Trends in Midwife‐Attended Births in the United States, 1989‐2009

Introduction: Data on attendance at birth by midwives in the United States have been available on the national level since 1989. Rates of certified nurse‐midwife (CNM)–attended births more than doubled between 1989 (3.3% of all births) and 2002 (7.7%) and have remained steady since. This article examines trends in midwife‐attended births from 1989 to 2009. Methods: The data in this report are based on records gathered as part of the US National Standard Certificate of Live Birth from a public use Web site, Vital Stats ( http://www.cdc.gov/nchs/VitalStats.htm ), that allows users to create and download specialized tables. Results: Between 2007 and 2009, the proportion of all births attended by CNMs increased by 4% from 7.3% of all births to 7.6% and a total of 313,516. This represents a decline in total births attended by CNMs from 2008 but a higher proportion of all births because total US births dropped at a faster rate. The proportion of vaginal births attended by CNMs reached an all‐time high of 11.4% in 2009. There were strong regional patterns to the distribution of CNM‐attended births. Births attended by “other midwives” rose to 21,787 or 0.5% of all US births, and the total proportion of all births attended by midwives reached an all‐time high of 8.1%. The race/ethnicity of mothers attended by CNMs has shifted over the years. In 1990, CNMs attended a disproportionately high number of births to non‐white mothers, whereas in 2009, the profile of CNM births mirrors the national distribution in race/ethnicity. Discussion: Midwife‐attended births in the United States are increasing. The geographic patterns in the distribution of midwife‐attended births warrant further study.     

Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971–2017

Archives of Gynecology and Obstetrics - Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association...     

Trends in the Use of Episiotomy in the United States: 1980–1998

Background: Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy. Methods: Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short‐stay non‐Federal hospitals. Results: From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self‐pay category. The incidence of first‐ and second‐degree lacerations to the perineum increased for women without episiotomies, but the more severe third‐ and fourth‐degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps‐assisted deliveries or vacuum extractions. Conclusions: Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.     

Trends and Characteristics of Home Births in the United States by Race and Ethnicity, 1990–2006

Background: After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. Methods: U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. Results: From 1990 to 2006, both the number and percentage of home births increased for non‐Hispanic white women, but declined for all other race and ethnic groups. In 2006, non‐Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non‐Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non‐Hispanic white women, two‐thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or “other” attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. Conclusions: Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non‐Hispanic white women, a larger proportion of non‐Hispanic black and Hispanic home births represent unplanned, emergency situations. (BIRTH 38:1 March 2011)     

The changing epidemiology of multiple births in the United States

OBJECTIVE: To describe changes in the epidemiology of multiple births in the United States from 1980 to 1999 by race, maternal age, and region; and to examine the impact of these changes on birth weight-specific infant mortality rates for singleton and multiple births. METHODS: Retrospective univariate and multivariable analyses were conducted using vital statistics data from the National Center for Health Statistics. RESULTS: Between 1980 and 1999, the overall multiple birth ratio increased 59% (from 19.3 to 30.7 multiple births per 1000 live births, P <.001), with rates among whites increasing more rapidly than among blacks. Women of advanced maternal age, especially those aged 30-34, 35-39, and 40-44 experienced the greatest increases (62%, 81%, and 110%, respectively). Although all regions of the United States experienced increases in multiple birth ratios between 1991 and 1999, the Northeast had the highest twin (33.9 per 1000 live births) and higher order birth ratios (280.5 per 100,000 live births), even after adjusting for maternal age and race. Between 1989 and 1999, multiple births experienced greater declines in infant mortality than singletons in all birth weight categories. Consequently, very low birth weight and moderately low birth weight infant mortality rates among multiples were lower than among singletons. CONCLUSION: It is important to understand the changing epidemiology of multiple births, especially for women at highest risk (advanced maternal age, white race, Northeast residents). The attribution of infertility management requires further study. The differential birth weight-specific infant mortality for singletons and multiples demonstrates the importance of stratifying by plurality when assessing perinatal outcomes.     

Down syndrome births in the United States from 1989 to 2001

OBJECTIVE: We investigated the observed and expected Down syndrome livebirths in the US from 1989 to 2001. STUDY DESIGN: Using birth certificate data, we recorded maternal age-specific live births from 1989 to 2001, and stratified them by women 15 to 34 and 35 to 49 years old. We estimated Down syndrome live births from 1989 to 2001, assuming no terminations. We recorded Down syndrome live births by year from 1989 to 2001. RESULTS: Despite an expected 1.32-fold increase in Down syndrome live birth rates from 1989 to 2001, Down syndrome live births actually declined. In 1989, the rate of Down syndrome cases was 15% lower than expected, decreasing to 51% by 1998. Women 15 to 34 had 45% fewer affected pregnancies in 2001, while women 35 to 49 had 53% fewer in 2001. We estimated that Down syndrome live births decreased from 3962 in 1989 to 3654 in 2001. CONCLUSION: Down syndrome live births declined in the US despite an expected increase caused by delayed or extended childbearing.     

Triplet births in the United States. An epidemic of high-risk pregnancies

OBJECTIVE: To more precisely understand the changes in triplet births in recent years. STUDY DESIGN: Analysis of recent government and medical publications pertaining to triplets. RESULTS: Triplet births are at much greater risk than singletons of poor birth outcomes. More than 9 of 10 triplet births are born preterm (< 37 completed weeks of gestation) as compared with < 1 of 10 singleton infants. The average weight of a triplet newborn (1,698 g) is one-half that of a singleton newborn (3,358 g). The infant death rate for triplet and other higher-order multiple births is 12 times higher than that for singletons (93.7 as compared with 7.8 infant deaths per 1,000 live births). CONCLUSION: Based on their frequency of preterm birth, low birth weight and infant death rate, it is appropriate to characterize all triplet pregnancies as high risk.