The World Health Organization multi-country survey on maternal and newborn health collected data on a wide variety of maternity care practices and outcomes in 24 countries in Africa, Asia, and Latin America. In March 2012 the British Journal of Obstetrics and Gynecology published a special issue disseminating the results of this research. Twelve original articles analyzed the survey results and presented recommendations for improving care in a wide variety of maternity-related areas such as preterm delivery, postpartum hemorrhage, preeclampsia, severe maternal morbidity, multiple birth, and perinatal mortality; see http://onlinelibrary.wiley.com/doi/10.1111/bjo.2014.121.issue-s1/issuetoc.
A recent report on Safe Prevention of the Primary Cesarean Delivery published by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine outlines concrete steps that birth attendants can take to reduce primary cesarean delivery rates. These include a re-examination of the definition of labor dystocia, as recent data show that contemporary labor progresses at a slower rate than was historically taught. Increasing women's access to continuous labor support, external cephalic version for breech presentation, and a trial of labor for women with twin gestations may also help to lower the primary cesarean delivery rate; see http://m.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery?IsMobileSet=true.
The State of the World's Midwifery 2014 will be released on June 3, 2014, during the 30th Triennial Congress of the International Confederation of Midwives. This United Nations Fund for Population Activities (UNFPA) report outlines recent progress in increasing the number of skilled and competent midwives, improving policies and regulations, and expanding the coverage of midwifery services and quality of care. The report includes data from 75 countries, and also includes individual country profiles detailing supply and demand aspects of the midwifery workforce; see http://unfpa.org/public/home/pid/16021.
Two articles reporting on the results of the Midwives Alliance of North America statistics (MANAstats) project were published in the January/February 2014 issue of the Journal of Midwifery and Women's Health. The first article describes the development and validation of the U.S. data registry for midwife-led births, and the second article reports on birth outcomes. Among the nearly 17,000 planned home births included in the study, 89 percent of women gave birth at home, with the majority of intrapartum transfers for failure to progress. Rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 94 percent, 1 percent, and 5 percent, respectively. Of the 1,054 women who attempted a vaginal birth after cesarean, 87 percent were successful. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1,000, respectively; see http://onlinelibrary.wiley.com/doi/10.1111/jmwh.2014.59.issue-1/issuetoc.
In 2011, the cost of an uncomplicated vaginal birth in a California hospital ranged from $3,296–$37,227, and the cost of a cesarean section from $8,312–$70,908, depending on which hospital a woman delivered in. Cost differences were not well explained by observable patient or hospital characteristics; see http://bmjopen.bmj.com/content/4/1/e004017.full.pdf+html?sid=e58553be-18e0-48dd-bd3e-5380fc3e3ef9.
In 2012, the U.S. preterm birth rate declined for the sixth straight year to 11.6 percent of births, down from a peak of 12.8 percent in 2006 but still higher than rates in most developed countries. About one third (32.8%) of U.S. births were delivered by cesarean section in 2012, the same percentage as in 2010 and 2011; see http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf. In 2012, the primary cesarean rate was 21.5 percent in a reporting area comprising 86 percent of U.S. births. There were large variations in primary cesarean rates by state, but rates generally increased from 2006–2009, and declined from 2009–2012; see http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_01.pdf.
In 2012, 1.36 percent of U.S. births were born outside a hospital, up 56 percent since 2004 (0.87%). For non-Hispanic white women, 1 in 49 births (2.05%) were out-of-hospital births. In 2012, out-of-hospital births comprised 3–6 percent of births in Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington; and from 2–<3 percent of births in Delaware, Indiana, Utah, Vermont, and Wisconsin. There were 53,635 out-of-hospital births in the United States in 2012, including 35,184 home births and 15,577 birthing center births. The risk profile of out-of-hospital births improved from 2004–2012, suggesting that appropriate risk selection of low-risk women is occurring and improving; see http://www.cdc.gov/nchs/data/databriefs/db144.pdf.
In 2011, almost one fourth (23.4%) of U.S. women were obese before becoming pregnant in a reporting area comprising 83 percent of U.S. births. Most births were paid for by private insurance (46%) or Medicaid (45%), while 4 percent of births were self-paid. Nearly half (48%) of U.S. women received WIC (Supplemental Nutrition Program for Women, Infants and Children) food during pregnancy, and 1.4 percent had used infertility services to become pregnant; see http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_04.pdf. In 2006–2010, 12 percent of reproductive age women had ever used infertility services in their lifetime, see http://www.cdc.gov/nchs/data/nhsr/nhsr073.pdf.