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Do Birth Certificate Data Accurately Reflect the Number of CNM-Attended Births? An Exploratory Study


  • Deborah S. Walker CNM, FNP, DNSc,

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    • Deborah S. Walker, CNM, FNP, DNSc, FACNM, is an Associate Professor-Clinical and Coordinator of the Nurse-Midwifery Concentration, College of Nursing and an Associate Professor-Clinical, OB/GYN, School of Medicine at Wayne State University in Detroit, Michigan.

  • Susanne Brooks Schmunk CNM, MS,

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    • Susanne Brooks Schmunk, CNM, MS, is in full-scope nurse-midwifery practice in Saginaw, Michigan. This project was undertaken in partial fulfillment of the requirements for her University of Michigan graduate degree.

  • Lisa Summers CNM, DrPH

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    • Lisa Summers, CNM, DrPH, serves as a Senior Technical Advisor in the Department of Professional Services at the American College of Nurse-Midwives.

College of Nursing, Wayne State University, 5557 Cass Ave., Rm. 346, Detroit, MI 48207. E-mail:


The number of midwife-attended births is increasing as reported on birth certificates in the United States. However, there is some evidence that births attended by certified nurse-midwives (CNMs) may not be accurately recorded. In this exploratory study, data on birth attendants for those clients giving birth during the study period were compared by using four sources: the client's hospital chart, the CNM birth log, hospital birth certificate records, and state vital statistics records. Researchers sought to determine the accuracy of birth attendant data as reflected in these four sources and whether other providers were listed as the birth attendant for actual CNM-attended births. During the study period, the CNM birth log showed that CNMs attended 97 vaginal births, whereas the client hospital charts for these same births noted 92 births as attended by CNMs (the other five were operative vaginal births). Hospital birth certificate and state vital statistics data during the study time period credited 88 and 82 of the client's births, respectively, to the CNMs. Exploration of the inaccurately reported birth attendant data, implications for practice, and recommendations for accurately recording birth certificate data are discussed.