The cesarean delivery rate in England has remained stable at 24 percent in 2010-11 compared with the same percentage in 2009-10 according to the Health and Social Care Information Centre, which was previously known as The National Health Service Information Centre (NHS Maternity Statistics, England—2010-11). Of all births, 14.8 percent were by emergency cesarean and 10.1 percent were by elective cesarean, compared with 14.8 and 10.1 percent, respectively, in the previous year. Of the 10 regions in England, London's Strategic Health Authority recorded the highest cesarean delivery rate at 28.2 percent whereas the North East region recorded the lowest at 22.4 percent. The average postnatal length of stay in 2010-11 was 1.2 days for spontaneous delivery, 1.8 days for instrumental delivery, and 2.8 days for cesarean delivery. The averages were 1.2, 1.9, and 2.9 days, respectively, in the previous year. Chief Executive of The NHS Information Centre Tim Straughan said, “Just below a quarter of deliveries in English hospitals are by caesarean. However, there is substantial variation in the caesarean rate in different areas of the country, with seven out of ten trusts with the highest rates of all in London.”

Breastfeeding rates are up sharply in the United States, according to a recent report from the Centers for Disease Control and Prevention (Breastfeeding Report Card—United States, 2012). Breastfeeding rates continue to rise, with increases of about 2 percentage points in breastfeeding initiation, and breastfeeding at 6 and 12 months. Breastfeeding initiation increased from 74.6 percent in 2008 to 76.9 percent in 2009 births. This improvement in initiation represents the largest annual increase over the previous decade. Breastfeeding at 6 months increased from 44.3 to 47.2 percent; breastfeeding at 12 months increased from 23.8 to 25.5 percent. The findings were published the same day that a federal health reform law (PL 111-148) provision took effect that requires health plans to cover comprehensive lactation support, counseling and equipment, such as breast pump rentals. The law also requires employers to provide breastfeeding women with break times and a private location that is not a bathroom to express milk or breastfeed for up to 1 year after giving birth (M. Healy, “Booster Shots,” Los Angeles Times, Aug. 1, 2012).

A 30 percent jump in the number of preterm births in the United States between 1992 and 2004 appears to be linked to the increasing numbers of medically induced labors, according to a recent study (BJOG online, Aug. 13, 2012). Researchers compared National Center for Health Statistics data on non-Hispanic white women from 1992 through 1994 with data from 2002 through 2004. The study found that preterm births increased from 6.4 percent of deliveries in 1992 to 8.5 percent in 2004, whereas labor induction increased from 13.7 to 26 percent during that the same period. The researchers also examined whether cesarean sections were associated with the increase in preterm births. They concluded that cesareans were not a major factor driving the increase because most were performed during labors that began naturally. Lead researcher Michael Kramer of the McGill University Faculty of Medicine in Montreal said that he does not think physicians are inducing labor for nonmedical reasons. The problem, he said, is that the decision to perform an early labor induction is “socially contagious,” adding, “the threshold has been going down for induction over the years, and I don't think we've shown that's been a benefit” (A. Seaman, Reuters, Aug. 31, 2012).

The following Statement on Rape and Pregnancy has been issued by the American College of Obstetricians and Gynecologists (Press Release, Aug. 20, 2012).

Recent remarks by a member of the U.S. House of Representatives suggesting that “women who are victims of ‘legitimate rape’ rarely get pregnant” are medically inaccurate, offensive, and dangerous. Each year in the U.S., 10,000–15,000 abortions occur among women whose pregnancies are a result of reported rape or incest. An unknown number of pregnancies resulting from rape are carried to term. There is absolutely no veracity to the claim that “If it's a legitimate rape, the female body has ways to shut that whole thing down.” A woman who is raped has no control over ovulation, fertilization, or implantation of a fertilized egg (i.e., pregnancy). To suggest otherwise contradicts basic biological truths.

Any person forced to submit to sexual intercourse against his or her will is the victim of rape, a heinous crime. There are no varying degrees of rape. To suggest otherwise is inaccurate and insulting and minimizes the serious physical and psychological repercussions for all victims of rape.

The Republican Congressman immediately came under fire for his remarks from both Republican and Democratic politicians, including President Obama. Expressions of outrage were also voiced by the American College of Nurse-Midwives, health experts, women's representatives, and consumer groups.

Pressure is growing to repeal China's one-child law, but “overzealous enforcement” continues to be a problem, according to a recent news article (E. Wong, NY Times, July 22, 2012). Reports of women being coerced into late-term abortions by local officials have thrust China's population control policy into the spotlight recently and ignited an outcry among policy advisers and scholars who are seeking to push central officials to fundamentally change or repeal a law that penalizes families for having more than one child. Pressure to alter the policy is building on other fronts as well, as economists say that China's aging population and dwindling pool of young, cheap labor will be a significant factor in slowing the nation's economic growth rate. The one-child policy was introduced in 1978 and initially applied to first-born children from 1979 in an effort by the Chinese government to alleviate social, economic, and environmental problems in China, according to Pascal Rocha da Silva (“La politique de l'enfant unique en République populaire de Chine” [The politics of one child in the People's Republic of China], University of Geneva, 2006:22–28). In addition to debate about the law itself, critics say that enforcement leads to widespread abuses because many local governments reward or penalize officials based on how well they keep down the population.

In 2011 the cesarean delivery rate in the United States was 32.8 percent of all births, unchanged from 2010, according to preliminary data from the National Center for Health Statistics (Births: Preliminary data for 2011. Natl Vital Health Stat 2012;61(5):5).

According to final data for 2010 (Births: Final data for 2010. Natl Vital Health Stat 2012:6(1):12), more than one in four births were by cesarean delivery for 46 states and Washington, DC. The vaginal birth after a previous cesarean (VBAC) rate was 9.2 percent and the primary cesarean delivery rate was 23.6 percent for a reporting area of 33 states and Washington, DC. The reporting area included 76 percent of all U.S. births in 2010. Of women who had a cesarean delivery, 27.2 percent experienced a trial of labor for all ages, but of women under 20 years of age, 46.6 percent had a trial of labor compared with 19.8 percent for women aged 35 years and older. The cesarean delivery rates remained unchanged for all but 11 states. Among the states, rates ranged from 22.6 percent in Alaska to 39.7 percent in Louisiana, a 76 percent difference.

The rate of inductions in 2010 was 23.9 percent of all births for the reporting area of 33 states and Washington, DC, but some underreporting of induction on the birth certificate is possible. Augmentation of labor was reported for 21 percent of all births, and 69.3 percent of women in 2010 had epidural or spinal analgesia. The use of forceps- and vacuum-assisted vaginal births continued to decline in 2010.

The number of births declined in the United States to 3,999,386 in 2010, which is 3 percent less than in 2009, according to the National Center for Health Statistics (NCHS) (Births: Final data for 2010. Natl Vital Health Stat 2012;61(1)). The teenage birth rate fell 10 percent to 34.2 per 1,000 women ages 15 to 19 years, and although birth rates for women in each 5-year age group 20 to 39 years declined, the rate for women aged 40 to 44 years continued to increase. The number, rate, and percentage of births to unmarried women declined. The preterm birth rate dropped for the fourth year in a row to 11.99 percent, and the low-birthweight rate was stable at 8.15 percent. The twin birth rate declined slightly to 33.1 per 1,000 births, and the triplet and higher-order multiple birth rate dropped 10 percent to 137.6 per 100,000 births.

The long-term declines in teenage birth rates have been linked to the strong pregnancy prevention messages directed to teenagers. Recently released data from the 2006-2010 National Survey of Family Growth conducted by the NCHS have shown increased use of contraception at first intercourse and use of dual methods of contraception (i.e., condoms and hormonal methods) among sexually active male and female teenagers. These trends have likely contributed to the recent birth rate decline, the NCHS report noted.