Birth And Fetal Death (BFDR) - STU2-ballot
2.0.0-Preview1 - trial-use United States of America flag

Birth And Fetal Death (BFDR) - STU2-ballot, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0-Preview1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

Change Log

Post-Ballot Changes


  • FHIR-43458 - Improve support for birth, transfer-from, and transfer-to locations. Added new BFDR Location Profile, and updated EncounterMaternity and EncounterBirth to reference the new profile. Data dictionary has been updated to correctly document mapping of SFN and FNPI fields, and all other facility-related fields.
  • FHIR-43473 - To improve consistency with VRDR the key reporting identifiers (birth cert no, fetal death report number, local file numbers, and overall record identifier) were moved from the Composition.identifier to the Bundle.identifier and were updated to use standardized extensions. The definitions of these extensions will also be moved to the Vital Records Common Library.


STU2 Ballot, January 2024

Major Changes

Minor Changes

STU 1.1 Update, July 2023

Jira Issue Description of Change Changes Made
FHIR-40613 On profiles:
Composition - Provider Live Birth Report
Composition - Provider Fetal Death Report
Make all slices on Composition.identifier optional (0..1) (as opposed to 1..1)
Update Composition.identifier slices to 0..1 on:
Composition - Provider Live Birth Report
Composition - Provider Fetal Death Report
FHIR-40680 Observations with value sets containing a mix of Conditions, Observations, and Procedures have been used in the IG. This is not how the data is represented in the real world. Split the Observations into separate profiles using the appropriate resource.
Replaced profiles:

Condition - Abnormal Condition of Newborn
Condition - Maternal Morbidity
Observation - Characteristic of Labor and Delivery
Added the following profiles:

Procedure - Assissted Ventilation Following Delivery
Procedure - Assisted Ventilation More Than Six Hours
Observation - NICU Admission
Procedure - Surfactant Replacement Therapy
Procedure - Antibiotic for Suspected Neonatal Sepsis
Condition - Seizure
Observation - None Of Specified Abnormal Conditions of Newborn
Procedure - Blood Transfusion
Condition - Perineal Laceration
Condition - Ruptured Uterus
Procedure - Unplanned Hysterectomy
Observation - ICU Admission
Observation - None Of Specified Maternal Morbidities
Procedure - Induction of Labor
Procedure - Augmentation of Labor
Observation - Administration of Steroids for Fetal Lung Maturation
Observation - Antibiotics Administered During Labor
Condition - Chorioamnionitis
Procedure - Epidural or Spinal Anesthesia
Observation - None Of Specified Characteristics of Labor and Delivery
FHIR-40847 Update to latest published version of US Core (5.0.1) Small updates based on US Core profiles changes
Update to Condition profiles due to split in US Core Condition into US Core Condition Encounter Diagnosis and US Core Problems and Health Concerns Profile
- after consultation on Zulip, all cause of death condition profiles are based on US Core Condition Encounter Diagnosis, and all other Condition profiles are based on US Core Problems and Health Concerns Profile
FHIR-40929 Revisit profile focus/subject mappings (mother and child/fetus) and update where needed
During the Connectathon implementers noticed that there were a few profiles where the focus and subject were the wrong way round. Need to list all the profiles and ensure that they are all correct and update where needed.
FHIR-41323 Add and update a “Change Log” narrative page to the BFDR This file/referencing page
FHIR-41325 Update Narrative pages for project info, correct external links, etc. Additionally, remove the IHE page and include relevant information on remaining narrative pages. Narrative pages
FHIR-41385 Add Extension to Live Birth Compositions to reference maternity Encounter

Composition.encounter is limited to a maximum of 1 encounter, however a Live Birth spans two encounters - the Birth Encounter and the Maternity Encounter. The two Live Birth Compositions have the Birth Encounter as the one encounter referenced. Pilot implementers have requested that we add an extension to these Compositions to reference the Maternity Encounter to allow them to more easily get to the data in that Encounter.

Add to Composition - Provider Live Birth Report and Composition - Jurisdiction Live Birth Report an extension (must support and 0..1) that references the Maternity Encounter.
Added: Extension-encounter-maternity-reference
Updated both Live Birth Compositions to optionally contain extension (on Composition.encounter)
FHIR-41386 Add receipt date Parameters profile similar to VRDR “Coding Status Values”
Adding a Parameters profile similar to StructureDefinition-vrdr-coding-status-values
will allow BFDR implementers to use status flags that result from the NCHS coding process, e.g., Receipt date – Day, Month, Year (IJE codes R_DY, R_MO, R_YR)
Added profile to VRCPL: Parameters-coding-status-values-vr
FHIR-41387 Add Extension similar to VRDR “Extension: Replacement Status of a Death Record”, for replacement status of a birth / fetal death record

Adding an Extension will allow implementers to designate a Replacement (amended) record (IJE code: REPLACE) in IJE exchanges.

In VRDR, the Extension is on the Death Certificate composition.

Similarly, in BFDR, the extension will be available for the 4 Compositions (Provider/Jurisdiction Live Birth Report & Provider/Jurisdiction Fetal Death Report)
Added profile: Extension-replacement-status
FHIR-41564 FHIR-IJE Mismatch: This profile is used for the value known as AUTOPF.

According to IJE Spreadsheet, the AUTOPF is a Y/N/NA value.
The profile provides only a boolean value.
Suggest that it be a codeable concept bound to a Y/N/NA valueset.
Updated as suggested
FHIR-41580 Obsolete value in PHVS_FetalPresentations_NCHS value set: SNOMEDCT code 163518000 – On examination – fetal presentation unsure Replace code with nullFlavor UNK in PhinVads value set: 2.16.840.1.114222.4.11.7113
FHIR-41596 Composition data sources for items on the mother’s/patient’s worksheet: The provider live birth composition HL7.FHIR.US.BFDR\Composition - Provider Live Birth Report - FHIR v4.0.1 and the provider fetal death report composition HL7.FHIR.US.BFDR\Composition - Provider Fetal Death Report - FHIR v4.0.1 include elements that have information that is directly asked from the mother and typically not found in the same format within an EMR unless this information is collected from the mother using the questions and wording of the jurisdiction’s mothers’ worksheet for the birth certificate via a patient portal or tablet that is uploaded to the EMR. The data source for this information should be the mother (live birth) or patient (fetal death). To help make this more explicit for implementers we are requesting that descriptions within the entries be updated to include such information on where the information may be found. Add data source to Composition, Profiles, add guidance on mapping tables page, add guidance on use cases page.
FHIR-41600 Add guidance on:Mother/Baby linkage: Consider adding guidance (perhaps on Use Cases) on how FHIR models mother/baby linkage using RelatedPerson and noting that EHR systems may not use this method of linking the two participants. Added guidance as suggested and also added guidance on alternate way of linking mother and baby found in some EHRs.
FHIR-41601 Add guidance on Plurality & Multiple Births Added guidance as suggested on Use Cases page
FHIR-41602 Add guidance on sources and coding of data for forms Added guidance as suggested on Use Cases page