This report shows trends of epidural or spinal anesthesia use for singleton vaginal deliveries from 2016 to 2024 and changes by select maternal characteristics.

Introduction:-Epidurals and spinal anesthesia are used to treat pain during labor. The American College of Obstetricians and Gynecologists recommends that pain relief be administered to laboring women upon request. Studies have found that women who received no pain treatment experienced increased pain and were more likely to have a cesarean delivery compared with those who received an epidural. Objectives-This report shows trends of epidural or spinal anesthesia use for singleton vaginal deliveries from 2016 to 2024 and changes by selected maternal characteristics. Methods:-This report uses data from the natality data file from the National Vital Statistics System to examine epidural or spinal anesthesia use for singleton births in vaginal deliveries. Differences between rates noted in the text are statistically significant at the 0.05 level unless otherwise noted. Key Findings:-From 2016 to 2024, the percentage of mothers having a singleton vaginal birth who used epidural or spinal anesthesia for pain relief during labor increased 8%, from 69.8% to 75.4%. Increases in the use of epidural or spinal anesthesia occurred across all maternal age groups (ranging from 7% to 12%) and all race and Hispanic-origin groups (ranging from 5% to 17%). The percentage of mothers who used epidural or spinal anesthesia increased among those covered by Medicaid, private insurance, and other sources of payment but decreased among mothers who self-paid for their deliveries. Epidural or spinal anesthesia use increased in 44 states and the District of Columbia, decreased in 2 states, and was essentially unchanged in 4 states from 2016 to 2024.

Objectives:This report presents 2024 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods:Descriptive tabulations based on birth certificates of the 3.63 million births registered in 2024 are shown for various maternal demographic and health characteristics; medical and healthcare utilization, including source of payment for the delivery; and infant health characteristics. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2024 are presented for selected items and by race and Hispanic origin for 2016-2024. Results:A total of 3,628,934 births occurred in the United States in 2024, an increase of 1% from the record low reported for 2023. The general fertility rate declined 1% from 2023 to 53.8 births per 1,000 females ages 15-44 in 2024. Birth rates declined for females ages 15-34 from 2023 to 2024, rose for women ages 40-44, and were unchanged for females ages 10-14 and women ages 35-39 and 45-49. The total fertility rate declined 1% to 1,599.5 births per 1,000 women in 2024, a record low. Birth rates declined for both unmarried and married women from 2023 to 2024. Prenatal care beginning in the first trimester declined to 75.5% in 2024. The percentage of women who smoked during pregnancy declined to 2.4%. The cesarean delivery rate increased by less than 1% to 32.4%. Private insurance as the source of payment for the delivery increased to 51.8% of births, while Medicaid deliveries declined to 40.2%. The preterm birth rate (10.41%) was unchanged from 2023; low birthweight births declined 1% (8.52%). The twin birth rate declined 2% in 2024 to 30.1 per 1,000 births; the triplet and higher-order multiple birth rate was 71.3 per 100,000 births compared with 73.8 for 2023.

This report presents 2023 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined.

Objectives:This report presents 2023 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods:Descriptive tabulations based on birth certificates of the 3.60 million births registered in 2023 are shown for various maternal demographic and health characteristics; medical and healthcare utilization, including source of payment for the delivery; and infant health characteristics. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2023 are presented for selected items, and by race and Hispanic origin for 2016-2023. Results:A total of 3,596,017 births occurred in the United States in 2023, down 2% from 2022. The general fertility rate declined 3% from 2022 to 54.5 births per 1,000 females ages 15-44 in 2023. The birth rate for females ages 15-19 declined 4% from 2022 to 2023; birth rates rose less than 1% for women ages 20-24, fell 1% to 3% for women ages 25-44, and were unchanged for females ages 10-14 and women ages 45-49. The total fertility rate declined 2% to 1,621.0 births per 1,000 women in 2023. Birth rates declined for both unmarried and married women from 2022 to 2023. Prenatal care beginning in the first trimester declined to 76.1% in 2023; the percentage of women who smoked during pregnancy declined to 3.0%. The cesarean delivery rate increased 1% in 2023 to 32.3%; Medicaid was the source of payment for 41.5% of births, an increase from 2022 (41.3%). The preterm birth rate (10.41%) and the low birthweight rate for 2023 (8.58%) were essentially unchanged from 2022. The twin birth rate declined 2% in 2023 to 30.7 per 1,000 births; the triplet and higher-order multiple birth rate decreased 6% to 73.8 per 100,000 births.

Background and Objectives:Beginning with the 2023 data year, the National Center for Health Statistics (NCHS) will use a different, expanded measure of perinatal mortality for standard publications. This measure, Definition III, includes fetal deaths at 20 weeks of gestation or more and infant deaths younger than 7 days. Definition III replaces Definition I (fetal deaths at 28 weeks of gestation or more and infant deaths younger than 7 days), which has been used in NCHS reports since the 1980s. This change is being made due to the implementation of national reporting of all fetal deaths at 20 weeks of gestation or more as of 2014, allowing for the use of Definition III, which more fully represents the perinatal events most likely to be affected by similar factors. This report describes the reason for this change and compares trends in perinatal mortality rates based on Definition I and Definition III from 2014 to 2022 and differences in the two measures by maternal race and Hispanic origin, age, and state of residence for 2022. Methods:Data for perinatal mortality are derived from NCHS's National Vital Statistics System's fetal death, birth, and period linked birth/infant death files. Perinatal mortality rates for Definition III are compared with those for Definition I. Results:In 2022, Definition III comprised 91.4% of perinatal deaths (fetal deaths at 20 weeks of gestation or more and infant deaths younger than 28 days) compared with 60.7% of perinatal deaths captured by Definition I. The perinatal mortality rate for Definition III was about 50% higher than that for Definition I (8.27 and 5.51, respectively, in 2022). Trends in perinatal mortality were similar for both measures during 2014-2022; rates were stable from 2014 through 2016 and then declined from 2016 through 2022. For 2022, patterns by maternal race and Hispanic origin and age were also similar, but more variation in patterns was observed by state.

Objectives:This report presents 2022 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined. Methods:Descriptive tabulations of data are presented and interpreted for all fetal deaths reported for the United States for 2022 with a stated or presumed period of gestation of 20 weeks or more. Cause-of-fetal-death data only are restricted to residents of the 43 states and District of Columbia where cause of death was based on the 2003 fetal death report revision and less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Results:A total of 20,202 fetal deaths at 20 weeks of gestation or more were reported in the United States in 2022. The 2022 U.S. fetal mortality rate was 5.48 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, 4% lower than in 2021 (5.73) and a new historic low for the United States. The fetal mortality rate in 2022 for deaths occurring at 20-27 weeks of gestation was 2.79, a 5% decline from 2021 (2.95). For deaths occurring at 28 weeks of gestation or more, the rate in 2022 was 2.71, a 3% decline from 2021 (2.80). In 2022, the fetal mortality rate was highest for Native Hawaiian or Other Pacific Islander non-Hispanic (10.36) and Black non-Hispanic (10.05) females and lowest for Asian non-Hispanic females (3.70). Fetal mortality rates were highest for women ages 40 and older, for women who smoked during pregnancy, and for women with multiple gestation pregnancies. Five selected causes accounted for 90.0% of fetal deaths in the 43-state and District of Columbia reporting area.

Objectives- This report presents 2022 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods-Descriptive tabulations based on birth certificates of the 3.67 million births registered in 2022 are shown by maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2022 are presented for selected items, and by race and Hispanic origin for 2016-2022. Results-A total of 3,667,758 births occurred in the United States in 2022, essentially unchanged from 2021. The general fertility rate declined 1% from 2021 to 56.0 births per 1,000 females ages 15-44 in 2022. The birth rate for females ages 15-19 declined 2% from 2021 to 2022; birth rates fell 7% for women ages 20-24, rose 1% to 5% for women ages 25-29 and 35-44, and rose 12% for women ages 45-49 (the first increase since 2016). The total fertility rate declined less than 1% to 1,656.5 births per 1,000 women in 2022. Birth rates declined for unmarried women but increased for married women from 2021 to 2022. Prenatal care beginning in the first trimester declined to 77.0% in 2022; the percentage of women who smoked during pregnancy declined to 3.7%. The cesarean delivery rate was unchanged in 2022 (32.1%); Medicaid was the source of payment for 41.3% of births. The preterm birth rate declined 1% to 10.38%; the low birthweight rate rose 1% to 8.60%. The twin birth rate was unchanged in 2022 (31.2 per 1,000 births); the 2% decrease in the triplet and higher-order multiple birth rate.

Objectives:This report describes changes in total, early, and late fetal mortality between 2022 and 2023 (provisional), as well as fetal mortality by maternal race and Hispanic origin and state of residence. Comparisons are made with findings from 2021 to 2022. Methods:Data are based on reports of fetal death filed in the 50 states and the District of Columbia and collected via the National Vital Statistics System. In this report, only fetal deaths reported at 20 weeks of gestation or more are included. Data for 2021 and 2022 are final and data for 2023 are provisional. Results:In 2023, the overall fetal mortality rate was 5.52 fetal deaths per 1,000 live births and fetal deaths, which was not significantly different from the 2022 rate (5.48). From 2022 to 2023, the early fetal mortality rate (20-27 weeks of gestation) significantly increased by 4% to 2.89 per 1,000, while the late fetal mortality rate (28 weeks of gestation or more) was essentially unchanged at 2.64. Among the race and Hispanic-origin groups, the fetal mortality rate increased for Asian non-Hispanic women and was not significantly different for other groups. Fetal mortality rates increased in 4 states, declined in 1 state, and were not significantly different for 45 states and the District of Columbia from 2022 to 2023. In comparison, from 2021 to 2022, the fetal mortality rate declined for total, early, and late fetal deaths, as well as for White non-Hispanic women and in five states.

Objectives-This report presents 2021 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for all fetal deaths reported for the United States for 2021 with a stated or presumed period of gestation of 20 weeks or more. Cause-of-fetal-death data are restricted to residents of the 41 states and the District of Columbia, where cause of death was based on the 2003 fetal death report revision and less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Results-A total of 21,105 fetal deaths at 20 weeks of gestation or more were reported in the United States in 2021. The 2021 U.S. fetal mortality rate was 5.73 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, which was essentially unchanged from the rate of 5.74 in 2020. The fetal mortality rate in 2021 for deaths occurring at 20-27 weeks of gestation was 2.95, essentially unchanged from 2020 (2.97). For deaths occurring at 28 weeks of gestation or more, the rate in 2021 (2.80) was not significantly different from 2020 (2.78). In 2021, the fetal mortality rate ranged from 3.94 for non-Hispanic, single-race Asian women to 9.89 for non-Hispanic, single-race Black women. Fetal mortality rates were highest for females under age 15 and aged 40 and over, for women who smoked during pregnancy, and for women with multiple gestation pregnancies. Five selected causes accounted for 89.9% of fetal deaths in the 41-state and District of Columbia reporting area.

Access to health care coverage during pregnancy and delivery allows women to receive the care needed to maximize the likelihood of a healthy pregnancy and baby (1). National birth certificate data on the principal source of payment for the delivery became available in 2016, when all states implemented the 2003 U.S. Standard Certificate of Live Birth. This certificate provides information on payment through private insurance; Medicaid; CHAMPUS, TRICARE, and other types of government insurance; and self-pay, which has been shown to reflect the uninsured status of the mother at the time of delivery (2). This report describes the principal source of payment for the delivery in 2021 overall and by maternal race and Hispanic origin, age, and education.

Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Perinatal mortality(late fetal deaths at 28 completed weeks of gestation or more and early neonatal deaths younger than age 7 days) can be an indicator of the quality of health care before, during, and after delivery, and of the health status of the nation (1,2). The U.S. perinatal mortality rate declined 30% from 1990 through 2011, was stable from 2011 through 2016, and declined 4% from 2017 through 2019 (1,3-5). This report describes changes in perinatal mortality, as well as its components, late fetal and early neonatal mortality, from 2020 to 2021, during the COVID-19 pandemic. Also shown are perinatal mortality rates by mother's age, the three largest race and Hispanic-origin groups, and state for 2021 compared with 2020.

This report provides health data from the National Center for Health Statistics.

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.

Objectives-This report presents 2020 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined.

Perinatal mortality (late fetal deaths at 28 completed weeks of gestation or more and early neonatal deaths under age 7 days) can be an indicator of the quality of health care before, during, and after delivery, and of the health status of the nation (1,2). The U.S. perinatal mortality rate declined 30% from 1990 to 2011, but was stable from 2011 through 2016 (1,3,4). This report presents trends in perinatal mortality as well as its components, late fetal and early neonatal mortality, for 2017 through 2019. Also shown are perinatal mortality trends by mother's age, race and Hispanic origin, and state for 2017-2019.

Objectives-This report presents 2019 fetal mortality data by maternal race and Hispanic origin, age, tobacco use during pregnancy, and state of residence, as well as by plurality, sex, gestational age, birthweight, and selected causes of death. Trends in fetal mortality are also examined.

Objectives-This report presents 2020 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Objectives-This report describes changes between 2019 and 2020 in the percentage of U.S. home births by month, race and Hispanic origin, and state of residence of the mother and makes comparisons with changes occurring between 2018 and 2019.