The cesarean delivery rate rose to 30.3 percent in Australia in 2005, compared with 29.4 percent in 2004 and 19.5 percent in 1996, continuing its overall upward trend over the last 10 years, according to Australia’s Mothers and Babies 2005 (AIHW National Perinatal Statistics Unit, November 2007). Cesarean delivery rates increased with maternal age, ranging from 16.8 percent for mothers aged less than 20 years to 45.5 percent for those 40 years and older. The proportion varied by state and territory, from 26.4 percent in Tasmania to 33.9 percent in Western Australia. Three states, Queensland, Western Australia, and South Australia, recorded cesarean delivery rates over 32 percent. The number of repeat cesarean deliveries are continuing to rise, and 83.2 percent of mothers with a previous cesarean section had a repeat procedure in 2005 compared with 81.6 percent in 2004, ranging in 2005 from 74.5 percent in Northern Territory to 88.2 percent in Western Australia. The number of vaginal births after a previous cesarean (VBAC) continued to decrease to 13.3 percent in 2005 from 14.6 percent in 2004. The full report (Perinatal Statistics Series No. 20) is available at http://www.npsu.unsw.edu.au.
The teen birth rate in the United States rose in 2006 for the first time since 1991, and unmarried childbearing also rose significantly, according to preliminary birth statistics from the U.S. National Center for Health Statistics (Births: Preliminary Data for 2006, Natl Vital Stat Rep 2007;56(7):1). The report showed that between 2005 and 2006, the birth rate for teenagers 15 to 19 years rose 3 percent, from 40.5 live births per 1,000 females aged 15 to 19 years in 2005 to 41.9 births per 1,000 in 2006. This increase follows a 14-year downward trend. “It’s way too early to know if this is the start of a new trend,“ said Stephanie Ventura, head of the Reproductive Statistics Branch, “But given the long-term progress we’ve witnessed, this change is notable.”
Birth rates increased for women in their twenties, thirties, and early forties between 2005 and 2006, as well as for teenagers. The preterm birth rate rose slightly between 2005 and 2006, from 12.7 percent to 12.8 percent of all births. The percentage of births delivered before 37 weeks of gestation has risen 21 percent since 1990. The low birthweight rate also rose slightly in 2006, from 8.2 percent in 2005 to 8.3 percent in 2006, which is a 19 percent jump since 1990.
The quality of maternity care in England provided by the National Health Service is being compromised by staff shortages and inadequate screening checks, according to a 2007 report from the Healthcare Commission (MedWire News, Jan 28, 2008). The Healthcare Commission is an independent “watchdog group” that assesses maternity services to check that they meet the required standards in a range of areas. The Commission also has a statutory duty to safeguard and promote the rights and welfare of children, from pregnancy onward. It looked at a range of issues, including quality of clinical care; women’s feedback on their experience; department resources (e.g., midwife and obstetrician staffing) and how these related to the number of deliveries managed by the trust; quality of facilities; and types of services made available to women.
The quality of postnatal care was assessed among 26,000 mothers enrolled in 148 maternity care health care trusts across England. Maternity health care trusts in the north of England had a relatively good standard of antenatal and postnatal care, but the quality of care tended to be consistently poorer among maternity units in London, the report stated. Most pregnant women were screened for fetal anomalies, but only 61 percent of ultrasound scans included all 11 checks recommended by the National Institute for Health and Clinical Excellence. Staff shortages showed that approximately 30 percent of hospitals had below recommended levels of obstetrician consultant attendance, and 6 percent had 10 fewer midwives per 1,000 deliveries than the national average. The report is available at www.healthcarecommission.org.uk.
United States breastfeeding rates have decreased from 2005 to 2006, according to the most recent Mothers Survey (Ross Products Division of Abbott, Columbus, Ohio). The data show that in-hospital breastfeeding rates declined from 66.3 percent in 2005 to 63.6 percent in 2006, and the 6-month rates declined from 32.9 percent to 30 percent, respectively. The decreases were reported in all ethnic groups. Decreases also occurred in exclusive breastfeeding rates, for in-hospital from 41.7 percent in 2005 to 38.4 percent in 2006, and at 6 months from 19.8 percent to 16.5 percent, respectively. Data from the National Immunization Survey, which also tracks and reports U.S. breastfeeding trends, targeted children born in 2004 and are not available for 2005 and 2006.
Umbilical cord blood banking is the topic of a new Committee Opinion issued by the American College of Obstetricians and Gynecologists (ACOG News Release, Feb. 1, 2008). Physicians should give balanced information to their pregnant patients who are considering cord blood banking, presenting both the advantages and disadvantages of public versus private cord blood banks, according to the ACOG Committee on Obstetric Practice and Committee on Genetics, which authored the opinion. Furthermore, physicians who recruit pregnant women for for-profit cord blood banking should disclose their financial interests and other potential conflicts of interest. Popularity in the process has increased in recent years, partly from marketing campaigns to consumers by cord blood banks, which were developed to store stem cells from cord blood for autologous use. However, the utility of long-term storage of autologous cord blood has been questioned. “Patients need to be aware that the chances are remote that the stem cells from their baby’s banked cord blood will be used to treat that same child—or another family member—in the future,” said Anthony R. Gregg, MD, chair of ACOG’s Committee on Genetics. Although ACOG takes no position for or against cord blood banking, it recommends that physicians disclose that there is no reliable estimate of a child’s likelihood of actually using his or her own saved cord blood later. Some experts estimate this likelihood at 1 in 2,700, whereas others argue that the rate is even lower. Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored, the Committee Opinion stated.
The breastfeeding babies of HIV-infected mothers remained HIV-negative and lived longer after receiving an extended course of the antiretroviral drug nevirapine (NVP), according to several new studies presented at a recent Conference on Retroviruses and Opportunistic Infections (NICHD News Release, Feb 6, 2008). Three coordinated, large-scale Phase III clinical trials sponsored by the National Institute of Allergy and Infectious Diseases found that NVP given once daily to breastfeeding infants from days 8 to 42 of life cut the rate of HIV transmission via breastfeeding by almost half at 6 weeks when compared with a single dose of NVP given to infants at birth, the current standard of care. Moreover, at 6 months, the risk of postnatal HIV infection or death for babies who received NVP for 6 weeks was nearly one-third less than the risk for infants given only a single dose. Another study sponsored by the National Institute of Child Health and Human Development and the U.S. Centers for Disease Control and Prevention found that giving NVP daily to breastfeeding infants from 7 days to 14 weeks of age cut the rate of HIV transmission by half for up to 9 months.
The authors of the studies maintain that these findings are critical because approximately 150,000 infants worldwide acquire HIV annually through breastfeeding, and the risk of HIV transmission is generally believed to be greatest during the earliest months of life. Despite that risk, the World Health Organization and UNICEF recommend that infants born to HIV-infected mothers who lack access to safe, affordable, and sustainable replacement feeding should breastfeed for at least 6 months, to protect infants from other causes of illness and death that pose a greater risk than HIV infection itself. Replacement feeding, early weaning, or both are not options for many women and their babies for economic, cultural, and health and safety reasons.
The link between pregnant and nursing women’s diets, breastfeeding, and the risk of infant allergies has recently been updated by the American Academy of Pediatrics (Pediatrics 2008;121(1):183-191). In 2000 the group advised breastfeeding women with a family history of allergies to avoid consuming cow’s milk, eggs, fish, peanuts, and tree nuts to prevent food allergies, asthma, and allergic rashes in infants. The update states that although breastfeeding helps prevent infant allergies, there is no convincing evidence that delaying the introduction of certain foods—including eggs, fish, or peanut butter—to children prevents allergies. The update also says that exclusive breastfeeding for at least 4 months can reduce the risk of rashes and allergy to cow’s milk among infants with a family history of allergies; exclusive breastfeeding for at least 3 months protects against wheezing in infants; some evidence recommends feeding hypoallergenic formulas to susceptible infants if they are not exclusively breastfed; evidence for the use of soy-based infant formula for the purpose of allergy prevention is not convincing; and infants should not receive solid food before 4 to 6 months.