My first two children were born at hospitals and it seemed like the children’s birth certificates magically showed up for me to sign sometime before we left the hospital. When Nicole was born at home, I had to go through a bunch of legwork to get her birth certificate. On the morning of Nicole’s birth, the midwife carefully explained to me what I would need to do: make an appointment with the county and take this letter and this form and a copy of a utility bill to establish residency. Click my heels three times and repeat, “There’s no place like home (for a birth).” (Just kidding). I nodded my head, yes, I will remember all of this stuff, but really I was lost in a haze of post-birth natural high, consumed by baby love, and I had no room for details in my brain. So about six weeks later when I went to the county, not only did I first go to the Office of Vital Records instead of the Health Department, I then dragged my three-year-old and newborn a few blocks more to the Health Department without an appointment, and I didn’t take a copy of the utility bill. Now I can look back and laugh, but at the time I was not amused about having made mistakes that meant yet more half-hour car rides with a 6-week-old who didn’t like the car seat.

When I think back to all the paperwork I had to fill out to get the birth certificate, I cannot recall having to answer any questions about breastfeeding. So I was surprised to read “Breastfeeding Status on U.S. Birth Certificates: Where Do We Go from Here?” Pediatrics, Vol. 122 No. 6 December 2008, pp. e1159-e1163. It explains that 79 percent of U.S. states collect breastfeeding data for birth certificates, or expect to do so within two years. According to this interesting United States map, California is not yet collecting breastfeeding data on birth certificates (so no, my memory isn’t quite that bad!) Researchers contacted the vital statistics registrars in each of the 50 states, as well as New York City, Washington, DC, and Puerto Rico. Nearly 57 percent of the registrars were already reporting breastfeeding status on state birth certificates, although the questions used to collect the information were not standardized. Most states use the Standard Certificate of Live Birth (SCLB) questionnaire (PDF), which asks, “Is the infant being breastfed at discharge?” Six states, New York City, and Washington, DC, developed their own questions. The study authors concluded:

Within the next 2 years, nearly 80% of US states are expected to be collecting breastfeeding data on their birth certificate. This represents a significant contribution to our national breastfeeding surveillance efforts, because data should be collected for every newborn in every participating state, thereby avoiding the potential for sampling bias. Because birth certificates also collect data on several relevant variables that are known to affect breastfeeding outcomes, the inclusion of a breastfeeding question on birth certificates has a strong potential to improve breastfeeding surveillance in the United States. Consistent with the Healthy People 2010 guidelines, we strongly encourage all states and US territories to collect exclusive breastfeeding data on their birth certificates and to monitor this outcome closely. Standardization of the breastfeeding question that is used on state birth certificates should be a priority so that breastfeeding outcomes can be compared across states. The revision of this question should involve a process that includes feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and training of professionals who collect these data.

Were you asked about breastfeeding when you applied for your child’s birth certificate? Do you think the information provided at that time is valuable? I agree that the pertinent question is whether or not the baby is being exclusively breastfed. It would be helpful to see which states are breastfeeding-friendly and which hospitals need to improve exclusive breastfeeding rates and reduce any unnecessary introduction of sugar water or formula.

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