Listening to Mothers III Report Debuts with Feedback on Birth and Maternity Care from 2,500 Women Around the U.S.
Last week, Childbirth Connection released the third in a series of reports (the first and second were released in 2002 and 2006) entitled Listening to Mothers. The Listening to Mothers III report is devoted to understanding the experiences and perspectives of childbearing women as a means to improving maternity care policy, practice, education, and research. Results from the first two reports have been widely used to do exactly those things.
The other intention behind the report's findings is to increase awareness among childbearing women of the issues in our maternity care system and motivate them to seek safe and effective care. Some people like to say, "What you don't know, can't hurt you," but in the case of knowing about your maternity care, what you don't know can impact the safety and health of you and your baby. When you know all of the choices available to you, you are empowered to make the best decisions for your family.
Below is a summary of some of the key findings (excerpted from the Childbirth Connection website). I encourage you to click through and read the full report. Earmark items that you want to learn more about. Highlight things that you want to mention to your care provider. Circle things to include in your own birth plan.
The use of prenatal ultrasound has increased, including a steep increase in use for an indication that is not supported by evidence. Between the second and third surveys, the proportion of women who had two or fewer ultrasounds decreased from 41% to 30%, while the proportion who had five or more ultrasounds increased from 23% to 34%. In the most recent survey, 68% of women reported that their caregiver used ultrasound near the end of pregnancy to estimate fetal weight, compared with 51% in Listening to Mothers II. Routine fetal weight estimation is not supported by evidence or clinical guidelines.
Many women report experiencing pressure from a care provider to have a cesarean, labor induction, or an epidural. The percentage of women who experienced pressure to have a cesarean rose from 9% to 13% between the second and third surveys, while pressure to accept an epidural increased from 7% to 15% and pressure to induce labor increased from 11% to 15%. The proportion of women who attempted to self-induce labor increased from 22% to 29% during the same period, which may be related to pressure to accept medical induction and desire to avoid such intervention. (In Listening to Mothers II, one-third of women who attempted self-induction did so to avoid a medical induction.)
Women's interest in and access to VBAC is shifting. The data on vaginal birth after cesarean (VBAC) suggest a small increase between the second and third surveys in the proportion of women with a prior cesarean who were interested in the option of a VBAC, from 45% to 48%. The proportion of women with a prior cesarean who reported a lack of access to VBAC grew to 56% in the current survey from 42% a decade earlier. For those who did not have the option of a VBAC, the proportion reporting that their care provider or their hospital was unwilling declined appreciably between the last two surveys, however, the proportion of mothers denied access to a VBAC for a medical reason unrelated to their prior pregnancy more than doubled (20% to 45%) across the past two surveys.
Hospital support for exclusive breastfeeding is improving, although women's intentions to and experiences with exclusive breastfeeding appear to be declining. Among women intending to exclusively breastfeed, there has been a marked decrease in the percentage of women who received free formula samples or offers at hospital discharge (from 80% to 66% to 49%) and whose babies received formula or water supplementation during the hospital stay (from 47% to 38% to 29%). Across the two most recent surveys there was an increase in newborns being primarily in their mothers' arms in the first hour after birth, a practice that facilitates breastfeeding, from 34% to 47%. However, the percentage of women nearing the end of pregnancy who hoped to breastfeed decreased over the three surveys, from 67% to 61% to 54%, as did the proportion exclusively breastfeeding at one week (falling from 58% to 51% to 50%.)