Objectives-This report describes changes between 2020 and 2021 in the percentage of home births by month, race and Hispanic origin, and state of residence of the mother, and makes comparisons with changes occurring between 2019 and 2020.

The number of births in the United States declined by 1% between 2012 and 2013, to a total of 3 932 181. The general fertility rate also declined 1% to 62.5 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 1% in 2013 (to 1857.5 births per 1000 women). The teenage birth rate fell to another historic low in 2013, 26.5 births per 1000 women. Birth rates also declined for women 20 to 29 years, but the rates rose for women 30 to 39 and were unchanged for women 40 to 44. The percentage of all births that were to unmarried women declined slightly to 40.6% in 2013, from 40.7% in 2012. In 2013, the cesarean delivery rate declined to 32.7% from 32.8% for 2012. The preterm birth rate declined for the seventh straight year in 2013 to 11.39%; the low birth weight (LBW) rate was essentially unchanged at 8.02%. The infant mortality rate was 5.96 infant deaths per 1000 live births in 2013, down 13% from 2005 (6.86). The age-adjusted death rate for 2013 was 7.3 deaths per 1000 population, unchanged from 2012. Crude death rates for children aged 1 to 19 years declined to 24.0 per 100 000 population in 2013, from 24.8 in 2012. Unintentional injuries and suicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 45.7% of all deaths to children and adolescents in 2013.

Approximately one third of all infant deaths in the U.S. are related to preterm birth. Infants who survive a preterm birth are at greater risk than those born later in pregnancy for early death and lifelong effects such as neurologic and cognitive difficulties. The rate of preterm births (i.e., <37 completed weeks' gestation) increased approximately 30% during 1981-2006. In 2007, this trend began to reverse; the U.S. preterm birth rate decreased for the fourth consecutive year in 2010, decreasing from the 2006 high of 12.8% to 12.0% in 2010. A total of 4,265,555 births were reported for 2006, including 542,893 preterm births, and 3,999,386 births were reported for 2010, including 478,790 preterm births. Although most of the recent decrease in this rate was among infants born at 34 to 36 weeks' gestation (i.e., late preterm), with a decrease from 9.15% to 8.49% during 2006-2010, the rate of infants born at <34 weeks' gestation (i.e., early preterm) also decreased from 3.66% in 2006 to 3.50% in 2010. Despite improvements in the rate of preterm births, the total number of infants born preterm remains higher than any year during 1981-2001. Substantial differences in preterm birth rates by race/ethnicity persist; additional examination of these differences can provide insight into potential areas for interventions.

OBJECTIVES: This report presents data for selected items exclusive to the 2003 U.S. Standard Certificate of Live Birth as well as key items considered not comparable between the 1989 (unrevised) and 2003 (revised) versions for states and territories that implemented the 2003 revision as of January 1, 2008. Information is shown for educational attainment, tobacco use during pregnancy, month prenatal care began, and checkboxes in the following categories: "risk factors in this pregnancy," "obstetric procedures," "characteristics of labor and delivery," "method of delivery," "abnormal conditions of the newborn," and "congenital anomalies of the newborn." METHODS: Descriptive statistics are presented on births occurring in 2008 to residents of the 27 states that implemented the revised birth certificate. RESULTS: There were 2,748,302 births to residents of the 27-state reporting area, representing 65 percent of 2008 U.S. births. About 78 percent of women had at least a high school diploma; 24.5 percent had an advanced education. One out of 10 women smoked during pregnancy (24-state reporting area) and one out of five smokers quit while pregnant. Almost three-quarters of women began prenatal care in the first trimester of pregnancy. The rate of prepregnancy diabetes was 6.5 per 1,000 and gestational diabetes was 40.6; risk of both types rose with maternal age. Nearly one out of four women had a primary cesarean delivery; less than 1 out of 10 women had a vaginal birth after cesarean delivery. About 27 percent of women attempted a trial of labor before a cesarean delivery. Seven percent of all infants were admitted to a neonatal intensive care unit.

OBJECTIVES: This report presents 2008 data on receipt of epidural and spinal anesthesia as collected on the 2003 U.S. Standard Certificate of Live Birth. The purpose of this report is to describe the characteristics of women giving birth and the circumstances of births in which epidural or spinal anesthesia is used to relieve the pain of labor for vaginal deliveries. METHODS: Descriptive statistics are presented on births occurring in 2008 to residents of 27 states that had implemented the 2003 U.S. Standard Certificate of Live Birth as of January 1, 2008. Analyses are limited to singleton births in vaginal deliveries that occurred in the 27-state reporting area only and are not generalizable to the United States as a whole. RESULTS: Overall, 61 percent of women who had a singleton birth in a vaginal delivery in the 27 states in 2008 received epidural or spinal anesthesia; non-Hispanic white women received epidural or spinal anesthesia more often (69 percent) than other racial groups. Among Hispanic origin groups, Puerto Rican women were most likely to receive epidural or spinal anesthesia (68 percent). Levels of treatment with epidural or spinal anesthesia decreased by advancing age of mother. Levels increased with increasing maternal educational attainment. Early initiation of prenatal care increased the likelihood of epidural or spinal anesthesia receipt, as did attendance at birth by a physician. Use of epidural or spinal anesthesia was more common in vaginal deliveries assisted by forceps (84 percent) or vacuum extraction (77 percent) than in spontaneous vaginal deliveries (60 percent). Use of epidural or spinal anesthesia was less likely when infants were born prior to 34 weeks of gestation or weighed less than 1,500 grams. Women with chronic and gestational diabetes were more likely to receive an epidural or spinal anesthesia than women with no pregnancy risk factors. Precipitous labor (less than 3 hours) was associated with decreased epidural or spinal anesthesia receipt. longer second stage of labor, and fetal distress (compared with women who receive opiates intravenously or by injection) (1,5,6). Severe headache, maternal hypotension, maternal fever, and urinary retention have also been associated with epidural/spinal anesthesia receipt (5). This report examines the relationship between epidural/spinal anesthesia receipt and selected characteristics of the mother and of labor among vaginal deliveries in the 27-state reporting area as reported on the 2003 U.S. Standard Certificate of Live Birth.

The number of births in the United States decreased between 2007 and 2008 (preliminary estimate: 4,251,095). Birth rates declined among all women aged 15 to 39 years; the decrease among teenagers reverses the increases seen in the previous 2 years. The total fertility rate decreased 2% in 2008 to 2085.5 births per 1000 women. The proportion of all births to unmarried women increased to 40.6% in 2008, up from 39.7% in 2007. The 2008 preterm birth rate was 12.3%, a decline of 3% from 2007. In 2008, 32.3% of all births occurred by cesarean delivery, up nearly 2% from 2007. Twin and triplet birth rates were unchanged. The infant mortality rate was 6.59 infant deaths per 1000 live births in 2008 (significantly lower than the rate of 6.75 in 2007). Life expectancy at birth was 77.8 years in 2008. Crude death rates for children aged 1 to 19 years decreased by 5.5% between 2007 and 2008. Unintentional injuries and homicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 51.2% of all deaths of children and adolescents in 2008. This annual article is a long-standing feature in Pediatrics and provides a summary of the most current vital statistics data for the United States. We also include a special feature this year on the differences in cesarean-delivery rates according to race and Hispanic origin.

The U.S. preterm birth rate (less than 37 weeks of gestation) rose by more than one-third from the early 1980s through 2006 (1). This rise has been a cause of great concern (2,3). Preterm infants are at increased risk of life-long disability and early death compared with infants born later in pregnancy (2,4). Many reasons, such as changes in maternal demographics and increases in multiple births, have been suggested for the growth in preterm births (5). Another factor cited is the heightened use of obstetric interventions such as induction of labor and cesarean delivery earlier in pregnancy (5,6,7). Although it is not possible to know whether an infant would be born preterm if labor was not induced or delivered by cesarean, studies suggest that increased use of these procedures before 37 completed weeks of gestation may have influenced the upswing in preterm birth rates (6,7). Preliminary 2007 and 2008 birth certificate data reveal a shift in the long upward trend in preterm births (8,9). This report describes this change.

OBJECTIVES: This report presents 2006 data on new checkbox items exclusive to the 2003 U.S. Standard Certificate of Live Birth. Information is shown for checkboxes in the following categories: "risk factors in this pregnancy," "obstetric procedures," "characteristics of labor and delivery," "method of delivery," "abnormal conditions of the newborn," and "congenital anomalies of the newborn." These categories are included on both the 1989 and the 2003 U.S. Standard Certificates of Live Birth; however, many of the specific checkboxes were modified, or are new to the 2003 certificate. Data on selected new (not modified) checkboxes are presented in this report. METHODS: Descriptive statistics are presented on births occurring in 2006 to residents of the 19 states that had implemented the 2003 U.S. Standard Certificate of Live Birth as of January 1, 2006. RESULTS: There were 2,073,368 births to residents of the 19-state reporting area, representing 49 percent of 2006 U.S. births. The rate of prepregnancy diabetes was 6.8 per 1,000 births and gestational diabetes was 38.7; risk of both types of diabetes rose rapidly with advancing maternal age. Cervical cerclage was reported at a rate of 2.9 per 1,000. External cephalic version was used in 3.2 of every 1,000 births; its success rate decreased with increasing maternal age. Almost all attempts at forceps or vacuum delivery were successful. About 25 percent of women who had a cesarean delivery attempted a trial of labor. Fifteen percent of women received antibiotics during labor. Rates for antenatal steroids (8.4) and surfactant replacement therapy (3.2) decreased with increasing gestational age. Large differences by race and Hispanic origin were generally seen for the receipt of steroids and surfactant replacement therapy regardless of gestational age. Six percent of all infants were admitted to a neonatal intensive care unit (NICU).

Data from a new item describing the characteristics of labor and delivery on the 2003 revision of the U.S. Standard Certificate of Live Birth (1) show that about 60 percent of women in the reporting area received epidural or spinal anesthesia for pain relief during labor and delivery in 2006 (2) (Fig. 1). As defined on the birth certificate, epidural or spinal anesthesia represents the administration to the mother of a regional anesthesia to control the pain of labor and delivery (3). As of January 1, 2006, the 18 states that collected this information were California, Delaware, Florida, Idaho, Kansas, Kentucky, New Hampshire, Nebraska, New York (excluding New York City), North Dakota, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, and Wyoming. These states comprised nearly 2 million births (45% of total births) in the United States in 2006 (2).