In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.

Enthusiasm for 'doing something about Safe Motherhood' has been expressed in many developing countries, but priorities for action cannot be identified without adequately assessing a country's maternal mortality situation. It is also important, however, to avoid embarking on time-consuming research measuring indicators which are not essential to developing programs. After presenting an overview of ideal Safe Motherhood program components, the paper lists a series of questions which serve as an assessment tool for collecting useful information and for identifying data sources on maternal mortality and health. The framework for these questions centers around the following steps: (1) gaining an overview of health policy relevant to maternal mortality and morbidities; (2) assessing the magnitude and causes of maternal mortality and morbidity, and the characteristics of groups at particular risk; and (3) assessing the available inputs in terms of services (access, quality, providers, what is provided at various tiers, etc.) and in terms of the culture and existing resources and groups.

Background: Obstetric ultrasound scans may fail to provide all the information that is needed because of poor visualisation. Two main causes of poor visualisation are addressed. These are poor foetal position and poor quality imaging due to beam distortion by overlying fatty tissue. Method: To improve communication with patients attending obstetric scans, a poster and leaflet were designed to explain these causes of inadequate scans. A questionnaire was used to assess the value of the poster. Results: 57/66 (86%) questionnaires were completed. 52 (91%) found the information on the poster was helpful and well explained. For 8 (14%) the information changed their thoughts about the scan. Conclusion: Clear communication aids the expectant mothers understanding of why scans may be suboptimal. The way this is recorded in the scan results is discussed.

The RCOG (2001) recommend external cephalic version (ECV) for breech presentation at term. When practised at term ECV has been shown to be safe and effective avoiding the associated risks of a vaginal breech delivery for the fetus and caesarean section for the mother. However, despite evidence of benefit, the provision of ECV varies due to lack of appropriately trained medical staff available to perform this procedure safely and effectively. This article describes the introduction of a midwife-led ECV service at the Royal Victoria Infirmary Newcastle and includes the preparation and rationale for expanding the midwife's role, the training undertaken and results of independent clinical practice. The authors report a midwife success rate of 43%, which is comparable to that of an experienced obstetrician.

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