1st Thoughts on Listening To Mothers 3

Listening to Mothers III Cover

Listening to Mothers III CoverIs it geeky that I get excited about things like the new Listening to Mothers III survey? Childbirth Connection released 2 previous versions of the survey in 2002 and 2006 and I found both of them very interesting. The third survey was released this morning, and I’ve been perusing it this morning over breakfast, and beyond. I’ll admit it is nearly lunchtime and I am still in my jammies, still reading….

The survey looked at 2400 mothers who had given birth between July 2011 and June 2012. Interviews were conducted online. The report has quotes from the moms sprinkled throughout –

Some interesting – and somewhat disjointed – tidbits I’ve come across so far:

Contrary to popular myth, the majority of insured births in this country were covered with PRIVATE insurance. (47% of all births) 38% of all births were covered under Medicaid or CHIP (still a large chunk, but not the majority of all births by a long shot). This leaves 15% of births as paid for out of pocket. We had to do this with our first, and it was a difficult burden since we had to pay the full, unadjusted by insurance pricing. Interestingly, mothers who were on Medicaid were “more likely to regularly have group prenatal visits, be medically induced, not have met their birth attendant until the birth, and have their baby spend time in the NICU.”

They asked moms if they had ever held back on asking their providers questions for three common reasons. 30% said they held back because the provider seemed to be in a rush, 23% because they did not want to be perceived as being difficult, and 22% because they knew they wanted care that was different from what the provider was used to. I sure hope that some of those women (especially in the last two categories) went to to switch to a new care provider who they felt more comfortable with. Expectant moms should be able to ask questions and receive the kind of care they want. Especially since more than 3/4 of women reported their care provider as the most important source of information in their pregnancy.

Quote from LTMIIIAs far as births, an unsurprising breakdown on the kinds of providers:
70% OB
10% Midwives
6% Family Practice Doctors

With 61% of them women and 39% men. 64% of women had “their” provider for the birth. 12% had someone they had “met briefly” and 21% had never met the provider who attended their birth.

There was an interesting 7% “Doctor of unknown specialty” – makes me wonder if those women did any research on their providers if they don’t even know what their specialty is!

Only 6% of births were attended by a doula. More than 75% of women knew about doula care, and of those who knew about doula care but did not use a doula, More than 1 in 4 “would have liked” to have doula care. Some work to do there!

A little more than half of first time moms and 17% of moms who had a previous child took childbirth classes. This seems about right to me. Of those who took classes, about half took a traditional series across several weeks, and half took an intensive or crash course over 1 or 2 days.

The internet ranks third in sources of pregnancy information (behind health care provider and childbirth classes). Many women sign up for regular email or text services to provide them with information on pregnancy, birth and parenthood. I’ve seen some pretty bad ones out there, still looking for a service I can comfortably recommend to my clients.
83% of all births (vaginal births and cesareans) use some form of pain medication. 67% of all births were with an epidural. 17% of all births did not use any pain medication.

More than two thirds of all women who births vaginally were lying on their backs to push their baby out. Only 43% of women got out of bed at all once admitted to the hospital. We need to make it easier for moms to move around in labor!

VBAC rate of 14% in all moms who had a previous cesarean. Only 22% of moms told their provider they wanted a repeat cesarean. 48% of women who desired a VBAC were denied that option. This angers me.

One commonly cited reason for the rising cesarean rate is “women are asking for it” – this survey shows 1% of moms do ask for it, and an overall cesarean rate of 31% – so let’s not blame moms for the huge increases!

I find it mind boggling that 8% of women who have a cesarean report an episiotomy as well. Makes me wonder if they understand what an episiotomy is….

In a very similar result to the last survey, 37% of women reported experiencing depression after giving birth, with 17% of them receiving a clinical diagnosis. Far too many women struggle without getting help. We need to make it easier to get help, and remove some of the social stigma.

Some mothers reported feeling pressure to accept induction (15%) cesarean (15%) or epidural (13%)

Only 20% of women understand that 39 weeks is the earliest that should be considered “full term” and that inductions should not be scheduled earlier than that without serious medical reason. Also there was an increase in the rate of women who tried to induce themselves, and those women who tried their own inductions had an increased rate of cesarean. More reason to encourage patience!

A very interesting chart from the full report, found on page 24:

Listening To Mothers III

Of the moms who planned to exclusively breastfeed, HALF were given the free samples of formula that are proven to sabotage breastfeeding. This is a shame and hospitals need to stop.

Average baby’s weight: 7.5 pounds

Having an episiotomy doubled the rate of women who said that perineal pain was a problem postpartum.

I found the questions on decision making (pages 55-59) very interesting, though hard to summarize and explain.

Also interesting were the questions asking about the knowledge of the risks of induction or a cesarean birth. None of the questions had a majority of moms who knew the right answers! Moms are clearly not learning accurate information about the risks of a cesarean.

In the conclusion, the report lists several concerns about care that is common but not evidence based. (page 59) Worth a read!

Quote from the conclusion:

“There was little indication that the maternity care system protects, promotes and supports the intrinsic physiologic capacities of this largely healthy population of women and their fetuses/newborns. Technology-intensive maternity care continues to dominate. Our maternity care system is failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.”

If you want to read the survey for yourself, you can download it from Childbirth Connection. The full report is 93 pages, but there is a nice summary of main findings that is much shorter, as well as sub reports on racial disparity, internet usage, the rise in cesareans, and induction of labor.

And now I can look forward to the postpartum survey, Listening to Mothers III: New Mothers Speak Out! which is coming this June.

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