Saturday, November 26, 2011

Listening to Mothers

Have you read the findings of the 2002 and 2006 national U.S. surveys of women's' childbearing experiences? The Listening to Mothers and Listening to Mothers II surveys are a great look at U.S. maternity care and mothers experiences in birth.


I have read an referenced these findings before, but here is a summary of the findings. I encourage you to download the Pdf's, read through the complete findings, view the graphs and charts, and develop a better sense of what childbirth is like in America.





The 2002 Listening to Mothers study was the first national U.S. survey of women’s childbearing experiences. 136 mothers of singletons were interviewed by telephone, and 1,447 completed an online survey within 24 months of their birth (Declerq et al, 2002). The survey was repeated in 2006 in Listening to Mothers II (Declerq et al, 2006).

In the 2002 survey, mothers were pleased with the care they received during birth. The majority of mothers felt that they understood what was happening, felt comfortable asking questions, that they got the attention they needed, and were as involved as they wanted to be in making decisions. Technology-intensive labor was the norm, with high numbers of women receiving an IV, epidural, pitocin, artificial rupture of membranes, or stitching. Almost half of women reported that their caregivers tried to induce labor. One third reported a non-medical factor as part of the reason for induction. Five percent of women chose labor induction to be able to give birth with the birth attendant of their choice. 

The women surveyed in 2002 reported that obstetricians delivered 80% of babies. This was the same in Listening to Mothers II (2006). Midwives attended 10% of births and family physicians attended 4% of births. 97% of births took place in hospitals. Doulas and midwives were most highly rated providers of labor support, but used only 5% and 11%, respectively. These findings were the same in Listening to Mothers II (2006). Three in ten women had never previously met the person who delivered their baby. Four percent of women had a nurse or assistant deliver their baby (not a doctor).

Nearly two-thirds of women received epidurals and most rated them highly. However, most couldn’t answer questions about side effects of epidurals. Use of the tub, showering, and birth balls was rated high for help with labor pain, but used by only eight percent of women.  71% of mothers did not walk around because they were hooked up to instruments, had pain meds, or were told not to by caregivers. Only twelve percent of women had anything to eat during labor, 31% had something to drink. Most were told by caregivers that it was not permitted. Three quarters of women gave birth on their backs.

Two-thirds of mothers had an unassisted vaginal birth; one fourth of mothers had a cesarean delivery. In LTMII (2006), one-third of mothers had a cesarean delivery. In the 2002 mothers who had a cesarean delivery, 51% were planned (predominantly repeated cesareans). 26% of mothers with previous cesareans had a VBAC (LTMII: 11%). 42%- 58% were denied the option of VBAC. (LMTII: only 1 mother out of all the 1st time c-secs requested her c-section with no medical reason).

By a margin of more than 5 to 1 mothers thought it was unlikely that they would choose a cesarean for non-medical reasons for a future birth. Women who had given birth more than a year prior to the survey were more likely to express willingness of caregivers to permit VBAC, compared to women who had given birth within a year of the survey.
           
Compared to women with vaginal births, those with c-sections were less likely to ‘room-in’ with the baby and be breastfeeding at one week, more likely to experience several health concerns after birth. Experienced mothers (compared to 1st timers) were less likely to attend CBE, use pain med and other interventions, report negative feelings during labor, have a physician as a birth attendant, give birth by cesarean.
           
In the 2006 version of the survey, researchers found that first-time mothers identified books as their most important source of information. More mothers were exposed to childbirth through TV than through childbirth education.
           
The greatest concern with the care received during birth was feeling “rushed.” In 2002 and in 2006, about half of women agreed that giving birth is a natural process that should not be interfered with unless absolutely medically necessary. One-third of women had limited understanding or none about her legal right to full information about any procedure and her right to refuse. More than one-third reported she would have liked to know about this during maternity care.

“What happens to childbearing women, infants and families matters deeply. A vast body of evidence is accumulating about lifelong implications of the medical, physical, and social environment during this crucial period. Growing evidence also supports the long-term impact on maternal well-being of conditions at this time.” (LTMII, 2006, p 8)

“Large segments of this population experiencing clearly inappropriate care that does not reflect the best evidence, as well as other undesirable circumstance and adverse outcomes.” (LTMII, p 8)


References:

Declerq, Eugene, Carol Sakala, Maureen P. Corry, Sandra Applebaum, Risher P. (2002) Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, 2002.

Declerq, Eugene, Carol Sakala, Maureen P. Corry, Sandra Applebaum (2006) Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection.
 




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