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In the following pages I have attempted to set forth, as briefly as seemed to be consistent with thoroughness, the scientific basis for and the practical application of the obstetrical art. At the same time, I have endeavored to present the more practical aspects of obstetrics in such a manner as to be of direct service to the obstetrician at the bedside.

—J. Whitridge Williams (1903)


So reads the introduction to Williams’ first edition of this textbook, Obstetrics—A Text-Book for the Use of Students and Practitioners. In this 25th edition, we strive to follow the tenets described by Williams. And, each chapter begins with a quote from his original textbook.

The science and clinical practice of obstetrics is concerned with human reproduction. Through quality perinatal care, the specialty promotes the health and well-being of the pregnant woman and her fetus. Such care entails appropriate recognition and treatment of complications, supervision of labor and delivery, initial care of the newborn, and management of the puerperium. Postpartum care promotes health and provides family planning options.

The importance of obstetrics is reflected by the use of maternal and neonatal outcomes as an index of the quality of health and life among nations. Intuitively, indices that reflect poor obstetrical and perinatal outcomes would lead to the assumption that medical care for the entire population is lacking. With those thoughts, we now provide a synopsis of the current state of maternal and newborn health in the United States as it relates to obstetrics.


The National Vital Statistics System of the United States is the oldest and most successful example of intergovernmental data sharing in public health. This agency collects statistics through vital registration systems that operate in various jurisdictions. These systems are legally responsible for registration of births, fetal deaths, deaths, marriages, and divorces. Legal authority resides individually with the 50 states; two regions—the District of Columbia and New York City; and five territories—American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.

The standard birth certificate was revised in 1989 to include more information on medical and lifestyle risk factors and obstetrical practices. In 2003, an extensively revised Standard Certificate of Live Birth was implemented in the United States. The enhanced data categories and specific examples of each are summarized in Table 1-1. By 2013, 35 states had implemented the revised birth certificate representing 76 percent of all births (MacDorman, 2015). Importantly, the 2003 version of the population death certificate contains a pregnancy checkbox to eventually be implemented by all states (Joseph, 2017).

TABLE 1-1General Categories of New Information Added to the 2003 Revision of the Birth Certificate

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