§ 3.6 p.m.
§ Lord Kilmarnock
My Lords, I beg to move that this Bill be now read a second time. In presenting this short Bill to your Lordships I bring before you a measure which has come unamended from another place where it was introduced by Mrs. Rosie Barnes, with all-party support. I hope that the same fair wind will speed it through your Lordships' House.
The main provision of the Bill is to amend the Births and Deaths Registration Acts by reducing from 28 weeks to 24 weeks the gestational age at which a baby is recognised as still-born. There is an important humanitarian motive for this which I shall shortly explain. It will also make the definition consistent with the consensus view of professional bodies about the gestational age at which a foetus could be said to be viable. Pressure to amend the law in this respect has increased since 1990 when the Human Fertilisation and Embryology Act inserted the time limit of 24 weeks for the majority of abortions under the Abortion Act.
As the law stands, considerable additional stress can be and is caused to parents if a child is born dead as the formal term of pregnancy is nearing its end but where the period of gestation is just too short for it to fall within the legal definition of a still-birth. In those circumstances the death is regarded as a miscarriage, which gives the baby no legal status and denies the parents the formal procedures which a still-birth involves.
It is true that some hospitals have introduced voluntary procedures, but these vary considerably from area to area. Some hospitals may have made arrangements with their local crematorium, others have burial areas in local cemeteries. But generally the remains of miscarriages are incinerated and the grief of parents has no outlet in any form of dignified procedure.
After 28 weeks the picture changes radically. The law, as it currently stands, requires certain definite procedures. The doctor or midwife who attended the delivery, or who examined the baby's body after delivery, will issue a medical certificate of a still-birth. The parents will attend before the local registrar and formally register their child as a still-birth. The 547 still-born child may be given a name and a still-birth certificate is issued. Documents are made available to allow for the child to be buried or cremated.
These formalities—in particular being able to name the child and obtain a birth certificate and, if they so choose, to arrange a funeral—are greatly valued by many parents as a recognition of the baby's existence.
By reducing to 24 weeks the limit by which a child born dead is formally and legally recognised as a still-birth it is estimated that in the UK as a whole the facility to formally register the dead foetus as a still-birth will be available in some 900 cases which would otherwise have been regarded as miscarriages. This is the humanitarian cause to which I referred and which I am sure will find favour both inside and outside the House. It also has the committed support of professional bodies such as the Royal College of Midwives, the Royal College of Nurses, the Royal College of Obstetricians and Gynaecologists, the British Medical Association, and voluntary organisations, in particular the Still-Birth and Neonatal Deaths Society—SANDS is the acronym—whose publication A Dignified Ending is to be recommended as essential background reading on this whole issue.
It may be appropriate to address here a question that might be forming in some people's minds concerning the very few abortions carried out after 24 weeks—there were only 21 such abortions in England and Wales in 1991—and their position under the Bill. In such cases, which will be very few in number, the delivery will be recorded as a still-birth and an abortion. At that stage in a pregnancy an abortion is most often carried out because of a substantial fetal abnormality. In these circumstances the disappointment of losing a wanted baby is bound to be heavy and the parents are likely to welcome being able to obtain a still-birth certificate. In this respect I would argue that the Bill constitutes an improvement on the present situation.
As a natural accompaniment to the lowering of the definition of still-birth to 24 weeks, the Bill also enables statutory maternity pay (SMP) and maternity allowance (MA) to be paid to those additional mothers who will now qualify under the new definition. This requires an amendment to the definition of "confinement" in the Social Security Contributions and Benefits Act 1992, which received Royal Assent on Thursday 13th February, but whose provisions do not come into effect until 1st July of this year, or if not in force by the time the provisions of this Bill come into force, the Social Security Act 1986. This will have the effect of enabling SMP and MA to be paid to qualifying mothers where a child has been still-born after 24 weeks' gestation.
As regards the number of women who will benefit from these changes to social security law, it is expected that about 300 more will qualify for SMP and MA than at present. The additional cost of these payments is estimated at £0.5 million in a full year. About 90 per cent. of these costs will be reflected in payments of SMA, with the remaining 10 per cent. being payments of MA. There will be no additional demand on the social security budget, as it has been agreed that the 548 Department of Health should cover this additional expenditure and transfer the necessary funds to the Department of Social Security for this purpose. A money resolution to this effect has been passed in another place.
The Bill will apply to England, Wales and Scotland but contains power also to make corresponding provision under the Northern Ireland Act 1974. It is proposed that the Bill should come into force on 1st October this year. This will allow time for making an Order in Council under the Northern Ireland Act and for the issue of instructions and necessary documentation to registrars, hospital administrators and medical practitioners.
I think it is incumbent on me to take the House very briefly through the clauses. Clause 1(1) amends the Births and Deaths Registration Acts in England and Wales and provides for an amendment to the existing definition of a still-birth in the terms that I have described. Clause 1(2) provides for a corresponding amendment to be made to the law of Scotland. Clause 2(1) (a) and (b) amends the definition of "confinement" in the Social Security Contributions and Benefits Act for the purposes of entitlement to maternity allowance and statutory maternity pay respectively by reducing the period of pregnancy after which a labour is treated as a confinement, where a child is born dead, from 28 weeks to 24 weeks.
Clause 2(2) (a) and (b) amends that definition for the same purposes in the Social Security Act 1986 in the unlikely event that the Still-Birth (Definition) Bill comes into force before the Social Security Contributions and Benefits Act, which comes into effect from 1st July 1992.
The effect of Clause 2(1) and (2) is to confer entitlement to statutory maternity pay and maternity allowance to qualifying women where a child is born dead after 24 weeks' gestation.
Clause 3 gives power to Her Majesty by Order in Council to make provision for Northern Ireland corresponding to that which the Bill makes for Great Britain. The clause prescribes the negative resolution procedure for the Order in Council. That will enable the order to be made as soon as possible after the Bill receives Royal Assent.
Clause 4 provides for the Short Title, commencement and extent.
I should like to conclude with a personal experience which, if not exactly within the scope of the Bill, is very close to it. Many years ago, my wife gave birth to a premature child who died minutes after birth and would therefore have qualified in this country for a birth and a death certificate whatever the period of gestation. However, this took place in Spain where the regulations are different. I am not criticising another country for having different procedures. I think that I could probably have made better arrangements than I actually did had my wife not suffered a serious haemorrhage and had I not been naturally more concerned with her survival than with the disposal of the baby's remains.
However, the result was that no proper burial took place and the child was consigned to a common grave. We had decided on a name for him, but it was never 549 recorded. It is something that my wife and I have never ceased to regret. I can testify on our behalf how extraordinarily difficult it is to get over a loss which has not been recognised or signified in any formal way. On those grounds, in addition to those that I have already stated, it gives me a particular satisfaction to present to your Lordships a Bill designed to alleviate the distress of a considerable number of parents faced with a similar type of grief.I commend the Bill to the House. I beg to move.
Moved, That the Bill be now read a second time. —(Lord Kilmarnock.)
§ 3.16 p.m.
§ Lord Rea
My Lords, I rise briefly to express my support for the noble Lord, Lord Kilmarnock, on the Bill, which, as he explained, is in effect consequential. It recognises that legislation which is now applicable to a foetus of 28 weeks' gestation —namely, that it should be registered and given what is in effect a combined birth and death certificate to allow burial or cremation—should apply to a foetus of 24 to 28 weeks' gestation.
The noble Lord very graphically described in personal terms the distress which parents feel when they lose a potentially viable child. It so happens that I have had a personal experience which is almost precisely the same. Therefore, I know that we are dealing with an important and sensitive area. I believe that the noble Lord presented the Bill in a very suitable and sensitive way.
In fact, the moment that the movements of an unborn child are detected by the mother is very significant. From then on the foetus starts to be felt as a separate entity from its parents. That usually occurs at around 16 to 20 weeks gestation. However, it has almost no chance of a separate existence outside the womb until 24 weeks. So that is the logical point at which the current definition should be changed, rather than waiting, as now, until 28 weeks. That may have been the logical age 40 years ago in 1953, when the current legislation was passed. But today it is possible for babies with as little as 24 weeks' gestation to survive.
Because of the remarks that I made about the feelings of the mother when experiencing foetal movements, there may be a case for lowering the age of still-birth even further than 24 weeks. The emotional bond starts to increase from the moment that those movements are felt. The mother's grief will not necessarily be any less if she loses the child at 23 weeks rather than at 24 weeks. Counselling and the parents' personal acclimatisation to their loss is helped, as the noble Lord pointed out so well, by the outward recognition of that loss that is allowed by registration, naming and a form of burial and cremation.
If we were to go below 24 weeks, the question of how far back one should go would arise. I can see endless difficulties in deciding on a suitable cut-off point. However, the organisation that the noble Lord mentioned, the Stillbirth and Neonatal Death Society, which supports mothers who have suffered a still-birth 550 or neonatal death, feels that future legislation should consider a gestation period that is even shorter than 24 weeks.
I think that this Bill has got it about right. I hope that the House will carry Mrs. Barnes' Bill through quickly without amendment so that it reaches the statute book before Parliament is dissolved. I have no difficulty in supporting the Bill and I hope that the rest of your Lordships' House will do the same.
§ 3.21 p.m.
§ Lord Walton of Detchant
My Lords, I am sure that we are all very grateful to Mrs. Rosie Barnes for introducing this Bill into another place. I congratulate the noble Lord, Lord Kilmarnock, on the clear, comprehensive and sensitive way in which he has explained its provisions in your Lordships' House. My comments, too, will be extremely brief.
An article published in the February 1991 issue of British Medical Association's News Review begins:Thirteen years after she gave birth to her first baby, who was born dead 24 weeks into her pregnancy, Jeanette Philpott gave birth to a second baby, also at 24 weeks—and also born dead. Her first baby was taken away immediately, but the second was given a dignified burial in a marked grave. Jeanette is sure she recovered much more quickly from her second loss than from her first because of the sensitive way in which it was handled. 'There was no comparison,' she said.The burial helped me to face the baby's death.The death of a stillborn baby is always a tragedy for the parents. Being able to have that death formally acknowledged is an important part of the grieving process. The ability to give the baby a dignified burial and to have a certificate recognising its existence is of very great value to parents suffering such a bereavement. This Bill would help to deal sensibly with parents' wishes. I commend it to the House and trust that it will be given an unopposed Second Reading.
§ 3.23 p.m.
§ Lord Carter
My Lords, I, too, should like to thank the noble Lord, Lord Kilmarnock, for introducing the Bill and explaining it so clearly. As is the convention, I speak from this Dispatch Box to give my personal view. I shall not be proposing any amendments. My personal view is particularly relevant because, like other noble Lords who have spoken, we experienced a miscarriage with our first child at seven months. Even though that happened 34 years ago, I can still remember very clearly the trauma of that time, especially for the mother.
As has been said, the Bill has been welcomed by everybody, including the Royal College of Midwives, the British Medical Association and others. We are dealing with what is a sensitive and agonising time for parents. Their bereavement would certainly be eased by the ability to say goodbye properly and to arrange a burial service.
Hospital practices in this area have not always been as sensitive as they might have been. There used to be many old wives' tales in maternity hospitals about what happened to dead foetuses. All that can be put behind us. The Bill will go a long way towards making a tragic time a little more bearable.
551 One of the financial effects of the Bill is to increase the entitlement to statutory maternity pay, which is entirely proper and sensible. As I have said, we all welcome the Bill. As far as I am aware, it went through the other place with the minimum of debate at all stages. I hope that today the Bill can have an equally speedy passage through this House.
§ 3.25 p.m.
§ Baroness Denton of Wakefield
My Lords, I too am grateful to the noble Lord, Lord Kilmarnock, for bringing forward the Bill and for sharing with us, as did other noble Lords, his own sad experiences. There can be few, if any, more difficult experiences for any person to face than the loss of a baby. I also express our gratitude to Mrs. Barnes who brought the Bill forward in the other place.
We have in recent years seen a radical change in the way the death of a baby, a still-birth or a miscarriage, is treated, and I am pleased to acknowledge the valuable work of health professionals and of the voluntary organisations in that respect. With a better understanding of the feelings of others has come also the realisation that bereaved parents should be given the opportunity to express their grief and time to come to terms in their own way with their loss. We have heard how difficult that is and that there is no limit to the time it takes. The proposals before us will extend to those parents whose baby is born dead between 24 and 28 weeks gestation the right to have their baby's existence legally acknowledged and recorded formally.
The noble Lord described the present situation when a child is born dead at a fairly late stage of pregnancy, even up to 28 weeks, where, because the period of gestation is just too short to fall within the existing definition of a still-birth, the parents are deprived of the registration of their child with all that that brings. The comfort for bereaved parents of being able to give their child a legal identity and to obtain a birth certificate is well appreciated.
Instances have arisen where twins were born prematurely before 28 weeks, with one born alive and the other born dead. As the law stands, one would be registered as a live birth whereas the remaining twin would be classed as a miscarriage and not registered. In other words, the child born alive would receive a birth certificate while the child born dead would receive no formal recognition. The child born alive, even if it died shortly afterwards, would also be entitled to a formal burial, whereas any arrangements made for the twin would be dictated very much by local practice.
Many hospitals have developed special procedures to deal with those tragic deaths, including where a child is born dead before 28 weeks, providing parents with a letter from the doctor or midwife stating that their baby was born before the legal age of viability. Such practices have been encouraged by the Department of Health, which has issued to the NHS copies of the Still-birth and Neonatal Death Society booklet Guidelines to Professionals. Those guidelines are a helpful source of information and play a useful 552 role in helping health professionals to have a better understanding of the special support parents may require after suffering the trauma of losing their baby.
The proposals in the Bill will require that all children born after 24 weeks of pregnancy, whether born alive or, sadly, born dead, are formally registered and not, as now, regarded differently in the eyes of the law.
The Bill is uncontroversial and worth while and will be welcomed by professionals and the public. The Government are on record as accepting that a change to 24 weeks in the definition of still-birth is called for and fully support the Bill.
I am also pleased to say that the Government fully endorse the noble Lord's proposal to amend the definition of "confinement" in social security legislation which is a logical consequence of the main purpose of the Bill. That will allow an estimated 300 more mothers every year to obtain statutory maternity pay or state maternity allowance where a child is born dead after 24 weeks of pregnancy instead of after 28 weeks of pregnancy as at present.
Today we may have the opportunity to exercise our privileges in a most worthwhile manner. For the unfortunate people involved in these tragic circumstances, and the professionals who help them, the Bill is an important piece of legislation. I hope that your Lordships will give it swift passage.
§ 3.29 p.m.
§ Lord Kilmarnock
My Lords, I am grateful to all noble Lords who have taken part in this short debate for their support. I take the point of the noble Lord, Lord Rea, that possibly an investigation of a lower limit might be desirable at some time in the future. I was glad to hear him say that at present we have got it about right. I was also grateful to the noble Lord, Lord Walton of Detchant, for his support and to the noble Lord, Lord Carter, on behalf of the Labour Party.
It was interesting to note that no fewer than three of your Lordships, including myself, have experience of something along those lines. That goes to show that it is not so remote a possibility or so unusual an experience.
It is not necessary for me to say more; not a voice has been raised against the Bill. Support has been universal, the Government accept it and will provide the necessary funding for the social security implications. Thus, my hopes that the Bill will receive a fair wind in your Lordships' House have so far been realised. It is very much my hope that your Lordships will give it a Second Reading today and that we shall manage to get it on to the statute book before Parliament is dissolved. I commend the Bill to the House.
On Question, Bill read a second time, and committed to a Committee of the Whole House.