Trends in the attendant, place, and timing of births, and in the use of obstetric interventions: United States, 1989-97.

OBJECTIVES This report presents recent trends in the circumstances surrounding live births in the United States. Specifically, this report will examine the changes in the attendant and place of birth as well as changes in the day and month of birth. Trends in the use of four obstetric procedures (electronic fetal monitoring, ultrasound, induction of labor, and stimulation of labor) are examined as well as trends in cesarean births, vaginal births after a previous cesarean, and births delivered by forceps and vacuum extraction. METHODS Descriptive tabulations were calculated for each year between 1989 and 1997 using data reported on birth certificates. RESULTS While the vast majority of births in 1997 were attended by physicians, 92 percent, this has declined steadily as the percent of births attended by midwives has slowly increased to account for 7 percent of all births. About 99 percent of births were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that were in residences increased whereas those in freestanding birthing centers declined. While births were more common on weekdays than on weekends in 1989, they have become even more concentrated on weekdays since 1989. The most popular months to give birth continue to be July, August, and September. The percent of mothers receiving electronic fetal monitoring, ultrasound, induction, and stimulation all increased over the period with the most dramatic increase being the doubling of the use of induction. Between 1989 and 1996, the rate of cesarean births dropped by 9 percent whereas the rate of vaginal birth after a previous cesarean (VBAC) increased by 50 percent. However, the trends appear to have changed between 1996 and 1997--the cesarean rate increased slightly while the VBAC rate declined by 3 percent. There is wide variation by State in both of these rates. The percent of births that were delivered by forceps consistently declined during the period whereas the use of vacuum extraction consistently increased.