Accuracy in Reporting of Kentucky Certified Nurse-Midwives as Attendants in Birth Registration Data

Birth certificate data are used nationally to determine health care policy and health care reimbursement and to demonstrate the legitimacy and value of certified nurse-midwives (CNMs) and certified midwives (CMs) in perinatal and neonatal outcomes. However, the validity of birth certificate data is questionable, in part because of the data collection process. These data are particularly crucial for midwife-attended births because the correct birth attendant is not always accurately identified on the birth certificate. The purpose of this project was to examine the actual number of CNM-reported births compared with those recorded by the Kentucky Office of Vital Statistics and to examine the process used by birth registrars to complete the birth certificate.

CNMs attending births in hospitals in Kentucky in 2017 logged their birth statistics. These numbers were compared with the 2017 Kentucky Vital Statistics Birth Certificate data of CNM-attended births. Kentucky birth registrars (50%) who work in facilities where CNMs attend births completed a 32-question survey to describe their process of collecting birth certificate data.

The comparison data revealed that CNM-attended births in Kentucky are underrepresented in the state vital statistics by as much as 19.2%. Birth registrars identified barriers to collecting accurate data including lack of training, multiple sources of data, incomplete prenatal records, and absence of systems to help ensure accuracy.

CNMs/CMs should keep personal and practice birth logs and routinely compare these with hospital data kept by the birth registrar. The state office of vital statistics and hospitals should target training to specific facilities that have the most inaccurate data. The Improving Midwifery Birth Numbers Initiative through the American College of Nurse-Midwives Division of Research Data Management Section should continue to encourage midwifery students to complete this research in all 50 states.