By Amanda Rebhi
WARNING: This article contains information and pictures about fetal loss.
“I’m sorry but your baby does not qualify as a child per the definition of the VA.” The words echoed around the pastel pink room and replayed over and over in my head. Only hours prior I had held my daughter, kissed her tiny hands, and looked at her face for the last time before laying her down gently in the hospital bassinet and allowed her to be taken down to the morgue.
I had suffered a placental abruption and my daughter was born still after 17 long hours of labor. But Liliana’s death fell just 3 days shy of 20 weeks gestation – at least as calculated by my Last Menstrual Period, a date I had made “easy” by saying 1 June. Had I recorded the more accurate 29 May, my daughter would have reached that arbitrary 20-week benchmark. I wouldn’t have heard that somber social worker say those cutting words. My daughter would have “qualified” for the VA to recognize her death. We wouldn’t have had to pay thousands of dollars out of pocket for her funeral expenses in the midst of the worst day of our life.
Despite having seen and felt her kicks and head-bumps, despite birthing her, despite cutting her cord and holding her perfect little body, despite her hands and feet (and eyes and nose and lips) formed as identical replicas of her daddy and her chin and face taking after me, despite her receiving a fetal death certificate, despite needing to make disposition decisions and calling funeral homes from my hospital bed…the VA had the gall to tell me that my baby isn’t considered a child. That Family Servicemember’s Group Life Insurance only covers qualified children of service members, starting at 20 weeks gestation. That those 3 extra days would have somehow changed the validity of her life to be worthy of a funeral.
The VA leaves parents with the choice between thousands of dollars of debt or the having hospital discard their baby along with medical waste.”
What happens when a young Airman loses their baby and doesn’t have a Captain and Engineer’s salary and savings to bootstrap the funeral expense? The expense of flying in their mom to help take care of them? The expense of ordering takeout every night because they have no will or physical strength to cook? The expense of childcare for their other children while the mother physically recovers or they attend grief counseling? The expense of memorial keepsakes? The VA leaves parents with the choice between thousands of dollars of debt or having the hospital discard their baby along with medical waste. As though their child were a bloody rag from surgery or a tumor cut from someone’s body.
While it does not relieve the pain of losing a child, Family Servicemembers Group Life Insurance through the VA helps remove one burden from the backs of bereaved parents – affording the funeral. Unfortunately, funeral expenses for a fetus or baby are just as expensive as for a toddler or teenager. From the cost of the funeral home services, to the casket or cremation and urn, to the burial plot, to transportation of remains, to taxes and fees…anyone who has buried a loved one knows costs easily skyrocket into the thousands. This is why service members receive the FSGLI “benefit” of a $10,000 child life insurance policy – it meets the national average expense to cover a funeral.
“Laying your child to rest is a basic human right.”
But burying your baby or fetus is not a benefit. Laying your child to rest is a basic human right. Not a parent on the planet views their child’s life insurance with glee or a greed to collect a payout. Every grieving parent should be able to have their loss recognized and have the peace of mind in at least the singular fact that they are financially able to afford burying their baby. Excluding parents of an unborn child due to an arbitrary cut-off calculated based on the often inaccurate recollection of the Last Menstrual Period is cruel. It also ignores medical realities and legal rights of parents.
Yes, the miscarriage rate in the United States can be as high as 25% of clinically recognized pregnancies. But, statistically, losing one’s baby after a heartbeat is detected at 8 weeks is only a 2-4% risk,. The risk of loss after 12 weeks is less than 1%. So once the second trimester is reached, it is all but expected that there will be a living baby. Those of us unfortunate few in that 1% prior to 20 weeks gestation often have full labors and deliveries of our babies who we get to see and hold as our hopes, dreams, and lives are shattered. For us, the VA provides no assistance to give our child a proper and dignified funeral.
The risk of loss after 12 weeks is less than 1%. So once the second trimester is reached, it is all but expected that there will be a living baby.”
The VA can say they “serve and honor” America’s veterans, they can say “I CARE”. But where was their service in honoring the life of my baby? Where was their commitment and advocacy for the rights of my daughter? What respect did they show my Lily? Where was the care in telling a bereaved mother that her baby doesn’t qualify as her child? We can be thanked for our years of selfless service to our country, but we cannot receive the mere decency of being able to provide our children with a dignified funeral. At least, not if they don’t “qualify” as a child. Not if they don’t make it to 20 weeks of gestation.
I believe that just as FSGLI helps alleviate the financial burden for bereaved parents of fetal children meeting the current arbitrary 20-week snap-line, the VA should provide such support to all grieving parents who have dedicated their lives to serving our country. Given the medical literature and risk factors, fetal eligibility for full FSGLI benefit should start in week 12, when the risk of loss hits 1%…when parents fully expect to welcome a living baby. This would better serve bereaved families and alleviate a large burden from the backs of grieving parents, a burden which they should never had to face.
Further, while first-trimester loss is sadly prevalent, providing funerary cost-reimbursement for the few, if any, parents who choose to take care of the disposition of their fetus’ remains following first-trimester losses would truly support all bereaved parents. While exceedingly rare in practice, many states do grant parents the legal right to give a dignified funeral to their miscarried child. There are even states trying to mandate fetal burial. For parents forced by law, or willfully exercising their right, or the religiously inclined, provisions or waivers should be made available to submit for funerary cost-reimbursement.
If the VA truly strives for the highest quality and continuous improvement, they will look at their policies and make the legal changes that are needed. Choose the harder right instead of the easier wrong, so parents can bury their children. Submit to change Public Law 110-389, Title IV, Section 402 to include miscarried children. Amend § 9.1 under authority 38 USC 502, 1965-1980A, to revise paragraph (k)(1) for a member’s miscarried or stillborn child. Change eligibility to the 12th week of gestation. Add a waiver process for earlier losses to receive funerary cost-reimbursement. Remove the minimum fetal weight entirely. Do this so the VA will be able to say “I CARE” knowing they are fully committed to taking care of service member families. Do this so no other mother and father will have to hear the echo of the words “your baby does not qualify as a child.”
Amanda Rebhi is a Captain in the Department of the Air Force currently serving in the National Capital Region.
DISCLAIMER: The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of the Air Force, the Department of Defense, or the U.S. government.
1- National Library of Medicine