Postgraduate Research Training in Reproductive Health - Fudan University, Shanghai

Postgraduate Research Training in Reproductive Health

Fudan University, Shanghai

Questions and answers

What is the definition of live birth?

organised by

The Fudan University, Shanghai
The Geneva Foundation for Medical Education and Research (GFMER)
The UNDP/UNFPA/WHO/World Bank Special Programme for Research in Human Reproduction, Department of Reproductive Health and Research, Family and Community Health Cluster World Health Organization (WHO/RHR)
The International Association of Maternal and Neonatal Health (IAMANEH)

in collaboration with

The Department of Health of the Canton of Geneva
The Faculty of Medicine, Geneva University and
The Geneva Medical Association

Definitions of live birth

World Health Organization / United Nations
1. World Health Organization, 1950
  A live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or any definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
  A fetal death is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, as indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
2. United Nations. (1955). Principles for a vital statistics system. Statistical papers series, M(19).
  A live birth is defined as the complete compulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live birth.
3. United Nations Statistics Division
  A live birth is the result of the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which after such separation breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered to be live-born.
Canada
1. Ontario Live Birth Database
  The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life.
Europe
1. European Union
  The complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which after such expulsion or extraction, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
Israel
1. Ministry of Health - Israel
  Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live-born. The number of live births includes all live births during the given calendar year, irrespective of registration of the date of birth.
New Zealand
1. Statistics New Zealand
  The birth of a child, who breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered liveborn. All liveborn infants should be registered and counted as such irrespective of length of gestation or whether alive or dead at the time of registration. If they die at any time following birth they should also be registered and counted as deaths.
United States of America
1. California Department of Health Services - Office of Health Information and Research
  The complete expulsion or extraction from its mother of a product of conception (irrespective of the duration of pregnancy) which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. This definition was promulgated by the World Health Organization in 1950 and is set forth in the California Administrative Code, Title 17, Chapter 1, Article 3.
2. Colorado Health Information Dataset
  The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes, or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born.
3. Florida Department of Health
  In the World Health Organization's definition, also adopted by the United Nations and the National Center for Health Statistics, a live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
4. Indiana State Department of Health
  A live birth is any infant who breathes or shows any other evidence of live (such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles) after separation from the mother’s uterus, regardless of the duration of gestation.
5. Kentucky Cabinet for Health Services
  The complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of the pregnancy, which, after such expulsion or extraction, breathes or shows any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles whether or not the umbilical cord has been cut or the placenta is attached. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.
6. National Bureau of Economic Research
  Every product of conception that gives a sign of life after birth, regardless of the length of the pregnancy, is considered a live birth. This concept is included in the definition set forth by the World Health Organization: "Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered liveborn".
  This definition distinguishes in precise terms a live birth from a fetal death (see the section on fetal deaths in the Technical Appendix of volume II, Vital Statistics of the United States). In the interest of comparable natality statistics, both the Statistical Commission of the United Nations and the National Center for Health Statistics (NCHS) have adopted this definition.
7. National Center for Health Statistics
  In the World Health Organization’s definition, also adopted by the United Nations and the National Center for Health Statistics, a live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
8. Ohio Department of Health
  The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
9. Wisconsin State Legislature
  2003 Wisconsin Act 110 addresses the meaning of the terms “born alive” and “live birth” as those terms appear in Wisconsin statutory and administrative law. The Act is based on the federal Born-Alive Infants Protection Act of 2002, enacted as P.L. 107-207 and codified as 1 U.S.C. s. 8. Act 110 provides that in the construction of Wisconsin laws, the term “live birth” is to be construed as follows unless the construction would produce a result inconsistent with the manifest intent of the Legislature: “Live birth” means the complete expulsion or extraction from his or her mother, of a human being, at any stage of development, who, after the expulsion or extraction, breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, a cesarean section, or an abortion, as defined in s. 253.10 (2) (a).
  For purposes of the definition of “live birth,” “breathes” means “draws air into and expels it out of the lungs one or more times.”
  Act 110 also includes two rules for construing Wisconsin laws that are to be observed unless construction in accordance with the rule would produce a result inconsistent with the manifest intent of the Legislature. The two rules of construction are: (1) an individual who undergoes a live birth is born alive; and (2) if a statute or rule refers to a live birth or to the circumstances in which an individual is born alive, the statute or rule shall be construed so that whoever undergoes a live birth as the result of an abortion, as defined in s. 253.10 (2) (a), has the same legal status and legal rights as a human being at any point after the human being undergoes a live birth as the result of natural or induced labor or a cesarean section.
Others
1. CDC Division of International Health
  Significant differences exist between infant mortality rates published by the Central Asian countries and the rates derived from several USAID-supported surveys, primarily due to differences between the definition of live birth used in the Central Asian countries and the WHO definition. WHO considers a live birth any child that breathes or shows any other sign of life after separation from the mother, irrespective of the duration of pregnancy. According to the definition of live birth currently used in Kazakhstan and other Central Asian countries, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and classified as a late miscarriage even if signs of life are present at the time of delivery. Accordingly, some events classified as late miscarriages in the official registration system would be classified as live births and early infant deaths according to the WHO definition. Also, significant underreporting of cases of infant death takes place in the official registration system.
  CDC is working with UNICEF and and the Ministries of Health in Central Asia to facilitate transition to the WHO definition of live birth in Central Asian countries by conducting educational seminars, providing specialized neonatal equipment, and assisting with the modification and subsequent implementation of government policies on infant mortality reporting.
2. eMedicine - Use of Vital Statistics in Obstetrics
  Delivery after 20 weeks’ estimated gestational age (EGA) in which any activity is noted is classified as a live birth, with the possible caveat noted under Abortion. This is a difficult definition, as the lower limit of reasonable viability currently remains around 23 weeks’ EGA. Thus, a spontaneous delivery at 21 weeks’ EGA with reflex motion but no ability to survive with or without intervention would nonetheless be considered a live birth.
3. Transition Newsletter, World Bank
  Failing to use the WHO definition of live birth.
  A baby’s death may go unrecorded because the baby was never officially alive. The WHO definition says an infant is alive if it exhibits any signs of life. The Soviet era-definition—still dominant in several CIS countries-uses breathing as the sole indicator of life. Under the Soviet definition, moreover, infants who are born before 28 weeks of gestation, who weigh less than 1,000 grams, or who are less than 35 centimeters long are not considered live births unless they survive for seven days.
4. Wikipedia
  A live birth of a human being occurs when a fetus is expelled and separated from the mother's body and subsequently shows some sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time. In the absence of such sign, the event is considered a fetal death. This definition was created by the World Health Organization in 1950 and is chiefly used for public health and statistical purposes. Whether the birth is vaginal or Cesarean, and whether the baby is ultimately viable, is not relevant to this statistical definition.