The cesarean delivery rate rose to 32.9 percent in 2009 from 32.3 percent in 2008 in the United States, an increase of 2 percent and another record high, according to preliminary data from the National Center for Health Statistics (Natl Vital Stat Rep 2010;59(3):6). In 2009 one-half of all births to women aged 40 years and older were by cesarean delivery.
A “Call to Action to Support Breastfeeding” was issued on January 20, 2011, by the U.S. Surgeon General Regina M. Benjamin, outlining steps that can be taken to remove some of the obstacles faced by women who want to breastfeed their babies in the United States. Whereas 75 percent of U.S. babies start out breastfeeding, the Centers for Disease Control and Prevention says, only 13 percent are exclusively breastfed at the end of 6 months. The rates are particularly low among African-American infants. Dr. Benjamin’s “Call to Action” identifies ways that families, communities, employers, and health care professionals can improve breastfeeding rates and increase support for breastfeeding:
- • Communities should expand and improve programs that provide mother-to-mother support and peer counseling.
- • Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding. Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.
- • Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies. They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed.
- • Employers should work toward establishing paid maternity leave and high-quality lactation support programs. Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day. They should also provide women with break time and private space to express breast milk.
- • Families should give mothers the support and encouragement they need to breastfeed.
To order printed copies of the Surgeon General’s “Call to Action to Support Breastfeeding” and other materials, e-mail email@example.com and reference the publication title.
In the United Kingdom, maternity data for 2009–2010 of all births occurring in National Health Service (NHS) hospitals are available from the NHS Information Centre, excluding home births and those occurring in independent sector hospitals (Hospital Episode Statistics: NHS Maternity Statistics, 2009–10). The Centre collects, analyzes, and presents national data and statistical information in health and social care.
Highlights of the report show that the number of deliveries in NHS hospitals dipped slightly in the past year, a decrease of 261 deliveries from 652,638 in 2008–09 to 652,377 in 2009–10. There was no change in the percentage of women having a spontaneous delivery with an episiotomy from 2008–09 to 2009–10, which has remained at 8.3 per cent (33,073 in 2009–10 and 32,834 in 2008–09). The rate of labor inductions was up slightly—20.8 percent (120,657) compared with 20.2 percent (108,617) in 2008–09. The cesarean delivery rate has remained relatively stable at 24.8 percent (157,356) in 2009–10 compared with 24.6 percent (154,814) in 2008–09. The percentage of women who had their first antenatal assessment within the first completed 12 weeks of pregnancy increased to 63.0 percent (292,637), which compares with 58.3 percent in 2008–09 (227,773). Preterm (< 37 wk) live-born singleton deliveries decreased by 1.1 percentage points in 2009–10, from 7.0 percent in 2008–09 to 5.9 percent.
The teenage birth rate declined 8 percent in the United States from 2007 through 2009, reaching a historic low at 39.1 births per 1,000 teens aged 15–19 years, according to a recent report from the National Center for Health Statistics (NCHS Brief No. 58, February 2011). Rates fell significantly for teenagers in all age groups and for all racial and ethnic groups. Teenage birth rates for each age group and for nearly all race and Hispanic origin groups in 2009 were at the lowest levels ever reported in the United States.
Teenage childbearing has been the subject of long-standing concern among the public and policy makers, the report noted. Teenagers who give birth are much more likely to deliver a low-birthweight or preterm infant than older women, and their babies are at elevated risk of dying in infancy (3). The annual public costs associated with teen childbearing have been estimated at $9.1 billion. The U.S. teen birth rate fell by more than one-third from 1991 through 2005, but then increased by 5 percent over two consecutive years. Data for 2008 and 2009, however, indicate that the long-term downward trend has resumed. Although the recent declines have been widespread by age, race and ethnicity, and state, large disparities nevertheless persist in these characteristics.
Preliminary data on births in the United States in 2009 show that the number of births declined 3 percent from 2008, according to the National Center for Health Statistics (Natl Vital Stat Rep 2010;59(3):1–7). The birth rates for women in their early twenties fell 7 percent, the largest percentage decline for this age group since 1973. Rates for women in their late twenties and early thirties also declined, whereas the birth rate for women in their early forties increased in 2009, up 3 percent from 9.8 births per 1,000 women in 2008 to 10.1, the highest rate since 1976 (10.6). The birth rate for unmarried women declined almost 4 percent from 2008 to 2009. The rate per 1,000 unmarried women aged 15–44 years was 50.6 in 2009 versus 52.8 in 2008. The preterm (< 37 wk gestation) birth rate declined for the third straight year to 12.18 percent of all births from 12.33 percent in 2008. The lower preterm rate for 2009 marks the first sustained (> 2 consecutive yr) decline in this rate since 1981. The low-birthweight rate was essentially unchanged between 2008 (8.18%) and 2009 (8.16%).
A Committee Opinion on “Planned Home Birth” has been published by the American College of Obstetricians and Gynecologists (ACOG) (Committee Opinion No. 476, February 2011). It states that “Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence.” It continues, “Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.” To support the latter statement and its overall negative position against home birth, the ACOG committee bases its opinions heavily on a recent meta-analysis by Wax et al (Am J Obstet Gynecol 2010;203:243.el-243.e8). The opinion paper lists the multiple benefits of fewer maternal interventions found by Wax et al that are associated with planned home birth when compared with hospital birth, but places major emphasis on the outcome of neonatal death noted above. The study by Wax et al has come under much criticism by Keirse (M. Keirse. Birth 2010:37(4):341–346) and other researchers for being flawed and biased, however, raising questions about the reliability of the evidence on which the committee based its position.
Little or no evidence exists that bed rest in pregnancy leads to better outcomes, according to a recent statement by the American College of Obstetricians and Gynecologists (ACOG) (J. Deardorff, Chicago Tribune January 29, 2011). Although about 700,000 pregnant women with complications that could lead to early labor are advised to go on bed rest every year, ACOG has said that “bed rest, hydration and pelvic rest does not appear to improve the rate of preterm birth and should not be routinely recommended.” In addition, a literature review from the Cochrane Database of Systematic Reviews in 2004 said that bed rest could have adverse effects on pregnant women and their families, as well as increase health care costs. Most doctors are aware of the lack of evidence supporting the practice, but they prescribe it out of habit and some might do so out of fear of being held liable or being sued for malpractice, the Chicago Tribune reports. Women who are prescribed “modified” bed rest must rest for 1 hour three times daily. Other women must be on bed rest all the time, meaning they cannot ride in a car, have sex, walk up stairs, or do household chores. Supporters of the practice say it can prolong a pregnancy for a woman at risk of early labor, as well as decrease stress, increase blood flow to the uterus, and decrease cervical pressure. Women with cervical insufficiency may benefit from bed rest and limited activity, but those types of problems occur in about 1 percent of all pregnancies and make up only 5 to 10 percent of all preterm births. However, experts say that most preterm births occur in women without risk factors and that some women placed on bed risk experience atrophied muscles and report feeling achy, sluggish, isolated, helpless, and dependent. “There’s no evidence-based way to keep someone from delivering prematurely,” said John Thorp, a maternal-fetal specialist at the University of North Carolina School of Medicine in Chapel Hill who helped draft the ACOG statement. By prescribing bed rest, Thorp said, “we’re ruining lives, at least temporarily.”