AP IMPACT: More U.S. babies born, fertility rate up, defying low-birth trend in Europe
By MIKE STOBBE , Associated Press
January 16, 2008

ATLANTA -
Bucking the trend in many other wealthy industrialized nations, the United States seems to be experiencing a baby boomlet, reporting the largest number of children born in 45 years.

The nearly 4.3 million births in 2006 were mostly due to a bigger population, especially a growing number of Hispanics. That group accounted for nearly one-quarter of all U.S. births. But non-Hispanic white women and other racial and ethnic groups were having more babies, too.

An Associated Press review of birth numbers dating to 1909 found the total number of U.S. births was the highest since 1961, near the end of the baby boom. An examination of global data also shows that the United States has a higher fertility rate than every country in continental Europe, as well as Australia, Canada and Japan. Fertility levels in those countries have been lower than the U.S. rate for several years, although some are on the rise, most notably in France.

Experts believe there is a mix of reasons: a decline in contraceptive use, a drop in access to abortion, poor education and poverty.

There are cultural reasons as well. Hispanics as a group have higher fertility rates, about 40 percent higher than the U.S. overall. And experts say Americans, especially those in middle America, view children more favorably than people in many other Westernized countries.

"Americans like children. We are the only people who respond to prosperity by saying, 'Let's have another kid,'" said Nan Marie Astone, associate professor of population, family and reproductive health at Johns Hopkins University.

Demographers say it is too soon to know if the sudden increase in births is the start of a trend.

"We have to wait and see. For now, I would call it a noticeable blip," said Brady Hamilton, a statistician with the Centers for Disease Control and Prevention.

Demographers often use the word boomlet for a small and brief baby boom.

To many economists and policymakers, the increase in births is good news. The U.S. fertility rate, the number of children a woman is expected to have in her lifetime, reached 2.1. That's the "magic number" required for a population to replace itself.

Countries with much lower rates, such as Japan and Italy, both with a rate of 1.3, face future labor shortages and eroding tax bases as they fail to reproduce enough to take care of their aging elders.

But the higher fertility rate isn't all good. Last month, the CDC reported that America's teen birth rate rose for the first time in 15 years.

The same report also showed births becoming more common in nearly every age and racial or ethnic group. Birth rates increased for women in their 20s, 30s and early 40s, not just teens. They rose for whites, blacks, Hispanics, American Indians and Alaska Natives. The rate for Asian women stayed about the same.

Total births jumped 3 percent in 2006, the largest single-year increase since 1989, according to the CDC's preliminary data.

Clearly, U.S. birth rates are not what they were in the 1950s and early 1960s, when they were nearly twice as high and large families were much more common. The recent birth numbers are more a result of many women having a couple of kids each, rather than a smaller number of mothers, each bearing several children, Astone said.

Demographers say there has been at least one boomlet before, around 1990, when annual U.S. births broke 4.1 million for two straight years before dropping to about 3.9 million in the mid-1990s. Adolescent childbearing was up at the time, but so were births among other groups, and experts aren't sure what explained that bump.

The 2006 fertility rate of 2.1 children is the highest level since 1971. To be sure, the fertility rate among Hispanics, 3 children per woman, has been a major contributor. That's the highest rate for any group. In 2006, for the first time, Hispanics accounted for more than 1 million births.

The high rate probably reflects cultural attitudes toward childbirth developed in other countries, experts said. Fertility rates average 2.7 in Central America and 2.4 in South America.

Fertility rates often rise among immigrants who leave their homelands for a better life. For example, the rate among Mexican-born women in the U.S. is 3.2, but the overall rate for Mexico is just 2.4, according to the Pew Hispanic Center, a Washington-based research organization.

"They're more optimistic about their future here," said Jeff Passel, a Pew Center demographer.

Some complain that many illegal immigrants come here purposely to have children.

"The child is an automatic American citizen, thus entitled to all benefits of American citizens. This gives a certain financial incentive for people coming from other countries illegally to have children here," said John Vinson, president of the Virginia-based American Immigration Control Foundation.

Fertility rates were also relatively high for other racial and ethnic groups. The rate rose to 2.1 for blacks and nearly 1.9 for non-Hispanic whites in 2006, according to the CDC.

Fertility levels tend to decline as women become better educated and gain career opportunities, and as they postpone childbirth until they are older. Experts say those factors, along with the legalization of abortion and the expansion of contraception options, explain why the U.S. fertility rate dropped to its lowest point, about 1.7, in 1976.

But while fertility declines persisted in many other developed nations, the United States saw the reverse: The fertility rate climbed to 2 in 1989 and has hovered around that mark since then, according to federal birth data.

Hans-Peter Kohler, a University of Pennsylvania sociology professor, and others say the difference has more to do with culture than race. For example, white American women have more children than white European even though many nations in Europe have more family-friendly government policies on parental leave and child care.

But such policies are just one factor in creating a society that produces lots of babies, said Duke University's S. Philip Morgan, a leading fertility researcher.

Other factors include recent declines in contraceptive use here; limited access to abortion in some states; and a 24/7 economy that provides opportunities for mothers to return to work, he said.

Also, it is more common for American women to have babies out of wedlock and more common for couples here to go forward with unwanted pregnancies. And, compared with nations like Italy and Japan, it's more common for American husbands to help out with chores and child care.

There are regional variations in the United States. New England's fertility rates are more like Northern Europe's. American women in the Midwest, South and certain mountain states tend to have more children.

The influence of certain religions in those latter regions is an important factor, said Ron Lesthaeghe, a Belgian demographer who is a visiting professor at the University of Michigan. "Evangelical Protestantism and Mormons," he said.

On the Net:
CDC report: http://www.cdc.gov/nchs
Population Reference Bureau: http://www.prb.org
Birth in the United States: http://www.newsweek.com/id/96400

One third of babies in this country are delivered by C-sections. A graphic new documentary asks why.

By Jennie Yabroff
NEWSWEEK
Updated: 2:36 PM ET Jan 19, 2008
There are many births in the documentary film "The Business of Being Born," including a scene of former talk-show host Ricki Lake giving birth naked in her tub. But the image that viewers may find most shocking is that of a baby being cut out of a woman's abdomen via Caesarean. This, according to Lake, the executive producer of the film, and Abby Epstein, the film's director, is the right reaction: one of their messages is that C-sections should only be performed when needed to guarantee the well-being of the mother and infant, and should not be a first choice for healthy mothers. New research into the risks associated with elective Caesareans supports their view. In a study, published in October's British Medical Journal, of 97,000 deliveries in 410 Latin American hospitals, perinatal specialist Dr. Jose Villar found the risk of death for mothers who had Caesareans, while slight (.01 percent of the women who delivered vaginally died vs. .04 percent who had elective C-sections), was triple that of those who delivered vaginally. "The C-section increases risk because it's major surgery," Villar says. Mothers who had undergone a Caesarean were also more likely to need blood transfusions and stay in the hospital more than a week after delivery. The risk of death for infants delivered via C-section-who are more likely to have a low birth weight-was double that of vaginal births, and C-section babies were more likely to have respiratory problems. According to a study published in the journal Birth, labor clears liquid from the infant's lungs, preparing the baby to breathe outside the womb. Caesareans impede this process. Yet the rate of Caesareans is spiking: in 2006, C-sections accounted for 31.1 percent of births nationwide, a 50 percent increase over the past 10 years. Natural birth-without drugs or interventions-whether at home or in a hospital, remains a rarity (despite the fact that home births don't have an appreciably higher risk rate than hospital births).

Amid the controversy over what constitutes an ideal birth experience, doctors, researchers and natural-birth advocates agree: Caesareans save lives when medically necessary. But defining medical necessity is complicated. Natural-birth advocates cite a "cascade of interventions" caused by hospitals' practice of using the drug Pitocin to stimulate labor. The drug can cause painful contractions, which doctors treat with an epidural painkiller. The epidural can then retard contractions and lead to more drugs, fetal stress and the doctor's recommendation of a Caesarean. Natural-birth advocates say that hospitals, driven by profits and worried about malpractice, are too quick to intervene. "I compare it to a restaurant. If you have customers who sit at a table and don't order anything, you're not making any money," says Jennifer Block, author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care." Normal labor, Block says, isn't profitable (according to "The Business of Being Born," a Caesarean can cost three times as much as a normal birth). If something does go wrong, in the eyes of the courts "a normal birth is a risk. The courts reward action," Block says.

Some doctors say the increased rate of Caesareans is partially attributable to maternal demand: busy mothers may want to schedule their deliveries. The phrase "too posh to push" predates Posh Spice, but reports that celebrities such as Posh (Victoria Beckham) and Britney Spears had Caesareans have popularized the procedure, some doctors say. And some women are scheduling them early. According to the March of Dimes, late preterm delivery (34 to 36 weeks) increased from 7.3 percent to 8.9 percent between 1990 and 2004 in the United States. "No one knows how much of that is maternal choice," says Ann Stark, head of neonatology at Texas Children's Hospital. "There are certainly women who want timed, elective delivery surgically." According to a recent study, attendance at Lamaze classes, which teach women how to manage labor pain without drugs, dropped 14 percent between 2000 and 2005.

Although the United States has one the highest rates of Caesareans-and of infant mortality-Villar says the rest of the developed world is catching up. But opinion differs on how to respond. Doctors such as Stark say we need a better sense of what goes on while the baby is still in utero. "One of the knowledge gaps is a clear understanding of the indications for C-sections," she says. (Known indications include breech position of the fetus, and pre-existing medical conditions such as extreme hypertension in the mother.) Naomi Wolf, author of "Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood," blames insurance companies and hospitals, who she says deny women information about their choices. Wolf and other natural-birth advocates say we need a better idea of what normal birth looks like, as movies and TV usually depict the process as painful and bloody. "We all have this idea that normal birth is a woman lying in a hospital bed screaming," says Block. If nothing else, "The Business of Being Born," with its indelible image of a naked, exhilarated Ricki Lake cooing "Hi there!" to her seconds-old son in her bathtub, will give them another view.

URL: http://www.newsweek.com/id/96400

POSTED: 4:08 pm EST January 30, 2008
Every woman who is about to give birth wants an uncomplicated delivery. But sometimes complications do arise and a doctor may decide it's necessary to perform a cesarean section. For example, the mother or the baby may have a health condition that would make a normal delivery dangerous. The baby may be too large or in the wrong position, or there may be multiple babies to be delivered.

But cesarean sections are performed for less serious reasons as well, such as speeding up the delivery or because the mother requests it. Cesarean section is now the most common surgery in the United States.

Although cesarean section is generally safe, it still is major surgery that carries risks for mother and baby. During a cesarean delivery, an incision is made in the mother's abdomen and another in the uterus. The baby is delivered through these incisions. The procedure requires a longer recuperation period than a vaginal birth, and there is an increased risk of maternal death. Some babies delivered via cesarean section experience breathing problems and other difficulties.

Until recently, it was thought that once a woman had delivered by cesarean all future births must be delivered the same way. Now doctors know that having a vaginal birth after cesarean (VBAC) can be safe for many women. The benefits include a quicker recovery, a lower risk of infection, and a reduced need for blood transfusions.

Discuss the risks and benefits of your delivery options with your doctor.

Content provided by Parrish Medical Center and Vim and Vigor, www.parrishmed.com.

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