Coffin birth

Coffin birth, also known as postmortem fetal extrusion,[1][2] is the expulsion of a nonviable fetus through the vaginal opening of the decomposing body of a deceased pregnant woman as a result of the increasing pressure of intra-abdominal gases. This kind of postmortem delivery occurs very rarely during the decomposition of a body. The practice of chemical preservation, whereby chemical preservatives and disinfectant solutions are pumped into a body to replace natural body fluids (and the bacteria that reside therein), have made the occurrence of "coffin birth" so rare that the topic is rarely mentioned in international medical discourse.

Typically during the decomposition of a human body, naturally occurring bacteria in the organs of the abdominal cavity (such as the stomach and intestines) generate gases as by-products of metabolism, which causes the body to swell. In some cases, the confined pressure of the gases can squeeze the uterus (the womb), even forcing it downward, and it may turn inside-out and be forced out of the body through the vaginal opening (a process called prolapse). If a fetus is contained within the uterus, it could therefore be expelled from the mother's body through the vaginal opening when the uterus turns inside-out, in a process that, to outward appearances, mimics childbirth. The main differences lie in the state of the mother and fetus and the mechanism of delivery: in the event of natural, live childbirth, the mother's contractions thin and shorten the cervix to expel the infant from the womb; in a case of coffin birth, built-up gas pressure within the putrefied body of a pregnant woman pushes the dead fetus from the body of the mother.

Cases have been recorded by medical authorities since the 16th century, though some archaeological cases provide evidence for its occurrence in many periods of human history. While cases of postmortem fetal expulsion have always been rare, the phenomenon has been recorded under disparate circumstances and is occasionally seen in a modern forensic context when the body of a pregnant woman lies undisturbed and undiscovered for some time following death. There are also cases whereby a fetus may become separated from the body of the pregnant woman about the time of death or during decomposition, though because those cases are not consistent with the processes described here, they are not considered true cases of postmortem fetal extrusion.

Causes

The causeNote a of postmortem fetal extrusion is not completely understood, as the event is neither predictable nor replicable under experimental conditions. Evidence has accumulated opportunistically and direct observation is serendipitous.[2] While it is possible that more than one cause can produce the same result, there is an accepted hypothesis,[2][3] based on established research in the fields of biochemistry and forensic taphonomy,Note b[4] and further supported by observational research, that accounts for the taphonomic mechanisms that would result in the most often encountered cases of postmortem extrusion of a non-viable fetus.

Typically, as a dead body decomposes, body tissues become depleted of oxygen and the body begins to putrefy; anaerobic bacteria in the gastrointestinal tract proliferate and as a result of increased metabolic activity, release gases such as carbon dioxide, methane, and hydrogen sulfide.[5][6] These bacteria secrete exoenzymesNote c to break down body cells and proteins for ingestion which thus weakens organ tissues. Increasing pressure forces the diffusion of excessive gases into the weakened tissues where they enter the circulatory system and spread to other parts of the body, causing both torso and limbs to become bloated. These decompositional processes weaken the structural integrity of organs by separating necrotizing tissue layers.[6] Bloating usually begins from two to five days after death, depending on external temperature, humidity, and other environmental conditions.[7] As the volume of gas increases, the pressure begins to force various body fluids to exude from all natural orifices.[8] It is at this point during the decomposition of a pregnant body that amniotic membranes become stretched and separated, and intra-abdominal gas pressure may force the eversion and prolapse of the uterus,Note d which would result in the expulsion of the fetus through the vaginal canal.[9] It has been observed that the bodies of multiparous womenNote e are more likely to spontaneously expel the fetus during decomposition than those who died during their first pregnancy, because of the more elastic nature of the cervix.[10]

History

Numerous documented cases of postmortem fetal extrusion were described in the medical compendium Anomalies and Curiosities of Medicine, first published in 1896.[3] The earliest presented case occurred in 1551 when a pregnant woman was tried and hanged by the courts of the Spanish Inquisition. Four hours after her death, and while the body still hung by the neck, two dead infants were seen to fall free of the body. This is unusual for the short amount of time elapsed between death and the postmortem delivery. As no information is given regarding other ambient circumstances, it is unclear whether the onset of putrefaction was accelerated, or if other causal factors were at work.[4] In the city of Brussels, in 1633, a woman died in convulsions and three days later a fetus was spontaneously expelled. In Weissenfels, in 1861, postmortem fetal extrusion was observed sixty hours after the death of a pregnant woman. Other cases are described, though only a few describe the unexpected discovery of fetal remains following exhumation. Most cases occurred before burial; in some of these, the body was in the casket while in other cases the body was still on its deathbed or on a bier.[3]

During the late 19th century, modern embalming techniques were developed, whereby preservative and disinfectant chemical compounds (such as formaldehyde) are pumped into a body, flushing out the body's natural fluids, and with them the bacteria that flourish during putrefaction and generate the gases that comprise the active force behind the expulsion of the fetus.[11] However, the phenomenon was still recognized by medical science and in 1904, John Whitridge Williams wrote a textbook on obstetric medicine that included a section on "coffin birth".[10] Although the text has remained an important reference in obstetrics, the subject, whether called "coffin birth" or "postmortem fetal extrusion", was excluded by its 13th edition in 1966,[12] and was not mentioned in the edition published in 2009.[13] The subject was discussed in German medical literature during the 20th century,[14][15][16][17] though more detailed case reports in the forensic literature have been published recently.[1][2]

In 2005, the body of a 34-year-old woman, eight months pregnant, was discovered in her apartment in Hamburg, Germany.[2] The body was bloated and discolored, and upon initial examination, it was found that the head of the fetus had made its appearance in the vaginal opening. At autopsy, medical examiners found that both the head and shoulders of the fetus had emerged, and concluded that it was a case of postmortem fetal extrusion in progress. The woman, who had given birth twice before, had died of a heroin overdose.[2] The case was unusual and serendipitous, as it was the first modern case in which medical practitioners were able to document a case of postmortem fetal extrusion in progress.[2]

In 2008, the body of a 38-year-old woman, seven months pregnant, was discovered in an open field four days after she had disappeared from her residence in Panama.[1] A plastic bag had been left over her head, and she had been gagged; the case was ruled a homicide. The body had suffered from the tropical heat and high humidity, and was bloated and highly discolored. At autopsy, the remains of the fetus were discovered in the woman's undergarments. Although the fetus was in a similar state of decomposition, the umbilical cord was intact and still attached to the placenta inside the uterus. This was the first forensic case in which it could be concluded that coffin birth had occurred based on the position of the bodies and the clear attachment of the umbilical cord to the un-expelled placenta.[1]

In 2019, the autopsy reports in the case of the Watts family homicides in August 2018 revealed that Shanann Watts (who had been 15 weeks pregnant at the time of her murder) had been found in a shallow grave and that the fetus had been expelled from her body, along with the placenta and umbilical cord.

Bioarchaeology

Postmortem fetal extrusion can be very difficult to recognize once a body has undergone complete skeletonization, and bioarchaeologists are often very cautious about asserting the presence of this phenomenon.[18][19] There are numerous cultural reasons why a mother and an infant might be interred together, so the joint presence of neonatal remains and an adult female is not taken as conclusive evidence of postmortem fetal extrusion;[18][19] however, there have been excavated burials where the position of a set of fetal remains relative to those of an adult female supported this hypothesis. There are a few general guidelines when an archaeologist is assessing the placement of the fetus and the adult:[18]

  1. If the fetal remains are found in a fetal position and are wholly within the pelvic cavity of the adult, the fetus died and was interred before delivery. The pregnant woman may therefore have died due to labor complications.
  2. If the infant is found alongside the adult, with the head oriented in the same direction as the adult, then the infant was delivered, whether naturally or by caesarian incision, around the time of death, and thereafter interred.
    1. Delivered infants have also been interred between or alongside the tibiae (shins), but the infant is still oriented in the same direction as the adult.
    2. If the majority of the fetal remains are in the pelvic cavity of the adult, yet the legs are extended and/or the cranium lies among the ribs, then the infant may have been delivered and then placed on top of the mother's torso before burial. As both bodies skeletonized, the infant's bones would have settled among the mother's ribs and vertebrae.
  3. If the fetal remains are complete and in a position inferior to and in-line with the pelvic outlet, with the head oriented opposite to that of the mother (toward the foot of the coffin or grave), then there is the possibility of coffin birth.[18][20]
    1. Evidence for postmortem fetal extrusion may be less ambiguous when the fetal remains are found to lie within the pelvic outlet of the adult, thus indicating that partial extrusion had occurred during decomposition.[21][22]

In 1975, it was reported that during the excavation of a medieval cemetery in Kings Worthy, England, fetal remains appeared to lie within the birth canal of the skeleton of a young woman, with the fetal cranium external to the pelvic outlet and between the two femora (thigh bones) and the fetal leg bones clearly within the pelvic cavity.[21] Other cases of coffin birth at archaeological sites have been described, such as in 1978 at a Neolithic site in Germany,[23] at a medieval site in Denmark in 1982,[22] and in 2009 at an Early Christian period site at Fingal, Ireland.[20] A coffin birth was also described in a 2011 episode of the BBC show History Cold Case, featuring the Roman era remains of a woman and three neonates discovered near Baldock, Hertfordshire.[24] Another was identified in 2006 in a 14th-century Black Death cemetery in Genoa, Italy.[25]

Applicability of diagnosis

Because postmortem fetal extrusion is so rare, and occurs under highly idiosyncratic conditions regarding the individual and the ambient environment,[3][5][10][18] this phenomenon has not been studied for possible applications to forensic investigation. Even if the study of postmortem fetal extrusion could lead to improved investigative methods, experimental research would be highly problematic. At present, forensic scientists have at their disposal an array of established techniques and procedures for a death investigation at the stages of decomposition when postmortem fetal extrusion typically occurs.[9]

In archaeology, the study of mortuary context, that is, the interpretation of the postmortem treatment of the dead, whether an individual or as pertains to patterns within a group, has led to the development of hypotheses on social status and/or hierarchy regarding many cultures, ancient and extant.[22][26][27][28][29] In addition, the determination of whether or not delivery actually occurred before death has a bearing on analyses of the mother's population, as the concentration of trace elements differ markedly between the skeletons of prepartum adult women (before giving birth) and women who are lactating; the identification of coffin birth would lead to more accurate analyses of the number of lactating women in a population or the rate of maternal mortality.[30] It is therefore necessary for investigators to be able to recognize postmortem fetal extrusion when encountered in an excavated burial.[19][31]

Comparable phenomena

There are also many cases where the remains of the fetus are found separate from the body of the mother, but expulsion was not through the birth canal, and separation of the two bodies may have been influenced by external environmental factors. The process of separation is so unusual that a specific term for the phenomenon may not have been proposed to the scientific community. These cases may have comparable results, but they are not cases of postmortem fetal extrusion.

In April 2003, the body of Laci Peterson washed up on a shore near San Francisco Bay; she had been pregnant when she disappeared four months earlier, and the fetus she had been carrying was discovered on a separate beach. When questioned by the media, medical authorities initially speculated that a "coffin birth" might have occurred.[32] However, at autopsy the cervix was found to be in a prepartum condition. Medical examiners later concluded that while Peterson's body was in the bay, the skin over the abdominal cavity had ruptured due to natural decompositional processes. Seawater entered the abdominal cavity and washed out most of the internal organs, along with the fetus.[33]

In 2007, a 23-year-old woman in India, over eight months pregnant, hanged herself after contractions had begun.[34] A viable infant was spontaneously delivered unassisted from the woman's body, which was suspended by the neck. The healthy infant was found on the floor, still tethered to the body of the mother by the umbilical cord. The primary cause of the delivery was the otherwise normal contractions, which had begun before death, and was therefore not related to processes of decomposition.[6][34] While this is not postmortem fetal extrusion, it may be referred to as a case of postmortem delivery, a term which is applied to a broad range of techniques and phenomena with a resultant delivery of a live infant.[35]

In 2008, in Germany, a 23-year-old woman in her third trimester was involved in a motor vehicle accident, and died; the non-viable fetus was found between her feet.[36] The vehicle caught fire following initial impact . The woman was unable to escape due to internal injuries and burned to death. Investigators came to the conclusion that the extreme heat of the fire burned away epidermal and subcutaneous tissue around the abdominal cavity, after which the anterior aspect of the uterus ruptured, causing the fetus to spill out of the uterine cavity and land on the floor between the woman's feet. The umbilical cord was still intact and connected the fetus to the placenta through the ruptured wall of the uterus. Unlike the woman, who suffered fourth-degree burns over her entire body, the body of the fetus was relatively undamaged.[36] Because the primary cause of separation from the mother's body was thermally induced traumatic rupture of the abdominal and uterine cavities; traumatic separation was not related to normal decompositional processes; and expulsion of the fetus did not involve passage through the birth canal, this is not considered a case of postmortem fetal extrusion.[36]

In animals

Whales can be subject to postmortem fetal extrusion. Many species float when dead, due to the gases of putrefaction. Drift whales that wash up on shore, and the carcasses of hunted whales, if not flensed (stripped of blubber) and processed in a timely manner, posed a risk. Tim Flannery wrote that "A rotting whale could fill with gas to bursting, ejecting a fetus the size of a motor vehicle with sufficient force to kill a man."[37]

See also

Footnotes

a.^ That is, the uterus could be forced partially or completely inside-out (eversion), and fall or be forced out of the vaginal opening (prolapse).
b.^ The etiology is a study of the specific processes and conditions that result in a particular medical condition.
c.^ Forensic taphonomy is the study of the processes of decomposition.
d.^ Exoenzymes are enzymes that function outside the cell membranes of bacteria.
e.^ Multiparous women are those who have experienced vaginal childbirth two or more times.

References

  1. ^ a b c d Lasso et al. 2009.
  2. ^ a b c d e f g Schulz 2005.
  3. ^ a b c d Gould and Pyle 1997.
  4. ^ a b Ubelaker 1997: 80.
  5. ^ a b Carter et al. 2007.
  6. ^ a b c Gill-King 1997: 93–108.
  7. ^ Galloway 1997.
  8. ^ Carter and Tibbett 2008.
  9. ^ a b Saukko and Knight 2004: 65.
  10. ^ a b c Williams 1904:755–756.
  11. ^ Dinn 1999: 15-17.
  12. ^ Eastman and Hellman 1966.
  13. ^ Cunningham et al. 2009.
  14. ^ Jungmichel and Musick 1941.
  15. ^ Panning 1941.
  16. ^ Prokop and Göhler 1976: 118.
  17. ^ Strauch 1921.
  18. ^ a b c d e Lewis 2007: 34–37, 91.
  19. ^ a b c Wells 1975: 1237.
  20. ^ a b O’Donovan et al. 2009: 70–71.
  21. ^ a b Hawkes and Wells 1975.
  22. ^ a b c Møller-Christensen 1982.
  23. ^ Kaiser 1978.
  24. ^ "The Woman and Three Babies". BBC Two.
  25. ^ Cesana et al. 2017
  26. ^ Larsen 1999: 126, 127, 131.
  27. ^ Bell 1992.
  28. ^ Solecki 1975.
  29. ^ Robb et al. 1992.
  30. ^ Lewis 2007: 37.
  31. ^ Ortner 2003: 176.
  32. ^ USA Today 15 April 2003.
  33. ^ Fleeman 2003: 141, 142.
  34. ^ a b Behera et al. 2007.
  35. ^ Lopez-Zeno et al. 1990.
  36. ^ a b c Vennemann et al. 2008.
  37. ^ "On the Minds of the Whales" by Tim Flannery, NYRB, 9 February 2012

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Algor mortis

Algor mortis (Latin: algor—coldness; mortis—of death), the second stage of death, is the change in body temperature post mortem, until the ambient temperature is matched. This is generally a steady decline, although if the ambient temperature is above the body temperature (such as in a hot desert), the change in temperature will be positive, as the (relatively) cooler body acclimates to the warmer environment. External factors can have a significant influence.

The term was first used by Dowler in 1849. The first published measurements of the intervals of temperature after death were done by Dr John Davey in 1839.

Dead on arrival

Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.

Death hoax

A death hoax is a deliberate or confused report of someone's death that turns out to be incorrect and murder rumors. In some cases it might be because the person has intentionally faked death.

Death messenger

Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.

Death rattle

Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling.

Dignified death

Dignified death is a somewhat elusive concept often related to suicide. One factor that has been cited as a core component of dignified death is maintaining a sense of control. Another view is that a truly dignified death is an extension of a dignified life. There is some concern that assisted suicide does not guarantee a dignified death, since some patients may experience complications such as nausea and vomiting. There is some concern that age discrimination denies the elderly a dignified death.

Dysthanasia

In medicine, dysthanasia means "bad death" and is considered a common fault of modern medicine.Dysthanasia occurs when a person who is dying has their biological life extended through technological means without regard to the person's quality of life. Technologies such as an implantable cardioverter defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation can extend the dying process.

Dysthanasia is a term generally used when a person is seen to be kept alive artificially in a condition where, otherwise, they cannot survive; sometimes for some sort of ulterior motive. The term was used frequently in the investigation into the death of Formula One driver Ayrton Senna in 1994.

Fan death

Fan death is a well-known superstition in Korean culture, where it is thought that running an electric fan in a closed room with unopened or no windows will prove fatal. Despite no concrete evidence to support the concept, belief in fan death persists to this day in Korea, and also to a lesser extent in Japan.

Funeral director

A funeral director, also known as an undertaker (British English) or mortician (American English), is a professional involved in the business of funeral rites. These tasks often entail the embalming and burial or cremation of the dead, as well as the arrangements for the funeral ceremony (although not the directing and conducting of the funeral itself unless clergy are not present). Funeral directors may at times be asked to perform tasks such as dressing (in garments usually suitable for daily wear), casketing (placing the human body in the coffin), and cossetting (applying any sort of cosmetic or substance to the best viewable areas of the corpse for the purpose of enhancing its appearance). A funeral director may work at a funeral home or be an independent employee.

Lazarus sign

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus raised from the dead in the Gospel of John.

Megadeath

Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.

Morgue

A morgue or mortuary (in a hospital or elsewhere) is used for the storage of human corpses awaiting identification or removal for autopsy or respectful burial, cremation or other method. In modern times corpses have customarily been refrigerated to delay decomposition.

Necronym

A necronym (from the Greek words νεκρός, nekros, "dead" and ὄνομα ónoma, "name") is a reference to, or name of, a person who has died. Many cultures have taboos and traditions associated with referring to such a person. These vary from the extreme of never again speaking the person's real name, often using some circumlocution instead, to the opposite extreme of commemorating it incessantly by naming other things or people after the deceased.

For instance, in some cultures it is common for a newborn child to receive the name (a necronym) of a relative who has recently died, while in others to reuse such a name would be considered extremely inappropriate or even forbidden. While this varies from culture to culture, the use of necronyms is quite common.

Necrophobia

Necrophobia is a specific phobia which is the irrational fear of dead things (e.g., corpses) as well as things associated with death (e.g., coffins, tombstones, funerals, cemeteries). With all types of emotions, obsession with death becomes evident in both fascination and objectification. In a cultural sense, necrophobia may also be used to mean a fear of the dead by a cultural group, e.g., a belief that the spirits of the dead will return to haunt the living.Symptoms include: shortness of breath, rapid breathing, irregular heartbeat, sweating, dry mouth and shaking, feeling sick and uneasy, psychological instability, and an altogether feeling of dread and trepidation. The sufferer may feel this phobia all the time. The sufferer may also experience this sensation when something triggers the fear, like a close encounter with a dead animal or the funeral of a loved one or friend. The fear may have developed when a person witnessed a death, or was forced to attend a funeral as a child. Some people experience this after viewing frightening media.The fear can manifest itself as a serious condition. Treatment options include medication and therapy.The word necrophobia is derived from the Greek nekros (νεκρός) for "corpse" and the Greek phobos (φόβος) for "fear".

Obituary

An obituary (obit for short) is a news article that reports the recent death of a person, typically along with an account of the person's life and information about the upcoming funeral. In large cities and larger newspapers, obituaries are written only for people considered significant. In local newspapers, an obituary may be published for any local resident upon death. A necrology is a register or list of records of the deaths of people related to a particular organization, group or field, which may only contain the sparsest details, or small obituaries. Historical necrologies can be important sources of information.

Two types of paid advertisements are related to obituaries. One, known as a death notice, omits most biographical details and may be a legally required public notice under some circumstances. The other type, a paid memorial advertisement, is usually written by family members or friends, perhaps with assistance from a funeral home. Both types of paid advertisements are usually run as classified advertisements.

Pallor mortis

Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.

Post-mortem interval

Post-mortem interval (PMI) is the time that has elapsed since a person has died. If the time in question is not known, a number of medical/scientific techniques are used to determine it. This also can refer to the stage of decomposition of the body.

Rigor mortis

Rigor mortis (Latin: rigor "stiffness", mortis "of death"), or postmortem rigidity, is the third stage of death. It is one of the recognizable signs of death, characterized by stiffening of the limbs of the corpse caused by chemical changes in the muscles postmortem. In humans, rigor mortis can occur as soon as four hours after death.

Skeletonization

Skeletonization refers to the final stage of decomposition, during which the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the skeleton is exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones. In a temperate climate, it usually requires three weeks to several years for a body to completely decompose into a skeleton, depending on factors such as temperature, humidity, presence of insects, and submergence in a substrate such as water. In tropical climates, skeletonization can occur in weeks, while in tundra areas, skeletonization may take years or may never occur, if subzero temperatures persist. Natural embalming processes in peat bogs or salt deserts can delay the process indefinitely, sometimes resulting in natural mummification.The rate of skeletonization and the present condition of a corpse or carcass can be used to determine the time of death.After skeletonization, if scavenging animals do not destroy or remove the bones, acids in many fertile soils take about 20 years to completely dissolve the skeleton of mid- to large-size mammals, such as humans, leaving no trace of the organism. In neutral-pH soil or sand, the skeleton can persist for hundreds of years before it finally disintegrates. Alternately, especially in very fine, dry, salty, anoxic, or mildly alkaline soils, bones may undergo fossilization, converting into minerals that may persist indefinitely.

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