Research Article
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Published Online: 6 June 2023

Increases in Obstetric Interventions and Changes in Gestational Age Distributions of U.S. Births

Publication: Journal of Women's Health
Volume 32, Issue Number 6

Abstract

Objective: To examine how changes in induction of labor (IOL) and cesarean deliveries between 1990 and 2017 affected gestational age distributions of births in the United States.
Materials and Methods: Singleton first births were drawn from the National Vital Statistics System Birth Data for years 1990–2017. Separate analytic samples were created (1) by maternal race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic white), (2) by maternal age (15–19, 20–24, 25–29, 30–34, 35–39, 40–49), (3) by U.S. states, and (4) for women at low risk for obstetric interventions (e.g., age 20–34, no hypertension, no diabetes, no tobacco use). Gestational age was measured in weeks, and obstetric intervention status was measured as: (1) no IOL, vaginal delivery; (2) no IOL, cesarean delivery; and (3) IOL, all deliveries. The joint probabilities of birth at each gestational week by obstetric intervention status for years 1990–1991, 1998–1999, 2007–2008, and 2016–2017 were estimated.
Results: Between 1990 and 2017, the percent of singleton first births occurring between 37 and 39 weeks of gestation increased from 38.5% to 49.5%. The changes were driven by increases in IOL and a shift in the use of cesarean deliveries toward earlier gestations. The changes were observed among all racial/ethnic groups and all maternal ages, and across all U.S. states. The same changes were also observed among U.S. women at low risk for interventions.
Conclusion: Changes in gestational age distributions of U.S. births and their underlying causes are likely national-level phenomena and do not appear to be responding to increases in maternal risk for interventions.

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References

1. Tilstra AM, Masters RK. Worth the weight? Recent trends in obstetric practices, gestational age, and birth weight in the United States. Demography 2020;57(1):99–121.
2. National Center for Health Statistics. 2019. Natality Birth Files: 1990–2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program [Last accessed: July 15, 2019].
3. Declercq E, Menacker F, MacDorman M. Rise in “no indicated risk” primary caesareans in the United States, 1991–2001: Cross sectional analysis. BMJ 2005;330(7482):71–72.
4. MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clin Perinatol 2008;35(2):293–307.
5. Miesnik SR, Reale BJ. A review of issues surrounding medically elective cesarean delivery. J Obst Gynecol Neonatal Nurs 2007;36(6):605–615.
6. Lantos JD, Lauderdale DS. What is behind the rising rates of preterm birth in the United States? Rambam Maimonides Med J 2011;2(4):e0065.
7. MacDorman MF, Declercq E, Zhang J. Obstetrical intervention and the singleton preterm birth rate in the United States from 1991–2006. Am J Public Health 2010;100(11):2241–2247.
8. American College of Nurse Midwives. American college of nursing midwives position statement: Elective primary cesarean birth; 2016. Available from: https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000062/Elective-Primary-Cesarean-Birth-PS-9-12-16.pdf [Last accessed: July 15, 2019].
9. Caughey AB, Cahill AG, Guise JM, et al. Safe prevention of the primary cesarean delivery. Am J Obst Gynecol 2014;210(3):179–193.
10. World Health Organization. WHO Recommendations Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections. World Health Organization: Geneva, Switzerland; 2018.
11. American College of Nurse Midwives. American college of nursing midwives position statement: Induction of labor; 2016. Available from: http://midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000235/Induction-of-Labor-2016.pdf [Last accessed: July 15, 2019].
12. Grobman WA, Rice MM, Reddy UM, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018;379(6):513–523.
13. Sotiriadis A, Petousis S, Thilaganathan B, et al. Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: A meta-analysis. Ultrasound Obst Gynecol 2019;53(1):26–35.
14. Souter V, Painter I, Sitcov K, et al. Maternal and newborn outcomes with elective induction of labor at term. Am J Obst Gynecol 2019;220(3):273-e1.
15. Zanardo V, Bertin M, Sansone L, et al. The adaptive psychological changes of elective induction of labor in breastfeeding women. Early Human Dev 2017;104:13–16.
16. Zhang X, Joseph KS, Kramer MS. Decreased term and postterm birthweight in the United States: Impact of labor induction. Am J Obst Gynecol 2010;203(2):124-e1.
17. Zhang J, Yancey MK, Henderson CE. US national trends in labor induction, 1989–1998. Obst Gynecol Surv 2002;57(8):498–499.
18. Mathews TJ, Hamilton BE. Mean age of mothers is on the rise: United States, 2000–2014. NCHS Data Brief 2016:1(232):1–8.
19. Osterman MJ, Martin JA, Curtin SC, et al. Newly released data from the revised US birth certificate, 2011. Natl Vital Stat Rep 2013;62(4):1–22.
20. Snowden JM, Mission JF, Marshall NE, et al. The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects. Obesity 2016;24(7):1590–1598.
21. Deputy NP, Kim SY, Conrey EJ, et al. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012–2016. Morb Mortal Wkly Rep 2018;67(43):1201.
22. Munafò MR, Smith GD. Robust research needs many lines of evidence. Nature 2018;553(7689):399–401.
23. American College of Obstetricians and Gynecologists. Management of late-term and postterm pregnancies: Practice bulletin no. 146; 2014 (Reaffirmed 2019). Available from: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2014/08/management-of-late-term-and-postterm-pregnancies [Last accessed: July 16, 2019].
24. American College of Obstetricians and Gynecologists. Committee on obstetric practice, society for maternal-fetal medicine committee opinion No. 765: Avoidance of nonmedically indicated early-term deliveries and associated neonatal morbidities; 2019. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/avoidance-of-nonmedically-indicated-early-term-deliveries-and-associated-neonatal-morbidities [Last accessed: July 16, 2019].
25. American College of Nurse-Midwives; Midwives Alliance of North America; National Association of Certified Professional Midwives. Supporting healthy and normal physiologic childbirth: A consensus statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives. J Midwifery Womens Health 2012;57(5):529–532.
26. Murthy K, Grobman WA, Lee TA, et al. Obstetricians' rising liability insurance premiums and inductions at late preterm gestations. Med Care 2009;47:425–430.
27. Fulton BD. Health care market concentration trends in the United States: Evidence and policy responses. Health Affairs 2017;36(9):1530–1538.
28. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Safe Prevention of the Primary Cesearean Delivery. American College of Obstetricians and Gynecologists; 2014. Available from: https://www.acog.org/-/media/Obstetric-Care-Consensus-Series/oc001.pdf?dmc=1&ts=20190710T1317052009 [Last accessed: July 10, 2019].
29. Millen KR, Kuo K, Zhao L, et al. Evidence-based guidelines in labor management. Obstet Gynecol Surv 2014;69(4):209–217.
30. Morris T. Health care in crisis. In: Health Care in Crisis. New York University Press: New York, NY, USA; 2018.
31. Roohan PJ, Josberger RE, Acar J, et al. Validation of birth certificate data in New York State. J Commun Health 2003;28(5):335–346.
32. Ziogas C, Hillyer J, Saftlas AF, et al. Validation of birth certificate and maternal recall of events in labor and delivery with medical records in the Iowa health in pregnancy study. BMC Pregn Childbirth 2002;22(1):1–7.
33. American College of Nurse Midwives, Midwives Alliance North America, National Association of Certified Professional Midwives. Supporting healthy and normal physiologic childbirth: A consensus statement by ACNM, MANA, and NACPM. J Perinat Educ 2013;22(1):14–18.
34. Committee on Obstetric Practice. ACOG committee opinion: Approaches to limit intervention during labor and birth. Obst Gynecol 2019;133(2):e164–e173.
35. Committee on Obstetric Practice, Society for Maternal-Fetal Medicine. ACOG committee opinion: Avoidance of nonmedically indicated early-term deliveries and associated neonatal morbidities. Obst Gynecol 2019;133(2):e156–e163.
36. ACNM Responds to Release of ARRIVE Trial Study Results. Available from: https://www.midwife.org/ACNM-Responds-to-Release-of-ARRIVE-Trial-Study-Results [Last accessed: October 20, 2020].

Information & Authors

Information

Published In

cover image Journal of Women's Health
Journal of Women's Health
Volume 32Issue Number 6June 2023
Pages: 641 - 651
PubMed: 36897311

History

Published online: 6 June 2023
Published in print: June 2023
Published ahead of print: 10 March 2023

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Availability of Data and Materials

The data are restricted natality files and may be accessed with permission from the National Center for Health Statistics (https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm). The authors are willing to share all Stata scripts used to clean, merge, and analyze the data.

Authors

Affiliations

Department of Sociology, University of Colorado Boulder, Boulder, Colorado, USA.
University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA.
Andrea M. Tilstra, PhD
University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA.
Department of Sociology, Nuffield College, University of Oxford, Oxford, United Kingdom.
Leverhulme Centre for Demographic Science, University of Oxford, Oxford, United Kingdom.
Kate Coleman-Minahan, PhD
University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA.
College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Notes

Address correspondence to: Ryan K. Masters, PhD, Department of Sociology, University of Colorado Boulder, Institute of Behavioral Science 421, 483 UCB, Boulder, CO 80309-0483, USA [email protected]

Authors' Contributions

R.K.M., A.M.T., and K.C.-M. all contributed to the study's conceptualization and wrote the main article text. R.K.M. and A.M.T. curated data, and R.K.M. conducted the formal analyses and prepared all figures. All authors reviewed the article.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was funded by a grant from the Eunice Kennedy Shriver Institute of Child Health Human and Human Development (RHD099359A) and also benefited from support provided to the University of Colorado Population Center (CUPC, Project 2P2CHD066613-06) from the Eunice Kennedy Shriver Institute of Child Health Human and Human Development.

Ethical Approval

The research was not sponsored by industry and did not include clinical trials. The University of Colorado Boulder Office of Research Integrity exempted the work from IRB, as the data are secondary records of deidentified individual-level births between 1990 and 2017. The data were obtained with National Center for Health Statistics permission via an application to NVSS (https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm).

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