Survey Raises Questions About New Mothers’ Ability to Make Informed Decisions Regarding Pre- and Postnatal Care.

Despite efforts to improve the quality of maternity care for women, results of a new national survey reveal that risky procedures are overused, beneficial practices are underused, and many women lack support and knowledge to effectively navigate their maternity care.

A quarter of women surveyed experienced three or more of five major medical procedures, such as labor induction, drugs to speed labor, and cesarean section, while only one in eight women had none of these interventions. Unnecessary interventions – such as inducing labor for convenience, or routine repeat cesareans – expose women and their babies to avoidable risks, said the authors said of the report, called Listening to Mothers III.

Eugene DeclerqEugene Declercq, professor of community health sciences at the BU School of Public Health, was the survey’s lead investigator. Listening to Mothers III, the third in a series of national surveys that explore women’s experiences before pregnancy and through the months after birth, was commissioned by Childbirth Connection and funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave birth in U.S. hospitals from mid-2011 to mid-2012.

Most women surveyed could not correctly identify the risks of labor induction or cesarean section, revealing problems with prenatal education. And one in four who had these procedures reported experiencing pressure from a care provider to do so. At the same time, mothers expressed a high degree of trust in maternity care providers, with nearly half rating them as “completely trustworthy.”

The survey also revealed that many beneficial practices are not consistently used. Around the time of birth, for example, just a fraction of women received continuous labor support from a doula, although many expressed interest in having doula care. Half of the women were not exclusively breastfeeding a week after birth, and many had not received help from a provider for notable symptoms of depression. Also, many women who would have liked the option of vaginal birth after a cesarean reported that their care provider or hospital was unwilling to provide this option.

“Underused maternity practices tend to be non-invasive, pose few if any risks, and use relatively few resources,” Declercq said. “They offer many opportunities to improve the quality, outcomes and cost of maternity care, with benefits for mothers and babies and those who pay for their care.”

Maureen Corry, executive director of Childbirth Connection, said women need more “decision-making tools” and information on health care providers’ performance in order to help them choose safe, effective care.

“Pressure to have unwanted procedures, a lack of awareness about their downsides, and unqualified trust in health care providers are a potent combination, making women and their babies vulnerable to poor quality care,” she said.

The national surveys have tracked women’s experiences for more than a decade, and have identified what the authors consider to be some promising trends. For example, hospital provision of formula samples to women who wanted to exclusively breastfeed has declined. Newborn “rooming-in” with mothers during the hospital stay is edging up. And use of episiotomy—a rarely needed cut to enlarge the vaginal opening just before birth that involves pain and other adverse effects—has declined.

The full survey report, questionnaire and data briefs are available at: http://transform.childbirthconnection.org/reports/listeningtomothers/

Submitted by: Lisa Chedekel chedekel@bu.edu