An Update on Research Issues in the Assessment of Birth Settings Workshop Summary (2013) / Chapter Skim
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2 Context and Background
2 Context and Background
Pages 7-24
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From page 7... ...
All of the data he described were based on information obtained from the birth certificates filed in the United States for each year.2 1 his section summarizes information presented by Brady Hamilton, Ph.D., National Center T for Health Statistics (NCHS) , Reproductive Statistics Branch, Washington, DC.
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From page 8... ...
The increase in out-of-hospital birth rate is occurring much more quickly for non-Hispanic white women. • acDorman pointed out that risk factors associated with different birth settings M have also been changing over time, with women in a home or birth center set ting much less likely than women in hospital settings to deliver preterm and low-birth-weight infants.
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From page 9... ...
One way to assess fertility patterns is with fertility measures, such as total fertility rate, which estimates the number of births that a group of 1,000 women would have over their lifetimes based on the birth rates by age of mother in a given year. Fertility rate can also be expressed as the expected number of births per woman.
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From page 10... ...
Health Trends in Childbirth Data from U.S. birth certificates can be used to assess not just demographic trends, but also health trends in childbirth.
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From page 11... ...
birth certificate data is preterm births. Since 2006, preterm birth rates have declined significantly for infants in each of the three largest ethnic groups (i.e., Hispanic, non-Hispanic black, and nonHispanic white)
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From page 12... ...
There has been a long and sustained decrease in preterm birth rates, although, again, with marked disparity. Finally, twin birth rates appear to have stabilized, while triple and higher-order birth rates are clearly declining.
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From page 13... ...
Not until the 1989 revisions of the birth certificate was it possible to distinguish, for the first time, between types of out-of-hospital births, that is, whether the births occurred in homes or in birthing centers. As with total out-of-hospital births, both home and birthing center births declined gradually from 1990 to 2004 and then increased rapidly from 2004 to 2010.
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From page 14... ...
From 2004 to 2010, out-of-hospital births increased more slowly for other racial and ethnic groups such that, by 2010, the percent of out-of-hospital births was four times higher for non-Hispanic white women than for other racial and ethnic groups. About 90 percent of the total increase in out-of-hospital births from 2004 to 2010 was due to an increase among non-Hispanic white women.
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From page 15... ...
SOURCE: CDC, 2013. Characteristics and Risk Factors Associated with Birth Setting MacDorman explained, "We know that only low-risk women should deliver outside of a hospital, but the precise definition of low risk remains controversial." In an effort to describe the risk status of home versus birth center versus hospital births, MacDorman examined trends in various characteristics and risk factors associated with the different birth settings.
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From page 16... ...
With respect to marriage status, also in 2010, 14 to 15 percent of women giving birth at home or in a birth center are unmarried, compared to 41.1 percent of women with a hospital birth. MacDorman reported 2010 trends for five select medical risk factors: preterm birth, low birth weight, multiple births, diabetes, and hypertension.
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From page 17... ...
birth certificate, such as smoking, make it difficult to examine trends over time. Meanwhile, the observed declines in percent of births born preterm or with low birth weight suggest, again, that selection of low-risk women as candidates for home and birth center births has improved over time.
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From page 18... ...
Six states had increases of 300 or more births occurring in birth centers between 2004 and 2010 (Florida, Oregon, Pennsylvania, South Carolina, Texas, and Washington) , together accounting for more than three-fourths of the increase in birth center births in the United States during that time period.
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From page 19... ...
average=41% increase FIGURE 2-6 Change in percentage of home births in the United States by state, 2004-2010.
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From page 20... ...
• n 2010, home and birthing center births had a lower risk profile than hospital I births for a variety of risk factors, including teen births, nonmarital births, pre term or low-birth-weight babies, multiple births, maternal smoking, hyperten sion, and diabetes. • onversely, out-of-hospital births had higher percentages of older mothers and C mothers having a fourth or higher-order birth, compared to hospital births.
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From page 21... ...
He urged medical professionals to be more outspoken in their support of the need for keeping good birth certificate data, as well as other vital data. Key Changes Since 1982 Paneth identified several key changes since 1982: • Decreased birth rates, but steady fertility rates.5 While fertility rates have shifted to higher age brackets, overall fertility rates have declined only 6.4 percent since 1982 (from 67.3 to 63.2 percent)
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From page 22... ...
A Closer Look at Out-of-Hospital Births Reviewing some of the data that MacDorman reported, Paneth said that he was surprised that about two-thirds of out-of-hospital births are home births and about one-third birth center births (and about 5 percent "other")
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From page 23... ...
Unsure of the actual legal status, Paneth observed the end result: "the closing of a birth center and an option for mothers." Paneth urged that vital data (from both birth and death certificates) be used to monitor planned out-of-hospital births and compare planned out-of-hospital births with hospital births in terms of risk factors for problem births (e.g., such as those presented by MacDorman)
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From page 24... ...
birth certificates nonetheless provide enough descriptive information such that unusual events that warrant further investigation, what Paneth calls "sentinel events," should stand out. He said, "Even without a denominator, their existence is of interest."
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