Last week, the National Center for Health Statistics (NCHS), part of the Centers for Disease Control (CDC) released 2014 information from the National Vital Statistics System, which works collaboratively with the NCHS. This information comes from birth certificates and captures all births that have occurred in the United States during the reporting period.

There was definitely some good news amongst the mammoth report. Here are some highlights:

General Fertility Rate

The general fertility rate (GFR- number of births/1,000 women) increased to 62.9 per 1,000 women between the ages of 15 to 44.. This increase is the first increase since 2007. Birth rates often decrease during periods of national financial instability. Possibly, people are feeling more positive about the economy and their own financial security. While the increase from 2013 to 2014 was only 1%, things may be turning around as it has been an eight year streak of consecutive decreases. it should be noted that non-Hispanic white women and Asian Pacific Islanders both had an increase in the GFR, the rate remained unchanged for non-Hispanic black women. The fertility rates of Hispanic and American Indian or Alaskan Native women both hit historic lows.

Teen Birth Rates

The birth rates amongst teens aged 15-19 declined to historic lows for all teens as well as for each race and Hispanic origin group. The birth rate for teens aged 15-19 dropped 9% from 2013 to 2014. It was 24.2 per 1,000 females aged 15-19. Comparing the 2014 rate to 2007, the rate has dropped 42%!

Cesarean Rates

The cesarean birth rate was 2014 was 32.2%, down from 32.7% in 2013. The 2014 cesarean birth rate is down 2% from the high of 32.9 in 2009. Of significance - the cesarean delivery rates for non-Hispanic black, Hispanic and Asian/Pacific Islanders declined for the first time since 1996. These groups have had 18 consecutive years of increasing cesarean birth rates. Non-Hispanic white women have consistently had the larger declines.

Preterm Birth Rates

The number of babies born before 37 completed weeks of gestation declined again to 9.57% of all births. Since 2007, the percentage of preterm babies is down 8% since 2007. In 2014, non-Hispanic black infants were about 50% more likely to be born preterm than non-Hispanic white, Hispanic, and Asian/Pacific Islander infants. Many campaigns, such a "Go the Full 40" (AWHONN) and "A Healthy Baby Is Worth the Wait" (March of Dimes) and others by additional organizations have been effective at reducing the number of non-medically necessary inductions before 39 weeks.

If you are interested in all the data - or even accessing the raw data for your own analysis, head over to the NCHS/CDC Vital Statistics website to download the reports or databases of your choice.

Leapfrog Group Releases Hospital Cesarean Rates

© Leapfrog Group

Additionally, last week, The Leapfrog Group - a nonprofit national watchdog group whose mission is to improve the safety, quality and affordability of health care by a) supporting informed health care decisions by those who use and pay for health care; and, b) promoting high-value health care through incentives and rewards, released a national cesarean rate by hospital report. This report, readily available to consumers, includes information on 48 states and Washington DC. You can read the full press release here.

1122 hospitals voluntarily responded to the 2015 Leapfrog Hospital Survey. Upon analysis, it was determined tht over 60% of reporting hospitals had excessive rates of cesarean sections. The Leapfrog Cesarean Report collaborated with Childbirth Connection to help explain the information contained in the report.

The report contains the NTSV cesarean rates for the 1122 hospitals. NTSV refers to a first time (nulliparous) pregnancy, that is full term (37th week or later) and there is one fetus (singleton) in the vertex (head down) position. The NTSV cesarean section rate is recognized as being directly associated with quality improvement activities that are being implemented to reduce the number of unnecessary cesareans.

The cesarean section target rate for NTSV population that the Leapfrog Group adopted is 23.9% based on a proposal by the HealthyPeople.gov's 2020 initiative, which seeks to improve the health and well-being of women, infants, children and families by the year 2020. It is important to realize that this NTSV rate is not the overall cesarean rate, which is much higher as it includes all births, not just those NTSV births.

"This is really about how well we, as doctors, nurses, midwives, and hospitals, support labor. Hospital staff that support labor appropriately and are sensitive to families' birth plans are shown to have lower C-section rates overall. If we want to improve this rate across the board, then hospitals must hold themselves to this standard to ensure safe short- and long-term outcomes for both mom and baby." Elliott Main, M.D., chair of Leapfrog's Maternity Care Expert Panel and medical director of Stanford's California Maternal Quality Care Collaborative.

Utah had the lowest number of NTSV cesareans at 18.3%. Kentucky was last with an NTSV cesarean rate of 35.3%. (Not all states had sufficient hospitals reporting data to calculate their ranking)

Consumers can find out the ranking of hospitals in their state by following this link. There is also a very helpful section in this report that includes information on how consumers can help navigate their maternity health care options to prevent unnecessary cesarean sections.

As a childbirth educator, will you share this information with the families you work with? How will you help them to understand the importance of their choice of birth locations? How can you help families to navigate this situation when they do not have the freedom of choice or do not have an alternative available to them?

References

Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2014. NCHS data brief, no 216. Hyattsville, MD: National Center for Health Statistics. 2015.

what does it mean when the hospital doesn't report

transparency acts of mass and NY

and if a firm like leapfrog can't get them imagine how hard for average consumer

Published: October 12, 2015

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