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Objectives. The percentages of cesarean deliveries attributable to specific indications (breech, dystocia, fetal distress, and elective repeat cesarean) were computed for 1985 and 1994. Methods. Data were derived from the 1985 and 1994 National Hospital Discharge Surveys. Results. Dystocia was the leading indication for cesarean delivery in both years. In comparison with 1985, cesareans performed in 1994 that were attributable to dystocia and breech presentation increased, those attributable to fetal distress did not change significantly, and elective repeat cesareans declined. Conclusions. Studying indications for cesareans can be useful for hospitals, clinicians, and researchers in determining strategies to lower primary and repeat cesarean rates. (Am J Public Health. 1998;88:1384-1387)

Objectives. Guidelines from the Institute of Medicine's 1990 report call for weight gains during pregnancy that are higher than those previously recommended. This study examines the potential implications of compliance with these guidelines for postpartum weight retention. Methods. Weight retention 10 to 18 months following delivery was examined for selected women who had live births in the 1988 National Maternal and Infant Health Survey. Women's actual weight gains during pregnancy were retrospectively classified according to the Institute of Medicine's guidelines. Results. Weight retention following delivery increased as weight gain increased, and Black women retained more weight than White women with comparable weight gain. The median retained weight for White women who gained the amount now being recommended was 1.6 lb whereas that for Black women was 7.2 lb. Conclusions. If pregnant White women gain weight according to the institute's guidelines, they need not be concerned about retaining a substantial amount of weight postpartum. Our findings suggest, however, that Black women are in need of advice about how to lose weight following delivery., Weight gains higher than those previously recommended for women during pregnancy and varied to account for the woman's pre-pregnancy weight are set forth in guidelines published in 1990 by the Institute of Medicine. A study of the potential implications for weight retention after delivery examined by this study found that weight retention increased as weight gain increased. More weight was retained by black women than by white women with comparable weight gains. For white women who gained the amount now being recommended, the median retained weight was 1.6 pounds, while for black women it was 7.2 pounds. While 45% of black women retained nine or more pounds, only 25% of white women retained this much weight. White women need not worry about retaining excess weight after delivery as long as they stay within the guidelines for weight gain during pregnancy. Black women tend to be advised to gain too little weight, so they need correct information on both weight gain during pregnancy and weight loss after delivery.

Abstract: The rate of cesarean section delivery in the United States rose from 4,5 per 100 deliveries in 1965 to 22.7 in 1985, and in 1985 an estimated 851.000 live births were cesarean deliveries, according to data flora the National Hospital Discharge Survey. This increase has been observed for all ages. and within all regions of the country. The rate for teenagers and mothers aged 20 to 29 was five to six times as high in 1985 as in 1965, trod four times as high for mothers aged 30 years and older. Repeat cesareans account for an increasing shine of ail cesarean deliveries: in 1985 one in three cesareans were repeals. [ABSTRACT FROM AUTHOR]

Abstract: In the 1980 National Natality Survey, married mothers were asked whether their doctors had suggested a weight gain lima during pregnancy and, if so, what limit was suggested. Current obstetric recommendations call for 22-27 £ weight gain. Previous research indicates that gaining < 16 pounds greatly increases the likelihood of a poor pregnancy outcome. Reported advice varied by mother's race, education, parity, and pre-pregnancy weight. Mothers given no advice or advised to gain < 22 pounds were far more likely than others to have an inadequate gain. The findings suggest that many more women should be told that it is appropriate to gain at least 22 pounds. [ABSTRACT FROM AUTHOR]

Using 1980 National Hospital Discharge Survey data, complications reported for cesarean and non-cesarean deliveries coded by the Ninth Revision ICD-CM are compared. While over 16 per cent of all deliveries in 1980 were by C-section. 94 per cent of the deliveries where maternal-infant disproportion was noted were by C-section, and this complication was noted in one-fourth of all C-section deliveries. Similarly, where malposition or malpresentation of the fetus was evident. 59 per cent oF the mothers were delivered by C-section, and this complication was noted in one-sixth of all C-section deliveries. C-sections were also associated with placenta praevia, pre-eclampsia, infections of the genito-urinary tract, anemia, multiple births, and were almost universal for mothers who had had a previous C-section delivery. Competing explanations for the rise in C-sections from 5.5 per cent of deliveries in 1970 to 16.5 per cent in 1980 are discussed in the context of these findings. (Am J Public Health 1983: 73:856-860.) [ABSTRACT FROM AUTHOR]

National Hospital Discharge Survey data indicate that the overall postpartum sterilization rate per 100 deliveries increased by 75 per cent from 4.0 in 1970 to 7.0 in 1975; by type of delivery, rates lose from 18.0 per 100 cesarean section deliveries and 3.2 for all other deliveries in 1970 to 19.0 and 5.0 respectively in 1975. The South had the highest postpartum sterilization rates overall. Deliveries to older mothers and cesarean section deliveries in hospitals with less than 100 beds were more often characterized by higher sterilization rates. (Am J Public Health 1981:71-1258-1261.) [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles in previous issues of the "American Journal of Public Health" including results of the epidemiological studies conducted by A. M. Walker and J. L. Fleiss on significance tests and confidence intervals and another on the need for preservation of stocks of variola virus and vaccination of military personnel. Lastly, "On Homelessness and the American Way," by Steven Jonas.

A letter to the editor about an increase in U.S. births by Cesarean section is presented.