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Making Vital Statistics

More Vital

Centers for Disease Control and Prevention

National Center for Health Statistics
Division of Vital Statistics
Reproductive Statistics Branch
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.
Development of the Revised Birth

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

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

– Mother’s Worksheet

– Facility Worksheet
Mother’s Worksheet

Data are obtained directly from the mother (e.g., race,

Hispanic origin, education, cigarette smoking, WIC

– 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.
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.
Guide to Completing Facility

To assist hospital staff in completing the FWS a

comprehensive instruction manual has been developed. It
– Definitions
– Preferred sources within
the medical record (e.g.,
prenatal care record, labor
and delivery record)
– Key words and common
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

– 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
Proposed New Birth Certificate:
Modified Items

– Mother’s and father’s race,

captures multiple race
– Mother’s and father’s
education, captures
highest degree attained
Proposed New Birth Certificate:
Modified 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
– Pre-pregnancy weight,
weight at delivery and
height, used to calculate
Body Mass Index
– Congenital anomalies
Proposed New Birth Certificate:
Important New Items

– Fertility therapy
– Did mother get WIC food
for herself during this
– Infections during
– Maternal morbidity
– Breast feeding
– Principal source of
payment for the delivery
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
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
The U.S. Standard Report of Fetal
Death: Cause of Fetal Death -- cont.

Data are obtained directly from the attendant or medico-legal


– 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
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.

 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

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
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.
Number of births and birth rates for teenagers
aged 15-19 years: United States, 1960-2000 –Teen childbearing
–Nonmarital childbearing
Number of births (in thousands)

100 700
Birth rate per 1,000 women

Number of births 600

500 –Preterm birth
60 Birth rate 400
–Low birthweight
aged 15-19

40 300
100 –Cesarean delivery
0 0
1940 1950 1960 1970 1980 1990 2000
Public Health Implications -- cont.

– Influence of fertility therapy on

twin and triplet/+ births Triplet/+ birth rates by race and Hispanic origin
of mother, 1980-99
– Maternal medical risk factors
Per 100,000 live births
– Neural tube defects
Non-Hispanic White
– Induction of labor White
All races
– Participation in the WIC 100 Black
– Prenatal care utilization 1980 1985 1990 1995 1999
– Socio-economic differentials Year
Note: Triplet/+ include births in greater than twin deliveries.

– Newborn need for intensive Rates are plotted on a log scale.