Birth and Fetal Death Registration Information for Hospital Staff

In Missouri, hospital birth certificate clerks or certifiers are those responsible for collecting and submitting the necessary data elements for the completion of the birth certificate as required by state law. The Missouri Electronic Vital Records (MoEVR) system, operated by the Missouri Department of Health and Senior Services – Bureau of Vital Records, exists to support the electronic registration of vital records, such as birth certificates, in Missouri.

Missouri Birth Record Registration and Filing Timeliness

A certificate of live birth for each birth occurring in Missouri must be filed within five (5) days after the date of birth (Section 193.085, RSMo) with the Missouri Department of Health and Senior Services by state law.

When a birth occurs in an institution or en route to an institution, the person in charge of the institution or such person's designated representative shall obtain the personal data, prepare the certificate, certify that the child was born alive at the place and time and on the date stated either by signature or an electronic process approved by the department, and file the certificate pursuant to this section or as otherwise directed by the state registrar. The physician or other person in attendance shall provide the medical information required by the certificate and certify to the facts of birth within five days after the birth. If the physician or other person in attendance does not certify to the facts of birth within the five-day period, the person in charge of the institution shall complete the certificate.

Live birth is defined by statute as the complete expulsion or extraction from its mother of a child, irrespective of the duration of pregnancy, which after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. The definition is also irrespective of birth weight.

Live birth certificate data is used in estimating population, for evaluation of maternal and perinatal health, for the study of fertility patterns, and to assist public health officials in the conduct and evaluation of programs.

Important Birth Registration Tips

  • Registration of births and fetal deaths is completed in the Missouri Electronic Vital Records (MoEVR) system using information from both the Mother’s Worksheet and the Facility Worksheet.
  • Names and words on Missouri birth certificates will print in all capital letters. When naming a child and providing related information, any unknowns, extra character spaces, incorrect suffixes, and other specific naming sequences such as adding numbers to names may prevent the automatic issuance of a social security number [known as Enumeration at Birth (EAB)]. For more info, see State Processing Guidelines for Enumeration at Birth.
    • The vital record will still be accepted and registered. However, the Social Security Administration (SSA) may have to be contacted directly and the completion of a Form SS-5 may be necessary to properly register a child for a social security number. In addition, while MoEVR can accept all general special characters and accents (viewable by logging in to MoEVR and clicking on “Accent Characters” in the upper right hand corner of the screen), some versions of birth certificates may not display all special characters and accents.
  • The person who gives birth to a child is always listed as the mother and should be the person who completes the Mother’s Worksheet.
  • If a mother is unmarried, the birth record should be registered without the father. If a father is to be added, paternity affidavits (mother’s affidavit, father’s affidavit, and if applicable, husband’s denial) must be sent in together to the Bureau of Vital Records after the registration of the birth. If only the father’s affidavit is sent, he will be added to the Putative Father Registry, but he will not be added to the birth certificate and the affidavit will be returned.
  • If sending a correction affidavit, supporting documents must always be included. Preferably the Mother’s Worksheet/Facility Worksheet should be used as supporting documents. If sending one of those worksheets you must send all pages, not just the page that supports the correction. If neither of these are available or they are listed incorrect, please call the bureau for further guidance at 573-751-6387 option 4.
  • Co-parents (same sex female couples) can only be added if they are married to the mother and if added at the time of birth. Otherwise, a court order is required to add a co-parent after birth registration.
  • Verify pre-pregnancy weight -vs- weight at delivery. If one of these fields is unknown, list 999. If you enter 99, it will recognize it as 99lbs and result in a query.
  • If a date field is unknown, you must enter a 9 for every required field.
    • Ex: mm/dd/yyy = 99/99/9999 or if one of the fields is unknown such as day of month is should be entered as 05/99/2020
  • If height is unknown, enter 99 for feet and 99 for inches. If you enter one 9 in each field, it will recognize it as 9ft 9in and result in a query.
  • If number of cigarettes is ½ of a cigarette round up to 1.
  • Number of previous cesareans (Risk Factors in Pregnancy): This number should not include the current birth. It should match or be less than the number of children now living and/or dead.
    • Ex: Mom has one previous child born via cesarean. This current baby was also born via cesarean. You would enter 1 as the number of previous cesareans, not 2.
  • Newborn living at time of report: This question is often misread and marked as no when child is actually living. It will be queried as unlikely based on weight, APGAR, and gestation.

Differences Between a Spontaneous Fetal Death and an Induced Termination of Pregnancy

Fetal Death

A fetal death is defined as a non-induced death prior to the complete expulsion or extraction from its mother of a fetus, irrespective of the duration of pregnancy, the death is indicated by fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Each spontaneous fetal death of twenty (20) completed weeks gestation or more, calculated from the date of last normal menstrual period began to the date of delivery, or a weight of three hundred fifty (350) grams or more which occurs in Missouri shall be reported.

If a spontaneous fetal death occurs, neither a birth certificate nor a death certificate shall be filed or issued—only a report of spontaneous fetal death, and if desired, a certificate of birth resulting in stillbirth certificate are available.

Induced Termination of Pregnancy (ITOP)

An induced termination of pregnancy (ITOP), also known as an abortion, is defined as the intentional destruction of life of an embryo or fetus in his or her mother’s womb or the intentional termination of pregnancy of a mother with an intention other than to increase the probability of a live birth or to remove a dead or dying unborn child.

Information received from the Report of Induced Termination of Pregnancy and the Complication Report for Post-Abortion Care are confidential, only used for statistical purposes, and to preserve maternal health and life by adding to the sum of medical knowledge through the compilation of relevant maternal health and life data and to monitor all abortions performed to assure that they are done only under and in accordance with the provisions of the law.

For more general information regarding these terms, visit the National Center for Health Statistics.

Recording Surrogacy Births

Surrogacy Births

When a surrogate mother is involved in a birth process, please note the following regarding filing of the birth certificate:

  • The hospital will list the surrogate as the mother.
  • If surrogate is not married and wishes to list the father on the record, paternity affidavits shall be completed. If father is not listed at this time, the father can be added later via surrogacy court order documents as applicable.
  • The surrogate should complete the mother's worksheet.
  • The surrogacy court order documents must be sent to the Amendment Unit for the mother (and father if not listed through paternity affidavits prior to court order) to be changed. Before sending documents, it is recommended parents contact the Bureau of Vital Records – Amendment Unit at 573-751-6387, option 2.

Same Sex Couples – Birth Registration Information

  • Women in same-sex marriages, lawfully entered into in jurisdictions where same-sex marriage legal, who give birth in Missouri, may choose to have their spouse listed as the baby’s co-parent on the birth certificate.
  • The person who gives birth to a child is always listed as the mother. In instances, where the mother wishes to list the biological dad on the birth certificate, she can list the father in lieu of the female spouse. The female spouse does not sign a Husband’s Denial of Paternity. In this case, the birth record is registered with only the mother on the record. Information for the “co-parent” is not added and the mother and father will need to complete paternity affidavits to add the father to the birth record after the record is registered.
  • A mother in a same-sex marriage who refuses to provide her spouse’s information on the record at the time of birth will require a court order to add the co-parent later.
  • Men in same sex relationships or marriages (using a donor egg/surrogate) will have the person who gives birth to the child listed as the mother. Paternity affidavits are then needed to add the biological father. If the couple choose to mix sperm, either father may be listed. Finally, a court order is then needed to remove the mother and add the father’s spouse/co-parent.
  • Unmarried same sex female couple using donor sperm.
    The person who gives birth to a child is listed as the mother. No father is listed on the birth certificate. A court order is required to add co-parent.
  • If a same sex female couple is not married, the person who gives birth to a child is listed as the mother, and then a court order is needed to list her partner.

For more information or guidance on additional scenarios, please contact the Bureau of Vital Records at 573-751-6387, Option 4.

Training Resources

Missouri Hospital Training Guide

National Center for Health Statistics - Training and Instructional Materials

Missouri Electronic Vital Records (MoEVR) Training and Support

Birth Certificate eLearning
The Bureau of Vital Records strongly encourages new birth registrars to take a specially designed one-hour online course before utilizing MoEVR. The course is available online at Applying Best Practices for Reporting Medical and Health Information on Birth Certificates. Clinical and non-clinical providers of medical/health information for the birth certificate or the report of fetal death will find considerable value in the course.

The National Center for Health Statistics (NCHS) at CDC, in partnership with the National Association for Public Health Statistics and Information Systems (NAPHSIS), and several individual jurisdictions designed the course.

The course:

    • Explains the importance of reporting birth record and fetal death information
    • Describes how birth registrars and clinicians can improve maternal and infant health data
    • Identifies resources available to assist birth registrars and clinicians
    • Tests what the individual learned about birth and fetal death registration

Missouri Hospital Data Quality Worksheets

The Bureau of Vital Records has developed Hospital Data Quality Worksheets to provide performance feedback to birth facilities and staff who register births. This two-page reports summarize the timeliness and completeness of selected birth registration items reported by a facility. Aggregate data for all birthing facilities in Missouri is presented for comparison. Facility births registered with missing data are compared to all births in the state and to the National Center Health Statistics quality threshold.

We encourage all birthing hospitals and facilities to utilize these worksheets to review and improve data collection quality. To start receiving these worksheets, please call 573-751-6387, option 4.

National Vital Statistics System

In the United States, the legal authority to register births lies within 57 jurisdictions (50 states, 2 cities, and 5 territories). The 57 jurisdictions share birth record information with the National Vital Statistics System (NVSS) at the Centers for Disease Control and Prevention (CDC). The compiled national natality statistics inform a variety of critical medical and health-related research efforts.

Why Go Electronic?

The benefits of being an electronically registered birth certifier in MoEVR include:

  • Quickly electronically certify a birth certificate anywhere, anytime
  • Real-time prompts, edits, and validations ensure record validity and reduces errors and registration issues.
  • Reduced registration lag times help ensure statutory compliance and decreased possibility of loss, theft, and fraud

Contact Bureau of Vital Records

The Missouri Bureau of Vital Records has field representative staff who travel the state training vital record data providers. Field staff can also arrange for telephone/web conference training calls.

If you are a vital record data provider (local county health agency, funeral home/director, hospital/licensed birthing center, county official, medical certifier, etc.) and would like to request a personalized training session or gain access to MoEVR, please call 573-751-6387, option 4.