Date of Award


Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Holly P. Kennedy



Introduction: Birth certificate data is used nationally to determine healthcare policy, allocation of funds, and to demonstrate the legitimacy and value of Certified Nurse-Midwives (CNMs) in maternal and neonatal outcomes. However, the validity of birth certificate data is questionable, in part because of the data collection process. This data is particularly crucial for midwife-attended births as the correct birth attendant is not always accurately identified. The purpose of this project was to examine the number of CNM reported births as compared to the number recorded by the Kentucky office of vital statistics and to look at the process used by birth registrars to complete the birth certificate.

Methods: CNMs (96%) attending births in hospitals in Kentucky in 2017 kept birth logs. These logs were compared to the 2017 Vital Statistics Birth Certificate data of CNM attended births. Kentucky birth registrars (47%) who work in facilities where CNMs attend births completed a 31 question survey regarding the process of collecting birth certificate data.

Results: In Kentucky, CNM attended births are underrepresented in the state vital statistics by 15.5%. 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 insure accuracy.

Discussion: CNMs need to keep personal and practice birth logs and routinely compare it to 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 (IMBUE) Initiative through the American College of Nurse-Midwives (ACNM) Division of Research Data Management Section can continue to encourage midwifery students to complete this research in all 50 states.

Open Access

This Article is Open Access