title: Midwife-attended births in the United States, 1990-2012: results from revised birth certificate data.
abstract: BACKGROUND
  Data on attendance at birth by midwives in the United States have been available on the national level since 1989, allowing for the documentation of long-term trends. New items on payer source and prepregnancy body mass index (BMI) from a 2003 revision of the birth certificate provide an opportunity to examine additional aspects of US midwifery practice.
  
  
  METHODS
  The data in this report are based on records on birth attendant 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), which allows users to create and download specialized tables. Analysis of new items on prepregnancy BMI and birth payer source are limited to the 38 states (86% of US births) that adopted the revised birth certificate by 2012.
  
  
  RESULTS
  Between 1989 and 2012, the proportion of all births attended by certified nurse-midwives (CNMs) increased from 3.3% to 7.9%. The proportion of vaginal births attended by CNMs reached an all-time high of 11.9%. Births attended by "other midwives" (typically certified professional midwives) rose to a peak of 28,343, or 0.7% of all US births. The distribution of payer source for CNM-attended births (44% Medicaid; 44% private insurance; 6% self-pay) is very similar to the national distribution, whereas the majority (53%) of births attended by other midwives are self-pay. Women whose births are attended by other midwives are less likely (13%) to have a prepregnancy BMI in the obese range than women attended by CNMs (19%) or overall (24%).
  
  
  CONCLUSIONS
  The total number of births attended by CNMs and other midwives has remained steady or grown at a time when total US births have declined, resulting in the largest proportions of midwife-attended births in the quarter century that such data have been collected.
authors.forename: Eugene
authors.initials: E
authors.lastname: Declercq
mesh_terms: D001719:Birth Certificates; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth / Q000639:trends; D006801:Humans; D007348:Insurance, Health; D050498:Live Birth; D008484:Medicaid; D008880:Midwifery / Q000639:trends*; D009721:Nurse Midwives; D009765:Obesity / Q000150:complications; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications; D014481:United States
keywords: certified professional midwives; midwifery trends home birth; nurse-midwives