Board of Certified Professional Midwives Forms

Birth Reporting Forms are how the Board of CPM fulfills SDCL 36-9C-37 and ARSD 20:86:03:10(6). The Dept. of Health, legislators, and the public expect the board to know when there was a need for transfer for medical care or intervention. The Birth Reporting form is also the first document reviewed when a complaint is received so timeliness and accuracy are important. 

When should you send a Birth Reporting Form?

• Intrapartum transfer – If the transfer of care is necessary during labor or birth, please provide a Birth Reporting Form, the Transport Form (a photo or photocopy is acceptable), and a typed narrative of why you transferred care. This must be postmarked within 30 days of the transfer. There is no fee. SDCL 36-9C-37. 
  
  
• Maternal Postpartum-no transfer – If no transfer occurs, please provide a Birth Reporting Form and the $100 birth delivery fee postmarked within 30 days of the birth. SDCL 36-9C-37. 
  
  
• Maternal Postpartum-transfer occurs - If transfer of care is necessary, or the client requires medical intervention within 42 days of the birth, please provide the Birth Reporting Form, $100 birth delivery fee, Transport Form (a photo or photocopy is acceptable), and a typed narrative of why you transferred care (even if you continued to provide care during and after the medical intervention). This must be postmarked within 30 days of the birth. If the transfer occurs after the Birth Reporting Form has been sent (even if the transfer is directed electronically), resend a copy of the Birth Reporting Form with a supplemental narrative of the current issue. ARSD 20:86:03:10(6)
  
  
• Neonatal Transfer - If you transfer care or the neonate requires medical intervention within 28 days of the birth, please provide a Birth Reporting Form, a $100 birth delivery fee, the Transport Form (a photo or photocopy is acceptable), and a typed narrative of why you transferred care (even if you continued to provide care during and after the medical intervention).  This must be postmarked within 30 days of the birth. If the transfer occurs after the Birth Reporting Form has been sent, (even if the transfer is directed electronically) resend a copy of the Birth Reporting Form with a supplemental narrative of the current issue. ARSD 20:86:03:10(6) 
  
  
• Late Birth Reporting - Any Form (including the typed narrative) postmarked after 30 days may be subject to disciplinary action. SDCL 36-1C-5 

Birth Reporting Form

The CPM responsible for filing the birth record shall submit the completed, original forms to:   Vital Records, 221 W. Capitol Ave, Pierre SD 57501.

• Parent’s Worksheets - this is to be filled out by the parents. 
  • First name - if they do not have a first name picked out yet, they cannot get a birth certificate or social security card.
  • Last name - if the mother is married, the child can be given any last name. If the mother is unmarried, the last name can only be the mother’s current legal last name, or father’s last name (with paternity), or a combination of both names. 
  • Same-gender parents - if the mother who gave birth is married, their spouse may be listed as the 2nd parent.
    
    
• Certifier Worksheets - this is to be filled out by the attending CPM. If any information is missing, the birth will not be registered until the completed forms are received.
  
  
• Newborn Screening - If metabolic and/or hearing screenings are refused; check the appropriate box indicating the reason. 
  
  
• Voluntary Acknowledgement of Paternity Affidavit (if applicable) - If parents aren’t married and would like to add the father and/or give the baby's father’s last name, this form must be completed and signed in front of a notary public by both parents. With a paternity affidavit, the last name of the child can either be the mother’s, the father’s, or a combination of both. 
• Proof of Pregnancy, Live birth, and Mother’s Presence in South Dakota at the time of Birth - Submit the signed Evidence Necessary to Establish the Facts of Birth Form with the other documents.
  
  
• Birth certificate Availability - Once the birth is filed then the birth certificate is available through the Vital Records Office or at any South Dakota Register of Deeds office.  The fee for obtaining a certified birth certificate is $15. The application (the last page of the Parent's worksheet attachment) and a valid photo ID are required to obtain a certified copy.
   
• Social Security card - If requested by the parents on the Parents Worksheets, the card will be mailed directly to them within 6-8 weeks using the mailing address listed for the mother.