Curtin S C
National Center for Health Statistics, Division of Vital Statistics, Hyattsville, MD 20782, USA.
J Nurse Midwifery. 1999 Jul-Aug;44(4):349-54. doi: 10.1016/s0091-2182(99)00059-2.
Although more than nine out of every ten births are attended by physicians, the percent of births attended by midwives increased during the 1989 to 1997 period and accounted for 7% of all births in 1997. About 99% of births in 1997 were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that occurred in residences increased over the period, while those in freestanding birthing centers declined. The percent of mothers receiving electronic fetal monitoring, ultrasound, and induction and stimulation of labor increased. The most dramatic increase was a doubling of the use of induction. In 1997, approximately 18% of all births were induced. Midwives as well as physicians increased the use of these obstetric procedures over the 1989 to 1997 period, and the use of many procedures by CNMs was as high, or nearly as high, as use by physicians. The rate of cesarean births dropped by 9%, from about 23% in 1989 to about 21% in 1997, while the rate of vaginal birth after a previous cesarean increased by 50%. The proportion of births assisted by forceps consistently declined during the period, while the use of vacuum extraction consistently increased. The number of episiotomies performed in the United States declined each year during the 1990-1996 period.
尽管每十例分娩中有九例以上由医生接生，但在1989年至1997年期间，由助产士接生的分娩比例有所增加，1997年占所有分娩的7%。1997年约99%的分娩在医院进行，与1989年基本持平，但在此期间，在家中进行的院外分娩比例有所上升，而在独立分娩中心进行的院外分娩比例则有所下降。接受电子胎儿监护、超声检查以及引产和催产的产妇比例有所增加。增幅最大的是引产的使用增加了一倍。1997年，约18%的分娩是引产。在1989年至1997年期间，助产士和医生都增加了这些产科程序的使用，许多程序由认证助产士的使用情况与医生相当，或几乎相当。剖宫产率下降了9%，从1989年的约23%降至1997年的约21%，而既往剖宫产术后阴道分娩率则上升了50%。在此期间，产钳助产的比例持续下降，而真空吸引的使用则持续增加。在1990 - 1996年期间，美国每年进行会阴切开术的数量都在下降。
