A new CDC report looks at the trends of home birth from 1990-2009. While home birth was relatively stable from 1990-2004, after that there was a 29% rise in the number of home births, though still a very low number.  You’re more likely to have a home birth if:

• Non-hispanic white woman
• Over 35
• Married

Interestingly enough 33% are listed as being attended by “other.”  This is dad, mom, EMT, etc.  I wonder if this is in part by midwives not wanting to be listed on the birth certificates.

While many like to cite the rise in the home birth rate as being from Ricki Lake and Abby Epstein’s Business of Being Born, it wasn’t released until May 2008. (See trailer below.) So what’s your take? Why do you think the rates of home birth are increasing?

_{MacDorman MF, Mathews TJ, Declercq E. Home births in the United States, 1990– 2009. NCHS data brief, no 84. Hyattsville, MD: National Center for Health Statistics. 2012.}

As this chart shows, the more prenatal care you had, the more likely you are to use epidural anesthesia. The lowest rates of use were women who had not received prenatal care, even when this is a known high risk group of labor complications. There are a couple of explanations, but one I’d like to explore is: Did more time in the “system” lead to a lack of confidence in one’s body? Did more prenatal care instill a fear of labor? Let’s talk about it.

Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. National vital statistics reports; vol 59 no 5. Hyattsville, MD: National Center for Health Statistics. 2011.

C-Section Trends from 96-07

Next we have the issue of ethnicity.  There are some groups that have lower cesarean rates, though all groups climbed.

C-Section Rates by ethnicty: 1996-2007

Here you can see a state by state break down of the 1996 c-section rate and the 2007 c-section rate, with the percent change. You will also note from Jill at the Unnecesarean that Florida, in 2008, had a 38.2% c-section rate, so the numbers are higher. That is what I expect we will see when the birth data for 2008 (preliminary) comes out in April.

C-Sections by State 1996-2007

Authors of Behind International Rankings of Infant Mortality: How the United States Compares with Europe explored what they refer to as the recent stagnation in the U.S. infant mortality rate that has generated widespread concern among researchers, policy makers, health care providers and activists.

Using data from the United States? Linked Birth/Infant Death Data Set and the European Perinatal Health Report, authors Marian F. MacDorman, Ph.D., and T.J. Mathews, M.S. of the CDC National Center for Health Statistics found that the main cause of the United States high infant mortality rate when compared with Europe is the ?very high percentage of preterm births in the United States.?

According to the study, while infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

Discussions of the U.S. infant mortality rate are often countered with criticism that the U.S. records data differently than other countries, reporting very premature babies as live births. While this is true for five of the 19 European countries whose data was analyzed, 14 of the 19 European countries require that all live births at any birth weight or gestational age be reported.

The United States remains near the bottom of the rankings.

The report states, ?Reporting differences have little effect on the percentage of preterm births because most preterm births occur well after 22 weeks of gestation. For example, the percentage of preterm births for the United States in 2004 was 12.5% when all births were included and 12.4% when births of less than 22 weeks of gestation were excluded.?

MacDorman and Mathews attribute much of the high infant mortality rate in the United States to the high percentage of preterm births. Using the direct standardization method to apply the U.S. gestational-age specific infant mortality rates to Sweden?s distribution of births by gestational age, the NCHS found evidence that lowering the percentage of preterm births could have a dramatic impact on infant mortality in the United States.

November is also Prematurity Awareness Month.? Considering the risks involved in preterm birth, you may be wondering what you can do as a birth activist or as a parent.? Here are some basic things to consider:

• Let labor begin on its own. Without a valid medical reason, let your baby pick his or her birthday for the safest, easiest birth.
• Choose a practitioner with a low induction rate. If you have a midwife or doctor who rarely sees anyone who goes past their due date, it should be a red flag.? Ask the receptionist for her opinion of how many women go past 40 weeks. The answer might surprise you.
• Know the signs of preterm labor. If you think you’re having any of the signs of preterm labor, call your midwife or doctor immediately.? The sooner you get help, the more likely that premature birth can be delayed or stopped completely.
• Be mindful of the risk factors. Face it, you have responsibility for some of the risk factors.? While there are certainly some risk factors for preterm labor that you don’t control, take charge of the ones you can, including prenatal care, good nutrition, not smoking, etc.

• Male Circumcision and HIV: The AAP Project
• Intact America (petition as well)

Please post a comment if you have some other great activist related websites on the topic.