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Article Excerpt
The Childbirth Connection (formerly Maternity Center Association) recently published Listening to Mothers II, their second national consumer survey of the maternity care experiences of women in the United States. Their first survey, Listening to Mothers I, published in 2002, was a landmark compilation of maternity care data in that it was the first national poll of the actual recipients of that care, namely women who had given birth in the previous 24 months. Prior to Listening to Mothers I, our only source of information about maternity care came from medical records and hospital reports and smaller studies that did not provide a national perspective. Never before had women themselves been asked about their experiences and perceptions of their care on such a large scale.
The 1,573 Listening to Mothers H survey respondents were a representative cross section of English-speaking reproductive aged women in the United States. They were between 18 and 45 years old and had given birth at a hospital to a single baby in 2005 that was still living at the time of the survey. Two hundred of the mothers were interviewed by phone which gave the surveyors the opportunity to ensure a representative ethnic mix of women. A follow up survey of 903 mothers was conducted 6 months after the initial survey primarily regarding their postpartum experiences, but a few more pregnancy and birth questions were included in this portion of the survey.
The content of the Listening to Mothers II Report is organized into 6 sections:
* Planning for Pregnancy and the Pregnancy Experience
* Women's Experiences Giving Birth
* Home with a New Baby
* Mothers' Experiences with Employment and Health Insurance
* Choice, Control, Knowledge and Decision Making
* Looking at Some Important Variations in Experience
Rather than report on all of the areas covered in the survey, I will focus on various issues that may be of interest to doulas and childbirth educators (CBEs) working with pregnant and birthing women. Additionally, I will comment on how the results of the survey differ from my own perception and experiences of working with women during this time in their lives.
My personal experience in maternity care includes 11 years as a childbirth educator and labor assistant, primarily attending hospital births. During this time I taught approximately 600 couples and attended about 40 births. I have been a Certified Nurse Midwife for nine years attending almost 500 women at home, in birth centers and in the hospital. Over the past nine years of teaching the ALACE Labor Assistant Training, I have interacted with over 500 workshop participants, the majority of whom have given birth. While my personal exposure and experience with pregnant and birthing women is not representative of a national experience, these cumulative experiences have afforded me a wide range of contact with women who have experienced maternity care in the United States.
As we know, there are many factors that influence the quality, style and outcome of a woman's pregnancy and birth. I think of these factors in three categories: 1) the woman's own attitude, philosophy, beliefs and perspectives regarding pregnancy and birth, 2) choice of provider, provider philosophy, the place of birth, institutional philosophy and style, and 3) the woman's medical health, both prenatally and during her pregnancy and labor.
Let me say a few words about personal and professional philosophy of care. My experience is that the majority of women in our culture are quite willing to follow whatever their providers tell them without question. As a culture, we have elevated the field of medicine, and the providers of medical care, to a level of blind trust, an area beyond question that does not require our own active participation. And therein lays the heart of the problem.
Women (and men for that matter) are not taking an active enough role in their health care decisions. When things don't go as they'd hoped or planned, they can feel traumatized, disappointed, angry, depressed and sometimes revengeful, for many years. I believe that part of the solution to this world of hurt that women carry with them for the remainder of their lives is to educate and support women in participating in their health care at all phases of their lives, but specifically for our purposes, during their pregnancy and births. And this is where childbirth education and labor support come into play.
Planning for Pregnancy and the Pregnancy Experience
Usually as doulas and CBEs, our first contact with our clients is in the last trimester of their pregnancy when the groundwork for their care has already been laid. Unfortunately, often it is only at this late date that women discover whether or not their personal philosophies for labor and birth matches those of their provider. And this only occurs for the women who have a conscious philosophy, or wishes for their labor and birth.
The survey asked women not only who their care providers were, but why they chose those providers. It was no surprise to find that OB/GYNs care for the majority of pregnant women in America (79%). 9% of the respondents saw midwives and 8% saw family practice physicians. The remaining 4% of women were seen prenatally by nurses, physician assistants, an unknown type of doctor, or "not sure". These statistics are consistent with national birth records for type of maternity care provider.
The reasons for choosing a maternity care provider are of interest. The respondents could pick the top three reasons for their choice. Not surprisingly, the majority of women see someone who is covered by their insurance plan (47%). The next highest category is that the woman had previous experience with that provider (42%). The following three categories each comprised 26% of the respondents' choices: recommendation from a friend or family member, the convenience of the office location, and preference for a female provider. Only 18% of women said that choosing a provider whose style fit her own was one of the top three factors in her choice. A provider having privileges at a preferred hospital was a leading factor for 17% of women, a recommendation by a health professional steered 13% of women, and 3% of women wanted a male provider.
What does this say to us about who women are seeing and why? Convenience and cost are high priorities. We allow our insurance carriers to choose our providers, and/or choose providers based on office location. Only 18% of women choose providers in regards to their philosophy of care.
I understand the financial constraints that we all face, and this is often the reason cited by many women for the choices they have made. But when faced with a once in a life-time event, the birth of this child, and the life-long impact this experience is likely to have on the mother, her baby and her family, I am concerned that women are not placing enough importance...
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