Live Birth

LIVE BIRTH, birth alive (of a fetus, child). The question of live birth of a fetus, i.e., whether the fetus was born alive or dead, has important significance, because, if it is proven that the child was born dead (with the exception of certain cases - death of the fetus before and during the act of birth), the proceedings in the case of alleged infanticide are terminated. Usually, shortly after birth, the first respiratory movements appear, the child begins to cry (as is believed due to irritation of the respiratory center in the medulla oblongata by venous blood). In former times, great importance was attached to the cry of the born fetus to prove live birth. Ancient German law required that: "Vox ejus audita sit intra quatuor parietes domus, in qua natus est" (His cry should be heard within the four walls of the house in which he was born). In forensic-medical practice, it is also often necessary to determine whether the child could have cried and how strongly. In such cases, one can speak with greater probability in the affirmative, the stronger and more perfect the breathing of the fetus. Weak children, as well as those who, due to internal or external causes, do not breathe fully, may not cry at all or cry very weakly. The changes occurring in the lungs during breathing relate to their volume, color, consistency, specific gravity, and provide the main points of support for determining live birth. Lungs that have not breathed appear as small organs occupying the posterior part of the chest cavity, with a smooth liver-like surface, thinned edges, reddish-brown or bluish-red color; their consistency by touch resembles meat. With the beginning of breathing, the volume of the lungs increases, their surface appears less smooth and as if marble-like - on one side due to the optical impression from the air in the alveoli, and on the other from the blood contained in the vessels passing between the individual lobules. The edges of the lungs become rounded, their color changes to pale pink, light red. With the help of a magnifying glass, the uniform distribution of air in the alveoli, resembling pearl bubbles, is visible. Breathing lungs by touch give the sensation of a cushion; a bloody fine-pored foam is removed from the surface of their sections; the latter is also noticeable in the bronchi. But most essentially is the decrease in the specific gravity of the lungs due to their filling with air, on which the hydrostatic lung test is based. With the beginning of respiratory movements, air besides the lungs also penetrates into the stomach and intestines of the fetus - this circumstance served as the basis for the second hydrostatic gastro-intestinal test (see Vital Tests). A positive result of the mentioned tests definitely indicates that the child breathed, swallowed air, therefore lived, provided the influence of putrefaction processes, as well as artificial introduction of air for resuscitation purposes is excluded; although the latter possibility is hardly to be considered in cases of infanticide. If there is indication of such intervention, then it should be remembered that when air is blown into the mouth of the fetus, the lungs are filled only partially (upper lobes); sometimes emphysema, ruptures are observed; besides this, significant distension of the stomach and intestines may occur, because with this method air enters the gastro-intestinal tract more than the lungs. Methods of artificial respiration, e.g., the Schultze method, also do not lead to complete filling of all parts of the lungs. A negative result of the lung test has much less significance; there are a number of conditions when the child is born alive, but the lungs are airless on autopsy. This is especially possible with significant prematurity (birth before 28-30 weeks of pregnancy, and sometimes even later than this term), when respiratory movements may not occur or only bronchial breathing is observed (weak development of respiratory muscles, underdevelopment of the respiratory center). Children may not breathe for some time, being in a state of apnea, if after the birth of the fetus the connection of the latter with the uterus is not disrupted. The most frequent cause of absence of breathing is asphyxia due to premature cessation of placental circulation or from compression of the head by the maternal birth canal, in which case the fetus lives for some time, heartbeats continue, but there are no respiratory movements or they occur weakly. Air may not enter the lungs if the child is born in intact membranes or pieces of them cover the openings of the mouth and nose. The same consequences are caused by obstruction of the respiratory passages by amniotic fluid aspirated during birth, mucus, meconium, as well as inflammation of the lungs, e.g., pneumonia alba, intentional or accidental birth in a bath, over vessels with water, under covers, blankets, etc. Finally, there are known cases when breathing lungs subsequently became airless (secondary atelectasis), in which case the air probably disappeared under the influence of the elasticity of the lungs themselves and by absorption by the blood. Consequently, absence of air in the lungs does not yet exclude live birth of the fetus. If, however, airless lungs contain foreign substances that could have been aspirated only after birth, e.g., impurities from the toilet, then it can be stated that the child was born alive. Likewise, when on a fresh corpse the lungs are airless (obstruction of the bronchi by mucus), but in the stomach, and sometimes in the small intestines, air is found by the hydrostatic test, this fact also gives grounds to recognize the live birth of the fetus. With negative findings of forensic-medical examination of the corpse with mandatory application of two vital tests, one can only with probability think that the fetus was born dead, or, following the formula of Casper, to state in the opinion that "the findings of the autopsy and especially the examination of the lungs do not give grounds to conclude that the child lived after birth".