United States Maternity Care Facts and Figures

This fact sheet updates various national maternity statistics provided in Evidence-Based Maternity Care: What It Is and What It Can Achieve with new data now available. The most recent update was December 2012. You can also download this fact sheet as a PDF.

Size of the Population Involved

In 2011, there were approximately 3.95 million births in the United States. This is down 1% from 2010, marking the second consecutive year that there have been fewer than 4 million births nationwide in over a decade (1).

Hospital Care of Childbearing Women and Newborns

Of those discharged from U.S. hospitals in 2009, 23% were childbearing women and newborns. Care of childbearing women and their newborns was by far the most common reason for hospitalization (2).

Six of the ten most common hospital procedures in 2009 were maternity-related (2):

Cesarean section, the most common operating room procedure in the country in 2009, was performed on 1.4 million women.2 The 2010 cesarean rate of 32.8% marked the first dip in the national rate in over a decade (3) and the rate remained unchanged in 2011 (1). The cesarean rate varied across states in 2010, from a low of 22.6% in Alaska to a high of 39.7% in Louisiana. It reached 46.7% in Puerto Rico (3). The 2010 cesarean section rate varied slightly by payer — from private insurance (35%) to Medicaid (32%) to uninsured women (31%) (4).

The rate of vaginal birth after cesarean (VBAC) was 9.2% in 2010, a rate that continues to decrease from a high of 35.3% in 1997 (2).*

*Note: The 2010 VBAC rate is based on reporting from the 33 states plus the District of Columbia that have adopted the revised (2003) birth certificate form (3) These states and territories comprise 73% of the U.S. population. Because of differences in how prior cesarean is ascertained in the 2003 birth certificate and previous versions of the birth certificate, rates should not be directly compared and differences in rates across years do not constitute a statistical trend.

Maternity Outcomes

The rate of preterm birth rose from 10.6% in 1990 to an all-time high of 12.8% in 2006. It has since declined for five consecutive years to 11.7% in 2011 (1)(3). Across states, the 2010 preterm birth rate ranged from 8.4% in Vermont to 17.6% in Mississippi, and was 16.7% in Puerto Rico.

The rate of low birthweight has risen fairly steadily over a quarter century. This rate was 6.7% in 1984, reached 8.3% in 2006, declined modestly in 2007 to 8.2%, and then again in 2011 to 8.1% (1)(3). Across states, the 2010 low birthweight rate ranged from 5.7% in Alaska to 12.1% in Mississippi (3).

In comparison with both non-Hispanic white and Hispanic infants, non-Hispanic black infants experienced much higher rates of both preterm birth and low birthweight (3).

Paying for Maternity Care

All payers. Facility charges billed a combined total of $111 billion for “mother’s pregnancy and delivery” and “newborn infants” in 2010 (4).

Medicaid. In 2010, 45% of all maternal childbirth-related hospital stays were billed to Medicaid (4). The two most common conditions billed to Medicaid as the primary payer in 2010 were pregnancy and childbirth (24%) and newborns (23%), which together comprised 47% of discharges billed to Medicaid (4). Between 2000 and 2010, newborn discharges billed to Medicaid decreased by 4%, and pregnancy and childbirth discharges decreased by 7% (4).

“Mother’s pregnancy and delivery” and “newborn infants” were the two most expensive hospital conditions billed to Medicaid in 2010, involving 26% of hospital charges to Medicaid, or $54 billion (4).

Private insurance. In 2010, 48% of all maternal childbirth-related hospital stays were billed to private insurers (4). The two most common conditions billed to private insurance as the primary payer in 2010 were pregnancy and childbirth (16%) and newborns (15%), which together comprised 31% of discharges billed to private insurance (4). Between 2000 and 2010, newborn discharges billed to private insurance decreased by 24%, and pregnancy and childbirth discharges decreased by 25% (4).

“Mother’s pregnancy and delivery” and “newborn infants” were the two most expensive hospital conditions billed to private insurance in 2008, involving 14% of hospital charges to private insurers, or $50 billion (4).

International Comparisons

World Health Statistics 2010 identified 33 countries with lower maternal mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates, 65 had lower low birthweight rates, and 32 had higher rates of exclusive breastfeeding to at least six months (5). The Organisation for Economic Co-operation and Development identified 24 high- and middle-income countries with lower cesarean rates in 2007 and just 4 with higher rates (6). Despite the poor international ranking, the International Federation of Health Plans recently reported that average U.S. payments for vaginal birth were far higher than all other countries reported, including Canada, France, and Australia (7).

References

1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. National Vital Statistics Reports web release 61(5). Hyattsville, MD: National Center for Health Statistics. October 2012. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf

2.  Wier LM (Thomson Reuters), Pfuntner A (Thomson Reuters), Maeda J (Thomson Reuters), Stranges E (Thomson Reuters), Ryan K (Thomson Reuters), Jagadish P (AHRQ), Collins Sharp B (AHRQ), ElixhauserA (AHRQ). HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009. Rockville, MD: Agency for Healthcare Research and Quality, 2011. Available at
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

3.  Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Wilson EC, and Mathews TJ. Births: Final data for 2010. National Vital Statistics Reports 61(1) Hyattsville, Maryland: National Center for Health Statistics, August 2012. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf

4.  U.S. Agency for Healthcare Research and Quality, HCUPnet, Healthcare Cost and Utilization Project. Rockville, MD: AHRQ. Available at: http://hcupnet.ahrq.gov/

5.  World Health Organization. World Health Statistics 2010. Geneva: WHO, 2010. Available at: http://www.who.int/whosis/whostat/2010/en/index.html

6.  Organisation of Economic Co-operation and Development. OECD Health Data 2010. Paris: OECD, 2010. Cesarean data available at: http://www.oecd.org/topic/0,3699,en_2649_37407_1_1_1_1_37407,00.html

7.  International Federation of Health Plans. 2010 Comparative Price Report: Medical and Hospital Fees by Country. Available at: http://ifhp.com/documents/IFHP_Price_Report2010ComparativePriceReport29112010.pdf