Recent changes in birth attendant, place of birth, and the use of obstetric interventions, United States, 1989-1997

Although more than nine out of every ten births are attended by physicians, the percent of births attended by midwives increased during the 1989 to 1997 period and accounted for 7% of all births in 1997. About 99% of births in 1997 were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that occurred in residences increased over the period, while those in freestanding birthing centers declined. The percent of mothers receiving electronic fetal monitoring, ultrasound, and induction and stimulation of labor increased. The most dramatic increase was a doubling of the use of induction. In 1997, approximately 18% of all births were induced. Midwives as well as physicians increased the use of these obstetric procedures over the 1989 to 1997 period, and the use of many procedures by CNMs was as high, or nearly as high, as use by physicians. The rate of cesarean births dropped by 9%, from about 23% in 1989 to about 21% in 1997, while the rate of vaginal birth after a previous cesarean increased by 50%. The proportion of births assisted by forceps consistently declined during the period, while the use of vacuum extraction consistently increased. The number of episiotomies performed in the United States declined each year during the 1990-1996 period. (C) 1999 by the American College of Nurse-Midwives.