Coffin birth
From Wikipedia, the free encyclopedia
Coffin birth,
known in academia by the more accurate term 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 encourage
the infant to emerge 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 numerous examples that
have demonstrated that the term coffin birth is a misnomer
under many circumstances. 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.
Contents
[hide]
Stages of death
|
1. Pallor mortis
2. Algor mortis 3. Rigor mortis 4. Livor mortis 5. Putrefaction 6. Decomposition 7. Skeletonization |
The etiologyNote
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 nonviable 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
intraabdominal 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]
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 the 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
prior to 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 few medical practitioners have been able
to observe and document the progress of postmortem fetal extrusion.
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.Note
f Although the fetus was in a similar state of
decomposition, the umbilical
cord was intact and still attached to the placenta inside
the uterus.[1]
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 prior to 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, at about 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 prior to 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]
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][25][26][27][28] In
addition, the determination of whether or not delivery actually occurred prior
to 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.[29] It
is therefore necessary for investigators to be able to recognize postmortem
fetal extrusion when encountered in an excavated burial.[19][30]
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.[31]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.[32]
In 2007, a
23-year-old woman in India, over eight months pregnant, hanged herself
after contractions had
begun.[33] 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
prior to death, and was therefore not related to processes of decomposition.[6][33] 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.[34]
In 2008, it was
reported from Germany that a 23-year-old woman in her third trimester was
involved in a motor vehicle accident and died; the nonviable fetus was found
between her feet.[35] Following
initial impact the vehicle she was in caught fire. 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.[35] 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.[35]
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