Attendant, Place and Timing, and Use of Obstetric Interventions of U.S. Births...

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Midwives and Doctors of Osteopathy were increasingly more likely to attend births; obstetric procedures, such as electronic fetal monitoring increased substantially; induction of labor doubled, and babies were more frequently delivered on weekdays--just a few of the changes in birth patterns in the United States during the 1990s. The report also found that for the first time in this decade, the rate of cesarean births increased slightly between 1996 and 1997 after a steady downward trend between 1989 and 1996.

Many of the circumstances surrounding having a baby in the United States changed between 1989-1997 according to the newly released report, "Trends in the Attendant, Place and Timing of Births, and in the Use of Obstetric Interventions: United States, 1989-97," from the National Center for Health Statistics, Centers for Disease Control and Prevention. Drawing data from birth certificates filed in state vital statistics offices and reported to the NCHS, this report profiles the latest nationwide practices in birth and delivery as well as variations by state.

Key findings from the report show:

*While the vast majority of births in 1997 (92 percent) were attended by physicians, this proportion has declined steadily as the percent of births attended by midwives has slowly increased to account for 7 percent of all births. For physician-attended births, the number attended by M.D's dropped almost every year of the period while those attended by D.O's consistently increased.

*About 99 percent of births were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that were in residences increased while those in freestanding birthing centers declined.

*While births were more common on weekdays than on weekends in 1989, they have become even more concentrated on weekdays since 1989. Births delivered by repeat cesarean and vaginal births that were induced are especially likely to occur on weekdays. The single most popular day is Tuesday. The most popular months to give birth continue to be July, August, and September.

*The percent of mothers receiving electronic fetal monitoring, ultrasound, induction, and stimulation all increased over the period with the most dramatic increase being the doubling of the use of induction of labor (from 9 percent in 1989 to 18 percent in 1997).
Between 1989 and 1996, the rate of cesarean births dropped by 9 percent (from 22.8 per 100 births to 20.7) while the rate of vaginal birth after a previous cesarean (VBAC) increased by 50 percent (from 18.9 per 100 women who have not had a previous cesarean to 28.3). However, the trends appear to have changed between 1996 and 1997--the cesarean rate increased slightly while the VBAC rate declined by 3 percent. The highest cesarean rate in 1997 was in Mississippi (26.7) while the lowest was in Colorado (15.3).
The percent of births that were delivered by forceps consistently declined during the period, from 5.5 to 2.8 percent of births, whereas the use of vacuum extraction consistently increased, from 3.5 to 6.2 percent.
Copies of the report by Sally C. Curtin and Melissa M. Park are available from NCHS or can be viewed or downloaded without charge from the NCHS website at
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