Birth characteristics in England and Wales: 2014

• There were 695,233 live births in England and Wales in 2014, of which 338,461 were girls and 356,772 were boys

• In 2014, the stillbirth rate remained at 4.7 per 1,000 total births, unchanged from 2013. There were 3,254 stillbirths in 2014 down from 3,284 in 2013 (a fall of 0.9%)

• The percentage of women giving birth at home was 2.3% in 2014, remaining unchanged since 2012

• 16.0 out of every 1,000 women giving birth had a multiple birth in 2014, an increase from 15.6 in 2013

• 10,989 mothers had a multiple birth in 2014; 10,839 women had twins, 148 had triplets and 2 had quads and above (multiple births include stillbirths)

• Women aged 45 and over were most likely to have a multiple birth; 105.5 out of every 1,000 women giving birth in this age group had a multiple birth

• In England and Wales 7.0% (48,547) of live births were low birthweight (under 2.5kg) in 2014. The percentage of low birthweight babies has remained unchanged since 2011

This bulletin presents statistics on births in England and Wales in 2014 by birth characteristics. In particular, it provides statistics on stillbirths, birthweight, gestational age and ethnicity, women giving birth at home and women having multiple births. Some of the main summary figures have been published previously. This is however, the first time that birth statistics for 2014 have been published on:

• birthweight and mother’s area of usual residence (only live births by low birthweight have previously been published)

• gestational age and ethnicity

• age of parents and quarter of occurrence for stillbirth

• quarter and month for live births

• place of birth

• multiple maternities

• maternities, live births, and stillbirths in hospitals by area of occurrence

In 2014 in England and Wales, 2.3% of women giving birth did so at home (Figure 1), unchanged since 2012. In 1960, the percentage of women giving birth at home was 33%, but this fell to a record low between 1985 and 1988 when only 0.9% of women gave birth at home. Between 1988 and 2008 there was a small rise in the percentage of women giving birth at home, with the exception of a period of relative stability between 1997 and 2004. More recently, between 2009 and 2012, the percentage of women giving birth at home declined slightly.

In 1950s post-war Britain the health service ran campaigns to persuade mothers to go into hospital to give birth. At this time housing conditions and general health were relatively poor and for many women hospital would have been the safest environment in which to give birth. The shift away from home births took place largely between 1963 and 1974, during which time the percentage of women giving birth at home fell from 30% to 4.2% at a rate of 2 to 3 percentage points per year.

Since the early 1990s, government policy in England has been that women should be provided with a choice about where to give birth, and the information they need in order to make the best choice for them (Maternity Matters).

The South West had the highest percentage of women giving birth at home in 2014 (3.2%) while the North East had the lowest (1.1%). The South West and the North East also had the highest and lowest percentages respectively of women giving birth at home in 2013.

In 2014, women aged 35 to 39 had the highest percentage of births at home (3.0%). In contrast, women aged 45 and over had the lowest percentage, with 1.0% of women in this age group giving birth at home in 2014. Figure 2 shows how the percentage of women giving birth at home varies by age group and provides a comparison between 2004 and 2014. The percentages of women giving birth at home have decreased in all age groups for women aged 30 and over and have increased in all age groups under 30.

Home births in the UK, 1955 to 2006 (819.1 Kb Pdf) is a detailed analysis examining how home maternity levels vary by mother’s age, number of previous live births within marriage, country of birth and local authority.

In 2014, there were 10,839 women who gave birth to twins, 148 to triplets and 2 to quads and above. These multiple maternities include both live births and stillbirths (background note 5 has more information).

The multiple maternity rate in 2014 increased slightly to 16.0 per 1,000 women giving birth, compared with 15.6 in 2013. Overall, the multiple maternity rate increased between 1976 and 2011. In 1976, there were 9.6 multiple maternities per 1,000 maternities, rising to a peak of 16.1 in 2011. The largest increase in the multiple maternity rate was recorded between 1990 and 1995, when the rate increased by 22% from 11.6 to 14.1.

In 1976, women aged 35 to 39 had the highest multiple maternity rate (13.4 per 1,000 maternities). Between 1976 and 2011 the multiple maternity rate increased for all age groups, but most notably for women aged 30 and over. The greatest increase was among women aged 45 and over; the multiple maternity rate increased from 9.8 in 1976, to 99.3 in 2011. Between 2011 and 2013 multiple maternity rates fell for women aged 20 to 39. For those aged under 20 and 45 and over, the rate has fluctuated since 2011.

When comparing 2014 with 2013, the multiple maternity rate increased very slightly for ages under 30 and ages 40 and over (Figure 3). Women aged 45 and over had by far the highest multiple maternity rate in 2014 (105.5 per 1,000 maternities), which has increased by 11% from 95.0 in 2013. Women aged under 20 had the lowest multiple maternity rate in 2014 (7.0 per 1,000 maternities), increasing from a recent low of 6.1 in 2013.

Although most multiple births occur naturally, many occur as a result of fertility treatment. On average, 1 in 6 of In Vitro Fertilisation (IVF) pregnancies are a multiple pregnancy, compared to 1 in 80 for women who conceive naturally (Multiple births in the UK - Statistics). With approximately 18,000 IVF babies born in the UK in 2013, this contributes significantly to the multiple birth rate. The average age of women undergoing IVF treatment in 2013 was 35 years (Fertility treatment in the UK 2013: Trends and figures).

The high multiple maternity rate among women aged 45 and over is a result of higher levels of assisted fertility treatments (including medicines which stimulate ovulation and assisted conception which includes IVF) at these ages.

In 2009, the HFEA launched the elective single embryo transfer (eSET) policy (now called the multiple births minimisation policy). This allowed centres to develop their own eSET strategy, with the aim to reduce the UK IVF multiple pregnancy rate to 10% over a period of years (Multiple births after IVF).

On average multiple births tend to have lower birthweights than singletons (Childhood, Infant and Perinatal Mortality in England and Wales, 2013), which is one reason why the infant mortality rate is around 5 times higher for multiple births than for singleton births. Multiple pregnancies are also associated with a higher risk of stillbirth, death under 28 days and child disability (Multiple births after IVF).

The baby’s ethnic group is obtained from the birth notification and is stated by the mother (background note 6 has further details). For babies born in 2014 where an ethnic group was stated, the highest percentage of all live births occurred in the White British group (65%), followed by the All Others group at 11%. The lowest percentages for all live births were for babies from the Bangladeshi and Black Caribbean groups (1.5% and 0.9% of all live births respectively).

The highest percentage of births before 37 weeks gestation occurred in the Black Caribbean ethnic group with 9.9% of births (591 births) being classed as preterm. The White Other ethnic group has the lowest percentage of preterm births with 6.4% of live births occurring before 37 weeks gestation (4,356 births).

The stillbirth rate in England and Wales in 2014 was 4.7 stillbirths per 1,000 total births, unchanged from 2013. The maternal and fetal risk factors for stillbirths include maternal obesity, smoking, and fetal growth restriction. Stillbirth rates reduce greatly as gestational age increases to 39 weeks; beyond 40 weeks, there is a very small rise in the stillbirth rate. In 2014, the stillbirth rate for babies born at 24 weeks gestation was 363.1 stillbirths per 1,000 total births, this compares with a rate of 1.2 at 40 weeks gestation.

Women aged 45 and over have the highest stillbirth rate (9.5 stillbirths per 1,000 total births). This compares with a rate of 7.6 for women aged 40 to 44, and a rate of 5.2 for women aged under 20.

Stillbirth rates vary by mother’s area of usual residence, with the lowest rate of English regions occurring in the East and the South West with 4.0 stillbirths per 1,000 total births. The highest rate is in Yorkshire and The Humber and the West Midlands with 5.0 stillbirths per 1,000 total births. The stillbirth rate for Wales was 5.2 in 2014.

Stillbirths and neonatal mortality rates are an indicator within the NHS Outcomes Framework 2014 to 2015 measuring the number of deaths in new born babies younger than 28 days in England. The Department of Health (DH) together with the stillbirth and neonatal death charity (Sands) and a number of important organisations such as NHS England, Public Health England (PHE), the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are working on a stillbirth programme. This includes identifying and agreeing the main messages that can be used to raise awareness of the risk factors for stillbirths among pregnant women and health professionals and the actions that can be taken to minimise these risks.

In Wales, a National Stillbirth Working Group was set up within the 1000 Lives Plus programme of work in April 2012, and includes representation of important stakeholders in maternity care. The National Assembly for Wales published an Inquiry into stillbirths in Wales in 2013, which identified a number of actions to improve the stillbirth rate in Wales. Further information can be found on the 1000 Lives Plus website.

An overview of stillbirth numbers and rates in England and Wales since 1927 and a European comparison is available and further statistics on stillbirths, including figures by cause group, birthweight and gestation can be found in Child Mortality Statistics.

Low birthweight (under 2.5kg), one of the known risk factors for infant deaths, can be caused by a number of factors. For example, smoking has been identified as a major risk factor contributing to low birthweight. Babies born to women who smoke weigh, on average, 200g less than babies born to non-smokers (NHS, Why should I stop smoking if I’m pregnant?).

In England and Wales, 7.0% (48,547) of live births were low birthweight in 2014, unchanged since 2011. The percentage of live births with low birthweight varies by region with the highest proportion of low birthweight babies being born in the West Midlands (8.2%) and the lowest proportion being born in the South West (5.8%). The percentage of live births under 2.5kg is also available by local authority - Births by area of usual residence.

Babies born weighing more than 4kg are considered to be of high birthweight. In 2014, 10.9% of live births in England and Wales weighed 4kg and above. The South West and East had the highest percentage of live births with a high birthweight (12%) while London had the lowest (8.8%). Gestational diabetes and a BMI over 30 in the mother are some of the risk factors for babies that are large for gestational age (NHS, Overweight and pregnant).

From the 2014 data year, some changes have been made to the published packages. Packages that have remained unchanged are:

• Birth summary tables

• Parents' country of birth

• Births by area of usual residence

• Childbearing for women born in different years

From October 2015, a number of births packages have been combined into two packages: Birth characteristics and Births by parents’ characteristics. Details of what are included in these packages are shown below:

• birth characteristics – provides summary statistics on stillbirths, including birthweight data for live and stillbirths by mother's area of usual residence and maternities, live births, and stillbirths in hospitals by area of occurrence. These tables also provide live birth statistics by month and quarter of occurrence, and maternity figures for multiple births and by place of birth. Prior to the 2014 data year these statistics were published in separate releases: Characteristics of birth 1 and Characteristics of birth 2

• births by parents’ characteristics – will provide live birth, stillbirth and maternity statistics by age of mother, type of registration (within marriage/civil partnership, joint, sole), and mean age of mother by birth order. It will also provide live birth statistics (numbers and rates) within and outside marriage/civil partnership, data on live births by age of mother and number of previous live-born children along with median birth intervals. Prior to the 2014 data year these statistics were published in separate releases: Characteristics of mother 1, Characteristics of mother 2 and Further parental characteristics

Multiple birth statistics, stillbirths, birthweight and the number of home births are monitored by the NHS and Department of Health to help ensure that adequate maternity and support services are available. Other organisations, such as the Multiple Birth Foundation, who provide advice, information and support to multiple birth families and health professionals, use multiple birth statistics to monitor trends.

Statistics on home births are used by organisations such as Birth Choice UK, to help women decide where they might like to have their baby and promote women’s rights to a home birth.