Evidence Based Birth

Updated Table on the State of Maternity Care in the U.S.

Updated Table on the State of Maternity Care in the U.S.

Today on ImprovingBirth.org’s blog, I talk about how I wrote this 2012 Labor Day post about the State of Evidence-based maternity care in the U.S. I also posted an updated table about the state of maternity care (see below).

I was actually sick on Labor Day. I was lying in bed as I worked on the article that included the original version of this table. As I compiled the evidence about the state of our maternity care system, I kept thinking to myself: “This is insane. Something has got to change.

Here is the updated table– now presented as a picture file. Feel free to share, tweet, pin, or print! Tell people they can visit this post to see the detailed list of medical references.  

To read more, visit my post on ImprovingBirth.org, and check out the initiatives that we have going on there, including the National Rally to Improve Birth and the Big Walk-In.


References

  1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, Wilson EC. Births: Final data for 2009. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. November 2011;60:1-70. Read the free full text here.
  2. *In 2007, 27% of low-risk females with no prior cesarean birth had a C-section. (The majority of this percentage consists of first-time mothers; however, because this includes a small number of women with prior children, this number may differ slightly from other data reported on the internet). Data accessed from September 2012 from HealthyPeople.gov. Click here to see the healthy people data set. Scroll down to MICH 7.1 and click on the link that says “Reduce cesarean births” to see the data.
  3. National Quality Forum. NPP Maternity action team. 2012. This is a multi-disciplinary team (including representatives from ACOG, midwifery, nursing, and many other organizations) that joined together in 2012 to work on reducing the C-section rate in the U.S.  Accessed November 25, 2012. Read more about the Maternity Action Team at this website.
  4. American Academy of Family Physicians. Trial of labor after cesarean, formerly trial of labor versus elective repeat cesarean section for the woman with a previous cesarean section. 2005. Accessed November 23, 2012. Read the free full text here.
  5. Bangdiwala SI, Brown SS, Cunningham FG, et al. NIH consensus development conference draft statement on vaginal birth after cesarean: New insights. NIH consensus and state-of-the-science statements. 2010;27. Read the free full text here.
  6. Laughon SK, Zhang J, Grewal J, et al. Induction of labor in a contemporary obstetric cohort. American journal of obstetrics and gynecology. 2012;206:e481-489. Read the summary here.
  7. Zhang J, Troendle J, Reddy UM, et al. Contemporary cesarean delivery practice in the United States. American journal of obstetrics and gynecology. 2010;203:e321-326. Read the free full text here.
  8. *In this table, “artificial induction” refers to labor induction with medications. a. Artificial induction with Pitocin (Oxytocin): U.S. Food and Drug Administration. Oxytocin drug label. 2008. The BLACK BOX is the FDA’s strongest warning for drugs available on the U.S. market. Read the black box warning against elective induction with Oxytocin on this label here. b. Artificial induction with Cytotec (Misoprostol): U.S. Food and Drug Administration. 2009. FDA Alert: Risks of Use in Labor and Delivery. Read the alert here.   
  9. Mozurkewich E, Chilimigras J, Koepke E, et al. Indications for induction of labour: a best-evidence review. British Journal of Obstetrics and Gynecology. 2009:116(5):626-636. Read the summary here.
  10. Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to mothers II: Report of the second national U.S. Survey of women’s childbearing experiences:. The Journal of perinatal education. 2007;16:9-14. Read the free full text here.
  11. a. (Pitocin augmentation in spontaneous labor) Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Syst Rev. 2011:CD007123. Read the summary here. b. (Pitocin augmentation in women with epidurals) CostleyPL, East CE. Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries. Cochrane Database Syst Rev. 2012:CD009241. Read the summary here.
  12.  Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2007:CD006167. Read the summary here.
  13.  Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev. 2000:CD002862. Read the summary here.
  14.  Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (ctg) as a form of electronic fetal monitoring (efm) for fetal assessment during labour. Cochrane database of systematic reviews. 2006:CD006066. Read the summary here. There is no reference for “intermittent” electronic monitoring because no studies have ever been conducted on this method of monitoring.
  15.  Coco A, Derksen-Schrock A, Coco K, et al. A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted. Family medicine. 2010;42:52-56. Read the free full text article here.
  16.  Kavitha A, Chacko KP, Thomas E, et al. A randomized controlled trial to study the effect of iv hydration on the duration of labor in nulliparous women. Archives of gynecology and obstetrics. 2012;285:343-346. Read the free full text article here.  
  17.  Chantry CJ, Nommsen-Rivers LA, Peerson JM, et al. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics. 2011;127:e171-179. Read the free full text article here.
  18.  Noel-Weiss J, Woodend AK, Peterson WE, et al. An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. International breastfeeding journal. 2011;6:9. Read the free full text article here.
  19.  Singata M, Tranmer J, Gyte GM. Restricting oral fluid and food intake during labour. Cochrane database of systematic reviews. 2010:CD003930. Read the summary here.
  20.  Lawrence A, Lewis L, Hofmeyr GJ, et al. Maternal positions and mobility during first stage labour. Cochrane database of systematic reviews. 2009:CD003934. Read the summary here.
  21.  Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012;5:CD002006. Read the summary here.
  22.  Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009:CD000111. Read the summary here.
  23.  The information in the table refers to water during the first stage of labor only (not during pushing/birth). Hodnett ED, Gates S, Hofmeyr GJ, et al. Continuous support for women during childbirth. Cochrane database of systematic reviews. 2011:CD003766. Read the summary here.

 

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4 Comments

  1. Larissa November 28, 2012

    Just a question…shouldn’t “routine electronic fetal monitoring” be “routine continuous electronic fetal monitoring”? Those are pretty different terms and the paper referenced addresses the latter.

    • Rebecca November 28, 2012

      Hi Larissa, you raise an interesting point! I did not distinguish between intermittent electronic fetal monitoring and continuous electronic fetal monitoring, because neither are supported by the evidence. Continuous electronic fetal monitoring has been shown to have multiple risks and basically no benefits. Intermittent electronic fetal monitoring has not been studied in clinical trials. The evidence-based alternative is intermittent auscultation, which is used at a very tiny percentage of births in the U.S. You can read more about the evidence for the different types of fetal monitoring here. http://evidencebasedbirth.com/evidence-based-fetal-monitoring/

      Thanks again for letting me clarify this issue!

  2. Knitted in the Womb November 29, 2012

    I’m curious about your statistic for cesearean births among first time mothers. The CDC Wonder linked birth stats database (http://wonder.cdc.gov/natality.html) gives a 32% cesarean rate for first time moms in 2009 (well, first live birth–that is the closest I can get from that data set to “all” first time moms), but you reference a 27% cesarean rate from the Healthy People 2020 data.

    I can’t actually find a data point for first time moms on the Healthy People website you linked to. The point titled “MICH-7.1″ is all LOW RISK women with no prior cesareans–which would be a subset of first time moms AND multiparas who’ve never had a cesarean–women with conditions such as twins, GD or pre-eclampsia–would not be included. The following data point, “MICH-7.2″ is women with prior cesareans who are otherwise low risk, so by definition excludes all first time moms.

    • Rebecca November 30, 2012

      You are correct! Based on your feedback, I altered the table so that it now reads “27% in low-risk women.” I also included instructions in the reference list for how to find the data point of all low-risk women with no prior cesareans, just to make sure people can find it.

      Like you, I went to the CDC’s Vital Stats program to try and figure this out.
      For other readers who may be interested, here are instructions for looking at the raw data on U.S. births. Go to http://www.cdc.gov/nchs/data_access/vitalstats/VitalStats_Births.htm and click on “Birth Data Files.” You will need to get a free log-in to look at all of the birth certificate information. It’s a little cumbersome, but if you play around with it enough you will be able to figure out how to create charts. Unfortunately, when I looked “me_rout” (Route/mode of delivery) and “LBO_REC” (live birth order), I found that a large percentage of these births (a total of more than 390,000) were not recorded as being C-sections or vaginal births– they are unknown. So in 2010, among first-time moms in the U.S., there were 387,277 C-sections, 824,099 vaginal births, that gives us a first-time mom C-section rate of 32%. However, this is likely not accurate because of the large number of deliveries that were not coded as being C-sections or vaginal deliveries.

      The main reason that there are so many missing numbers is because of the changing birth certificate– different states started reporting different data on different years. You can read more info about that here (as well as estimates of the current primary C-section rate and VBAC rate) http://www.childbirthconnection.org/article.asp?ck=10554

      Again, thanks for the suggestion! There is nothing better than commentors for peer review– it makes for a better blog post for everyone who visits here in the future. :)