In Today’s Issue:

🔗 The best resources I found this week
📖 Deep dive: The Laws No One Told You About: Legal Realities of Bereavement Care

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🔗 The Best Resources I Found This Week

📢 Virtual event: Our next bereavement training event is coming up
Forget Me Not and Share Pregnancy & Infant Loss Support are partnering up for a special event with expert training, peer connection, and practical strategies designed specifically for bereavement coordinators. Register here on Forget Me Not.

🏠 Yes, Families Can Take Their Baby Home
"I had no idea families could take their baby home" was the most common reaction at Dr. Cacciatore's recent training. This guide walks through the legal standing, state requirements, and how to have these conversations with confidence—including what hospital policies can't override. At-home funerals after stillbirth

📋 Your State's Disposition Laws for Early Loss
Most nurses don't realize half of U.S. states have laws requiring notification of parental rights for miscarriages under 20 weeks. This state-by-state breakdown shows you exactly what your hospital is legally required to tell families—and what you might be missing. State miscarriage and stillbirth laws

📖 Deep Dive

The Laws No One Told You About: Legal Realities of Bereavement Care

In preparation for our upcoming Bereavement Summit (350 sign ups so far! 🎉) we asked every attendee a few questions about the challenges they have around bereavement car. I was surprised to hear a lot of confusion around legal obligations. Nurses asked: "Can I legally photograph this baby?" "How long can the family stay?" "What if they want to take their baby home?".​

Here are 6 laws around bereavement care you may not have known.

1. HIPAA Doesn't Stop at Death (And It Might Surprise You)

The Misconception:
Most nurses believe HIPAA protection ends when a patient dies, so photographing a stillborn baby doesn't require the same consent as photographing a living infant.

The Reality:
HIPAA protects a deceased person's health information—including photographs—for 50 years following death. Any photo that could identify the baby (even without showing the face) is considered Protected Health Information and requires written parental consent before it can be taken, stored, or shared.​

This includes:

• Bereavement photos taken by nurses

• Clinical photos for the medical record

• Images captured by volunteer photographers like Now I Lay Me Down To Sleep

What This Means for You:
Even when parents request photos, you must obtain written consent that specifies how images will be used (medical record, personal keepsake, education, publication). Verbal permission isn't enough. The consent form should clarify that images can't be removed from public view once shared, and parents retain the right to withdraw consent at any time—though this won't affect images already in circulation.​

2. Death Certificates: The 20-Week Line That Isn't Universal

The Misconception:
A fetal death certificate is required at 20 weeks gestation in all states.

The Reality:
While most states require fetal death certificates at 20 weeks gestation, several states have different thresholds:​

• Pennsylvania: 16 weeks

• Hawaii: 24 weeks

• New York: 20 weeks

These certificates must typically be filed within 5 to 10 days of death, and in most cases, a physician, medical examiner, or coroner must sign them. If no attending physician is involved, the medical examiner must be notified and will complete the certificate.​

What This Means for You:
Know your state's specific gestational age threshold. If a family delivers at 19 weeks in Pennsylvania, they're entitled to a death certificate. In Hawaii, they wouldn't qualify until 24 weeks. This directly affects what memorial options and legal documentation families can access.

3. Parents Can Take Their Baby Home—Here's What the Law Says

The Misconception:
Hospitals must retain custody of a stillborn baby's body until a funeral home takes over.

The Reality:
According to the Cuddle Cot, in most states, parents have the legal right to take their baby home after stillbirth, and there is no legal time limit on how long the baby can remain at home.​

Some states explicitly protect this right:

• Texas (HB 635, 2015): Clarified that hospitals must release fetal remains to parents upon request, regardless of gestational age—even for losses under 20 weeks.(texastribune)​

• Illinois (2001): Requires hospitals to notify parents in writing of their right to arrange burial or cremation within 24 hours of delivery.(heavensgain)​

• Indiana (2014): Mandates both oral and written notification of disposition rights before the mother's discharge.(heavensgain​)

Parents are responsible for coordinating with a funeral director if they want the baby returned to hospital or mortuary care later. Some hospitals incorrectly tell families they cannot take babies home due to "policy"—but policy does not override state law.(cuddlecot)​

What This Means for You:
If a family asks to take their baby home, your role is to:

1. Confirm your state allows it (most do).

2. Provide written information about caring for remains at home.

3. Connect them with your bereavement coordinator and a funeral director for guidance on timeline and transport.

4. Document their decision in the medical record.

Do not tell families "it's against policy" without verifying state law first.

4. Early Loss (Under 20 Weeks): What Hospitals Are Legally Required to Do

The Misconception:
Since death certificates aren't required under 20 weeks in most states, hospitals have no legal obligations to inform families about their options or offer any bereavement support for early miscarriages.

The Reality:
While death certificate laws typically begin at 20 weeks, many states have passed separate legislation specifically protecting parental rights for early pregnancy losses. These laws require hospitals to:

Inform families about their right to final disposition:

• Georgia (2022): Funeral directors or individuals assuming responsibility for disposition must obtain parental authorization for remains at any gestational age.​

• Utah (2001): Parents must be notified within 24 hours of miscarriage about their right to determine final disposition and given 72 hours to decide.​

• Illinois (2001): Requires notification for losses at any gestational age, not just those requiring death certificates.​

Disclose hospital disposition practices:

• South Dakota (1998): Facilities must disclose their method of final disposition to families—meaning hospitals must explain whether tissue will be incinerated, buried, or otherwise handled.​

• Vermont (2023): Parents must give permission for final disposition when no funeral director is involved.​

Even in states without specific statutes, treating fetal tissue under 20 weeks as "medical waste" (side note–can we please advocate for another term here?) without offering parental choice may violate patient autonomy principles and open hospitals to legal risk.​

What This Means for You:
Don't assume early losses fall outside legal protections. Check if your state has miscarriage disposition laws.

If families ask about remains under 20 weeks, don't default to "we handle it as tissue." Offer burial, cremation, or hospital disposition as options, and document their choice. Many hospitals now extend memorial services, keepsakes, and certificates to families experiencing losses before 20 weeks—not because it's required everywhere, but because it honors both legal rights and compassionate care standards.

5. Autopsy Consent: What You Can and Can't Require

The Misconception:
Hospitals can require autopsy for stillbirths as part of standard protocol.

The Reality:
In the United States, hospitals cannot perform an autopsy without parental consent, except when ordered by a coroner or medical examiner in cases of suspicious death.​

Parents have the legal right to:

• Request an autopsy even if not recommended by the clinical team

• Decline an autopsy without penalty

• Have a physician of their choice present during the procedure

Some hospitals falsely imply that refusing autopsy will delay discharge or burial arrangements. This is not legally accurate in most jurisdictions.​

What This Means for You:
Present autopsy as an option, not a requirement. Explain the potential benefits (finding a cause, guiding future pregnancies) while respecting that families may decline for religious, cultural, or personal reasons. Document their decision clearly.

6. Disposition Laws: Burial, Cremation, and the Texas Controversy

The Misconception:
Families are always free to choose how fetal remains are handled.

The Reality:
This varies dramatically by state, and recent legislation has created confusion.

Texas attempted to require burial or cremation of all fetal tissue—including from miscarriages and ectopic pregnancies—through Senate Bill 8 (2017). A federal judge struck it down in 2018, ruling it placed an undue burden on patients and was unconstitutionally vague. The law would have required:​

• Remains to be buried or cremated (not placed in landfills, even after medical waste incineration)

• Costs to be borne by families or counties

• Compliance regardless of parental wishes​

While that specific law was blocked, other states have burial/cremation laws that are enforceable. The legal landscape remains in flux.​

What This Means for You:
Stay updated on your state's current laws via your hospital's legal team or bereavement coordinator. Don't assume what was true two years ago still applies today.

Key Takeaways for Nurses

1. HIPAA applies for 50 years post-death—always get written consent before photographing.

2. Death certificate thresholds vary by state—know your state's specific gestational age requirements.

3. Parents can take babies home in most states—don't let internal policy override legal rights.

4. Early loss laws are expanding—offer disposition choices even under 20 weeks, and know your state's notification requirements.

5. Autopsy requires consent—unless ordered by a medical examiner.

6. Disposition laws are changing—verify current requirements in your state annually.

Understanding the legal framework isn't just about compliance—it's about protecting families' rights during their most vulnerable moments and ensuring your unit operates with both compassion and legal clarity.

👋 That’s a Wrap!

Before you go: Here are ways we can help your hospital

We offer bereavement boxes to give as gifts to those who leave the hospital after a miscarriage, stillborn, or infant death. Reply to this email “Sample” to get a free sample sent to your hospital.

What we prioritize:

1. Tools for hospitals to create a bereavement experience for families to begin their grief journey

2. Educating nurses with modern bereavement standards and continuing education.

3. Helping hospitals build a foundation of trust and support, so bereaved families feel seen and cared for—now and in the years to come.

These boxes were born out of our own personal losses, including Jay’s (CEO) 15 years of experience working in labor and delivery as a CRNA and witnessing time and again how the hospital experience can profoundly shape a family’s grief journey, for better or for worse.

Until next week,

Trina and Jay
Co-founders of Forget Me Not