As a longtime pregnancy care provider, it was difficult to choose a single story as representative of pregnancy and birth. Most of the stories are meaningful because of the context of the relationship with the woman and the family—a few are tragic and yet filled with grace and the amazing strength displayed by even the very young, some are truly epic tales, and all are learning opportunities. Pregnancy experiences are filled with consternation at the myriad of changes, discomforts, and worries. They are filled with laughter as women's bodies alter in amazing ways; we waddle, unconsciously rest plates on our bellies, and lose sight of our feet (Figure 4-1). Our partners and/or supportive others alternate between reassurance and befuddlement. And then a child appears, miraculously from a space that seems far too small to accommodate, and (regardless of the outcome) a new journey begins.
Figure 4-1Graphic Jump Location
Dr. Mindy A. Smith and her husband, Gary, touching bellies during Mindy's pregnancy with Jenny.
- Planned pregnancy—Approximately 85% of sexually active women not using a contraceptive method will become pregnant over the course of a year. The probability of conception is 15% to 33% per cycle, depending upon the frequency of sexual intercourse.1
- Unplanned pregnancy—Half of all pregnancies in the United States are unintended, and approximately half of these unintended pregnancies end in abortion.2
- • Unintended pregnancy (defined as a pregnancy mistimed or not wanted at the time conception occurred) is the result of lack of use of a contraceptive or failure of the contraceptive.
- • Unintended pregnancy occurs among women of all ages, socioeconomic status, and marital status. Although unintended pregnancies are often associated with teens, 41% of pregnancies among women 35 to 39 years of age and 51% of those among women older than 40 years are unintended.3
- • Some unintended pregnancies end in abortions. A total of 827,609 legally induced abortions occurred in the United States in 2007 (16 per 1000 women aged 15 to 44 years).4
- The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged <25 years (51%).
- Of all abortions for which gestational age was reported, 62.3% were performed at ≤8 weeks' gestation.4
- Maternal mortality has declined dramatically in the United States over the past century. Rates declined from 607.9 maternal deaths per 100,000 livebirths in 1915 to 12.7 per 100,000 livebirths in 2007. Still, maternal mortality over the past 25 years has not improved.5 The leading causes of pregnancy-related death are embolism (20%), hemorrhage (17%), and pregnancy-induced hypertension (16%).6 Major racial disparities continue to exist.
- • Maternal mortality (2007) in non-Hispanic black women was 34 per 100,000 live births compared with 10.4 per 100,000 live births in non-Hispanic whites and 9.6 per 100,000 live births in Hispanics. African-American women have 2.7 times the risk of pregnancy-related death compared with whites.
- Care delivery ...