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Chapter: Forensic Medicine: Paediatric forensic pathology

Infanticide and concealment of birth

During the neonatal period most medico-legal problems relate to infanticide, concealment of birth, and identity.

Infanticide and concealment of birth

During the neonatal period most medico-legal problems relate to infanticide, concealment of birth, and identity.

 

Definitions and statutory provisions

The medico-legal investigation of suspected infanticide and concealment of birth will inter alia be influenced by the provisions of the Births and Deaths Registration Act 51 of 1992, the Criminal Procedure Act 51 of 1977, and the General Law Amendment Act 46 of 1935.

Definitions (s 1 of Act 51 of 1992)

``Birth'' in relation to a child means the birth of a child born alive.

``Still-born'', in relation to a child, means that it has had at least 26 weeks of intra-uterine existence but showed no sign of life after complete birth, and ``stillbirth'' in relation to a child, has a corresponding meaning.

Other statutory provisions

``At criminal proceedings at which an accused is charged with the killing of a newly-born child, such child shall be deemed to have been born alive if the child is proved to have breathed, whether or not the child had an independent circulation'' (s 239(1) of Act 51 of 1977).

``At criminal proceedings at which an accused is charged with the concealment of the birth of a child, it shall not be necessary to prove whether the child died before or at or after birth'' (s 239(2) of Act 51 of 1977).

``Any person who disposes of the body of any child with intent to conceal the fact of its birth, shall be guilty of an offence'' (s 113(1) of Act 46 of 1935).

 

Medico-legal problems

In cases of alleged infanticide or concealment of birth, it is necessary to establish the following:

1.           whether the infant was viable (ie its uterine age)

2.           whether it had lived (ie whether it had breathed)

3.           if it had lived, for how long

4.           what the cause of death was

5.           how long it had been dead when found

6.           whether it could be identified as belonging to a particular mother (ie by virtue of identity and evidence in the mother of a recent birth, compatible with the age of the infant)

7.           if stillborn, why it had not lived (ie cause of death)

Whereas the mass and length of the newborn infant can be used only for an approximation of the uterine age, the presence and size of the centres in the lower end of the femur and in the calcaneum (heel bone) and talus (ankle bone) are a reliable measure of the uterine age from the fifth to the ninth month (see photographs 41 and 44).

To establish whether the child breathed or not (besides general appearance, photographs 46), the hydrostatic test is applied to the lungs. This involves testing whether the lungs or portions of them float when immersed in water. The inference here is that air breathed after birth is responsible for this flotation.

This is a valid conclusion only if it can be established that putrefaction gases did not cause flotation. By applying pressure to the portions of lung that float the putrefaction gases are readily displaced, in contrast to air trapped in the minute alveolae (lung pockets). This method of establishing whether the child breathed is not reliable in the case of advanced putrefaction. Where the newborn's lungs expanded fully, the appearance of the lungs as they fill the chest cavity or confirmation from the microscopic picture is sufficient evidence to justify the finding of a live birth. During the first few hours of life the changes which are observable at the place of attachment of the umbilical cord to the child's belly may assist in determining inter alia the duration of life. The presence of breast secretions in the stomach are also indicative of live birth. The presence of air in the middle ears confirms that the baby swallowed and therefore was alive  -   air can only reach the middle ear cavity by entering the cavity via the Eustachian tubes during the process of active swallowing.

See photograph 46 for the appearance of the lungs of a newborn.

 

Case study

The body of a newborn infant wrapped in newspaper (date of issue decipherable) was found two days after the newspaper date.

At the post-mortem examination the body was free of vernixcaseosa (the fatty substance covering the foetal skin), 44 cm in length and 3 kg in mass. The umbilical cord had been cleanly cut and tied, but revealed no observable changes. Ossification centres were present in the calcaneum, talus and lower end of the femur. The stomach was empty, and the lungs filled the pleuralcavity. The lungs floated in water before and after the pressure test. The bronchial tree contained an abundance of markedly frothy fluid with a fragrant odour. A sample of this fluid was taken for chemical analysis, and a sample of infant blood for grouping.

The suspect mother was apprehended a week later, and on clinical examination showed evidence of having recently given birth. In her room at the address where she was employed as a domestic help a packet of detergent powder was found, which chemically matched the fluid sample taken at the post-mortem examination. Later the mother confessed that the infant had cried after birth, that she had tied and cut the umbilical cord, and that then, a little later, she had tried to bath the baby, which was fouled with meconium, in a small bath of water to which she had added some of the detergent powder. The baby had slipped from her hands into the bath and, despite being promptly removed, had shortly thereafter ``choked'' and died. Overcome by fear, she had attempted to dispose of the body.

 

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