The State of Maternity Care in the U.S. – Updated

by | Nov 28, 2012


Over at’s blog, I discussed 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.

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 for 2018– 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 ( below ).

To find out how you can help, visit, and check out the initiatives that are going on there, including the March for Moms and the Mother-Friendly Hospital Initiative.

You can also purchase this table as a glossy poster at the EBB online store.

  • Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, Wilson EC. Births: Final data for 2009National 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.
  • *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 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • *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. 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.  
  • 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.
  • 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.
  • 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. . 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.
  •  Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2007:CD006167.
  •  Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev. 2000:CD002862.
  •  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. There is no reference for “intermittent” electronic monitoring because no studies have ever been conducted on this method of monitoring.
  •  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.
  •  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.
  •  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.
  •  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.
  •  Singata M, Tranmer J, Gyte GM. Restricting oral fluid and food intake during labour. Cochrane database of systematic reviews. 2010:CD003930.
  •  Lawrence A, Lewis L, Hofmeyr GJ, et al. Maternal positions and mobility during first stage labour. Cochrane database of systematic reviews. 2009:CD003934.
  •  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.
  •  Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009:CD000111.
  •  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.

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