The 2009 Indiana Natality Report includes information on
live births to Indiana
residents that occurred during calendar year 2009. Information is presented at the state, county, and city level (for the 31 Indiana cities with populations over 25,000). This
report includes data by age, race, and marital status of the parents; characteristics of the newborn, e.g., birth order and
age of mother; and outcome indicators, e.g., tobacco use during pregnancy, gestation length, and birthweight.
The 2009 Indiana Natality Report also includes information on the number of reported pregnancies by county of residence
and age of mother. Reported pregnancies include resident live births, fetal deaths, and terminated pregnancies (performed in Indiana). Rates
per 1,000 females in selected age groups are also provided.
Beginning with the 2009 Indiana Natality Report, we are suppressing the number
and percent/rate of births and pregnancies at the county and city subgroup level
when there are fewer than 5, including 0 events. This is done to protect the confidentiality of individuals.
Rates or percents based on less than 20 in the numerator are considered
unstable. These rates or percents are marked with a "U".
The Indiana State Department of Health (ISDH), through provisions in
Indiana Code 16-37-1, administers "...a system of vital
statistics for Indiana." The ISDH Vital Records Division compiles data from original birth certificates filed with the
ISDH and from transcripts of original certificates for Indiana residents giving birth in other states. The Data Analysis Team
in the Epidemiology Resource Center in the Public Health and Preparedness Commission compiles these data and produces standard statistical reports.
Indiana began using the 2003 US Standard Certificate of Live
Birth (the 2003 "revised" certificate) on January 1, 2007.
Although much of the information collected from the mother remained the same, some
questions were rephrased or the information gathered in a different manner.
This resulted in significant changes in some variables.
The major variables affected were month prenatal care began, smoking during pregnancy,
place of birth, and alcohol use during pregnancy.
Mother's alcohol use is no longer collected. The 2007, 2008, and 2009 data on prenatal care, tobacco use,
place of delivery,
primary cesarean delivery and vaginal birth after previous cesarean delivery are
not considered comparable to data prior to 2007 due to the significant changes
in wording on the
certificates. These changes are detailed below:
Prenatal Care: The month prenatal care began has been changed
from a box asking for the month of pregnancy in which prenatal care began, to
questions asking for the date of last normal menses and the date of the first
prenatal visit. The month prenatal care began is then calculated from
these two variables. If the day of the month was unknown, the day of the
month was imputed using a program that the National Center for Health Statistics (NCHS) has developed. NCHS has
observed a decrease in the
percent of mothers receiving care in the first month for all states who have
adopted the revised certificate and considers it to be the
result of better reporting.
Tobacco Use: In 2006, the question was asked "Did mother smoke during pregnancy?"
Depending on the response, the facility would check one of the following boxes: Yes, No, or Unknown.
Starting in 2007,
more detailed information
was collected -- the average number of cigarettes (or packs of cigarettes) that were smoked during
the three months prior to becoming pregnant, the first three months of pregnancy, the second three months
of pregnancy, and the last trimester of pregnancy. If the mother smoked at any time
during her pregnancy,
she was considered to be a smoker for this report.
Primary cesarean and vaginal birth after previous cesarean (VBAC): In 2006,
there were check boxes
for the method of delivery, which included VBAC. The certificate now contains check boxes for
vaginal/spontaneous, vaginal/forceps, vaginal/vacuum, and cesarean delivery. Under cesarean, the question is
asked "Was a trial of labor attempted?" with check boxes for yes and no. To determine if the method
of delivery was a primary cesarean, repeat cesarean, or VBAC, we looked at a new
risk factor: "Mother had a previous cesarean delivery." If the box was
checked, we then looked at the number of previous cesareans.
Weight Gain: In 2006, weight gain during pregnancy was asked
directly. Starting in 2007, two new questions were asked instead --the
mother's pre-pregnancy weight and the mother's weight at delivery. Weight gain
was then calculated based
on those two responses.
Place of birth: The place of birth information has
been expanded and classified into slightly different categories. In
home births are now sub-divided into intended and unintended
of mother and father: Indiana now uses the 1997 Office of Management
and Budget (OMB) standards for collecting data on race and ethnicity.
Starting with the 2007 birth certificate, mother and father can
check more than one box for race. All racial and ethnicity information is now sent to the National
Center for Health Statistics (NCHS) which imputes a single ("bridged") race to the mother and
father based on the combination of races, Hispanic origin, sex, and age. This
"bridged" race is what is used in this report.
relationship between the two OMB standards and the terms used to
report race and ethnicity in this report are as follows: