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The incidence of vaginal birth after cesarean (VBAC) and characteristics of VBAC births are investigated using 1980-85 National Hospital Discharge Survey Data collected by the National Center for Health Statistics. Only 3.4 per cent of mothers with previous cesarean delivery had VBAC in their subsequent 1980 delivery; this increased to 6.6 per cent in 1985. Because VBAC is a relatively infrequent event, 1980-85 data were combined and indicate that in this period 4.9 per cent of mothers with previous cesarean had a vaginal birth in their subsequent delivery. Combined 1980-85 VBAC rates are under 10 per cent for all age, race, marital status, region, hospital size, hospital ownership, and expected source of payment groups. Between 1980 and 1985, over 1.4 million repeat cesareans were performed for mothers having a live birth. Evidence suggests that potentially over 500,000 of these repeat cesareans could have been VBACs (over and above the 74,000 VBACs which occurred). VBAC mothers' mean length of hospital stay is 3.2 days, which compares closely with 3.0 days for other vaginal deliveries, but both contrast sharply with 5.6 days for repeat cesareans and 6.0 days for primary cesareans. Except for the uterine scar from the previous cesarean, VBAC mothers appear to have about the same history and frequency of complications as mothers with other vaginal deliveries. If the 500,000 repeat cesareans had been VBACs, surgical fees and costs for 1.2 million days of hospital stay would have been averted over the 1980-85 period. [ABSTRACT FROM AUTHOR]

After increasing by 9 per cent in the period 1976-80 in the United States, pregnancy rates declined by 4 per cent between 1980 and 1984 (from 111.9 to 107.3 pregnancies per 1,000 women aged 15-44 years). Between 1984 and 1985, the rate rose by less than 1 per cent to 108.2. More detailed data by age and race, available only through 1983, indicate that the decline in the 1980-83 period was not shared by all age groups. For example, pregnancy rates continued to increase for women in their thirties, and teenage pregnancy remained substantially the same. In 1983, 61 per cent of all pregnancies ended in live birth, 26 per cent in induced abortion, and 13 per cent in fetal loss. Pregnancy rates in that year were two-thirds higher for women of races other than White than for White women, and pregnancies of other-than-White women were more likely to terminate as an induced abortion or fetal loss. However, White teenagers and teenagers of other races were about equally likely to have their pregnancy end in induced abortion or fetal loss. [ABSTRACT FROM AUTHOR]

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]

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. [ABSTRACT FROM AUTHOR]

The article focuses on the statistics of cesarean delivery in the U.S. in 1965 to 1986. During 1965, the rate of cesarean delivery was 4.5%, 22.7% in 1985, and has finally reached 24.1% in 1986. Such data is fairly uniform for women of all ages and marital statuses, and has been observed in hospitals of all sizes and types of ownership. The National Center for Health Statistics conducted the National Hospital Discharge Survey to monitor the annual trends of cesareans. Information came from about 200,000 medical records for inpatient discharges from a representative national sample of over 400 non-federal general and special short-stay hospitals. It also showed that almost one-fifth of teenage deliveries were cesareans.

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

Studies changes in indications for cesarean deliveries in the United States, for 1985 and 1994. Leading indications for cesarean delivery; Changes in the performance of cesareans attributable to dystocia, breech presentation and fetal distress; Strategies to lower cesarean rates.

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.