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Different percentages of epidural use have been reported over the years and through different studies. Following are a few large U.S. studies and reports related to birth data spanning from 2002 to 2008. The Listening to Mothers Survey results indicated that approximately 59% of mothers who gave birth vaginally received an epidural during labor. In this study, Declercq et al (2002) reported that between 26% and 41% of women were not able to discuss side effects commonly associated with epidurals. [1] According to a document reporting national birth certificate data from 2008, 61% of women who had a singleton vaginal birth in 27 states received an epidural. [2] Non-Hispanic white women received an epidural (69%) more than women in other racial and ethnic groups. Higher levels of education were associated with higher levels of epidural uptake, as was earlier entry into prenatal care, having gestational diabetes, and having the birth attended by a physician. On the other hand, increasing maternal age was inversely associated with epidural uptake, as was delivering a baby prior to 34 completed weeks of gestation or a baby weighing less than 1,500 grams at birth. Zhang et al (2010) reported a lower percentage of women (43.8%) attempting vaginal birth and opting for induction among the over 228,000 women who delivered in 19 hospitals across the U.S. whose birth data were analyzed for this study. [3] In this same study, the cesarean delivery rate was overall two times higher for women whose labor was induced than for those with spontaneous labor (21.1% vs 11.8%), as well as for first-time mothers delivering a single non-breech baby (31.4% vs 14.2%).
References:
  1. Declercq, E., Sakala, C., Corry, M., Applebaum, S., & Risher, P. (2002). Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association.
  2. Osterman, M. & Martin, J. (2011). Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area, 2008. National Vital Statistics Reports, 59 (5).
  3. Zhang J, Troendle J, Reddy UM, et al, for the Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010;203:x-ex-x-ex.
A recent report by MacDorman, Mathews, and Declercq (1) analyzed US birth data from 1990 to 2009 and found that while home births increased by 29% between 2004 and 2009, they still represent less than 1% of all U.S. births. The report also addresses variations by race/ethnicity, age, geographic location, attending provider, and maternal risk factors.
References:
  1. MacDorman, M., Mathews, T., & Declercq, E. (2012). Home Births in the United States, 1990-2009. NCHS Data Brief, 84.
Given the current rising c-section rates and the widely debated causes underlying this trend, this question seems very appropriate, yet, unfortunately it is also at the center of heated debates in scientific literature. In 1985, the World Health Organization (WHO) estimated that health care systems in developing countries would need to maintain a cesarean rate no lower than 1% of total births and ideally around approximately 5-10%, in order to effectively reduce the toll of birth-related maternal and neonatal morbidity and mortality.(1, 2) Furthermore, WHO identified an upper recommended threshold of 15% of total births occurring in industrialized countries. Rates above this threshold could be detrimental for population health, with maternal and neonatal benefits no longer outweighing the costs and risks associated with this procedure. (1,2) While this WHO c-section rate recommendation has been widely contended over the years , recent literature has confirmed that cesarean section rates higher than the proposed 15% upper threshold are associated with increased morbidity and mortality for both mothers and babies. (2,3,4)
References:
  1. Anon. Appropriate technology for birth. Lancet 1985; 2: 436–37.
  2. Althabe F, Belizan JF. Caesarean section: The paradox. The Lancet 2006;368:1472-3.
  3. Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz, F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth 2006; 33(4): 270-7.
  4. Villar J, Valladares E, Wojdyla D, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 2006; 367: 1819–29.

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