THE NEW BIRTH CERTIFICATE

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THE NEW BIRTH CERTIFICATE

• Making Vital Statistics More Vital

Centers for Disease Control and
Prevention National Center for Health
Statistics Division of Vital Statistics Reproducti
ve Statistics Branch
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Development of the Revised Birth Certificate 12th
Revision

• The U.S. Standard certificate of Live birth had
  11 revisions during the 20th century. The last
  revision, still in use, was in 1989.
• The revision process began with a consensus from
  the States that a revision was needed.
• In 1998, the National Center for Health
  Statistics (NCHS), Centers for Disease Control
  and Prevention (CDC) assembled an expert panel to
  evaluate the current certificate and recommend
  changes.

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Development of the Revised Birth Certificate

• The Panel to Evaluate the U.S. Standard
  Certificates and Report Parent Group was composed
  of
• State vital registration and statistics
  executives - Patricia W. Potrzebowski (Chair),
  PA Donald Berry, DE Carol V. Getts, MI Karen
  Grady, NH Dorothy S. Harshbarger, AL Michael R.
  Lavoie, GA A.Torrey McLean, NC Barry Nangle,
  UT Alvin T. Onaka, HI Lorne A. Phillips, KS
  Steven Schwartz, NYC.
• Researchers and representatives of data providers
  and user organizations - (e.g., AAP, ACNM, ACOG,
  AHA, AHIMA, AMA, and ASTHO).

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Development of the Revised Birth Certificate --
cont.

• In a series of meetings over 16 months, the
  Panel reviewed literature, suggestions, and
  recommendations and heard outside testimony from
  other experts and private citizens.
• The revision was viewed as a opportunity to
  improve the data collection process.
• Recommendations were made as to
• Content
• Format
• Standard definitions
• Standardized collection of data from the most
  accurate sources
• Standardized worksheets to gather data from
  medical records (Facility Worksheet) and from the
  parents (Mothers Worksheet)
• The Panel made its final recommendations in 1999.
• NCHS was mandated to test the new documents.

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New Worksheets

• To encourage collection from the best sources,
  two standard worksheets have been developed and
  tested.
• Mothers Worksheet (MWS)
• Facility Worksheet (FWS)

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Mothers Worksheet

• Data are obtained directly from the mother
  (e.g., race, Hispanic origin, education,
  cigarette smoking, WIC participation).

• Testing of the MWS was done with women who had
  recently had a live birth.
• Slight modifications were made to the worksheet
  as a result of their comments.
• Generally, testing indicated that the MWS worked
  well.

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Facility Worksheet

• Data are obtained directly from medical records
  of the mother and infant (e.g., date of last
  menstrual period (LMP), birthweight, risk
  factors, method of delivery).
• Testing of the FWS was done with hospital staff
  across the country.
• Hospital staff were interviewed about current
  methods of gathering birth certificate data.
• Staff (clerical and nursing) were asked to
  complete the FWS using medical (including
  prenatal) records and interviewed about their
  reactions to the FWS.
• Results of the testing led to modification or
  deletion of some items.
• Generally, staff reported that the FWS could be
  completed efficiently and accurately.

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Guide to Completing Facility Worksheet

• To assist hospital staff in completing the FWS a
  comprehensive instruction manual has been
  developed. It includes

• Definitions
• Preferred sources within the medical record
  (e.g., prenatal care record, labor and delivery
  record)
• Key words and common abbreviations

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Detailed Specification for Electronic Systems

• Because almost all births are registered
  electronically, for the first time, detailed
  specifications for each data item on the
  electronic birth certificate have been developed.
  The specifications include

• Suggested electronic screens
• Response categories
• Drop-down menus
• Edits
• Help screens
• Ability to edit and query at data entry
  resolution of data issues at the source

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Proposed New Birth CertificateModified Items

• Mothers and fathers race, captures multiple
  race identification
• Mothers and fathers education, captures highest
  degree attained

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Proposed New Birth CertificateModified Items --
cont.

• Cigarette smoking before and during pregnancy,
  captures levels of smoking
• Method of delivery includes fetal presentation
  and trial of labor prior to cesarean delivery
• Pre-pregnancy weight, weight at delivery and
  height, used to calculate Body Mass Index
• Congenital anomalies

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Proposed New Birth CertificateImportant New
Items

• Fertility therapy
• Did mother get WIC food for herself during this
  pregnancy
• Infections during pregnancy
• Maternal morbidity
• Breast feeding
• Principal source of payment for the delivery

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The U.S. Standard Report of Fetal Death Modified
Items

• The U.S. Standard Report of Fetal Death was also
  revised with changes similar to the birth
  certificate.
• Modified items include
• Maternal morbidity
• Smoking
• Method of delivery
• Congenital anomalies

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The U.S. Standard Report of Fetal Death Cause of
Fetal Death

• Cause of fetal death now captures the single
  initiating cause as well as other significant
  causes.

• Other additions include
• whether autopsy or histological placental
  examination was performed
• if autopsy or histological placental examination
  results were used in determining cause of death

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The U.S. Standard Report of Fetal Death Cause of
Fetal Death -- cont.

• Data are obtained directly from the attendant or
  medico-legal certifier.
• Format changes introduced to prompt attendant to
  provide specific cause of death
• Item testing was done with medical specialists
• Slight modifications were made as a result of
  their comments

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The Revised U.S. Standard Certificate of Death

• The Revised U.S. Standard Certificate of Death
  now includes an item on Maternal Mortality.
• This will allow us to better identify maternal
  deaths and improve the quality of maternal
  mortality data.

• 36. IF FEMALE
• Not pregnant within past year
• Pregnant at time of death
• Not pregnant, but pregnant within 42 days of
  death
• Not pregnant, but pregnant 43 days to 1 year
  before death
• Unknown if pregnant within past year

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Summary

• The quality of birth certificate data will be
  greatly improved as a result of
• Collection of data from the best sources
• Standardized worksheets for the facility and the
  mother
• A comprehensive instruction manual
• Detailed specifications for the electronic system
  and the ability to edit and query as data are
  entered

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Public Health Implications

• More accurate and comprehensive reporting on the
  birth certificate will enhance our ability to
  analyze and track crucial indicators of maternal
  and child health, including demographic
  characteristics, health care utilization, and
  outcomes.

• Teen childbearing
• Nonmarital childbearing
• Preterm birth
• Low birthweight
• Cesarean delivery

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Public Health Implications -- cont.

• Influence of fertility therapy on twin and
  triplet/ births
• Maternal medical risk factors
• Neural tube defects
• Induction of labor
• Participation in the WIC program
• Prenatal care utilization
• Socio-economic differentials
• Newborn need for intensive care

Triplet/ birth rates by race and Hispanic origin
of mother, 1980-99
Per 100,000 live births
Non-Hispanic White
275
White
All races
100
Black
Hispanic
50
1980
1985
1990
1995
1999
Year
Note Triplet/ include births in greater than
twin deliveries. Rates are plotted on a log
scale.