1. William M. Sappenfield, MD, MPH Professor & Chair, Dept. of Community & Family Health Director, Lawton & Rhea Chiles Center for Healthy Mothers & Babies University of South Florida College of Public Health Non-Medically Indicated Deliveries Before 39 Weeks in Florida: What Can Birth Certificates Tell Us?

2. Data Files  Birth Certificates, 2004-2010  Linked Birth Certificates and Hospital Discharges, 2004-2007

3. Methods Restricted Live Births to:  Singleton  Florida Residents  Term (37 weeks or more)  No medical conditions prior to or during pregnancy Non-Medically Indicated:  Induction or cesarean  No labor  37 or 38 weeks gestation  No Joint Commission indications

4. Percent of NMI Single Liveborn Infants of Early Term, Linked & Birth Certificate Files, 2004-10 Data Source: Florida Live Birth Certificate and Linked Birth Certificate and Hospital Discharge Data

5. Percent of NMI Single Live Births <39 Wks Among Term Births for Florida Hospitals by Quintile Data Source: Florida Live Birth Certificate Data Highest 20% Lowest 20%

6. Percent of NMI Single Live Births <39 Wks Among Term Births for Florida Hospitals by Quintile Data Source: Florida Live Birth Certificate Data Six FL Pilot Hospitals Highest 20% Lowest 20%

7. Percent of NMI Single Live Births <39 Wks Among Term Births for Florida Hospitals by Quintile Data Source: Florida Live Birth Certificate Data Six FL Pilot Hospitals Highest 20% Lowest 20% HEN Hospitals

8. Percent of NMI Single Live Births <39 Wks Among Term Births for FL HEN Hospitals, 2011 Highest 20% Lowest 20% Data Source: Florida Live Birth Certificate Data 6 FL Pilot Hospitals

9. Hospital Fact Sheets Using Birth Certificate Data

10. Maternal and Hospital Risk Factors NMI Delivery Before 39 Weeks, Florida 2006-07 Inductions Primary Cesareans Repeat Cesareans Maternal Characteristics Older AgeX Non-Hispanic White, HispanicXXX Higher EducationX Medicaid, Private InsuranceXXX Greater ParityX MarriedXXX Underweight, Overweight, ObeseXX Hospital Characteristics Lower % of Hospital Midwife BirthsXX Government Hospital OwnershipX

11. Take Home Points Birth certificate data provide a surrogate measure of NMID <39 weeks—Small overestimate in the percent Birth certificate data show major differences in the percent of NMID <39 weeks among Florida hospitals Birth certificate data show substantial rate improvement in Big 5 Florida Pilot Hospitals compared to the HEN Linked data show major differences in percent by mother and hospital characteristics. The “Fact Sheets” may be helpful in sharing your hospital information with others.