Some Statistics for Pregnancy, Labor, and Birth

 

As you are preparing to teach a class, do you ever wonder about the incidence of certain interventions? Knowing what percentage of women experience something may help you decide how much time to spend on it in class. Do you get questions from students in class about how likely they are to have something happen to them? This document is to gather as many of those numbers into one place as possible.

Please note: some of these statistics are based on governmental records of data, for example, how many babies are born each year in the US. Some of these statistics are research results, which are based on a specific statistical sample of women in specific settings, and may or may not be applicable to the population as a whole. Some are estimates, like the percentage of women who have experienced sexual abuse.

It is important to clarify with students that all statistics show you is the relative chance of something happening to “the average pregnant woman.” To find out how likely it is to happen to them, they should consult with a caregiver familiar with their history and condition.

 

Demographics

·          Babies born each year in the U.S:) 4,140,419 in 2005 (CDC)

·          In Washington State:  80,474 in 2003 (CDC)  In King County: 26,032 in 2002 (WA Vital Stats)

·          Age of mothers… percentage of all mothers who were in this age group: 10-14 years old: .2% of mothers. 15-19: 11%. 20-24: 25%. 25-29: 26%. 30-34: 23%. 35-39: 11%. 40-44: 2%. 45-54: .13% (CDC – 2001)

·          Age of mothers… amongst 1000 women in this age group, how many had babies in 2005: 10 – 14 year olds: .7 per 1000. 15 – 17: 21.4; 18-19: 69.9; 20 – 24: 102.2; 25 – 29: 115.6; 30 – 34: 95.9; 35 – 39: 46.3; 40 – 44: 9.1. 45 – 49: .6   http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm

·          Unwed mothers: 36.8% of mothers in 2005, (CDC)

·          Average number of children born to a woman over a lifetime, in U.S. in 2000: 2.1  (CDC)

·          Twins are 2.9% of live births. Higher order multiples: .18% (CDC)

·          Most women who gave birth had wanted to become pregnant either prior to (15%) or at the time (42%) they became pregnant. However, over 4 out of 10 pregnancies resulting in births were unplanned, that is, the women did not want to become pregnant at the time they conceived this pregnancy; this includes 34% who had hoped to become pregnant at some point in the future, and 8% who had never wanted to become pregnant. (LM2)

·          Infant mortality. 6.63 infant deaths per 1,000 live births in 2004. There are 39 other countries with lower infant mortality rates. (CIA). Nearly 1 in 10 infant deaths were from sudden infant death syndrome (SIDS). There were a total of 2,648 deaths from SIDS in 1999. (CDC)

·          Histories that expectant moms bring into the room with them:

1.    Pregnancy history: Approximately 35% of women will have had an abortion before the age of 45. Approximately 25 – 30% of pregnancies end in miscarriage, so many of the women will have experienced a past miscarriage. 25% of couples experience infertility at some point in their lives. In 2001, 40,000 babies were born in the US as a result of fertility treatments (source). In (LM2), 4% of women reported having medical assistance with getting pregnant; the percentage jumped to 20% in women over age 35. (the exact numbers may be a little higher, as LM2 excluded mothers of multiples, and multiples are more common after fertility treatments)

2.    Abuse history: Approximately 1 in 3 women have been sexually abused at some point in their lives. 31% of American women report having been physically or sexually abused by a husband or boyfriend at some point in their lives. (Commonwealth Fund survey, 1998). Of the women who experience abuse at some point in their lives, 30% report it began during their pregnancy. It is estimated that 6 – 20% of pregnant women will be physically abused during pregnancy. 

 

Pregnancy

 

Prenatal care (includes info on low birthweight and preterm babies

·          About 3 in 10 women have a visit to a health care provider to plan their pregnancy before they conceive. (LM)

·          83% of mothers learned about their pregnancy from a home pregnancy test (LM2)

·          Women who received prenatal care in their first trimester: 84.1% (CDC 2003). 83.2% (WA) 17% of women reported that they could not get their first prenatal appointment as early as they wanted to. (LM2)

·          Women receiving late or no prenatal care: 3% (WA 2001)

·          Prenatal Caregivers: 77% OB/Gyn. 7% Family Physician. 13% Midwife. 4% Nurse or PA

·          Preterm birth (before 37 weeks gestation): 12.1% nationwide in 2003 (CDC) In Washington, 12% in 2001 (WA)

·          Low birthweight: 7.9% nationwide in 2003 (CDC).

·          Proportion of infants who did not survive first year amongst very low birth weight (1500 grams or less) 51%.  Amongst moderately low weight (1500-2499 grams) 14%.  (MO)

·          Value of prenatal care. Rates of complications among high-risk patients in a prenatal care program (including education, more frequent visits, and more provider attention) compared to non-participants.  Preterm birthrate: 7.4 vs. 9.1%   Rate of low birthweight babies: 5.8 vs. 6.4% (MO)  Preterm labor episodes successfully stopped: 11.4 vs. 6.6%

·          Cost of prenatal care for one mother: $702. Cost savings available in the first year of care for an infant of normal birthweight rather than low birthweight: $59,700.

·          Smoking in pregnancy: 11% in 2003 (CDC)

·          Before pregnancy, 25% of women were obese according to body-mass-index, and 26% overweight. At the time of study, 3 – 12 months ater birth, 32% were obese, and 29% overweight. (LM2)

·          Median weight gain in pregnancy: 30 pounds (LM2)

Childbirth Education / Sources of Information

·          36% of women report taking classes: 70% of new moms, 19% of experienced moms (LM) In LM2: 56% of new moms, 9% of experienced.

·          They took classes because they wanted to learn about labor and birth (82%), wanted to prepare for a natural childbirth (37%), because their caregiver recommended it (26%), and because it was viewed a routine thing one does in pregnancy (11%) LM2

·          Women reported that their childbirth classes had these effects: 88% had a better understanding of childbirth options, 78% more confident in ability to give birth, 70% better able to communicate with health care providers, 60% increased trust in hospital, 585z decreased fear of medical interventions, 54% increased trust in health care provider. 14% said the class made them more afraid. (LM2)

·          Of those who took classes, 88% at hospital or caregivers’ office, 4% at home, 7% at a community site. (LM)

·          Most important sources of information about pain relief ]: 25% relied most on doctor or midwife, 15% on classes, 9% on friends or relatives, 3% Internet. (And own experience for multiparous women.)  (LM)

Ultrasound

99% of women had one. 59% had 3 or more. 15% had six or more. (LM2)

Variations in Pregnancy:

·          Gestational Diabetes: 3.5% (WA)

·          Pregnancy Induced Hypertension: 5% Eclampsia: .4%  (WA)

·          Prolapsed cord: 1 per 1000. CDC 2004

·          Abruptio placenta: 4 per 1000 CDC: 2004

·          Breech presentation: 4% CDC 2004

Group B Strep

·          Before prevention methods were widely used, approximately 8,000 babies in the United States would get GBS disease each year. One of every 20 babies with GBS disease dies from infection. (CDC - www.cdc.gov/ncidod/dbmd/diseaseinfo/groupbstrep_g.htm )

·          30 – 40% of pregnant women normally carry the bacteria (in the throat, intestines, or vagina) without having any illness. Newborn babies can be infected before birth if vaginal bacteria infect the amniotic fluid, during birth, or after birth by close physical contact with mother

·          Most GBS infections occur in babies less than 3 months of age, with an incidence of about 1 case per 1000 births

·          If a mother is a carrier of GBS, there’s a 50% chance her baby will be infected. Less than 1% of full-term babies who become carriers of GBS develop GBS meningitis of other severe GBS infection.

·          If baby is born prematurely, especially before 32 weeks, then the mother’s antibodies to GBS are not transferred across the placenta and the baby is at much greater risk of GBS disease.

Source for last four items: http://www.meningitis.ca/groupbstrepdisease.html

Due Dates:

·          Preterm (before 37 weeks): 12.8% (WA)

·          Term (37-41 weeks): 79% (WA)

·          Post-term babies (after 42 weeks): .07% (WA)

Induction / Augmentation

·          CDC 2004: 21% induction / 13% augmentation

·          Self-induction: 22% of women tried to start their own labors, using methods such as walking/exercise, sexual intercourse, or nipple stimulation. About 21% of these women succeeded in starting their own labors. 58% of the women who tried to induce labor were just ready for pregnancy to be over with. 33% were trying to avoid medical induction. (LM2)

·          41% of surveyed women say their doctors tried to induce their labors. 84% of medical inductions started labor. (LM2)

·          In Seattle area, hospitals with Pitocin induction rates of 5 – 20% were St. Joseph, Stevens, Swedish Ballard, Tacoma General, Valley General, Valley Medical, and Whidbey. Hospitals with induction rates between 21 – 50% were Auburn, Evergreen, Group Health, Overlake, Providence Everett.  These hospitals did not report: Northwest, St. Clare, Swedish First Hill, and UWMC.  Pitocin augmentation rates generally ranged from 15 – 60%. (CEAS)

·          Reasons for induction: 59% of induced moms report that induction was for medical reasons only, 18% for non-medical reasons only, and 16% for medical and non-medical reasons in combination. (LM)

·          Of those who were induced: 19% say induction was because “I wanted to be done with my pregnancy and have my baby.” 11% said “this helped ensure my chosen caregiver would attend my birth.” 6% said “I wanted to control the timing of my birth to make work or personal plans” and 11% provided other non-medical reasons. (LM)

·          Means of induction: of moms who were induced, they report 80% oxytocin, 49% amniotomy, 33% sweeping membranes, 24% prostaglandin gel, pouch, or tablet. Most women had a combination of multiple methods. (LM2)

·          Of 19 Seattle hospitals, 10 say they “often” use Pitocin, 9 say sometimes. 9 “often” use prostaglandins, 9 “sometimes” and only St. Francis says “never.”  For rupture of membranes, 10 say often, 8 say sometimes, Evergreen says ‘rarely’. For Foley / dilators, 6 say sometimes, 11 say rarely, and Auburn and Whidbey say never.

·          Augmentation: Moms report: 54% had membranes broken, 53% artificial oxytocin. (LM)

·          Of mothers who had ultrasounds to check baby’s weight, 16% were told baby would be over 8 pounds, 14 oz. Only 12% were that big.

 

Care During Labor and Medical Interventions

 

Cost of Care

Prenatal care and postpartum follow-up by a doctor or midwife: I have had a hard time finding an estimate. May be around $1500. http://199.106.73.174/resources/low/1800030/

Hospital charges.  (All Washington state CHARS data, 2005)

For normal labor and vaginal delivery w/o complications, costs range from $2400 – 11,000 in Washington state, from $3000-9400 in King Cty.

For cesarean birth without complications, costs range $4400 – 19,000 in Washington, $4400 – 15,900 in King County

For normal newborn care: $477 – 4300 in Washington, 1072 – 4300 in King County

Birth Center fees: approximately $1500

 

Electronic Fetal Monitoring

·          Used in 84% of all live births. (CDC) 

·          By moms’ report: 93% of moms had EFM: 73% had EFM alone, 20% had EFM combined with a handheld device such as a Doppler. Among those using EFM, 66% were monitored continuously, 23% were monitored most of the time. Only 4% were monitored intermittently, and only 7% had only a baseline measure. Only 6% were never attached to a fetal monitor. (LM)

·          Of women who had electronic monitoring, 70% were monitored externally. 22% had both external and internal EFM, and 4% were monitored only by internal EFM. (LM)

·          Increase in risk of c-section associated with the use of EFM: 41% (MO)

·          Significant differences observed in one-minute Apgar scores below 4 among infants who received continuous EFM: None  (MO)

·          False positive rate for multiple late decelerations in fetal heartbeat…: 99.8%  (MO)

·          World Health Organization: In conclusion, the method of choice for the monitoring of the fetus during normal labour is intermittent auscultation…. Individualized care of the labouring woman is essential, and this may be achieved more smoothly by the personal contact required by regular auscultation. Only in women with increased risk, such as labours which are induced or augmented, complicated by meconium-stained amniotic fluid or by any other risk factor, does electronic monitoring seem to be advantageous. In the majority of labours without increased risk, electronic monitoring increases the number of interventions with no clear benefit for the fetus and with a degree of additional discomfort for the women. (WHO)

Food in Labor

·          56% of moms say they were interested in drinking something, and 27% in eating something between when their labor began and when they gave birth. At birthplace, 34% were permitted to eat or drink, only 13% were allowed to eat in labor. Looking only at vaginal births, 35% actually did drink something, 14% ate something.

·          In the Seattle area, the following hospitals allow food in labor: Auburn Regional Medical Center, Group Health, Northwest, St. Francis, Stevens, Swedish Ballard, Tacoma General. UWMC, Valley General, Whidbey General. The following say it is the provider’s decision: Providence Everett, St. Clare, St. Joseph, Swedish First Hill. Overlake, Evergreen, and Valley Medical do not allow food in labor. (CEAS)

I.V. / Heplock

·          86% of moms receive an IV (LM)

·          Of 19 hospitals in the Seattle area, 15 say they “often” use IV’s, 4 say “sometimes”. 11 say they “often” use heplocks, the rest say “sometimes.” (CEAS)

Urination

·          52% of moms had a catheter to remove urine (LM)

Group B Strep

Incidence: 10 – 30% of all adults are colonized with group B streptococcus. 12 – 35% of pregnant women. Chance of transmission to fetus / infant: 40 – 75%. Disease in infants (presumably this means symptomatic infectious disease) 1 – 2% (1 – 3: 1000 live births)  (MB)

Length of Labor

·          By moms’ reports: average length 10.3; 43% say 1-6 hours, 7% more than 24 hours (LM)

·          Friedman curve (obstetrical definition): From 4-10 cm dilation, a good rate is 3.0 cm / hr. Minimum is 1.2 cm / hr.

·          Leah Albers study of ‘normal’ birth without intervention: 4-10 cm: nulliparas 7.7 hours on average (19.4 hours still within range of normal), with normal progress defined as half a centimeter per hour; second stage 53 minutes average (up to 147 normal.) For multips: 5.7 hours / 13.7 hours and 17 minutes/57 minutes.

·          Precipitous labor: Precipitous <3 hr: 2% overall. (From first time moms who have a .7% chance to 8th-time moms who have a 5% chance) CDC 2004

·          Prolonged >20 hr: .5% overall (first time moms 1%, second timers .2%)  CDC 2004

·           

Comfort Techniques

·          Labor support/who provides: 96% had someone providing emotional support and/or assistance with physical comfort: 82% partner or husband, 56% nurse, 38% family member or friend, 34% doctor*, 8% midwife*, 3% doula. (LM2)

·          Labor support from primary caregiver. Of those attended by obstetricians, 37% received supportive care in labor; of those attended by family physicians, 44%. Of those attended by midwives, 66%. (LM2)

·          Labor support / how effective: 90% of moms described the supportive care they received as good or excellent. Most likely to be given an “excellent” rating: doula – 88%; family or friend – 73%; partner or husband – 72%; doctor – 71%, midwives and nursing staff – 68%. (LM2)

·          71% did not walk around once they were admitted to the hospital. Primary reason: connected to things (67%), pain medications (32%), caregiver telling them not to walk (28%), choosing to stay in one place (21%) (LM)

·          Non-drug methods of pain relief: 61% used breathing techniques, 60% used movement or position changes. 32% used hands-on techniques such as massage and touch; 30% used mental strategies such as relaxation or visualization. 15% used hot or cold objects, 12% used environmental changes such as music or aromatherapy, 8% used showers, 6% used tubs, 5% used birth balls, 1% used sterile water injections. (LM)

·          Moms’ report of effectiveness of pain relief: 89% said tub or Jacuzzi was somewhat helpful (49% said very helpful). Other positive ratings: Hot or cold objects: 82%. Hands-on: 81%, position changes 79%, environment changes 76%, birth balls very helpful to 32% of those who used them. (LM)

·          Breathing techniques were rated as at least somewhat helpful by 69% (22% said very helpful), but 30% rated them as not very helpful or not helpful at all. (LM)

Pain Medication

·          By mothers’ report: 80% used some pain medication: 63% had epidurals, 30% had narcotics. 5% had general anesthesia, 2% were given nitrous oxide, 2% were given pudendal or other local blocks. (LM)

·          Moms’ report of effectiveness of pain relief: 78% said epidural was very helpful; Narcotics rated 66%, pudendal or other local blocks 57%, nitrous 52%. (LM)

·          Common narcotics at Seattle area hospitals (how many hospitals use): Stadol – 13; Fentanyl – 11; Morphine – 8; Nubain – 6; Demerol – 2.  (CEAS)

·          Epidural Rates at Seattle hospitals: 5% - Whidbey (approx). 39 – 69% - Auburn, Group Health, Highline, Overlake, Providence Everett, St. Joseph, Swedish Ballard, Tacoma General, Valley General, Valley Medical. 70 – 90% - Evergreen, Northwest, St. Clare, St. Francis, Stevens, UWMC. No rates reported: Swedish First Hill. (CEAS)

Epidural Side Effects

For all the details on research results, see separate article.

What parents know about epidural side effects (from LM survey taken after birth):

 

 

Agree strongly %

Agree somewhat

Disagree Somewhat

Disagree Strongly

Not Sure

Epidurals provide more effective pain relief than any other method

54

23

5

6

12

E. require certain interventions such as EFM and IV

34

29

6

4

28

E. often involve interventions such as Pitocin or catheter

24

29

13

9

26

E increase the chance of fever

4

16

23

16

40

E increase chance of baby eval for infection

5

12

24

18

41

 

Positions for Birth

·          74% lay on their backs, 23% upright (propped up, squatting or sitting), 3% side-lying, 1% hands and knees. (LM)

Episiotomy, Perineal Lacerations, Stitches

·          Seattle hospitals: Less than 25% - Evergreen, Highline, Swedish Ballard (according to records), Group Health, St. Joseph, UWMC, Valley General (approximate rates). 30 – 60% - Northwest, Stevens, Valley Medical (approx). 80-90% - St. Francis, Tacoma General (approximate). Hospitals not reporting rates: Auburn, Overlake, Providence Everett, St. Clare, Swedish First Hill, Whidbey General.

·          Moms report: 52% had stitches to repair tear or cut. 27% had episiotomy.

Forceps and Vacuum Extractor

·          Moms report: 7% vacuum extraction, 3% forceps.

·          CDC 2004 says: 4% vacuum extractor, 1% forceps

·          Seattle area hospitals in 2007 stated forceps were “extremely rare” to 2%. Except the university hospital (affiliated with medical school), which reported a rate of 8% forceps (Great Starts survey)

Cesarean Rates and Rates of VBAC (Vaginal Birth After prior Cesarean)

·          Cesarean rate recommended by World Health Organization: 12%

·          Current rates in United States. From The Center for Disease Control: www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_09.pdf

 

 

1996

2001

2002

2003

2004

2005

change 2004-5

change 1996 - 2005

Total Cesareans

20.7%

24.4

26.1

27.5

29.1

30.2

á 4%

á 46%

 

 

 

 

 

 

 

 

Change 2003-4

Change 1996-2004

Primary Cesarean

14.6%

16.9

18

19.1

20.6

 

á 8%

á 41%

VBAC

28.3%

16.4

12.7

10.6

9.2

 

â 13%

â 67%

 

·          Primary cesarean rate is the rate for births to women with no previous cesarean. VBAC rate is the percentage of women with prior cesareans who had a vaginal birth with this birth.

·          Chance of a woman needing an emergency cesarean with any labor: 2.7%.

·          Risk of death with c-section is 3-7 times higher than risk of death for vaginal birth. (ACOG)

·          Cesarean rate for certified nurse-midwives who attended hospital births: 11.6%  VBAC rate with certified nurse-midwives: 68.9%  (MO)

·          Risk of uterine rupture in women with a previous cesarean. 1.6 per 1000 for those who choose repeat cesarean. 5.2 per 1000 for those who go into spontaneous labor. 7.7 per 1000 if induced without prostaglandins. 24.5 per 1000 for those who are induced with prostaglandins. http://content.nejm.org/cgi/content/abstract/345/1/3. The Vermont/New Hampshire VBAC Project findings show the overall risk of infant death from a VBAC attempt is 6 per 10,000 compared to 3 per 10,000 planned cesarean births.

·          Dehiscence (opening of the scar) occurs in 1.1% of VBAC’s. A true uterine rupture occurs for .3 - .7%

 

Rates by Seattle hospital (from 2005 CHARS data available from the state). Range from 19.5% - 36.4%. All the numbers.

 

“Patient Choice” Cesareans:

In 1999, 1.56% of births in women with no prior history of c-section. In 2000, 1.73%. In 2001, 1.87%.

These numbers are based on an examination of statistics from 1,920 hospitals, in 18 states which publish data about childbirth. They represent women who had a c-section who did not labor, had no history of c-section and had no medical indication for a c-section divided by the number of all deliveries, both vaginal and c-section, in women with no history of c-section. Source: www.healthgrades.com/products/index.cfm?fuseaction=mod&modtype=content&modact=Media_PressRelease_Detail&&press_id=104

 

Caregivers

 

Choosing a care provider: 83% of women did not meet with multiple care providers before choosing theirs (LM2)

79% chose OB/Gyn, 8% family physician, 9% midwife (LM2)

Who was at the labor and birth

·          Staff: 62% of moms report five or fewer different hospital staff were present. 38% said more than 5. 7% say more than ten staff members had been present. (LM)

·          Main caregiver at birth: For 71% of women, the primary prenatal care provider was also at the birth. However, for 9% of women, their birth was attended by someone they had only met briefly, and 19% by caregivers the mother had never met. (LM2)

 

Birth attendant, Washington state data (WA)

 

Total births

MD

DO

Cert Midwife

Lic. Midwife

Other

Midwife

Nurse

Hosp Admin

Father

Other

Unknown

Washington 2001

79,101

67,211

1,953

6,721

1,763

98

473

489

71

310

12

%

85

2.5

8.5

2

.1

.6

.6

.09

.4

 

Washington 2005

82364

72064

1127

6824

1441

41

549

0

50

243

25

%

87.5

1.4

8.3

1.7

.05

.7

0

3

.3

.03

King County 2005

27160

24702

4

1867

498

9

17

0

3

55

5

%

90.9

.01

6.9

1.8

.03

.1

0

.01

.2

.02

 

Midwives

·          Percentage of births attended by midwives: In 1999, In 1999, CNM’s attended 7.2% of all births in the US (9.4% of all vaginal births). ACNM  (In New Zealand, 70% of births are midwife-attended – MO)

·          Birthplaces: 96% of CNM-attended births were in hospitals; 2.4% in birth centers; 1% in the home. (ACNM) Midwives are able to deliver at most hospitals in the Seattle area. However, they are not allowed at: Swedish First Hill, Valley General in Monroe, Valley Medical in Renton, and Whidbey General. (CEAS)

·          Patient interaction: The average CNM sees 140 clients a month and attends 10 births a month. Typically spend 40 minutes on a new client visit; 20 minutes on return visits. They remain with the mother through most of her labor, then attend birth and initial recovery stage. (ACNM)

·          Intervention rates: Episiotomies. In 4 studies of nurse-midwives between 1992 and 1995, rates ranged from 5 -15% (ACNM) Cesarean: In 7 between 1989 and 1997, studies of nurse-midwives’ patients, cesarean rates ranged from 4.3 – 13.1% (ACNM)

·          Infant mortality: In 1991: the total rate nationwide was 8.6 per 1000. For CNM attended births: 4.1 per 1000. In 1998, the National Center for Health Statistics determined that, after controlling for risk factors, the risk of infant death was 19% lower at births attended by CNM’s than by physicians. Risk of neonatal mortality within first 28 days was 33% lower for CNM-attended births. This is believed to be attributed to prenatal care which involved more patient education, and to CNM presence throughout labor. (ACNM)

Obstetricians

·          Percent of female obstetricians who would choose an elective cesarean section rather than any other mode of delivery (for an uncomplicated, singleton pregnancy with a cephalic presentation and no obstetric problems): 31%.  Of midwives surveyed, 5% would choose c-section.  (Al-Mufti, et al, 1997. Cited in MO)

Labor Support

·          Moms reported receiving support from Husband or partner: 92%. Nursing staff: 83%. Doctor: 53%. Another family member or friend: 50%. Midwife: 11%. Doula: 5%. 1% of moms report receiving no support. (LM)

·          Moms’ rating of quality of support received: “Excellent” ratings were received by 71% of doulas, 66% of midwives, 60% of family members and friends, 59% of husbands/partners, 52% of doctors, and 48% of nursing staff.

Doulas.

·          For patients who received continuous support from a doula, compared to patients who did not, difference in: duration of labor – 1.64 hours less; need for any analgesia – 36% less; need for any oxytocin – 71% less, need for forceps – 57% less; need for cesarean section – 51% less. (Scott, 1999, cited in MO)

·          How often are doulas present at births in Seattle area hospitals? Often – Group Health, Northwest, Swedish First Hill, Valley General, Whidbey. Sometimes – Auburn, Evergreen, Highline, St. Joseph, Swedish Ballard, Tacoma General, UWMC, Valley Medical. Rarely – Providence Everett, St. Clare, St. Francis, Stevens. (CEAS)

·          5% of women used a doula, but 78% had heard about doulas, and 52% reported a good understanding of doulas and doula care. (LM)

 

Place of Birth

·          Hospital: 97%. Birth center: 1%. Home: 1%. (LM)

Birth Location, Washington state data for 2002 (WA)

 

Total Births

Hospital

Birth Center

Federal Facility

Home

Born on Arrival

Other

Washington 2002

78,599

73,993

525

2907

1063

60

42

%

94%

0.7

3.7

1.4

0.08

0.05

Washington 2005

82364

77535

771

3107

917

32

5

 %

94.1%

0.9%

3.8%

1.1%

0.04%

0.01%

King County 2005

27160

26613

305

0

231

10

1

 %

98.0%

1.1%

0.0%

0.9%

0.04%

0.00%

 

Newborn Procedures

Vitamin K shots: If babies are not treated with vitamin K, the incidence of vitamin K deficiency bleeding (VKDB) in the first week of life is .4 to 1.7%. Late VKDB (week 2 – 12) occurs in 4.4 to 10.5 per 100,000 births. Disabling or fatal hemorrhage occurs in 2.2 per 100,000 births.  (MB)

Unexpected Outcomes:

Cesarean almost 1 in 3. Miscarriage 1 in 4. Preterm 1 in 8. Birth defects 1 in 28.  Infant mortality (= 28 weeks pg to 28 days old). 1 in 150. Hearing loss 1 in 250. Downs 1 in 800. SIDS 1 in 2000.

 

Breastfeeding

Initiation and Duration:

·          American Academy of Pediatricians recommendation for breastfeeding duration: Exclusive breastfeeding for the first 6 months after birth. Iron-enriched solid foods and breastmilk should be combined for the second half of the first year. “It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired” (AAP, 1997)

·          World Health Organization recommended age of weaning: at least 2 years.

·          Average age for weaning worldwide in 1992: 4.2 years (MO)

Benefits of Breastfeeding:

·          Incidence of otitis media (ear infections): 19% lower for breastfed than formula fed. Duration of episodes: 5.9 days for breastfed vs. 8.8 days for formula. (MO)

·          Diarrheal illness – 50% lower in breastfed infants

·          If the child was introduced to milk other than breastmilk before 4 months of age, there was a 25% higher risk of asthma and a 30% higher risk of allergies at age 6. (MO)

·          Estimated probability of ever having respiratory illness, in children who: received breastmilk exclusively for at least 15 weeks: 17%; received partial breastfeeding for at least 15 weeks – 31%; were exclusively bottle-fed for at least 15 weeks – 32.2%.  (MO)

·          Percent reduction in breast cancer risk among women who breastfed for 12 – 24 months: 61% (Romieu, 1996, cited in MO)

·          Average cost for one year of formula: $1710.

The longer the baby is breastfed, the greater the benefits:

·          Rate of recurrent otitis media (ear infections) in infants who were exclusively breastfed for less than 4 months: 20.5%. For babies who were breastfed for 6 months or more: 10%

·          Incidence of obesity among children who were never breastfed: 4.5%, who were exclusively breastfed for 2 months: 3.8%; for 3-5 months: 2.3%; for 6-12 months: 1.7%  (MO); 12+ months: .8%.

·          Percent reduction in risk of breast cancer for women: who have breastfed for at least two weeks - 13%; who have breastfed for at least two years – 27%; who began to breastfeed at age 20 or younger, and continued for at least six months – 46%. (Newcomb 1999, cited in MO)


Sources of Information

 

AAP: American Academy of Pediatricians. Current policy statements can be found at: https://www.aap.org/policy/pprgtoc.cfm#B

ACNM: American College of Nurse-Midwives.

CDC: Center for Disease Control: includes birth rates amongst teens, unwed mothers, ethnic groups, etc. Includes cesarean and VBAC rates, birthweight data, etc. Most statistics are from 2001, some are from 2000. www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_10.pdf

CEAS: Childbirth Education Association of Seattle, 2002 Hospital Survey. The hospitals included were: Auburn Regional Medical Center, Evergreen, Group Health Central, Highline, Northwest, Overlake, Providence Hospital in Everett, St. Clare, St. Francis, St. Joseph, Stevens, Swedish Ballard, Swedish First Hill, Swedish Providence (their birth center is now closed, so I do not include any info on it above), Tacoma General, University of Washington Medical Center, Valley General in Monroe, Valley Medical in Renton, and Whidbey General.

HG: Health Grades.  2002 analysis of data from 1998-2000. www.healthgrades.com The hospitals I include in the numbers here are: Evergreen, Group Health Central, Highline, Overlake, Swedish (main campus), UW Medical Center, Valley General.

LM: Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. Maternity Center Association, 2002. www.maternitywise.org/listeningtomothers/index.html

MB: College of Midwives of Manitoba. http://www.midwives.mb.ca

MO: Mothering Magazine’s article “What the Numbers Say” compiled by Tiffaney Isaacson, Mothering, March/April 2002.

WA =

   Washington State Department of Health Center for Health Statistics, all for 2001. www.doh.wa.gov/ehsphl/chs/chs-data/birth/bir_vd.htm

WHO: World Health Organization’s Care in normal birth: report of a technical working group, 1996.  http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_table_of_contents.en.html

 

Compiled by Janelle Durham, January 2003.