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In 2010 the rate of cesarean deliveries dropped slightly in the United States for the first time in more than a decade to 32.8 from 32.9 in 2009, according to preliminary figures from the National Center for Health Statistics (Births: Preliminary data for 2010. Natl Vital Stat Rep 2011;60(2):5). The rates either dropped slightly or essentially remained the same for all age groups. However, the declining pattern from 2009 to 2010 was not consistent across all race and Hispanic origin groups. Cesarean deliveries were down for non-Hispanic white women (from 32.8% to 32.6%); the rate was not significantly different for non-Hispanic black women (34.4% compared with 35.5%) but increased for Hispanic women (from 31.6% to 31.8%).

Pregnant women in Britain may soon be able to have a cesarean section on request as a result of new guidelines from the National Institute for Health and Clinical Excellence (NICE) (Associated Press, November 4, 2011). The agency’s guidelines are usually accepted by the government and determine what will be paid for by its health system. “In general, a C-section is a safe operation, especially when performed as a planned procedure,” the new guidelines say. Critics describe the proposed change as the health system caving into the “too posh to push” crowd. Planned to take effect in late November 2011, the guidelines state that pregnant women “with no identifiable reason” should be allowed a cesarean if they still want it after having a discussion with mental health experts. NICE estimates that a cesarean section costs about £800 ($1,280) more than a vaginal birth. The agency says it routinely updates guidance every few years and denies there was any pressure to change its more restrictive advice about cesareans. In recent years, however, advocates and some doctors have criticized the United Kingdom’s health system for not giving women a greater choice in childbirth.

Women with low-risk pregnancies can choose whether they prefer to give birth in a hospital obstetric unit, a midwifery unit, or at home, knowing that giving birth is generally very safe, according to the findings of the Birthplace study in England (Birthplace in England Collaborative Group. BMJ 2011;343:d7400). The findings were reported in a landmark prospective cohort study of almost 65,000 low-risk births that included nearly 17,000 planned home births and 28,000 planned midwifery unit births. The nationally funded Birthplace study addressed the safety, costs, and provision of maternity care according to where women with low-risk pregnancies planned to give birth comparing those who planned to give birth in hospital obstetric units with those who planned to give birth at home or in midwifery units. Overall, outcomes for the baby did not appear to differ between the planned places of birth, but first-time mothers planning a home birth had an increase in poor outcomes for the babies compared with those planning a hospital birth—although poor outcomes were still uncommon in both settings.

Peter Brocklehurst, who led the study at the National Perinatal Epidemiology Unit at the University of Oxford stated:

These results should reassure pregnant women planning their birth that they can make informed decisions about where they’d most like the birth to happen, knowing that giving birth in England is generally very safe. There is an increase in risk for first-time mums planning home births, but poor outcomes for the baby are still uncommon.

Jane Sandall, Professor of Social Science and Women’s Health at King’s College London, says:

These findings show that women who planned birth in midwifery-led units experienced fewer interventions with no increased risk to the baby. This was also the case for women having their subsequent babies at home. These findings provide good evidence for women to make the best, informed choices for their own circumstances and preferences.

Birth rates declined significantly across the United States during the recent recession, suggesting that women delayed having children during tough economic times, according to a report from the Pew Research Center (S. Tavernise, New York Times, October 12, 2011). The analysis was based on data from the National Center for Health Statistics and the Census Bureau on all 50 states and the District of Columbia. According to the study, the nationwide birth rate declined to 64.7 births per 1,000 women in 2010, from 69.6 births per 1,000 women in 2007. The study’s lead author, Gretchen Livingston, said it is not unusual for birth rates to decline during poor economic times, adding that birth rates dropped 26 percent from 1926 to 1936. She noted that in the new study, birth rates declined in every age group except among women aged 40 through 44, who likely could not delay childbirth any longer. “What people seem to be doing is not so much deciding not to have children, but postponing until things start to recover,” Livingston said. Historically, birth rates have recovered as the economy has improved, she added. Birth rates also varied by demographic group, the study found. Hispanics experienced the biggest decline at 5.9 percent from 2008 to 2009, followed by blacks at 2.4 percent and whites at 1.6 percent.

In an effort to boost the number of Baby-Friendly hospitals in the United States, the Centers for Disease Control and Prevention (CDC) has awarded nearly $6 million over 3 years to the National Initiative for Children’s Healthcare Quality (NICHQ) (CDC Press Release, October 13, 2011). The project aims to improve hospital maternity care practices to better support mothers to breastfeed their newborns. “We know that breastfeeding rates are higher in Baby-Friendly hospitals, yet only 5 percent of babies in this country are born in these facilities,” said William H. Dietz, MD, PhD, director of the CDC’s Division of Nutrition, Physical Activity and Obesity. Breastfeeding is one of the most effective preventive measures a mother can take to protect the health of her infant. A CDC report from August 2011 (http://www.cdc.gov/vitalsigns/Breastfeeding/index.html) highlighted the shortage of Baby-Friendly hospitals in the United States and outlined the importance of the hospital experience with respect to infant feeding decisions. As the award recipient, the NICHQ will coordinate a variety of activities to increase the number of facilities designated as Baby-Friendly.

New mothers will go home from the hospital without an infant formula “goodie bag” in the state of Rhode Island (D. Klepper, A/P San Francisco Chronicle, November 28, 2011). The state’s seven maternity hospitals stopped formula giveaways in late 2011 to encourage breastfeeding, making it the first state to end the widespread practice. State health officials hailed the decision, and Stephanie Chafee, a nurse and the wife of Governor Lincoln Chafee, called the decision a critical step toward increasing breastfeeding rates. “As the first ‘bag-free’ state in the nation, Rhode Island will have healthier children, healthier mothers, and a healthier population as a whole,” Chafee said. “This is a tremendous accomplishment.” Thirty-eight percent of Rhode Island mothers breastfeed their babies 6 months after birth, compared with 44 percent nationally, according to a 2011 report by the CDC. State Health Director Michael Fine said the state hopes to raise the percentage of Rhode Island mothers to 60 percent by 2020.

The preterm birth rate fell in the United States for the fourth year in a row to 11.9 percent in 2010, from 12.8 percent in 2009 (Births: Preliminary data for 2010. Natl Vital Stat Rep 2011;60 (2):5–6). Preterm births declined 1 to 2 percent between 2009 and 2010 among each of the largest race and Hispanic origin groups. Although still substantially higher than that of other groups, the 2010 preterm rate for non-Hispanic blacks is the lowest reported in the nearly three decades for which comparable rates have been available (1981). Since 2006 when the preterm rate for all births peaked, the rate has declined 7 to 8 percent for non-Hispanic black and non-Hispanic white infants, and 4 percent among Hispanic infants. The downward trend from 2006 to 2010 is also significant for most states and the District of Columbia. The 2010 rate of low-birthweight infants (<2,500 g per 100 births) was 8.15 percent, which was not significantly lower than the rate for 2009 (8.16 percent).

The surrogacy industry in India has boomed since 2002, when commercial surrogacy was legalized in the country, and it is becoming an important part of India’s lucrative medical tourism market (N.S. Roy, New York Times, October 4, 2011). In India, fertility clinics charge prospective parents approximately $14,000 for surrogacy, compared with an estimated $70,000 in the United States. A 2008 study valued the assisted reproductive technology industry in India at $450 million a year. However, the success of the industry masks growing concerns about the rights of the women who choose to become surrogate mothers, many of whom are poor and sometimes illiterate. New legislation is expected to be ratified by early 2012 that will attempt to regulate the clinics and doctors involved in assisted reproductive technologies and their relationships with prospective surrogate mothers. But a team of researchers from a nongovernmental women’s health agency, Sama, has raised concerns about the bill. “The many ethical issues that are emerging out of unrestrained spread of the technologies remain,” the researchers state. They welcome the attempt to regulate the industry, but fear that the legislation favors the rights of the commissioning couple over those of the surrogate mother. The proposed law makes it clear that the surrogate mother will have no rights over the child she has contracted to bear. Although most clinics will protect the woman’s health, nutrition, and daily needs, the responsibility for her care is left to individual doctors and clinics.