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Obstetrics is concerned with human reproduction and as such is always a subject of considerable contemporary relevance. The specialty promotes health and well-being of the pregnant woman and her fetus through quality perinatal care. Such care entails appropriate recognition and treatment of complications, supervision of labor and delivery, ensuring care of the newborn, and management of the puerperium. Postpartum care promotes health and provides family planning options.

The importance of obstetrics is reflected by the use of maternal and neonatal outcomes as an index of the quality of health and life among nations. Intuitively, indices that reflect poor obstetrical and perinatal outcomes would lead to the assumption that medical care for the entire population is lacking. With those thoughts, we now provide a synopsis of the current state of maternal and newborn health in the United States as it relates to obstetrics.

Vital Statistics

The National Vital Statistics System of the United States is the oldest and most successful example of intergovernmental data sharing in public health. The National Center for Health Statistics collects and disseminates official statistics through contractual agreements with vital registration systems. These systems that operate in various jurisdictions are legally responsible for registration of births, fetal deaths, deaths, marriages, and divorces. Legal authority resides individually with the 50 states; two regions—the District of Columbia and New York City; and five territories—American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.

Standard certificates for the registration of live births and deaths were first developed in 1900. An act of Congress in 1902 established the Bureau of the Census to develop a system for the annual collection of vital statistics. The Bureau retained authority until 1946, when the function was transferred to the United States Public Health Service. It is presently assigned to the Division of Vital Statistics of the National Center for Health Statistics, which is a division of the Centers for Disease Control and Prevention (CDC). The standard birth certificate was revised in 1989 to include more information on medical and lifestyle risk factors and obstetrical practices.

In 2003, an extensively revised Standard Certificate of Live Birth was implemented in the United States to enhance collection of obstetrical and newborn clinical information. The enhanced data categories and specific examples of each are summarized in Table 1-1. By 2011, 36 states had implemented this revised birth certificate representing 83 percent of all births (Hamilton, 2012).

TABLE 1-1General Categories and Specific Examples of New Information Added to the 2003 Revision of the Birth Certificate

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