THE NEW BIRTH CERTIFICATETHE NEW BIRTH CERTIFICATE

Making Vital Statistics Making Vital Statistics More VitalMore Vital

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Center for Health StatisticsNational Center for Health Statistics

Division of Vital StatisticsDivision of Vital Statistics

Reproductive Statistics BranchReproductive Statistics Branch

Development of the Revised Birth Development of the Revised Birth Certificate 12Certificate 12thth Revision Revision

The U.S. Standard certificate of Live birth had 11 revisions during 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 20th century. The last revision, still in use, was in 1989.

– The revision process began with a consensus from the States that a The revision process began with a consensus from the States that a revision was needed.revision was needed.

– In 1998, the National Center for Health Statistics (NCHS), Centers for In 1998, the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) assembled an expert panel to Disease Control and Prevention (CDC) assembled an expert panel to evaluate the current certificate and recommend changes.evaluate the current certificate and recommend changes.

Development of the Revised Birth Development of the Revised Birth CertificateCertificate

The Panel to Evaluate the U.S. Standard Certificates and Report The Panel to Evaluate the U.S. Standard Certificates and Report Parent Group was composed of:Parent Group was composed of:

– State vital registration and statistics executives - State vital registration and statistics executives - Patricia W. Patricia W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; Lorne A. Phillips, KS; Steven Schwartz, NYCLorne A. Phillips, KS; Steven Schwartz, NYC. .

– Researchers and representatives of data providers and user Researchers and representatives of data providers and user organizations - (e.g., AAP, ACNM, ACOG, AHA, AHIMA, AMA, and organizations - (e.g., AAP, ACNM, ACOG, AHA, AHIMA, AMA, and ASTHO).ASTHO).

Development of the Revised Birth Development of the Revised Birth Certificate -- cont.Certificate -- cont.

In a series of meetings over 16 months, the Panel reviewed In a series of meetings over 16 months, the Panel reviewed literature, suggestions, and recommendations and heard outside literature, suggestions, and recommendations and heard outside testimony from other experts and private citizens.testimony from other experts and private citizens.

– The revision was viewed as a opportunity to improve the data The revision was viewed as a opportunity to improve the data collection process.collection process.

– Recommendations were made as to:Recommendations were made as to: ContentContent FormatFormat Standard definitionsStandard definitions Standardized collection of data from the most accurate sourcesStandardized collection of data from the most accurate sources Standardized worksheets to gather data from medical records (Facility Standardized worksheets to gather data from medical records (Facility

Worksheet) and from the parents (Mother’s Worksheet)Worksheet) and from the parents (Mother’s Worksheet)– The Panel made its final recommendations in 1999.The Panel made its final recommendations in 1999.– NCHS was mandated to test the new documents.NCHS was mandated to test the new documents.

New WorksheetsNew Worksheets

To encourage collection To encourage collection from the best sources, two from the best sources, two standard worksheets have standard worksheets have been developed and been developed and tested.tested.

– Mother’s Worksheet Mother’s Worksheet (MWS)(MWS)

– Facility Worksheet Facility Worksheet (FWS)(FWS)

Mother’s WorksheetMother’s Worksheet

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

– Testing of the MWS was Testing of the MWS was done with women who had done with women who had recently had a live birth.recently had a live birth.

– Slight modifications were Slight modifications were made to the worksheet as a made to the worksheet as a result of their comments.result of their comments.

– Generally, testing indicated Generally, testing indicated that the MWS worked well.that the MWS worked well.

Facility Worksheet Facility Worksheet

Data are obtained directly from Data are obtained directly from medical recordsmedical records of the mother and of the mother and infant (e.g., date of last menstrual period (LMP), birthweight, risk infant (e.g., date of last menstrual period (LMP), birthweight, risk factors, method of delivery).factors, method of delivery).

– Testing of the FWS was done with hospital staff across the country. Testing of the FWS was done with hospital staff across the country. – Hospital staff were interviewed about current methods of gathering birth Hospital staff were interviewed about current methods of gathering birth

certificate data.certificate data.– Staff (clerical and nursing) were asked to complete the FWS using Staff (clerical and nursing) were asked to complete the FWS using

medical (including prenatal) records and interviewed about their reactions medical (including prenatal) records and interviewed about their reactions to the FWS.to the FWS.

– Results of the testing led to modification or deletion of some items.Results of the testing led to modification or deletion of some items.– Generally, staff reported that the FWS could be completed efficiently and Generally, staff reported that the FWS could be completed efficiently and

accurately.accurately.

Guide to Completing Facility Guide to Completing Facility WorksheetWorksheet

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

– DefinitionsDefinitions– Preferred sources within Preferred sources within

the medical record (e.g., the medical record (e.g., prenatal care record, labor prenatal care record, labor and delivery record)and delivery record)

– Key words and common Key words and common abbreviationsabbreviations

Detailed Specification for Electronic Detailed Specification for Electronic SystemsSystems

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

– Suggested electronic screensSuggested electronic screens– Response categoriesResponse categories– Drop-down menusDrop-down menus– EditsEdits– Help screensHelp screens– Ability to edit and query at data entry; Ability to edit and query at data entry;

resolution of data issues at the sourceresolution of data issues at the source

Proposed New Birth Certificate:Proposed New Birth Certificate:Modified ItemsModified Items

– Mother’s and father’s race, Mother’s and father’s race, captures multiple race captures multiple race identificationidentification

– Mother’s and father’s Mother’s and father’s education, captures highest education, captures highest degree attaineddegree attained

Proposed New Birth Certificate:Proposed New Birth Certificate:Modified Items -- cont.Modified Items -- cont.

– Cigarette smoking before Cigarette smoking before and during pregnancy, and during pregnancy, captures levels of smokingcaptures levels of smoking

– Method of delivery includes Method of delivery includes fetal presentation and trial fetal presentation and trial of labor prior to cesarean of labor prior to cesarean deliverydelivery

– Pre-pregnancy weight, Pre-pregnancy weight, weight at delivery and weight at delivery and height, used to calculate height, used to calculate Body Mass IndexBody Mass Index

– Congenital anomaliesCongenital anomalies

Proposed New Birth Certificate:Proposed New Birth Certificate:Important New ItemsImportant New Items

– Fertility therapyFertility therapy– Did mother get WIC food Did mother get WIC food

for herself during this for herself during this pregnancypregnancy

– Infections during pregnancyInfections during pregnancy– Maternal morbidityMaternal morbidity– Breast feedingBreast feeding– Principal source of Principal source of

payment for the deliverypayment for the delivery

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

The U.S. Standard Report of The U.S. Standard Report of Fetal Death was also revised Fetal Death was also revised with changes similar to the with changes similar to the birth certificate.birth certificate.

Modified items include:Modified items include:

– Maternal morbidityMaternal morbidity– SmokingSmoking– Method of deliveryMethod of delivery– Congenital anomaliesCongenital anomalies

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

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

Other additions include:Other additions include:– whether autopsy or whether autopsy or

histological placental histological placental examination was performed examination was performed

– if autopsy or histological if autopsy or histological placental examination placental examination results were used in results were used in determining cause of deathdetermining cause of death

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

Data are obtained directly from the attendant or medico-legal Data are obtained directly from the attendant or medico-legal certifier.certifier.

– Format changes introduced to prompt attendant to provide specific Format changes introduced to prompt attendant to provide specific cause of deathcause of death

– Item testing was done with medical specialistsItem testing was done with medical specialists– Slight modifications were made as a result of their commentsSlight modifications were made as a result of their comments

The Revised U.S. Standard The Revised U.S. Standard Certificate of DeathCertificate of Death

The Revised U.S. Standard Certificate of Death now includes an The Revised U.S. Standard Certificate of Death now includes an item on item on Maternal MortalityMaternal Mortality..

This will allow us to better identify maternal deaths and improve This will allow us to better identify maternal deaths and improve the quality of maternal mortality data.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

SummarySummary

The quality of birth certificate data will be greatly improved as a The quality of birth certificate data will be greatly improved as a result of:result of:

– Collection of data from the best sourcesCollection of data from the best sources– Standardized worksheets for the facility and the motherStandardized worksheets for the facility and the mother– A comprehensive instruction manualA comprehensive instruction manual– Detailed specifications for the electronic system and the ability to edit Detailed specifications for the electronic system and the ability to edit

and query as data are enteredand query as data are entered

Public Health ImplicationsPublic Health Implications

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

–Teen childbearingTeen childbearing–Nonmarital childbearingNonmarital childbearing–Preterm birthPreterm birth–Low birthweightLow birthweight–Cesarean deliveryCesarean delivery

1940 1950 1960 1970 1980 1990 20000

20

40

60

80

100

Birt

h ra

te p

er 1

,000

wom

en a

ged

15-1

9

0100

200

300

400

500600

700N

umber of births (in thousands)

Number of births

Birth rate

Number of births and birth rates for teenagers aged 15-19 years: United States, 1960-2000

1980 1985 1990 1995 1999

Year

Per 100,000 live births

White

Black

All races

Note: Triplet/+ include births in greater than twin deliveries. Rates are plotted on a log scale.

50

100Hispanic

Non-Hispanic White 275

Triplet/+ birth rates by race and Hispanic origin of mother, 1980-99

Public Health Implications -- cont.Public Health Implications -- cont.

– Influence of fertility therapy on Influence of fertility therapy on twin and triplet/+ birthstwin and triplet/+ births

– Maternal medical risk factorsMaternal medical risk factors– Neural tube defectsNeural tube defects– Induction of laborInduction of labor– Participation in the WIC Participation in the WIC

programprogram– Prenatal care utilizationPrenatal care utilization– Socio-economic differentialsSocio-economic differentials– Newborn need for intensive Newborn need for intensive

carecare