Trends in midwife-attended births in the United States, 1989-2009.
BACKGROUND
Data on attendance at birth by midwives in the United States have been available on the national level since 1989. Rates of certified nurse-midwife (CNM)-attended births more than doubled between 1989 (3.3% of all births) and 2002 (7.7%) and have remained steady since. This article examines trends in midwife-attended births from 1989 to 2009.


METHODS
The data in this report are based on records gathered as part of the US National Standard Certificate of Live Birth from a public use Web site, Vital Stats (http://www.cdc.gov/nchs/VitalStats.htm), that allows users to create and download specialized tables.


RESULTS
Between 2007 and 2009, the proportion of all births attended by CNMs increased by 4% from 7.3% of all births to 7.6% and a total of 313,516. This represents a decline in total births attended by CNMs from 2008 but a higher proportion of all births because total US births dropped at a faster rate. The proportion of vaginal births attended by CNMs reached an all-time high of 11.4% in 2009. There were strong regional patterns to the distribution of CNM-attended births. Births attended by "other midwives" rose to 21,787 or 0.5% of all US births, and the total proportion of all births attended by midwives reached an all-time high of 8.1%. The race/ethnicity of mothers attended by CNMs has shifted over the years. In 1990, CNMs attended a disproportionately high number of births to non-white mothers, whereas in 2009, the profile of CNM births mirrors the national distribution in race/ethnicity.


CONCLUSIONS
Midwife-attended births in the United States are increasing. The geographic patterns in the distribution of midwife-attended births warrant further study.
Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA. declercq@bu.edu
Eugene
E
Declercq
D005260:Female; D006801:Humans; D050498:Live Birth / Q000208:ethnology; D008880:Midwifery / Q000639:trends*; D009321:Natural Childbirth; D009721:Nurse Midwives / Q000639:trends*; D011247:Pregnancy; D044469:Racial Groups; D014481:United States / Q000208:ethnology