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![Page 1: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/1.jpg)
US Birth Outcomes in a Comparative Context
Update of Data from Birth By the Numbers.
These slides largely mirror those used in the video, but add some others of interest and update the originals
with the most recent available data as of
July 1, 2013
Gene Declercq, PhD
NOTE: There is a lag of 2-4 years in the reporting of vital statistics from the US and abroad
BirthByTheNumbers.org
![Page 2: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/2.jpg)
BirthByTheNumbers.org
Key Question
Is the U.S. really doing as badly as it seems in
international comparisons?
BirthByTheNumbers.org
![Page 3: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/3.jpg)
BirthByTheNumbers.org
Is the U.S. really doing that badly?
How Do we Compare Outcomes?Neonatal Mortality Rate
Infant Deaths in First 28 days
X 1,000________________
Live Births
![Page 4: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/4.jpg)
Outcomes: Comparative Neonatal Mortality RatesRank Country Rank Country Rank Country
1 San Marino (1) 14 Israel 27 Belarus
Andorra Monaco Netherlands
IcelandRepublic of Korea Greece
Japan Ireland Cuba
Singapore Belgium Lithuania
Cyprus Czech Republic New Zealand7 Luxembourg (2) France United Kingdom
Slovenia Germany Switzerland
Sweden Italy Croatia
Finland Denmark Malaysia
Estonia 24 Austria (3) 37 United States (4)
Norway Spain Canada, Hungary, U.A.E.
13 Portugal 26 Australia Poland, Qatar, Serbia
Source: State of the World’s Children2013. http://www.unicef.org/sowc2013/statistics.html
BirthByTheNumbers.org
![Page 5: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/5.jpg)
Outcomes: Comparative Neonatal Mortality RatesRank Country Rank Country Rank Country
1 San Marino (1) 14 Israel Belarus
Andorra Monaco Netherlands
IcelandRepublic of Korea Greece
Japan Ireland Cuba
Singapore Belgium Lithuania
Cyprus Czech Republic New Zealand7 Luxembourg (2) France United Kingdom
Slovenia Germany Switzerland
Sweden Italy Croatia
Finland Denmark Malaysia
Estonia 24 Austria (3) 37 United States (4)
Norway Spain Canada, Hungary, U.A.E.
13 Portugal 26 Australia Poland, Qatar, Serbia
Source: State of the World’s Children2013. http://www.unicef.org/sowc2013/statistics.html
BirthByTheNumbers.org
TWO PROBLEMS(1) Comparisons – Five countries
highlighted had fewer combined births than the state of Alaska
(2) Measurement – Is neonatal mortality the best measure to use?
![Page 6: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/6.jpg)
Outcomes
Five countries in red background share a particular characteristic – almost no one actually lives there. Total Births in these countries in 2012 were 11,429 or fewer than the 11,450 in Alaska in 2011
Country 2012Births
Andorra 757
Iceland 4,146
Luxembourg 6,034
San Marino 285
Monaco 207
TOTAL 11,429
BirthByTheNumbers.org
![Page 7: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/7.jpg)
BirthByTheNumbers.org
What’s a Fair Comparison with the US?
In the most recent year available (2010):
• Countries with at least 100,000 births
• Countries with a total per capita annual expenditure on health of at least $1,500 in US dollars.
![Page 8: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/8.jpg)
Defining a Set of Countries to Compare with the U.S.17 Comparison Countries (SOURCE: OECD, Health Data 2012 & State of World’s Children)
2010 Total Births
(000)
2010Total exp. health –
PC, US$ PPP
2010-11% Births by
Cesarean
Australia 307 3,670 31.2
Belgium 123 3,969 19.9
Canada 388 4,445 26.1
Czech Republic 116 1,884 23.3
France 792 3,974 20.2
Germany 699 4,338 30.8
Greece 117 2,914 NA
Hungary 100 1,601 33.4
Italy 557 2,964 37.7
Japan 1,073 3,035 18.0
Korea 478 2,035 34.6
Netherlands 181 5,056 15.6
Portugal 97 2,728 33.0
Spain 499 3,076 24.9
Sweden 113 3,758 16.2
United Kingdom 761 3,433 24.1
United States 3,954 7,990 32.8
BirthByTheNumbers.org
![Page 9: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/9.jpg)
BirthByTheNumbers.org
IOM chose 16 peer countries. 13 are same as the one’s we’ve used. They use 3 countries (Denmark, Finland, Switzerland) that have 100,000 births. We include Belgium, Czech Republic, Greece and Hungary
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How is the U.S. doing relative to comparison countries?
Neonatal Mortality Rate
Infant Deaths in First 27 days
X 1,000_____________
Live Births
Perinatal Mortality Rate
Fetal deaths + deaths in the first week
X 1,000 _______________Live births + fetal
deaths
BirthByTheNumbers.org
![Page 11: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/11.jpg)
Neonatal Mortality Rates (per 1,000 births), 2010, Industrialized Countries with 100,000+ Births
1.21.6
1.6
2
2.12.3
2.3
2.42.5
2.5
2.62.8
3
3.2
3.43.8
4.2
0 1 2 3 4 5
JapanCzech Republic
Sweden
Greece
Spain
Germany
Italy
Korea
Belgium
Portugal
France
Netherlands
AustraliaUnited Kingdom
U.S. White
Canada
United States
Source: OECD Health Data 2013 and NCHS, Deaths Final Data for 2007. BirthByTheNumbers.org
![Page 12: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/12.jpg)
BirthByTheNumbers.org
Perinatal Mortality Rates (per 1,000 births), 2010, Industrialized Countries 100,000+ Births
JapanKorea
Czech RepublicPortugal
Australia*SpainItaly#
SwedenGreece
GermanyNetherlands
Belgium#Canada#
United States*Hungary
United KingdomFrance
0 2 4 6 8 10 12 14
2.93.33.43.53.63.8
4.44.85.0
5.45.6
6.06.2
6.66.9
7.312.1
*2005; #2008
![Page 13: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/13.jpg)
Maternal Mortality Ratios
Maternal Mortality Ratio
Maternal Deaths all causes X 100,000
_______________Live births
![Page 14: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/14.jpg)
Maternal Mortality Rates, (per 100,000 births), 2010, Industrialized Countries with 200,000+ births
2.4
3.4
4.1
4.2
5
5.5
7.7
9
10.5
12.7
14.7
2 15
Australia*
Italy*
Spain
Japan
United Kingdom
Germany
France#
Canada#
US WNH**
United States**
Korea*
Sources: OECD Health Data 2013; NCHS. 2009. Deaths, Final Data, 2007.
U.S. 2007:Black non-Hispanic 28.4White non-Hispanic 10.5Hispanic 8.9
Maternal Mortality Rate
*2009; #2008; **2007
![Page 15: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/15.jpg)
BirthByTheNumbers.org
Other countries do better because the U.S. is different: -- more diversity, -- weaker social support system, -- inequality in our health care
system.
What if we compared subgroups in the U.S. to other countries?
![Page 16: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/16.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17 - 100K)
All 6.4 17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
![Page 17: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/17.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17 - 100K)
All 6.4 17
White Non-Hispanic 5.3 17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
![Page 18: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/18.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17- 100K)
All 6.4 17
White Non-Hispanic 5.3 17
White NH, Native Born 5.4 17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
![Page 19: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/19.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17- 100K)
All 6.4 17
White Non-Hispanic 5.3 17
White NH, Native Born 5.4 17
White NH, Singleton Birth 4.6 15
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
![Page 20: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/20.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17- 100K)
All 6.4 17
White Non-Hispanic 5.3 17
White NH, Native Born 5.4 17
White NH, Singleton Birth 4.6 15
White NH, 30-34 yrs old 4.1 13
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
![Page 21: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/21.jpg)
US Subgroups in Comparative Contextwith other Industrialized Countries
US Subgroup U.S. IMR 2009
Rank (17- 100K)
All 6.4 17
White Non-Hispanic 5.3 17
White NH, Native Born 5.4 17
White NH, Singleton Birth 4.6 15
White NH, 30-34 yrs old 4.1 13
White NH, 37-41 weeks 2.3 1
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD: NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
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Examining Trends over Time
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Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*
2
3
4
5
Rate
per
1,0
00 l
ive b
irth
s
Source: OECD Health Data, 2013
U.S.
* Countries with 100,000+ births (2011): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Hungary, Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, U.K.
2.2
4.2
4.6
3.1
Industrialized Countries
26% decrease
13% decrease
Source: OECD Health Data, 2013 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
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Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*
2
3
4
5
Rate
per
1,0
00 l
ive b
irth
s
Source: OECD Health Data, 2013 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
U.S.
* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Hungary, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.
2.3
4.1
4.6
3.1
If the U,S. neonatal mortality rate equaled the current average rate of the other countries in 2011, that would mean almost 6,955 fewer deaths to babies 28 days or younger annually.
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BirthByTheNumbers.org
Perinatal Mortality Rates, 2000-2010 , U.S., & Ave. for Industrialized Countries*
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20104.5
5
5.5
6
6.5
7
U.S. 6 %
decrease
Industrialized Countries
21% decrease
* Countries with 100,000+ births (2006): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Hungary, Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, United Kingdom
![Page 26: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/26.jpg)
Maternal Mortality Ratios (per 100,000 births), 2000-2009, U.S. & Ave.
Industrialized Countries*
4
8
12
16
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Dea
ths
per
100
,000
liv
e b
irth
s
Industrialized Countries
3 % Decrease
U.S.30%
Increase
* Countries with 200,000+ births (2009): Australia, Canada, France, Germany, Italy, Japan, S. Korea , Spain, United Kingdom
Sources: OECD Health Data 2013; NCHS. 2010. Deaths, Final Data, 2007.
Case Ascertainment??
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BirthByTheNumbers.org
What about process?
![Page 28: US Birth Outcomes in a Comparative Context Update of Data from Birth By the Numbers. These slides largely mirror those used in the video, but add some.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649ced5503460f949b98fd/html5/thumbnails/28.jpg)
US Cesarean Rates, 1989-2011
20
22
24
26
28
30
32
34
% Tot US 23 22.722.622.321.821.220.820.720.821.222.0 23 24 26 28 29 30 31 32 32 33 33 33
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11
%
Source: National Center for Health Statistics Annual Birth Reports
%
1,296,779
If the 2011 cesarean rate was the same as in 1996, there would have been 478,000 fewer cesareans in the U.S. in ’11.
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Primary Cesarean and VBAC Rates, U.S., 1989-2010
5%
10%
15%
20%
25%
30%
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
Prim Ces Rate
VBAC
r = -.95
Source: NCHS. Annual Birth Reports & Vital Stats
Note: 2005-2010 unofficial
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15.6%16.2%
18.0%19.9%20.2%
23.3%24.1%
24.9%26.1%
30.8%
33.0%
34.6%37.7%
32.8%
33.4%
31.2%
10% 45%
*NetherlandsSweden
Japan*Belgium
FranceCzech RepublicUnited Kingdom
Spain*Canada
Germany*Australia
United States*PortugalHungary
KoreaItaly
Sources: OECD Health Data 2013; U.S. Natality Data; Japan – sample; Lancet 6736(09)61870-5.
Cesarean Rates in Industrialized Countries* with 100,000+ Births, 2011
*2010
* No data on cesarean rates in Greece
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18202224262830323436
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
WNH BNH Hisp
Total cesarean rates by race/ethnicity, U.S. 1989-2011
Source: National Center for Health Statistics Annual Birth Reports
1989 WNH +1.4percentage
points
2011 BNH +3.1 percentage
points
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BirthByTheNumbers.org
Total Cesarean Rates (per 100 births) by Age of Mother: United States, 1996 and 2011
14.517.4
20.623.8
27.431.6
22.4
28.031.5
35.9
42.2
49.2
0
10
20
30
40
50
60
<20 20-24 25-29 30-34 35-39 40-54
1996 2011
54% 61% 53% 51% 54% 56%%
Source: National vital statistics system, NCHS, CDC.
Per
cent
Overall increase, 1996-2010: 58.5%
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VBAC Rates*, U.S.,1990-2010
5%
10%
15%
20%
25%
30%
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: NCHS Vital Stats. http://www.cdc.gov/nchs/VitalStats.htm
* Number of VBACs among women with prior cesarean
NOTE: Rates for 2005-2010 are unofficial
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VBAC Rates, Selected Countries, 2004
0 10 20 30 40 50 60
NetherlandsNorwayFinland
SwedenGermany
Czech RepDenmark
FranceBelg-Flanders
ScotlandSpain-Valencia
SloveniaMalta
EstoniaCanada
LithuaniaLatvia
U.S. VBACs
51
41
45
5155
25
2732
3539
41
919
24
25
25
20
8
Source: Adapted from Peristats, US & Canadian Data
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BirthByTheNumbers.org
Do High Rates of Intervention Matter?
1. Outcomes (NMR & GA)
2. Costs
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Gestational Age, U.S. All Births, 1990, 2011
0%
5%
10%
15%
20%
25%
30%
<32 32-33 34-36 37-38 39 40 41 42+
1990
2011
* Only births occurring at home. Source: Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, and Mathews TJ. Births: Final data for 2011. National vital statistics reports; vol 62 no 1. Hyattsville, MD: National Center for Health Statistics. 2013.
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Source: Althabe F.Cesarean Section Rates and Maternal & Neonatal Mortality Birth.2006;33:270
Cesarean Rates and Neonatal Mortality
Low Income
Medium Income
High Income
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Percent of singleton preterm (<37 weeks) births by method of delivery, United States,
1991-2006
0
2
4
6
8
10
12
1991 1996 2001 2006
Per
cen
t
Cesarean noinduction
Cesarean afterinductionattempt
Inducedvaginal
Spontaneousvaginal
Note: Births with method of delivery and induction of labor not stated are excluded.Source: MacDorman et al. AJPH, 2011.
9.7%
5.7%
6.7%
11.0%
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National Costs and Hospitalizations
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LEADING MAJOR DIAGNOSTIC CATEGORIES by
NUMBER OF HOSPITAL DISCHARGES, U.S., 2009
1,274,786
1,490,050
1,621,592
2,210,056
3,370,140
3,429,592
3,964,889
4,300,390
4,591.515
5,801,081
0
1,00
0,00
0
2,00
0,00
0
3,00
0,00
0
4,00
0,00
0
5,00
0,00
0
6,00
0,00
0
7,00
0,00
0
Endocrine, Nutritional & Metabolic
Mental Diseases & Disorders
Kidney & Urinary Tract
Nervous System
Musculoskeletal System
Digestive System
Respiratory System
Newborns & Other Neonates
Pregnancy, Childbirth
Diseases of The Circulatory System
AHRQ. 2011. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 7/16/2011.
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MEDIAN FACILITY LABOR & BIRTH CHARGES BY SITE & MODE OF BIRTH, U.S., 2010
$5,003$7,419
$8,726
$4,489$5,231
$7,519
$8,962
$4,081
$0
$18,000
Hospital Vaginalno Complications
Hospital VaginalComplications
Hospital CesareanNo Complications
Hospital CesareanComplications
Sources: AHRQ. 2010. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 4/12/13;
$8,570
$10,234
$17,688
$14,938
NOTE: Hospital charges; no physician costs
Charge in 2000
Increase in Charge in 2000-2010
Charge in 2010
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Estimated Total Charges, Hospital Birth, U.S., 1993-2010 (000,000)
0
10,000
20,000
30,000
40,000
50,000
60,000
1993
1995
1997
1999
2001
2003
2005
2007
2009
Vag no Compl.
Vag w Compl.
Ces no Compl.
Ces w/ Compl.
Sources: AHRQ. 2009. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 4/16/13.
$ 51,031
$ 14,039
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BirthByTheNumbers.org
Have maternal request cesareans played a major role in these
increases?
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http://www.childbirthconnection.org
Asking Mothers about
Maternal Request Cesareans
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BirthByTheNumbers.org
Two Components to Maternal Request Primary Cesarean
1. Mother made request for planned cesarean before labor
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BirthByTheNumbers.org
Two Components to Maternal Request Primary Cesarean
1. Mother made request for planned cesarean before labor
2. Cesarean for no medical reason
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BirthByTheNumbers.org
Patient Choice Primary Cesareans• Combining reason for cesarean and timing of
decision found only about 1% of respondents had a planned primary cesarean for no medical reason.
“I think that [cesarean] is… the best way … to give birth. It is a planned way, no hassle, no pain, the baby doesn’t struggle to come out, the baby is not pressed to come out …I think that … everybody should have the baby by cesarean section.” (quote from LtM2)
Studies from England and Canada confirm very low rates of maternal request cesareans
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Pressure to Accept Interventions by Method of Delivery
Did you feel pressure from any health professional to have a cesarean? % yes
7%
28%
28%
22%
0% 5% 10% 15% 20% 25% 30%
Vaginal
VBAC
PrimaryCesarean
RepeatCesarean
Source: Declercq et al. 2013. Listening to Mothers III.BirthByTheNumbers.org
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BirthByTheNumbers.org
Have maternal request cesareans played a major role in these increases?
NO!So what is the reason for the
increasing cesarean rate?
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BirthByTheNumbers.org
Have maternal request cesareans played a major role in these increases?
NO!So what is the reason for the
increasing cesarean rate?
Practice Changes
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Cesarean Rates, Low Risk*, First-Time Mothers for Medical Risk Factors & Labor Complications
30
35
40
45
50
1991 1996 2009
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Prolonged Labor
Birthweight > 4000g
*Singleton, Vertex, Full Gestation Births
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20
22
24
26
28
30
32
34
% Tot US 23 22.722.622.321.821.220.820.720.821.222.0 23 24 26 28 29 30 31 32 32 33 33 33
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11
%
Source: National Center for Health Statistics Annual Birth Reports
%
1,296,779
Revisiting the trend in cesareans in the US for comparison
BirthByTheNumbers.org
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30
35
40
45
50
1991 1996 2009
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Prolonged Labor
Birthweight > 4000g
Cesarean Rates, Low Risk*, First-Time Mothers for Medical Risk Factors & Labor Complications
*Singleton, Vertex, Full Gestation Births BirthByTheNumbers.org
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30
35
40
45
50
1991 1996 2009
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Birthweight > 4000g
Cesarean Rates, Low Risk*, First-Time Mothers for Medical Risk Factors & Labor Complications
Source: CDC Vital Stats. http://www.cdc.gov/nchs/VitalStats.htm*Singleton, Vertex, Full Gestation Births
BirthByTheNumbers.org
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Women have not changed nearly as much as practice patterns have
BirthByTheNumbers.org
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Other Cool Slides that Might be Useful in Class
BirthByTheNumbers.org
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Induction No53%
Epidural No39%
Epidural Yes61%
Induction Yes47%
Epidural No22%
Epidural Yes78%
First-time mothers who experienced labor
Cesarean Yes20%
Cesarean Yes5%
Cesarean Yes31%
Cesarean Yes19%
Cascade of intervention in first-time mothers who experienced laborBase: first-time mothers with full term births who experienced labor n=821
Note: in this group, which included 93% of first-time mothers, the overall epidural rate was 71% and overall cesarean rate was 19%
BirthByTheNumbers.org
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Inductions in Vaginal Births, U.S., 1990-2010
5%
10%
15%
20%
25%
30%
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Source: Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm. BirthByTheNumbers.org
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BirthByTheNumbers.org
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Total U.S. Births, 1990-2011
19901992
19941996
19982000
20022004
20062008
20103,800,000
3,900,000
4,000,000
4,100,000
4,200,000
4,300,000
4,400,000
3,953,593
4,316,233
Net Decrease 2007-2011362,640 or 8.4%
BirthByTheNumbers.org
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U.S. Fertility Rates (per 1,000) by Race/Ethnicity, 1989-2011
50
60
70
80
90
100
110
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
AllWNHBNHHisp
Fertility rates computed by relating total births, regardless of age of mother, to women 15-44 years. BirthByTheNumbers.org
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Proportion of Births to Older Mothers, U.S. 1990-2011
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
NOTE: Since 2003Cesarean Rate Increased by 20%
> 35> 35
>30
BirthByTheNumbers.org
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Are Babies Getting Bigger?% Singleton Babies by Birthweight, U. S.,
1991-2010
11% 11% 10% 8% 8%
30% 30% 29%28% 27%
0%
10%
20%
30%
40%
50%
1991 1996 2001 2006 2010
3500-3999gms
4000+gms41% 41% 39%
36% 35%
BirthByTheNumbers.org
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Rates of Multiple Births (proportion of all babies in multiple births), U.S., 1980-2011
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
BirthByTheNumbers.org
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Percentage of Live Births Attended by Certified Nurse Midwive’s, U.S. 1989 - 2011
2%
4%
6%
8%
10%
All 3.3% 3.6% 4.1% 4.6% 4.9% 5.2% 5.6% 6.2% 6.7% 7.1% 7.3% 7.3% 7.6% 7.7% 7.6% 7.5% 7.4% 7.4% 7.3% 7.5% 7.6% 7.8% 7.8%
'89 '90 '91 '92 '93 '94 '95 ''96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11
Source: National Center for Health Statistics, Final Data Births, annual reports,1989-2011
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For more information and additional resources regularly
check:
BirthByTheNumbers.org
The site is updated as additional data becomes available.
BirthByTheNumbers.org