In August, a review of Midwife-led continuity models vs other models of care for childbearing women was published by the Cochrane Database of systematic reviews. It included 13 trials involving 16,242 women, and found that women who had midwife-led continuity models of care were less likely to experience regional analgesia, episiotomy, and instrumental birth, and were more likely to experience spontaneous vaginal birth. Women who were randomized to receive midwife-led continuity models of care were less likely to experience preterm birth and fetal loss before 24 weeks' gestation, although there were no differences in fetal loss/neonatal death of at least 24 weeks or in overall fetal/neonatal death. The majority of included studies reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. Similarly, there was a trend toward a cost-saving effect for midwife-led continuity of care compared with other care models. The authors concluded that most women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications. The report is available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract.
The European Perinatal Health Report: The health and care of pregnant women and babies in Europe in 2010 was released in August 2013 and is available at: http://www.europeristat.com/. This report brings together data from 26 European Union member states, plus Iceland, Norway, and Switzerland. The report presents data on infant, fetal and perinatal mortality, low birthweight and preterm birth alongside data about health care and maternal characteristics that can affect the outcome of pregnancy. It also illustrates differences in the ways that data are collected and explains how these can affect comparisons between countries. The report found wide differences between the countries of Europe in indicators of perinatal health and care. This account is the most comprehensive report on the health and care of pregnant women and babies in Europe since the first European Perinatal Health Report (based on 2004 data) was published in 2008. Another report in this series will be published in late fall 2013.
An Update on Research Issues in the Assessment of Birth Settings: Workshop Summary was published in September 2013, and is available at: http://www.nap.edu/catalog.php?record_id=18368. This study contains a summary of a March 2013 workshop on this topic convened by the Institute of Medicine, National Academy of Sciences, and the National Research Council. The report contains a wealth of current information on a variety of topics related to birth settings, including assessment of risk in pregnancy, birth settings and health outcomes, workforce issues, data and measurement issues, cost and reimbursement issues, and perspectives from providers.
In Fall 2013, the Journal of Clinical Ethics published a special issue devoted entirely to the ethics of home birth. It includes 16 articles with varying perspectives on home birth, and an excellent article on the legal status of home birth and midwifery care in the United States.
Listening to Mothers III is the third in a series of landmark studies that surveyed American women about their maternity experiences. This study surveyed 2,400 mothers who gave birth in hospitals in 2011 and 2012. Like the first two Listening to Mothers studies, Listening to Mothers III asked women about their desires and experiences in pregnancy and childbirth, facilitating comparisons over time. New content was also added, including an in-depth section on shared decision-making for medical interventions such as cesarean section, among other topics. Two new reports in the Listening to Mothers series were released this year: Listening to Mothers III: Pregnancy and Birth in May, and Listening to Mothers III: New Mothers Speak Out in June. Both reports are available at: http://www.childbirthconnection.org/article.asp?ck=10450.
The number of out-of-hospital births in the United States continued to increase in 2011, according to Births: Final data for 2011, available at: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_01.pdf. In 2011, there were 49,893 out-of-hospital births, comprising 1.26 percent of births in the United States. Of these, 33,043 (0.84%) were home births and 14,206 (0.33%) were birthing center births. After a gradual decline from 1990 to 2004, the percent of home births increased by 50 percent from 2004 to 2011, while the percentage of birthing center births increased by 58 percent during the same period. Out-of-hospital births were more common among non-Hispanic white women with one out of every 53 births (1.89%) among this group in the United States in 2011 an out-of-hospital birth.
The cesarean delivery rate in the United States remained at 32.8 percent of U.S. births in 2012 for the third straight year, according to Births: Preliminary data for 2012, available at: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_03.pdf. Previously, the U.S. cesarean rate had increased from 20.6 percent of U.S. births in 1996 to a high of 32.9 percent in 2009. The percent of low birthweight births was 7.99 percent in 2012, down from a high of 8.26 percent in 2006. The preterm birth rate in the United States fell from a high of 12.80 percent in 2006 to 11.54 percent in 2012, although the U.S. rate is still higher than in most other developed countries. Previously, the preterm birth rate had increased from 9.40 percent in 1984 to a high of 12.80 percent in 2006.
A recent report explored changes in cesarean rates by gestational age in the United States, and identified a decline from 2009 to 2011 in cesarean deliveries at 38 weeks' of gestation and an increase at 39 weeks' of gestation. The authors concluded that this shift toward longer pregnancies is consistent with efforts to reduce non-medically indicated deliveries before 39 weeks' of gestation. The report is available at: http://www.cdc.gov/nchs/data/databriefs/db124.pdf.
After a plateau from 2000 to 2005, the U.S. infant mortality rate declined by 12 percent from 2005 (6.86 infant deaths per 1000 live births) to 2011 (6.05). Declines from 2005 to 2011 were most rapid for non-Hispanic black women and among selected southern states that had traditionally higher-than-average infant mortality rates. Information is available at: http://www.cdc.gov/nchs/data/databriefs/db120.pdf.