Massachusetts Registration of Home Births Packet (R-3PH)
Official state formOther requestsForm R-3PHFree downloadLast verified November 10, 2026
Packet parents use to register a home birth that no physician attended. It has instructions, two parent worksheets, a midwife worksheet and a sample affidavit. It is presented to the city or town clerk where the birth occurred, not mailed to the state registry.
Who can use this form
- Parents of a child born in Massachusetts outside a hospital, with no physician attending, when mother and baby were not moved to a hospital for postnatal care.
- The packet says parents must report the birth to the city or town clerk where it occurred within 40 days.
- The midwife or other birth attendant completes the Part C worksheet and a notarized statement about the birth.
- For a birth more than 365 days ago, the packet says to check with the city or town clerk about a delayed record of birth.
What to send with it
- Part A, Parent Worksheet for Certificate of Live Birth, completed and signed.
- Part B, Parent Worksheet for Confidential Birth Reporting, and Part C, the midwife or attendant worksheet. The clerk does not keep these; they go to the state health department for statistics.
- Proof of the facts of birth: a notarized statement from the birth attendant (the packet has a sample affidavit). More statements are needed if the attendant was the father or a close family member.
- Proof of the place of birth: proof of the mother's residence, such as a street listing, voter registration or assessor's records for the year of birth.
- If the parents are married to each other: a certified copy of their marriage license, as the packet states.
- Parents bring the evidence and worksheets to an appointment with the clerk, who prepares a birth certificate verification form for them to sign.
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- 10.15.2021
- Source
- Official government page