Where babies are born and who attends their births: findings from the revised 1989 United States Standard Certificate of Live Birth.
OBJECTIVE
To examine the results of changes in the birth certificate with regard to characteristics of the mothers and the birth weights of their infants. The United States Standard Certificate of Live Birth was revised in 1989 to include specific designations for the place of births out of hospital and the presence of a nurse-midwife or other midwife at the birth.


METHODS
All results are based on data from the Natality, Marriage and Divorce Statistics Branch of the National Center for Health Statistics, Centers for Disease Control. In all cases reported here, the data represent at least 91% of all United States births in 1989.


RESULTS
Different patterns of birth attendance emerged in different settings. In residential births, other midwives and "others" attended 66% of all births, whereas in freestanding birth centers, physicians and certified nurse-midwives attended 75.1% of all births. The characteristics of the mothers differed substantially according to who attended their births in these settings. Substantial interstate variations in place and attendant were also documented.


CONCLUSIONS
The positive outcomes achieved in certain settings indicate a need for further research into the factors that influence birth outcomes.
Declercq
E R
ER
Merrimack College, North Andover, Massachusetts.
D000328:Adult; D001719:Birth Certificates; D001724:Birth Weight; D016550:Birthing Centers / Q000706:statistics & numerical data*; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery; D009721:Nurse Midwives; D010820:Physicians; D014481:United States / Q000453:epidemiology