Tuesday, May 13, 2008

Birth certificates

In the fall of 1980, on a cool October Friday night, I delivered the first baby of my medical career. As a third year medical student, I was one week into my second clinical rotation. For those who are old enough to be fans of the television series Dallas, the delivery occurred during the episode where the world was finding out that Sue Ellen shot J.R. That fact was part of the reason I got to do the delivery assisted only by the mother of the baby and the lowest ranking LVN in the labor suite at Jefferson Davis Hospital in Houston, Texas. Everyone else in the hospital was watching Dallas.

At the time that I delivered that baby boy, the birth certificate, an important document which is key to much in life, was filled out and signed by the physician who delivered the baby. That night filling out that document seemed almost as important as the delivery of the baby. I was as meticulous with this task too. The resident physician who was supervising me (from the TV room) was required to sign it. 1980 was back in the pre-electronic era of pen and paper. A blank at the bottom of the page was for the physician or midwife who "attended" the delivery to sign, attesting to the truth of the information contained on that page.

Since that night I have signed countless birth certificates. When I was a resident obstetrician the hospital would not issue your pay check if you had any incomplete charts or unsigned birth certificates. Many of my colleagues were caviler about both. They must have missed the lecture on vital statistics in medical school.

In addition to the date and the time of the birth along with the weight of the baby, the birth certificate contains a wealth of information. Facts such as the county and state where the child's mother and if she is married, her husband, were born. If the mother is unmarried at the time of birth, the father must sign the birth certificate himself to have his information included. Information about the mother's other pregnancies if there were any and whether or not the birth was one of multiple births such as twins or triplets. Also the mode of delivery: vaginal, operative vaginal (forceps) or Cesarean section is listed.

Today birth certificates, in Texas at least, are not signed by the person who attends the delivery. The birth certificate is a computer generated document filled out by a records clerk in the hospital. The information is provided by the mother and also taken from the hospital delivery record. This allows the birth certificate to be filed in a timely fashion. It also facilitates the issuing of a social security number for the newborn.

In this the electronic age, I appreciate the need for swiftness in the filing of the birth certificate, a vital document in establishing an identity. Yet, I am dismayed when I think about the human touch that has been lost. There is no review of the information recorded by a person who knows the mother and hopefully the father of the baby. There is no signature of someone who was present with these parents in that all important moment when this person, whose birth is being certified, made her entrance into the world.
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