting into a debate with you regarding whether or not the WHO/WHA has any interest in setting any country's policy (on anything) is in the scope of this discussion (we're trying to define stillbirth with a world-view). If we're interested in reaching a consensus here on the 'lead definition' of this article - I'd like to 'be bold' and put it out there that the lead definition (intro) should read as follows:

“

A stillbirth is a fetal death in late pregnancy. At what gestational age (point in pregnancy) a miscarriage becomes a stillbirth varies by policy where the stillbirth occurs. A majority of reporting areas place the miscarriage to stillbirth dividing line from 20 to 24 weeks after conception .

”

Ferrylodge, your "Other defintions of stillbirth" section should be included in this article - so long as it remains NOPV. Also, at some point - someone should probably create a new article called 'Fetal death' so this can link to that. Peace. J.Nevels 19:30, 26 January 2007 (UTC)

J. Nevels, parts of the present intro were stable for years. Your proposed language is already well within the scope of the present intro to this article, wouldn't you agree? Therefore, I disagree with changing the present intro.

Also, your suggested intro uses terms like "reporting areas" that have no meaning without further explanation. I presume you mean government agencies worldwide that collect info about stillbirths. However, this gives undue weight to countries that do not speak English and therefore cannot define the word "stillbirth." It also gives undue weight to government agencies as opposed to dictionaries of the medical, legal, and standard variety.

I know that the United Nations has attempted to redefine the word "death" so that it excludes fetal death. Some doctors would like to redefine the word "abortion" so that it does not include unpopular things like abortion in the third-trimester. And, it appears that some people would like to adopt a uniform definition of "stillbirth" that only applies after viability, so that no one will think that a human being could possibly be born before viability. Personally, I would like to make sure that all of these new-fangled definitions are put in contexrt at Wikipedia, rather than pushing aside the more common and longstanding definitions that continue to appear in very reputable dictionaries, both medical and non-medical.Ferrylodge 20:29, 26 January 2007 (UTC)

Ferrylodge, I appreciate your comments and wish you the best of luck in furthering this article to world-class status. Disagree as you will, it's not your article (or mine). Does anyone else have anything to add/share/comment on? J.Nevels 20:52, 26 January 2007 (UTC)

J. Nevels, I am well aware that it's not my article or yours. That's why I've given up trying to restore this section that provides a balanced look at definitions of the word "stillbirth." But please also keep in mind that the English language is not mine or yours or Wikipedia's, to do with as you or I or Wikipedia pleases.Ferrylodge 21:02, 26 January 2007 (UTC)

Ferrylodge, sorry, but you're mistaken. Common people just like me (I should know - I am one) redefine the English language (and words like stillbirth) daily in capitol buildings all over the United States (just like I did in my state). That's why I think it's a good idea to create an all-encompassing definition - then explain the nuances of it all later in the article. Just my 2 cents. Any others in on this? J.Nevels 21:12, 26 January 2007 (UTC)

J. Nevels there is a difference between creating an all-encompassing definition on the one hand, and using Wikipedia to redfine the English language on the other hand. And, you still haven't answered my question: don't you agree that the definition you suggest is already well within the scope of the present intro to this article?Ferrylodge 21:26, 26 January 2007 (UTC)

Great reply, Ferrylodge! Short, sharp and shiny. I think Wikipedia should be using all-encompassing definitions because it's a world-view encylopedia. Where differences exist in the definition (and I'm well aware that they do), I believe they can be shown later in the article in a passage much like you have proposed. I think the six sentences currently serving as the intro need to be deleted and replaced with what I'm proposing - or something else that all editors can reach consensus on within a short amount of time.J.Nevels 21:43, 26 January 2007 (UTC)

Ferrylodge, this assertation is a real head-scratcher, "However, this gives undue weight to countries that do not speak English and therefore cannot define the word 'stillbirth.'" I'm perfectly sure that non-English languages all have a term equivalent to "stillbirth" and that WHO officials are perfectly capable of communicating through competent translators. If language barriers had ever posed such a paralytic administrative issue before I'm sure that WHO would've dissolved decades ago.
Ferrylodge has, from the posts above, clearly come here with something to prove. Wikipedia is an encyclopedia, it is not a place to prove a point, or a soapbox. Inclusivity is a good goal, but adding original research, Undue weight, and POV to the article isn't the way to achieve it. I agree with J. Nevels's suggested intro, which could perhaps be married to Andrew c's, see thread "LEAD discussion" below. -Severa (!!!) 21:59, 26 January 2007 (UTC)

Severa, you're right, I did clearly come here with something to prove. I have tried to prove that various users are mistaken in trying to adopt (and use Wikipedia to espouse) a narrow definition of stillbirth that is plainly contrary to the definition currently in use in prominent English-language medical dictionaries and in many other contexts. I have tried to prove that there is nothing wrong with providing a balanced intro, instead of one which hides existing differences in the definition. Severa, you have already deleted a perfectly reasonable and balance section on this subject, and I have no doubt that you will continue to try to color this article with your own personal opinions.Ferrylodge 22:06, 26 January 2007 (UTC)

[edit] Contradiction?

After much discussion, it seemed like we were settling on an intro to this article that at least could be used until we come up with something better. However, I see that Joie de Vivre has deleted the following sentence: "Stillbirth is the delivery of an infant which is dead at birth, regardless of the stage of development." This sentence was a stable part of this article from 15 May 2003 until 7 February 2006.

The stated reason for deleting this sentence now is that it is contradictory to another sentence in the intro: “A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body.”

Unclear is why the former sentence was deleted instead of deleting the latter. In any event, there is no contradiction. If a stillbirth is any delivery of a dead infant at any stage, then the occurrence of a dead fetus after mid-second trimester will be a stillbirth.

Accordingly, I will re-insert the sentence that was a stable part of this article from 15 May 2003 until 7 February 2006, until we have reached a solution which is more suitable to everyone.Ferrylodge 02:58, 15 January 2007 (UTC)

I have little interest in how this turns out, other than to make sure there isn't contradicting information. The contradiction that I see is between the first two sentences. The first sentence says "A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died, (comes out of its mother)." The next sentence says "Stillbirth is the delivery of an infant which is dead at birth, regardless of the stage of development."

The first sentence gives parameters, the next sentence says there are no parameters, as long as what comes out is "an infant". Certainly, this definition should not rest on what people consider an "infant" to be; it's not technical. In my humble opinion, the exiting material does not necessarily become an "infant" just because it exits.

The dictionary swordfight makes it clear that there is not a solid answer. I suggest you list the different meanings by source, grouping the ones that are similar, so that the article can clarify that different sources use the term differently. In any case, the contradicting sentences should be rectified, and the one that relies on "infant" should be changed. Joie de Vivre 04:37, 15 January 2007 (UTC)

Joie --- you don't mind if I call you Joie, do you? :-) --- I agree that the current language is awkward, though not a flat-out contradiction. Anyway, if you would like to change "infant" to "fetus" then I would have no objection, but others might. One possible advantage of using the word "infant" is that it is vague, so people can read into it whatever meanings they like. The word "fetus" is much less vague (i.e. in humans the fetal stage starts at about two months). I don't think that there is any crying need for a mathematically precise and standardized definition of the word "stillbirth", and even if there were such a need, we are not the ones to fill the need. Either "infant" or "fetus" is fine with me. Notice that I added a section that lays out all of the non-legal definitions.

The intro paragraph currently starts out like this: "A stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body. Stillbirth is the delivery of an infant which is dead at birth, regardless of the stage of development." We could flip the sentences, like so: "Stillbirth is the delivery of a fetus which is dead at birth, regardless of the stage of development. For example, a stillbirth occurs when a fetus, of mid-second trimester to full term gestational age, which has died in the womb or during labour or delivery, exits the maternal body." If no one has any objection, then I'd be glad to do that, or you can, though I suspect someone might object, this being Wikipedia and all.Ferrylodge 05:17, 15 January 2007 (UTC)

Check out my current edit and see what you think. It keeps all the info and presents it without and, hopefully, presents it without contradiction or POV. Sure, you can call me Joie. Joie de Vivre 05:56, 15 January 2007 (UTC)

Looks good to me.Ferrylodge 06:08, 15 January 2007 (UTC)

Great. Joie de Vivre 15:56, 17 January 2007 (UTC)

[edit] Undue weight and OR

I am in complete agreement with Andrew c about bending over backwards for a controversy in definition. In fact, I'm not even convinced that there is much of a controversy, because the majority of sources which make reference to gestational age are in agreement that stillbirth is a late-pregnancy occurrence. The "Other Definitions of Stillbirth" section is clearly not in keeping with WP:NPOV#Undue weight:

"We should not attempt to represent a dispute as if a view held by a small minority deserved as much attention as a majority view, and views that are held by a tiny minority should not be represented except in articles devoted to those views. To give undue weight to a significant-minority view, or to include a tiny-minority view, might be misleading as to the shape of the dispute. Wikipedia aims to present competing views in proportion to their representation among experts on the subject, or among the concerned parties."

The opening text of the Other Definitions section, by stating, "...there is no single medical definition of the term 'stillbirth', and no single standard definition of this term," is presenting a minority definition as being on equal footing with the majority one, and, thus, fails to present competing views in proportion to their acceptance among experts on the subject (the medical community) and is misleading as to the shape of the dispute. WHO defines "stillbirth" as follows: [5]

"Birth of a baby showing no signs of life. For international comparisons of perinatal mortality rates only such stillborn infants with a birth weight of 1000 gr. or more are included (from 1989 it is recommended that the lower weight limit should be 500 gr). Sometimes stillborn babies are not weighed, in these cases a gestational age of 28 completed weeks or a body length of 35 cm can be taken as equivalent to 1000 gr birth weight."

The evidence used to support the claim that stillbirth is also defined as being an early-pregnancy event is, at best, tenuous. Dictionary definitions which make no reference to gestational age, only ambiguous references to a "fetus," "child," "infant," or to the "products of conception" are insufficient. WP:OR#SYNTHESIS is clearly applicable in this case:

"Editors often make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article in order to advance position C. However, this would be an example of a new synthesis of published material serving to advance a position, and as such it would constitute original research. "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article."

Therefore, we cannot combine A ("the unborn young from the end of the eighth week after conception to the moment of birth") and B (" The birth of a dead child or fetus"), to produce C. We need a source which states, definitively, that stillbirth is defined as occurring this early, otherwise publishing that conclusion in this article is OR. -Severa (!!!) 01:54, 18 January 2007 (UTC)

I am in complete agreement with Joie de Vivre that the present intro to this article is perfectly acceptable. It accurately reflects the definitions described later in the article, which themselves are an accurate reflection of the diversity of definitions globally.

The article is clearly in conformity with WP:NPOV#Undue weight. Severa cites a World Health Organization (WHO) definition of "stillbirth" here. Actually, that definition is from the European Regional Office of the WHO. In any event, Severa is certainly free to add that definition to the other definitions discussed in the article: "Birth of a baby showing no signs of life." However, unlike EVERY other one of the definitions already cited in our Wikipedia article, that European regional WHO definition uses the word "baby". Moreover, if that WHO paragraph is understood as denying that a "stillbirth" can occur for a fetus under 1000 grams (which is by no means clear from the WHO paragraph), then that would again be unlike EVERY other one of the definitions already cited in this Wikipedia article, ALL of which say that a stillbirth can occur at least a month before a fetus reaches 1000 grams.

The European Regional WHO publication thus emphatically confirms the correctness of the statement that Severa finds objectionable: "...there is no single medical definition of the term 'stillbirth', and no single standard definition of this term".

Severa further argues that "We need a source which states, definitively, that stillbirth is defined as occurring this early, otherwise publishing that conclusion in this article is OR." On the contrary, if a dictionary says that a stillbirth is synonymous with fetal death, then it would be original research to speculate or assert that some fetal deaths after eight weeks' development therefore do not qualify as "stillbirths." There are NO DICTIONARIES that exclude unborn human beings after eight weeks' of development from the word "fetus". Some of them exclude human beings before 8 weeks, but NONE of them exclude a human being after 8 weeks. So, if an encyclopedia or dictionary says that "stillbirth" is synonymous with "fetal death", then that dictionary or encyclopedia is AT LEAST saying that "stillbirth" includes death of unborn human beings after 8 weeks' of development. The only way that there could be an original research (OR) issue here would be if the present article asserted that many sources say "stillbirth" includes embryonic death, which of course the present article does not assert.Ferrylodge 02:30, 18 January 2007 (UTC)

Hey. Ferrylodge. Do not drag me into this as a supporter of your idea. All I wanted was to get rid of the dueling contradictions in the first paragraph that were making this article look like crap: "A stillbirth is only X." followed immediately by "A stillbirth is both X and Y." I tried to take care of the gross contradictions, but I would support making a clearer definitions. I personally think that if it's translucent, if it couldn't survive on its own, if it's more blood than baby, it's a miscarriage. I think there has to be a nearly-full-size baby or at least a baby able to survive outside the mother in order for it to be a "stillbirth". There has to be a "birth" and a clumpy period is not a "birth", in my humble, non-medical opinion. Of course, someone else will have to prove that. I'm mostly saying that what you did (citing me as a supporter without my knowledge or support) is very poor manners. Joie de Vivre 14:56, 18 January 2007 (UTC)

I apologize, Joie. I said, "I am in complete agreement with Joie de Vivre that the present intro to this article is perfectly acceptable." I should have instead said, "I am in complete agreement with Joie de Vivre that the present intro to this article is without contradiction or POV." I regret the error.

As for what you or I "personally think" the definition of "stillbirth" should be, it seems like it would be better to focus instead on what well-known and reliable sources already say it means. I have a big problem with shifting definitions of words according to prevailing personal opinion. Words have meanings, and if we don't like those meanings then we should use other words instead. If definitions shift in the wind, then we won't even be able to comprehend what was written a hundred years ago, and whatever texts our generation writes will soon become incomprehensible to future generations. Ferrylodge 15:34, 18 January 2007 (UTC)

What I meant was that I hoped it was presented without POV. (I knew that I should have put in "hopefully"!) The dueling contradictions had to go. If people think that presenting them both constitutes POV, I am not going to stand in their way. I really don't know enough about it. What I do mind is being presented as a supporter or witness of one side or another, based on an attempt at rectifying a logical error. Have a nice day. Joie de Vivre 16:18, 18 January 2007 (UTC)

[edit] UK details

The above is a long discussion, and I commend the above editors for the quality and civility of discussion. A few thoughts from a UK GP's perspective, with important citation from RCOG seting out the complexities of UK definition:

• Not all terms are necessarily exclusive to each other and there can be overlap.
• Concepts of definition dates have changed in the UK when the recognised age of viability was reduced from 28 to 24 weeks (this was established with simultaneous changes to limit on "routine" abortions, still birth definitions, and indeed the Mat B1 form issued for women to officially notify their employers of their pregnancy and entitlement to maternity rights & maternity leave) - Stillbirth Definition Act 1992
• Pregnancy loss prior to 24 weeks is termed an "abortion". As pregnancy loss occurs following fetal death in such cases, "live birth" is not considered relevant. "Miscarriage" is a euphemism for the more precise medical term of "spontaneous abortion", as people associate the term "abortion" used in common speech for the deliberate termination of pregnancy (whether herbal, medical or surgical). Of course there are also extreme premature deliveries that can be live-born before 24 weeks (if they subsequentky die then this would be considered neonatal death).
• After 24weeks there is potential viability, hence options are: live birth, neonatal death (live birth but subsequently dies) or stillbirth.
• UK law "requires that any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life be registered as a stillbirth", but note well that "the Department of Health and the Office for National Statistics have agreed that a fetus that is expelled after 24 weeks of pregnancy, provided it was no longer alive at the 24th week of pregnancy (this fact being either known or provable from the stage of development reached by the dead fetus), does not fall within the category of births to be registered as stillbirths under the above Acts."REGISTRATION OF STILLBIRTHS AND CERTIFICATION FOR PREGNANCY LOSS BEFORE 24 WEEKS OF GESTATION. Royal College of Obstetrics and Gynaecology (January 2005).
  This results from the UK definitions of pregnancy that includes the concept of a developing fetus. Hence following fetal death that is not expelled, the woman is nolonger pregnant with that fetus. The expulsion of a fetus that died before 24 weeks, but expelled after this time would not therefore be considered a still birth. But this requires proof of such death prior to 24-weeks, either that the death was known pre-expulsion (e.g. through ultrasound imaging) or that the fetal development, as determined after expulsion, is clearly felt to be less than that expected by 24 weeks.
• Hence UK definition has not been solely to do with second trimester point expulsion, rather it depends on viability which was redefined in 1992, and the point of fetal death rather than when it is expelled.
• We know that "abortion" in common usage is the same as "non spontaneous abortions" (i.e. surgical abortion or medical abortion) and also the same as termination. Nuances of differences are not appropriate in an opening to such topics (if we wish to start splitting hairs then consider the issue of consent - with it is a legal termination, without it is assault and grievous bodily harm). Likewise this article should not get too specific in its opening - stillbirth is generally used to imply the expulsion/delivery of a dead fetus after the time when live viable fetus can also be born. Prior to this are various forms of abortion. Still birth, miscarriages and terminations are each subsets of the overall concept of pregnancy loss. David Ruben ^Talk 04:26, 18 January 2007 (UTC)

Thanks for your comment, Dr. Ruben. Currently, the opening of this article includes the following sentence: "in the United Kingdom, 'stillbirth' is used to describe an infant delivered without life after 24 weeks gestation." Does this seem accurate to you? As I understand it, "gestation" refers to the age of the fetus rather than to the duration the fetus has been in the mother's uterus; therefore this sentence in the opening of the article seems consistent with the distinction that you have pointed out ("expulsion of a fetus that died before 24 weeks, but expelled after this time would not therefore be considered a still birth"). But, if I am mistaken, and the current opening of this article misdescribes the UK situation, how would you modify that sentence in the opening of this article?Ferrylodge 04:43, 18 January 2007 (UTC)

Dr. Ruben, did you come here in response to the post I left at Wikipedia talk:WikiProject Medicine? I sincerely appreciate the information you've provided. Hopefully, it will help shed some light on the situation. Thanks! -Severa (!!!) 23:23, 18 January 2007 (UTC)

[edit] European legal definitions

Here is a source summarizing various European legal definitions of stillbirth:

http://www.eurocat.ulster.ac.uk/pdf/Report%208%20Appendix%207.pdf

How many are irrespective of gestational age?-Andrew c 18:53, 18 January 2007 (UTC)

The word "stillbirth" is an English word. It's not clear to me why evidence from non-Enlish-speaking countries would be relevant as to the definition of this word.Ferrylodge 21:18, 18 January 2007 (UTC)

Here is my main issue. In the US abortion and similarly fetal death is a very polarized, politicized issue. Because of this, the legal definition and reporting of fetal death is mixed up with right to life issues (as seen by the lack of agreement in the CDC reporting guidelines). However, as seen by the European definitions, it is clear that a 1st-early 2nd trimester miscarriage is NOT the same thing as an abortion (to a significant part of the world). In medical literature everywhere miscarriage, stillbirth, and live birth are all distinct (if not slightly overlapping) concepts. Even in common language, I'd go on a limb and say most people would recognize a stillbirth not as synonymous with a miscarriage, but instead a late-term pregnancy loss. (but that is besides the point). All you have supporting your position that stillbirth is controversial, and ambiguous, and undefinable is a small minority of reporting areas in the US and circumstantial definitions that depend on other arguably ambiguous words such as "birth" and "fetus". As I said above, unless you have a definition that specifically says "irregardless of gestational age", these vague definitions are simply that: Vague. It isn't clear that they support either view. Anyway, the point behind posting the link was we may want to use that information in the legal section if we decide to be less ethnocentric.-Andrew c 22:33, 18 January 2007 (UTC)

If we're discussing the definition of an English word, there is nothing "ethnocentric" about concentrating on English-speaking countries. If this were a thread about the definition of the word "voila" then I would wholeheartedly support discussion of non-English-speaking countries. Moreover, you say that the word "fetus" is ambiguous. Do you know of any reputable English-language dictionary or encyclopedia that excludes human beings after the embyonic stage from the defintion of "fetus"? Does Wikipedia's fetus article indicate any ambiguity about whether any post-embryonic humans are included?Ferrylodge 23:03, 18 January 2007 (UTC)

I am in complete agreement with Andrew c. When the vast majority of sources in the world define "stillbirth" as late-term pregnancy loss, those few regions in the U.S. with aberrant early-term-inclusive definitions should not be used to suggest that there is controversy throughtout the entire world, or that there is "no single standard definition of this term." That is clearly a violation of WP:NPOV#Undue weight, because it is "misleading as to the shape of the dispute," and fails to present competing views in proportion to their acceptance among experts on the subject. Unique U.S. legal definitions of "stillbirth" can be discussed in the "Legal definitions of stillbirth" sub-section, but, to carry those definitions beyond the actual scope of their use would clearly be an example of undue weight.

And, as for the WHO publication "emphatically confirm[ing]" the statement "there is no single standard definition of ["stillbirth"]", Ferrylodge, I believe you are splitting hairs. The majority of sources we have found which discuss the gestational age at which stillbirth can occur concur that it is late-term. The only disagreement between sources is the precise timing, whether at 20 weeks, 24 weeks, 28 weeks, or so forth. The solution, then, is to word the definition vaguely, as in the case of "mid-second trimester to full-term," in order to accommodate the plurality of time frames; it is not to conclude that there is no consensus, whatsoever, as to in which stage of pregnancy stillbirth can occur. -Severa (!!!) 23:17, 18 January 2007 (UTC)

[edit] Reasons for Reverting

I strongly object to the recent wholesale deletion of definitional material that has been in this section since this section was created. Definitions from mainstream dictionaries such as Dorland’s Medical Dictionary have simply been erased, in favor of definitions more suited to the new conclusions which are now stated in this section.

These recent edits are problematic from an original research standpoint, from a point of view standpoint, and perhaps from many other standpoints described in Wikipedia guidelines and policies.

If one is looking for how standard encyclopedias, dictionaries, and medical instututions define the term "stillbirth", then there is no reason to go delving into articles such as the following: Archibong, E. I.; A. A. Sobande and A. A. Asindi (March 2003). "Antenatal intrauterine fetal death: a prospective study in a tertiary hospital in south-western Saudi Arabia". Journal of Obstetrics & Gynaecology Vol. 23 (2): pp.170-173. PMID 12745563

In my opinion, it is extremely inappropriate to delete a reference such as Dorland’s Medical Dictionary in favor of some obscure article about a tertiary hospital in south-western Saudi Arabia. There is surely a medical journal article somewhere that supports virtually every viewpoint imaginable, and that is why reliance upon standard and reputable reference books is highly preferable in a situation like this.

Moreover, explicit reference to sources such as Stedman’s Medical Dictionary and Merriam-Webster’s Medical Dictionary were deleted from the footnotes. A mere link is given to “7 definitions via reference.com” without any kind of distinctions among those various definitions, some of which are medical and some of which are non-medical.

I will revert these edits, which I find to be the most inappropriate edits I have ever seen at Wikpedia. Please try to be more objective and even-handed.Ferrylodge 21:53, 18 January 2007 (UTC)

I have removed this section completely due to a lack of consensus to introduce this material. You have framed the debate in a manner that you prefer and completely deleted my contribution without an attempt to work with me. You created this section all by yourself and I propose that everyone vote on if it should be included (and whether my version or your version or a new version be used). And while we are voting, we should discuss if we should restore the semi-longstanding LEAD version that specifically mentions the 2nd trimester. Neither you nor myself can force our views into this article, so we should get a consensus to have community support behind one of us (or a 3rd option). I'm not trying to make people take sides, but I want clear support behind whatever happens to this article.-Andrew c 22:07, 18 January 2007 (UTC)

I replaced the section thinking that my reversion did not work properly. I did not notice that you decided to completely delete the section. Now I realize you have done so.

I am more than happy to work with you if you would be reasonable and discuss your massive changes and deletions before you make them.Ferrylodge 22:10, 18 January 2007 (UTC)

[edit conflict] Now onto the specifics. I am sorry you didn't like my source. I was trying to find a medical source that supported a birth weight cut off point. Maybe my mind was drawing a blank or I didn't search hard enough. I know the WHO uses the 500g for reporting, but I wasn't sure if that worked as well under the medical section. We have specific US states using 350g, but again that is legal, not medical. It is obvious that birthweight is used as a factor, but again disapproval of one source is not reason enough to delete everything I did. Furthermore, you had listed 6 different sources that all said the exact same thing. I am sorry you did not like the way I worded the link, but couldn't you have changed that instead of reverting me wholesale? This isn't a contest. The person with the most links in the article doesn't win anything. 2 links can do the job of 6 (which is what my edit did).-Andrew c 22:15, 18 January 2007 (UTC)

(I'll try and keep up with the conversation, though I have some other stuff going on this evening.)

When we're talking about what the various notable definitions are, the number of prominent dictionaries and encyclopedias having one type of definition as opposed to another type of definition is very pertinent. If only one prominent dictionary says that the sky is blue and twenty say the sky is green, then that 20:1 ratio is very pertinent.

You seem to be saying that, when a dictionary defines “stillbirth” as “birth" or "delivery" of a dead fetus, then that is ambiguous even though the word “fetus” clearly applies to any human after 8 weeks from conception. I would find it very difficult to believe that a reputable medical dictionary would say "Stillbirth is the birth (or delivery) of a dead fetus" if the authors of the dictionary only had SOME later-stage fetuses in mind. Do any of references [7] [8] [9] [10] have an ambiguous definition of "fetus" or of "birth" or of "delivery"?Ferrylodge 22:52, 18 January 2007 (UTC)

This is where I am going to agree with Severa's OR claims above. Look at [7]'s definition of birth. You could take definition #5 ("extraction") and mix it with #2 for fetus to mean that a miscarriage at week 9 is considered a stillbirth because 'a post-8 week unborn young human is extracted'. But then if you take #2 and arguably #1 from birth and mix it with #2 for fetus, you get something else. So to answer your question, yes, there is ambiguity. (want me to do the same for [8] [9] [10]?)-Andrew c 23:51, 18 January 2007 (UTC)

Andrew, read this comment you've written, and tell me if you think you might be able to write it a bit more understandably. I cannot sort it out, and doubtless a visiting editor would not be able to either. By "7" I assume you mean Stedman's Medical Dictionary, which defines stillbirth as "The birth of a dead child or fetus." It would help if you would say so, and spare me having to hunt down these quotes. I do not know what "#5" refers to. Is that footnote "5" in my version which Severa has deleted? If that's what you mean, why use brackets for "[7]" and a "#" for "5"? Please try and clarify your comment so that an average person like me can understand without extensive investigation. Thank you. Ferrylodge 00:20, 19 January 2007 (UTC)

Please excuse me for being confusing. The brackets are referencing the same thing your brackets are referencing, the sources in the article (previous revision ). The # refers to the definition number. When I said "Look at [7]'s definition of birth." I meant to go to the thefreeDictionary.com link and type in birth to get the Stedman's definitions for birth. Once you are there, you will see 6 different definitions, and they are numbered. When I reference #5 and #1 and #2, I am refering to the specific number that Stedman's assigns each definition. Same thing for fetus (there are 2 different definitions of fetus given by Stedman's). With this source, fetus isn't ambiguous, but birth is. Therefore, the definition of stillbirth, which uses the ambiguous word "birth" is also ambiguous. Does that make sense? Sorry, sometimes I only make sense to myself. Hope this helps.-Andrew c 03:11, 19 January 2007 (UTC)

Also, I understand you have other obligations, and I will be patient in moving forward and editing the article (but I would request that we remove the disputed section just for the time being). I forgot to address your first paragraph. I think dictionary definitions are not that important because this is an encyclopedia. We should see how our cited sources use the term (such as medical and legal documents), we should see how college texts use the term, see how the media uses the term, etc. This would be like changing the whole abortion article because I found over 12 definitions that defined abortion stopping at 20 weeks. Sure that is a valid technical definition, but it only warrants a side note. There is no need to reframe the abortion article due to a discrepancy found in dictionaries (although in this case, the technical jargon found in many medical journals supports this use of abortion). But on top of that, and this will be the 3rd time I have said it, these concise definitions do not support the late, exclusive position, or the early, all-inclusive position because the terms are ambiguous. What is meant by infant, baby, child, fetus? What is meant by birth, delivery, etc? Someone who has some very heavy, menstrual like bleeding and cramping (say a 9-week miscarriage) is not going to describing their experience as giving birth to an infant. So I stand by my statement that these dictionary definitions, while ambiguous, do not prove the prevalence of the term controversy. In practical application we just have a handful of US States who legally define the term for statistical purposes in a fairly unorthodox manner. I DO think it is important enough to mention in the legal section, and even point out term ambiguity in the lead. But I believe the way the medical section was written, and the way the lead currently is phrased could be improved for accuracy's sake (andto represent majority/common usage). -Andrew c 00:01, 19 January 2007 (UTC)

Ferrylodge, you objected to Andrew c's "massive changes" to the article. However, the "Other Definitions of Stillbirth" section is also a large, recent addition, written solely by you. When something is under dispute, all Wikipedians share the same responsibility to gain consensus from other users before their desired changes are implemented in the article. You have no more authority than Andrew c to decide, alone, which version is preferrable, and thus I have again reverted to the earlier, undisputed version of the article. I have objected to your edits under WP:NPOV#Undue weight and WP:NOR#Synthesis as outlined in the post "Undue weight and OR" above. You will need to address these concerns and gain consensus from other users before your section can be included in the article. Thanks. -Severa (!!!) 23:42, 18 January 2007 (UTC)

Andrew c, please see my comment above at 00:20, 19 January 2007. I cannot respond to you if I do not understand what you are saying.

Severa, as you know, I have never suggested that I have "more authority than Andrew c to decide, alone, which version is preferrable". You say that “the vast majority of sources in the world define ‘stillbirth’ as late-term pregnancy loss”. That is incorrect. First of all, what kind of sources do you deem persuasive, Severa? A document from some country where English is not spoken? How would they know what the definition of the English word “stillbirth” is? And do you think that a journal article about tertiary hospitals in Saudi Arabia is of equal definitional weight with Dorland’s Medical Dictionary or Stedman’s Medical Dictionary or the Merriam-Webster Medical Dictionary or Random House Dictionary or Webster's Dictionary or American Heritage Dictionary? When reputable medical and non-medical dictionaries such as these state that “stillbirth” is the birth of a dead fetus, what do you find ambiguous about that statement? Is it not true that every medical dictionary and encyclopedia in the English language includes a post-8-week human being within the definition of “fetus”?

Additionally, Severa, I wish you would refrain from deleting material without giving any explanation whatsoever. For example, you deleted the following statement: "However, the federal guidelines themselves mention (at page 1) that fetal death and stillbirth are interchangeable terms." Do you deny that the CDC document says this?Ferrylodge 02:53, 19 January 2007 (UTC)

Sorry this is getting silly and I think Ferrylodge this risks looking like pedantic trolling. In UK any dictionary or encyclopaedia making such a definition would be either over simplifying or just plain wrong, they are not the ultimate authority (see above posting re UK medical & legal definition). That a UK dictionary (whether for the specialist or the non-specialist) uses a simplistic definition does not consititute a valid alternative definition as to what in the UK would be correct. Dictionaries frequently are imprecise in their choice of terms of fetus/neonate/baby, and unless very clear specific clarification is provided along with sourcing for the data (which they do not), then I would not place too much reliance on this line of argument. The long discussions above on "grey areas" clearly shows that a dictionairy's couple of line entry can not completely and precisely explore the topic.

Example1 - The Concise Oxford Dictionary 9th edition 1995, defines stillbirth as "the birth of a dead child" which certainly had me raise my eyebrows, for the definition of a child is given as "1a a young human being below the age of puberty. b an unborn or newborn human being. 2 one's son or daughter (at any age)..." and in turn human being is defined as "any man or woman or child of the species homo sapiens". So this would seem to permit interpretations of still birth from a 1st day post implanted blastocyst to term, and possibly even of a never-implanted fertilised egg being expelled (which medically & legally in the UK would not even be considered an established pregnancy). I doubt that many people would typically opt for term child for an unborn fetus/baby.

Example2 Chambers Twentieth Centurary Dictionary revised edition 1981 defines still birth as "birth of the already dead or very nearly dead, as in suspended animation". This is incorrect for the UK, as a " breathe or show any other signs of life" would not count as still birth, but rather a live birth (with then possibly a neonatal death). The choice of phrase "very nearly dead" is clearly imprecise. David Ruben ^Talk 04:07, 19 January 2007 (UTC)

Dr. Ruben, I certainly would not want to become a “pedantic troll”, as you put it. Nor would I want to assert that you are becoming a pedantic troll, and therefore I will instead be polite, assume good faith, and refrain from personal attacks.

The intro to this article currently says, “in the United Kingdom, ‘stillbirth’ is used to describe an infant delivered without life after 24 weeks gestation.” I entirely agree with that statement, and have never questioned that statement. The UK has a statute in place on the subject of stillbirth, and most of your reputable dictionaries and encyclopedias have adopted the statutory definition of that word. For example, as Andrew C has pointed out, the Oxford Concise Medical Dictionary and the Oxford Dictionary of Nursing both say that “stillbirth” occurs after 24 weeks.

You now cite the Concise Oxford Dictionary (1995), as providing definitions that would seem to permit interpretations of stillbirth from a 1st day post implanted blastocyst to term. As I have previously mentioned, some other non-medical dictionaries also include both fetal and embryonic deaths, such as the dictionary WordNet 2.1 from Princeton University, which defines stillbirth as “a natural loss of the products of conception [syn: spontaneous abortion]”. This is perhaps similar to the definition you quote from the Concise Oxford Dictionary. But very few dictionaries permit interpretations of stillbirth from the moment of conception. Therefore, I have not argued that this Wikipedia article should give them any weight at all.

What should be given weight are the very substantial number of authorities that define stillbirth as synonymous with fetal death or birth of a dead fetus. Those authorities may not be numerous in the UK, but they are numerous elsewhere. In the United States, for example, the Centers for Disease Control (CDC) says that fetal death and stillbirth are synonymous (see page one of this document). Unlike your two non-medical dictionaries, this statement by the CDC is supported by numerous medical dictionaries, some of which I have cited (e.g. Dorland's, Stedman's, Merriam-Webster's).

We are speaking here about the definitions of words. As a UK general practitioner, you should agree with what the intro to this article says about the UK. Perhaps you have less expertise in what the word “stillbirth” means in other English-speaking countries.Ferrylodge 04:50, 19 January 2007 (UTC)

Thank you Ferrylodge, indeed my direct experience is only on the UK. I found these links that would suggest Australia, Canada, New Zealand & European Union definitions seem like UK not to accept before a point effectively near to 20 weeks (vs close to 8 weeks):

1. An interesting explanation for the changes to the Canadian definition of the term: "Starting in 1959, the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization. At the same time, the compulsory registration of stillbirths was extended to 20 weeks gestation from 28 weeks and the new period of gestation incorporated into the definition: Stillbirth means the complete expulsion or extraction from its mother, after at least 20 weeks pregnancy, of a product of conception in which, after such expulsion or extraction, there is no breathing, beating of the heart, pulsation of the umbilical cord, or unmistakable movement of voluntary muscle." History Vital Statistics - Stillbirth Database
2. Here is a link to European Union definition: "STILLBIRTHS - The expulsion or extraction from the mother of a dead foetus after the time at which it would normally be presumed capable of independent extra uterine existence (commonly taken to be after 24 or 28 weeks of gestation). Infants who are born alive but die shortly after birth are excluded from this category" Europa
3. For New Zealand: "The Births, Deaths and Marriages Registration Act 1995, which took effect from 1 September 1995, redefined what constituted a stillbirth. Before this Act, a stillbirth was defined as a child born dead after 28 weeks of pregnancy. Under the current definition a child is stillborn if it is born dead and weighs 400g or more at birth, or is born dead after the 20th week of pregnancy." Statistics New Zealand, of course no fetus even remotely close to 8 weeks gestation will be 400g
4. This report on Australian statics AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE NATIONAL PERINATAL STATISTICS UNIT PERINATAL STATISTICS SERIES - Number 12 - Australia’s mothers and babies 2000 (PDF) on page 30 gives interesting table of various Australian and WHO definitions. In essence minimum of 400 g or 20 weeks (legal definition uses gestation only if weight not available, National Health Data Dictionary takes either.

In short all these definitions (Australia, Canada, New Zealand, European Union) seem to specify either gestation age or a birth weight that will generally correspond closer to 20 weeks than 8 weeks. David Ruben ^Talk 13:33, 19 January 2007 (UTC)

Dr. Ruben, thank you for not arguing that the medical definitions I cited (in medical dictionaries like Stedman’s, Merriam-Webster’s and Dorland’s) are somehow ambiguous. Instead, you cite four sources from Europe, New Zealand, Canada, and Australia respectively, to show that there are other definitions in use throughout the world in addition to the ones I described. If you look at the now-deleted section I wrote on this subject, you will see that I did not assert that the definitions in Dorland’s, Merriam Webster’s, or Stedmans were the exclusive medical definitions outside England. Do you think that the section I wrote was somehow unbalanced or misleading? For the sake of discussion only, let us suppose that New Zealand has the exact same definition as in England; would that mean that definitions in the United States should not be mentioned in this Wikipedia article?

A few comments about the four documents you cite, but please feel free to skip these comments which are somewhat detailed....Regarding the Eurostat document, I don’t think it adds much to the already-acknowledged definition in England. Most countries in Europe are not English-speaking, so it’s difficult to understand why a Eurostat document (or English translation of a Eurostat document) would add to what we already know about England’s definition of “stillbirth”. Note that the Eurostat glossary explicitly says at the top that it pertains to “demography”, and so its definition should not necessarily be extended beyond its intended application. Moreover, the Eurostat document is internally inconsistent: it says that “stillbirth” involves a “dead foetus”, while also adopting a definition of “death” that does not even apply to a fetus (“Definition of a Death: According to the United Nations (UN) definition, a death is the permanent disappearance of all evidence of life at any time after live birth has taken place .... This definition therefore excludes foetal deaths”).

Regarding your Canadian document, I believe you are mixing up the definition of a “stillbirth” with the requirements for stillbirth “registration”. The Canadian document says that, “In 2001, most provinces and all three territories required a stillbirth with a gestational age of at least 20 weeks or a birth weight of at least 500 grams TO BE REGISTERED” (emphasis added). Note those last three words in the quote. The Canadian document goes on: "Starting in 1959, the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization.” That WHO definition plainly includes demise prior to viability, and excludes embryonic death. Do you really want to argue that the WHO definition of “fetal death” excludes deaths prior to viability, even though the WHO definition says nothing about viability, and instead is “irrespective of the duration of pregnancy”?

Regarding your New Zealand document, it refers to “The Births, Deaths and Marriages Registration Act 1995” and definitions contained therein. This again involves registration. It is only fair to note that statutes often have definitions sections which adopt definitions different from those in standard dictionaries or in standrd use. You have cited no standard New Zealand dictionaries that show conformity with the 1995 Registration statute. I am not asking you to do so, but am merely pointing out that a definition in a particular statute on a particular subject does not necessarily say much about the standard definition or the medical definition. That is why I added the now-deleted section to this Wikipedia article, because it is not enough to merely talk about legal definitions.

Finally, regarding Australia, I agree with you that the Australian Institute of Health and Welfare adopts a definition of “stillbirth” that only applies after 20 weeks. It adopts an identical definition of “fetal death”, which directly contradicts the widely accepted WHO definition of “fetal death”. Additionally, I would find a definition in standard medical or non-medical dictionaries more persuasive than a random publication of a huge bureaucracy which does not even conform with widely accepted WHO definitions.Ferrylodge 14:57, 19 January 2007 (UTC)

I find it odd, Ferrylodge, that you discount the Statistics Canada source because it does not touch upon the "definition of a 'stillbirth'", only "the requirements for stillbirth 'registration.'" However, this decription applies equally to the CDC source, which provides information on "reporting requirements." Dismissing the AIHW source as the "random publication of a huge bureaucracy" is a strange criticism given the fact that the AIHW and CDC are both government agencies in their own countries. If the AIHW source is invalid for this reason, then, by extension, so is the CDC source (although I most certainly do not regard the CDC as a "huge bureaucracy" or its publications as "random").
The ultimate question we are seeking to answer here is what is the most common definition of "stillbirth." The sources provided by Davidruben give a picture of which legal definition is most prevalent — at least in the Western world. Per WP:NPOV#Undue weight these government definitions should not be presented out of context or extended beyond their rightful scope. Detailed discussion should be limited to the "Legal definitions of stillbirth" section.
I think the next goal should be to browse medical sources — perhaps the web sites or publications of medical institutions - to get an idea of the prevalence of definitions used in the medical community. And, no, dictionary definitions are not a sufficient substitute, given what Dr. Ruben has said about dictionaries often being imprecise in their choice of terms. -Severa (!!!) 16:44, 24 January 2007 (UTC)

Severa, I find it odd that you think “The ultimate question we are seeking to answer here is what is the most common definition of ‘stillbirth.’” Wikipedia purports to be a balanced source of information, rather than a source of information exclusively about one of several points of view.

The section on Late-term_abortion is an example of this. There is an honest acknowledgment that, “the exact point when a pregnancy becomes late-term is not clearly defined.” Therefore more than one definition is discussed (though you recently reverted another).

You mention Dr. Ruben, and I notice that he recruited you to rejoin this discussion instead of himself answering the questions I posed to him in this thread. I said: “If you look at the now-deleted section I wrote on this subject, you will see that I did not assert that the definitions in Dorland’s, Merriam Webster’s, or Stedmans were the exclusive medical definitions outside England. Do you think that the section I wrote was somehow unbalanced or misleading?” No answer from him or from you. I asked, “Do you really want to argue that the WHO definition of ‘fetal death’ excludes deaths prior to viability, even though the WHO definition says nothing about viability, and instead is ‘irrespective of the duration of pregnancy’?” No answer from him or from you.

But, I have no problem answering your questions. Regarding the CDC Document, it does not deal only with reporting requirements. The title of the document is “State Definitions and Reporting Requirements.” Neither the definitions given on page 3, nor the discussion on page 1 of the CDC document are restricted to reporting requirements. In contrast, the very sentence that Dr. Ruben seems to be relying upon in the Canada document says, “In 2001, most provinces and all three territories required a stillbirth with a gestational age of at least 20 weeks or a birth weight of at least 500 grams TO BE REGISTERED” (emphasis added). In contrast, the Canada document says: "Starting in 1959, the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization.” Why do you discount that part of the Canada document, Severa? After all, the WHO definition plainly includes demise prior to viability, and excludes embryonic death.

Regarding the Australia document, I do not dismiss it, as you allege. I pointed out that it adopts a definition of “fetal death”, which directly contradicts the widely accepted WHO definition of “fetal death”. Does it not? To my mind, this reduces the persuasiveness of the Australian document. I think definitions in standard medical and non-medical dictionaries are more persuasive than a random publication of a huge bureaucracy which does not even conform with widely accepted WHO definitions. In contrast, the CDC document confirms with widely accepted WHO definitions, does it not?

I also disagree with your proposal to “browse medical sources — perhaps the web sites or publications of medical institutions - to get an idea of the prevalence of definitions used in the medical community. And, no, dictionary definitions are not a sufficient substitute, given what Dr. Ruben has said about dictionaries often being imprecise in their choice of terms.” There are numerous and very reputable medical dictionaries (and legal dictionaries and standard dictionaries) accessible on the internet. If you want to look beyond them, I’m sure you can find plenty of sources to support whatever particular viewpoint you wish to promote, and I do not have the time or interest to play tit for tat with you. You seem quite enthusuastic to delete standard medical definitions, and I hope you will reconsider.

You are correct that Dr. Ruben said, “Dictionaries frequently are imprecise in their choice of terms of fetus/neonate/baby, and unless very clear specific clarification is provided along with sourcing for the data (which they do not), then I would not place too much reliance on this line of argument.” I would like examples of where reputable dictionaries like Stedman’s Medical Dictionary, or the Merriam-Webster Medical Dictionary, or the Dorland’s Medical Dictionary are imprecise in their use of the term “fetus.”Ferrylodge 17:29, 24 January 2007 (UTC)

[edit] LEAD discussion

While the above stuff has to deal with a proposed medical definition section, I thought we shouldn't ignore the LEAD discussion. A little history (as best as I can compose). The page from May 2003 until Feb 2006 used the terms "stillbirth, pregnancy loss, miscarriage, or spontaneous abortion." synonymously, adding "regardless of the stage of development." 11 months later, this was changed to mention "mid-second trimester" and stood until 8 days ago. The age limit was removed and that was reverted. And then the minor edits and source piling began (oh yeah, my source says X, or yeah? my 5 sources say Y). There were attempts at compromise, but no side seemed that willing to give enough. I believe this stems for a differing of opinions. One side believes strongly that there is no majority definition, and each definition should be represented equally, or at least the wording should be vague enough not to ignore certain broad definitions. The other side believes that there is a majority usage, and that the article should represent the majority use. Efforts to convince the other side of the majority (or lack there of) have failed, so it would seem we are at a stand still.

Now, in my personal opinion, the current lead needs work. The second sentence is problematic because it says "miscarriage" has a similar meaning, and that meaning is pre-20 weeks (which is the exact opposite of one meaning of stillbirth). Whether on purpose or not, it excludes the late to full term dead fetuses, the ones which are almost universally considered stillbirths. I also believe the second paragraph is problematic in the way it compares and contrasts the different uses. It is giving equal weight to the uses, when I believe equal weight is actually undue weight to the minority use. But this goes back to what I said above. Can I prove to Ferrylodge that one use is more common than another? So far I have been unable to.

Finally, I believe there is nothing wrong with using the common medical definition in the lead. This article is mainly about a medical condition. It wasn't politicians that found out that placental abruption could cause stillbirth. It wasn't a government organization that determined Rh disease could cause stillbirth. The diagnosis and treatment of stillbirth is not done by the high courts. There should surely be information about how the state deals with stillbirth, but I would propose using similar language from my most recent medical definition section edit for the lead.

Stillbirth is often medically defined as a fetal death "during the late stages of pregnancy."[4] This may occur in utero, or during labor and delivery. The term is often used in distinction to live birth and miscarriage. A fetal death shortly after birth is referred to as a neonatal death. Stillbirths and neonatal deaths are combined with the term perinatal deaths.

The exact point between a miscarriage and a stillbirth is difficult to agree upon, but distinctions such as a fetal weight over 500g,[5] a gestational age of 20-24 weeks,[6] or simply after viability[7] are used by varying sources. Some medical dictionaries define "stillbirth" ambiguously as the "birth" or "delivery" of a dead "fetus", "baby", "child", or sometimes "infant", without further comment.[8] The term 'fetal death' is sometimes used instead, avoiding the ambiguity.

Governmental and medical organizations have sometimes used alternate definitions for statistical and other purposes. In this context, stillbirth sometimes includes early fetal death (miscarriage) in addition to later fetal death.

This would no longer necessitate a separate medical definition section. Just an idea. I am not married to any particular wording, so comments and suggested changes are welcome. Feel free to post proposals of your own here as well.-Andrew c 02:16, 19 January 2007 (UTC)

Andrew c, Severa has said that, “the vast majority of sources in the world define ‘stillbirth’ as late-term pregnancy loss”. How would you suggest that I disagree with that statement other than by citing well-known and very reputable dictionaries of the English language? You call this "source-piling." Perhaps it would be source-piling if I were citing obscure articles about tertiary Saudi Arabian hospitals (as you did), but in point of fact I cited sources like Dorland’s Medical Dictionary, Stedman’s Medical Dictionary, the Merriam-Webster Medical Dictionary, Random House Dictionary, Webster's Dictionary, and American Heritage Dictionary. Then you summarily delete these references as if they were irrelevant source-piling.

Moreover, I think you are being overly fastidious about the second sentence of the lead. Obviously, miscarriage is a similar concept to stillbirth, and only the time-frame is different; the second sentence merely says that the terms are similar, not that they are synonymous. However, since you do not like that sentence, I will go ahead and delete it. I hope that that might narrow the points of contention, and expedite this discussion.

Andrew c, you say that the second paragraph gives “undue weight to the minority use” of the term “stillborn.” And yet when I list reputable medical dictionaries to the contrary, you say I’m “source-piling”, you delete those footnotes of mine, and you substitute some article about tertiary hospitals in Saudi Arabia. Do you understand why this discussion is frustrating for me? You apparently are arguing that those medical sources which say "stillbirth is birth of a dead fetus" have vague definitions of the word "fetus". But as far as I know, every medical dictionary in the English language includes within the term "fetus" all human beings after 8 weeks of development. I think that you are seeing ambiguity where none exists.Ferrylodge 03:16, 19 January 2007 (UTC)

Right now, I don't see any issues with your proprosal, Andrew c. It seems to cover all the bases we logically can and fairly address many of the concerns which have been raised here. I also think it avoids UW issues neatly by placing everything in context. -Severa (!!!) 16:57, 24 January 2007 (UTC)

I present, for discussion, the following draft intro:

“

A stillbirth is a type of fetal death that occurs in late pregnancy[4]. The dividing line between a miscarriage (another type of fetal death) and a stillbirth is not universally agreed upon. Distinctions such as a fetal weight over 500g,[5] a gestational age of more than 20-24 completed weeks,[6] or simply after viability[7] are used by varying government agencies responsible for maintaining vital records. Some medical dictionaries define "stillbirth" ambiguously as the "birth" or "delivery" of a dead "fetus", "baby", "child", or sometimes "infant", without further comment.[8] Governmental and medical organizations have sometimes used alternate definitions for statistical and other purposes. In this context, stillbirth sometimes includes early fetal death (miscarriage) in addition to later fetal death. Stillbirth may occur in utero, or during labor and delivery. The term ‘stillbirth’ is often used in distinction to ‘live birth’ and ‘miscarriage’. A fetal death shortly after birth is referred to as a neonatal death. Stillbirths and neonatal deaths are combined with the term perinatal deaths.

”

Thoughts? J.Nevels 17:27, 29 January 2007 (UTC)

I'm not particularly vested in how this turns out. However, since you asked, I think that the above paragraph is well-written, and clarifies that, at least between these editors, there is not a clear consensus on the defintion. Joie de Vivre 18:09, 29 January 2007 (UTC)

I disagree with altering the present lead, which has been the subject of lengthy discussion, and parts of which have been stable for years. I don't think that the new language is as accurate as the existing language in the intro. The proposed intro asserts that some existing dictionary definitions are "ambiguous." However, if the goal of changing the present intro is so that it won’t be “ambiguous”, then that is not accomplished by the suggested language: saying that a “stillbirth” is a type of fetal death that occurs in late pregnancy is also ambiguous, since the word “late” is undefined.

Additionally, I do not agree that existing medical dictionaries or other dictionaries are "ambiguous" if they say that stillbirth is birth of a dead fetus; there is nothing “ambiguous” about that, if the meaning of the terms "fetus" and "birth" are clearly defined. See the section on dictionary definitions that was unwisely deleted from this article.

I recognize that, as J. Nevels said, “common people just like me (I should know - I am one) redefine the English language (and words like stillbirth) daily....” However, I don’t think we should use Wikipedia to do so, and instead we should try to be neutral and objective.

J. Nevels likes the WHO’s definition of “stillbirth” for purposes of their manual on refugee situations, and he's perfectly entitled to like it. However, there are other bureaucratic definitions that are much less ambiguous (see the definitions in Canada and the U.S. that are already cited in the present article, and which unambiguously allow for interchangeability of the terms “fetal death” and “stillbirth”).Ferrylodge 19:04, 29 January 2007 (UTC)

So is the proposal workable? Can we take out the word "ambiguously"? What other changes can be made?-Andrew c 19:11, 29 January 2007 (UTC)

What's wrong with the current intro? It reflects a broad range of definitions. And why completely scrap it instead of suggesting changes to it?Ferrylodge 19:17, 29 January 2007 (UTC)

Joie de Vivre, thank you for your comments. Andrew c, great suggestion... we'll strike the word "ambiguously" from the draft intro (see above). Ferrylodge, I appreciate your opinions. I believe that there are a number of editors here that clearly believe the current intro can be better written - and - it should be. The language of the *proposed intro* is written in a style which is neutral and objective. Your dissent to various points has been acknowledged time and again - and this most recent change to the proposed intro (striking "ambiguously") is an effort to reach consensus by addressing your concerns. I believe that based on this current discussion, we can all agree that the intro will be changing (hopefully for the better, and by the consensus of all with an interest). If anyone has anything to add the proposed intro that will make it even better - please feel free to share your proposed changes. J.Nevels 20:00, 29 January 2007 (UTC)

I believe I have stated before my issues with the current lead. We are being ambiguous when there is no need to. Most medical definitions and most international government agencies recognize some sort of age/weight restriction which could generally be classified as later in a pregnancy. (mid-second trimester). We should state generally what a miscarriage is for the majority first, instead of saying "some sources say X... in contrast, other sources say Y". This is giving the minority view undue weight by making the different definitions seem equal. But I believe this is a point that we disagree upon. On top of that, I believe the current wording isn't that encyclopedic. It seems rather basic, while I think we could put a little more information in the lead to give a better, higher caliber overview. But the current intro isn't terrible. It's better than some of the past versions. I think we could work it up more, and I think we should state in the first sentence that a miscarriage is normally defined as being later in a pregnancy. -Andrew c 21:41, 29 January 2007 (UTC)

Andrew C., I agree with you that the current intro isn't terrible, and is better than some of the past versions. Therefore, let's work with it, instead of completely scrapping it and replacing it with something else. You've already contributed to writing part of the present intro, and so I'm still uncertain what your remaining concerns are.

I disagree with you about what "most medical definitions" say. If it's important to survey medical definitions (which I agree it is), then why not restore this deleted section, which shows that the current first sentence of the intro is supported by more medical and non-medical definitions than any other? If you would like to add additional authoritative definitions to that deleted section, then go ahead, but I disagree that the deleted section is "source-piling" as you previously mentioned. If we agree it's relevant to determine what the most common definition is, then it's also relevant to mention the various authoritative dictionaries.

As far as using this article to define terms like "miscarriage", it seems to me that the current intro already does so sufficiently, and a link is provided for people who want to find out more about miscarriage. You say, “we should state in the first sentence that a miscarriage is normally defined as being later in a pregnancy.” That’s incorrect. The term miscarriage usually implies “prior to 20 weeks” as the miscarriage article explains. Can’t we just leave that matter for the miscarriage article?

And incidentally, why is it important what international government agencies say? Suppose the African Union has some agency on funeral burials that publishes a pamphlet on that subject, and then some lowly translator in Johannesburg translates a word in that pamphlet as "stillbirth". Why is that more significant than a definition that the national government in Canada has used uniformly for more than half a century? In any event, since this is a definitional issue, I continue to believe we should rely primarily on well-known and reputable dictionaries as opposed to other sources.Ferrylodge 22:26, 29 January 2007 (UTC)

(reset indent) Folks, if there's nothing wrong with the 6 sentence lead that's being currenty used - fine. If there *is* something wrong with it - let's be very specific on what we think is wrong about it - provide a proposed change - and lets talk about it. My proposed change was just that - a proposal. For the small amount of actual work that's been done to make the article better - the length of this discussion page is patently absurd! J.Nevels 22:52, 29 January 2007 (UTC)

[edit] Stedman's Medical Dictionary

Andrew c asserts that Stedman's Medical Dictionary (which is one of many dictionaries that I have cited) has an ambiguous definition of "stillbirth." So let's look in detail at why this ambiguity is completely imaginary.

Stedman’s Medical Dictionary says that a stillbirth is “1. The birth of a dead child or fetus” or “2. a child or fetus dead at birth.” Andrew c, if I understand correctly, you are asserting that the word “fetus” is not ambiguous here, but the word “birth” is ambiguous, because (you say) Stedman’s gives five different definitions for “birth”:

1. The emergence and separation of offspring from the body of the mother. 2. The act or process of bearing young; parturition. 3. The circumstances or conditions relating to this event, as its time or location. 4. The set of characteristics or circumstances received from one's ancestors; inheritance. 5. Origin; extraction.

Normally, it is assumed that the primary definition is being used, unless there is some reason to believe otherwise. Yet, you focus on definition #5. Obviously, definition #5 is irrelevant here, because it refers to someone’s heritage (e.g. “he is of foreign birth”). It is patently false and frivolous to suppose that definition #5 is the definition of "birth" that Stedman uses in either definition of the word “stillbirth”. This should be obvious. And I think your attempts to find ambiguity in the other reputable dictionaries I cited will be equally fruitless.Ferrylodge 03:55, 19 January 2007 (UTC)

[edit] Womb and Uterus

"ConfuciusOrnis" has decided to remove the word "womb" from this article and replace it with the owrd "uterus." I reverted so that the article would contain both words, which are synonymous, and I wrote this in the edit summary: "When two words are synonymous, there is no need to completely remove one of them from an article."

Then ConfuciusOrnis reverted back here. He wrote in his edit summary: "No, actually they're not. Stop trying to insert loaded terms into the articles."

First of all, I am not trying to insert anything. The word "womb" was in the lede of this article long before I ever touched this article. See here.

Secondly, the words "womb" and "uterus" are synonymous, and therefore I will revert again so that the article does not arbitrarily exclude one of those words due to any POV or other mistake. There is no consensus to completely removge the word "womb" from this article, and this word has been used in this article for a long time. The article can use both the words "womb" and "uterus." The latter is a more clinical word, and the former word is also in common use. Wikipedia guidelines say: "Write for the average reader and a general audience—not professionals or patients. Explain medical jargon or use plain English instead if possible." There is n othing inappropriate about using the word "womb" in this article.

Following are several dictionary definitions that demonstrate "womb" is synonymous with "uterus":

From Medicine-net.com....

"Womb: The womb (uterus) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is the corpus. The corpus is made up of two layers of tissue."

From Encarta:

"uterus of woman: a uterus, especially a woman's ( not in technical use )"

From the US National Institutes of Health:

"The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called the uterus.

From the Meriam-Webster Online Dictionary:

"1 : UTERUS"

From Dictionary.com:

"the uterus of the human female and certain higher mammals."

From American Heritage Dictionary for "uterus" (via Dictionary.com):

"A hollow muscular organ located in the pelvic cavity of female mammals in which the fertilized egg implants and develops. Also called womb"

From WordNet (via Dictionary.com):

"Womb: hollow muscular organ in the pelvic cavity of females; contains the developing fetus [syn: uterus]"

From American Heritage Stedman's Medical Dictionary (via Dictionary.com):

"womb (wm) n. See uterus."

From Merriam-Webster's Medical Dictionary:

"Main Entry: womb Pronunciation: 'wüm Function: noun : UTERUS"

Both the words "womb" and "uterus" are perfectly acceptable in this article. The word "womb" has been in the article a long time (long before I ever edited this article). It would be either POV or a mistake to completely remove and bar the word "womb" from this article.Ferrylodge 14:13, 20 September 2007 (UTC)

Since absolutely none of your arguments differ in any meaningful way from those that where shot down at talk:Pregnancy, I'll simply point you once again to that conversation just in case you'd forgotten. Good day!. ornis (t) 14:23, 20 September 2007 (UTC)

You are edit-warring, and I have left a 3RR message at your talk page. I have not been to the pregnancy article in days, but will go there now. I certainly did not cite a single one of the definitions above at the pregnancy article.Ferrylodge 14:30, 20 September 2007 (UTC)

I think you are thinking of the abortion article, CO - Ferrylodge has been spamming this long list of dicdefs in quite a few places, shopping as it were - so its easy to get confused. KillerChihuahua^?!? 16:02, 20 September 2007 (UTC)

Killer, I assume you meant WP:SHOPPING, as your link leads to Wikiproject: shopping malls XD. Ah well, I needed some humor in the situation anyway Kuronue | Talk 21:20, 20 September 2007 (UTC)

Dang, you're right - thanks for correcting me. KillerChihuahua^?!? 21:24, 20 September 2007 (UTC)

And another point that has been really irking the hell out of me: "lede" is not a word. •Jim62sch• 21:47, 20 September 2007 (UTC)

It is, in journalism, Jim. And of course that's what we're doing here, right?  :) Tvoz |talk 00:41, 21 September 2007 (UTC)

Actually, we're writing an encyclopedia, we're not doing journalism. At least I hope that's what we're doing. ;)

Back to linguistics: "lede" was never a proper spelling for lead, in fact lead has been spelled lead for over one thousand years. I've no doubt that in ME someone misspelled lead as lede, but given the lack of orthographic rules in the ME period, such a misspelling would be a curiosity at best, and no doubt an effort to conform to a dialectical or regional spelling of words rhyming with "need" (as was standard for example with bede for bead (prayer)). Note that there was a variant spelling of the verb "leden" in ME, but it was only a variant, nothing more.

What likely happened in journalism is that an editor misspelled the word and then developed a back-rationale for the spelling (no doubt based on my above example). Although many linguists are loath to accept error or lack of linguistic understanding and knowledge as a genesis for both variant spellings and bad neologisms, I have no problem with such a concept.

In other words, "lede" is just a variant spelling, and interestingly, one that the OED doesn't recognise. •Jim62sch• 13:31, 22 September 2007 (UTC)

[edit] Womb-Uterus debate: central location proposed

As this has enveloped multiple articles, I propose we choose one location for the debate, post accodingly on the talk pages of all involved articles, and hash it out in one place. There has been a good bit of repetition, as well as edit warring on articles where there is little or no discussion on the talk pages. IMO we can work it out ourselves, but if not, we can move to mediation if desired. I suggest Talk:Pregnancy/Womb-Uterus debate. I am cross posting this on all involved articles. KillerChihuahua^?!? 11:06, 21 September 2007 (UTC)

[edit] Quiet birth?

Why is the first piece of information in this article that stillbirth means "quiet birth"? If there's a more complicated etymology than meets the eye, I'd sincerely be interested, but the present bit of information does nothing for the article in my opinion. However, an fuller explanation of the origin would justify its presence. MagnesianPhoenix (talk) 06:53, 5 January 2008 (UTC) [signed retroactively]