=?UTF-8?Q?Mothers II: Second National Survey of Wome? =?UTF-8?Q?n’s Childbearing Experiences?
From: GIN11153@aol.com
Wed Oct 25 22:57:37 2006
Many important points here:
Technology-Intensive Childbirth is the Norm for
Great Majority of Primarily Healthy Women
-- Listening to Mothers II: Second National Survey of Women’s Childbearing
Experiences, Shows that U.S. Maternity Care System Fails to Provide the Care
that Mothers Want and that is in Best Interest of Themselves and their Babies
--
NEW YORK, NY, October 24, 2006 – Although the great majority of pregnant
women in the U.S. are healthy and have good reason to anticipate uncomplicated
childbirth, Childbirth Connection’s new _Listening to Mothers II_
(http://www.childbirthconnection.org/article.asp?ClickedLink=205&ck=10068&area=2) survey
shows that technology-intensive childbirth care is the norm. The survey was
conducted by Harris Interactive for _Childbirth Connection_
(http://www.childbirthconnection.org/) , in partnership with _Lamaze International_
(http://www.lamaze.org/) . The national survey polled 1,573 women who gave birth in
2005 and found that most mothers experienced numerous labor and birth
interventions with various degrees of risk that may be of benefit for mothers with
specific conditions, but are inappropriate as routine measures. Overall, survey
mothers experienced the following interventions: electronic fetal monitoring
(94%), intravenous drip (83%), epidural or spinal analgesia (76%), one or more
vaginal exams (75%), urinary catheter (56%), membranes broken after labor
began (47%), and synthetic oxytocin (Pitocin) to speed up labor (47%).
Additionally, more than four out of ten mothers (41%) reported that their
caregiver tried to induce their labor. When asked if the induction caused labor
to begin, more than four out of five of those women (84%) indicated that it
did, resulting in an overall provider induction rate of 34%. Among all survey
mothers whose providers tried to start their labors, 79% cited one or more
medical reasons for being induced, while 35% cited one or more non-medical
reasons. Overall, 11% of mothers reported experiencing pressure from a health
professional to have labor induction, and those reporting pressure were more
likely to have had it.
Listening to Mothers II was conducted in January and February 2006. It
provides health professionals, payors, policymakers, hospitals and women and
families with an unprecedented look at experiences of childbearing women and their
infants. It also gives all of these groups a basis for improving conditions
for mothers and babies by comparing their actual experiences to their
preferred experiences, to care to which they are legally entitled, to care supported
by best evidence, and to optimal outcomes.
“The data show many mothers and babies experienced inappropriate care that
does not reflect the best evidence, as well as other undesirable circumstances
and adverse outcomes. This sounds alarm bells,†said Maureen Corry,
executive director of Childbirth Connection. “Few healthy, low-risk mothers require
technology-intensive care when given good support for physiologic labor. Yet,
the survey shows that the typical childbirth experience has been transformed
into a morass of wires, tubes, machines and medications that leave healthy
women immobilized, vulnerable to high levels of surgery and burdened with
physical and emotional health concerns while caring for their newborns.â€
Survey Reveals Gaps Between Actual and More Optimal Experiences and Outcomes
Listening to Mothers II identified many gaps between their experiences,
their desires and best medical practice. For example:
· Within this largely healthy population, four labors in ten were
started artificially and one mother in three had a cesarean.
· A great majority (85%) felt that a woman who wants a VBAC (vaginal
birth after cesarean) should be able to make that decision, but most women
who were interested in a VBAC were denied this option by their caregiver (45%)
or hospital (23%).
· Virtually all of the mothers asked felt that they should be
informed about all (78% and 81%) or most (19% and 17%) of the complications related
to labor induction and cesarean, respectively, before deciding to have these
interventions, yet the majority of mothers were poorly informed about
several complications of labor induction and cesarean section and most had
incorrect knowledge or were not sure.
· Among the vaginal birth mothers who experienced episiotomies
(25%), only 18% stated that they had been given a choice about it.
Safe and Effective Care Practices Were Under Used
In addition to overuse of interventions, the survey showed a striking under
use of several care practices known to be safe and effective, and especially
appropriate for healthy, low-risk women. Only a small proportion of women
experienced these beneficial practices, including use of highly rated drug-free
methods of pain relief (e.g., immersion in a tub, shower, use of large "birth
ball"), monitoring the baby with handheld devices instead of electronic
fetal monitoring, drinking fluids or eating during labor, moving about during
labor, giving birth in non-supine positions, and pushing guided only by their
own reflexes rather than caregiver-directed pushing.
“These findings are of particular concern,†notes Judith Lothian, PhD, of
Lamaze International. “The care practices that promote, protect and support
normal birth appear to be unavailable to the vast majority of childbearing
women in the United States.â€
Cesarean Section: Making the Decision and the Implications
Despite considerable media attention to the concept of “maternal request
cesarean,†this systematic national sample of mothers found that the phenomenon
barely existed in 2005. Less than one-half of 1% (1 woman out of 252) of
mothers in the survey who had a first-time cesarean reported that they had
requested it themselves. Another contention – that vaginal birth is a threat to a
mother’s pelvic floor – also had not been embraced by the mothers in the
survey, with far less than 1% of mothers who had either a first or repeat
cesarean citing this as the reason for their cesarean.
Study director Eugene Declercq, PhD, of the Boston University School of
Public Health, explained, “The survey found scant evidence of maternal request
cesareans. Rather, mothers indicated that the primary decision-maker concerning
their cesarean was their care provider, either during or before labor. In
contrast to an image of doctors pressured by mothers to perform a cesarean,
one-fourth (25%) of those mothers who had a cesarean indicated that they felt
pressure from a health professional to undergo their cesarean. This hardly
supports the theory that the rapidly rising cesarean rate is based on maternal
request. Research is needed into the complex interplay between mothers and their
doctors regarding cesarean decision-making to better understand why the U.S.
cesarean rate has escalated 41% in the past decade.â€
Pain and Its Impact on Postpartum Health
Mothers with cesareans described how abdominal surgery had a big impact on
their postpartum health. More than three-quarters (79%) reported pain at the
site of the incision in the two months after birth, with 33% citing it as a
major problem, and18% of those with a cesarean had ongoing pain at the site of
the cesarean scar at least 6 months after giving birth.
Mothers with a cesarean were also twice as likely to report that postpartum
pain interfered with their daily life than did mothers with vaginal
deliveries with 22% describing that pain interfered "quite a bit" or “extremely†with
routine activities compared to 10% of mothers with a vaginal birth.
Missed Opportunities
Given the increased recognition of the importance of the period before and
between pregnancies, and the conditions under which women enter pregnancy, the
data shows that there are deficiencies in care that could potentially lead
to less optimal outcomes for mothers and babies.
Alarmingly, about half of the mothers surveyed had a body mass index
considered to be “overweight†(25%) or “obese†(24%) and most mothers did not
visit a healthcare provider to plan for a healthy pregnancy.
Less than half (47%) of mothers reported being asked during pregnancy about
feelings of depression and only one-third (35%) were asked about physical or
verbal abuse. However, more than three-quarters of providers (76%) did
discuss signs of premature labor with the women and mothers reported being
confident in their ability to recognize them.
Despite the importance of early contact for attachment and breastfeeding,
most babies were not in their mothers’ arms during the first hour after birth,
with a troubling proportion with staff for routine, non-urgent care (39%).
Although 61% of the mothers wanted to breastfeed exclusively as they neared the
end of their pregnancy, just 51% of all mothers were doing so one week after
birth, a troubling missed opportunity.
On the positive side, most mothers learned of their pregnancies in the early
weeks of their pregnancy, started prenatal care well within the first
trimester and saw the same provider throughout the pregnancy. Nearly all mothers
(96%) reported having received supportive care (comfort, emotional support,
information) while in labor from at least one person, most often
husbands/partners or the nursing staff.
Information Seeking
During pregnancy, mothers sought information about pregnancy and birth
through a variety of sources, with first-time mothers naming books (33%) as their
primary information source, followed by friends and relatives (19%), their
provider (18%) and the Internet (16%), while experienced mothers named as their
leading information source their own past experience (48%), followed by
their doctor or midwife (18%), the Internet (13%) and books (12%). Fully
two-thirds (68%) had watched one or more of eight television shows specially created
to depict childbirth, with more than half of the viewers regularly watching
at least one of these shows. Far more mothers were exposed to childbirth
through TV shows than through childbirth education classes. Only one-fourth (25%)
of women reported taking childbirth education classes during their most
recent pregnancy, with a majority (56%) of new mothers taking classes, while only
one in eleven (9%) experienced mothers took classes. As women neared the end
of pregnancy, most felt confident, but a majority also felt fearful about
their upcoming birth.
Mothers and Employment
Listening to Mothers II also explored mothers’ experiences with paid work
and childbirth and found mothers under considerable stress to balance
employment and family obligations. More than half the mothers (58%) reported being
employed during pregnancy, working on average until 10 days before the due date.
Only half the mothers who were employed full-time received paid maternity
leave. Most mothers (57%) who were employed during pregnancy returned to work
by 12 weeks after the birth of their baby. Less than half the mothers (46%)
indicated they were able to stay at home as long as they liked.
More than one-third (37%) of mothers reported having to pay for some of
their maternity care costs out-of-pocket, with an average expenditure for this
group of $1,000.
About the Survey
Harris Interactive® conducted Listening to Mothers II: The Second National
U.S. Survey of Women’s Childbearing Experiences on behalf of Childbirth
Connection. The survey consisted of 1,373 online and 200 telephone interviews with
women who had given birth in a hospital to a single live baby in 2005, with
weighting of data to reflect the target population. The weighting included
propensity scores, to adjust for the propensity to be online, a methodology
developed and validated by Harris Interactive. Interviews were conducted from
January 20 through February 21, 2006, and the survey took approximately 30
minutes to complete. The Listening to Mothers II survey will also serve as the
basis for quarterly issue briefs that will explore in greater detail the key
issues described in the report.
Gail Neuman RNC CPHW SNP
student nurse practitioner and student midwife
Perinatal education
Perinatal Nurse Associates
Santa Ana, CA
