Article on Hi Tech Interventions in Labor, etc.

I got this article from an online newsletter that I receive. Thought it was
appropriate to share with you ladies (and gentlemen)...

- Jen


Landmark Childbirth Interventions Survey Shows Mothers Hi-tech, but Happy
By Barbra Williams Cosentino, RN, CSW

Have you ever wondered if other women's experiences during childbirth and
the postpartum period were similar to yours? Most likely you have, because
the majority of women are fascinated by birth stories, including their own.
If things about your birth experience upset or surprised you, if they were
different from what you were led to believe might happen during labor and
delivery, you've probably wondered why they occurred and what, if anything,
could have been done to prevent it.

The national Maternity Center Association recently issued the first
comprehensive survey of American women's childbearing experiences, gathering
data that had never been collected before at the national level. Called
"Listening to Mothers," the landmark survey provides health care providers,
pregnant and parenting women, and the general public with a more complete
understanding of the childbearing experience as it is experienced in America
today.

For the study, which was conducted by Harris Interactive and the Maternity
Center Association, a national not-for-profit health organization dedicated
to the needs and interests of childbearing women and their families, nearly
1,600 women, who had given birth within the previous 24 months, were
surveyed. The survey, which is one component of MCA's Maternity Wise program
to promote evidence-based maternity care, was the first national tally of
women's pregnancy, labor, and postpartum experiences, and, as such, has
far-reaching implications. "Although more than four million women give birth
in the United States every year, this is the first time that women from
across the country have systematically described their childbearing
experiences," explains Maureen Corry, MCA executive director.

High Labor Intervention Rates

The survey found that technology-intensive labor was the norm, with a
majority of women reporting having had the following interventions while
giving birth: electronic fetal monitoring (93 percent), intravenous drip (86
percent), epidural analgesia (63 percent), artificial rupture of membranes
surrounding the baby (55 percent), bladder catheter for drainage of urine
(52 percent), and stitching to repair an episiotomy or tear (52 percent).
Almost half of the women reported that their caregiver had tried to induce
labor, most commonly through the use of oxytocin. Dr. Eugene Declercq, chair
of the National Advisory Council, lead author of the report, and professor
of maternal and child health at the Boston University School of Public
Health, says: "Given that childbearing women are, for the most part, a well
and healthy population, these high rates of intervention are of great
concern. Mothers and others responsible for the health and well-being of
mothers and babies need to repeatedly ask: 'Is a decision to use a specific
intervention supported by the best evidence?'"

The survey did find high levels of satisfaction with care during the labor
and birth process, however. Ninety-four percent of the mothers surveyed felt
that they understood what was happening, 93 percent felt comfortable asking
questions, and 89 percent felt they had an active voice in decision-making.

Almost two-thirds of the women used epidural analgesia, including 59 percent
who had a vaginal birth, and the majority rated it as "very effective" in
relieving pain. Drug-free methods rated either "very" or "somewhat" helpful
included: application of ice or heat (82 percent), hands-on techniques (81
percent), position changes (79 percent), and environmental changes (76
percent). The use of breathing techniques was used by 61 percent of
women-with 70 percent finding them somewhat helpful, and the remainder
finding them of little or no help. Immersion in a tub was rated "very
helpful" by almost half of the women who used it; but both immersion and
showering, which was also found helpful, were used by only 8 percent of the
women surveyed. Once contractions were well established, 71 percent of women
were not permitted to walk around.

Twenty-four percent of women surveyed had a Cesarean delivery; about half of
those had been planned. Survey participants expressed primarily negative
views of the ideas of C-sections on demand without medical reason. Of women
with a previous Cesarean, 26 percent were able to give birth to their next
child vaginally.
Almost three in ten women had never before met, or met only briefly, the
person who delivered their baby. Seventy percent of first-time mothers took
childbirth education classes, while only 19 percent of mothers who had given
birth before did.

Overall, the women surveyed felt generally positive about their care during
the labor and delivery process, particularly praising the level of support
and understanding given to them by the doctor/midwife and the nursing staff.
Doulas (trained labor support companions) and midwives were the most highly
rated providers of labor support, and were associated with lower levels of
pain medications, yet were used by only small proportions of women (five
percent and eleven percent, respectively).

After the Baby is Born

During the hospital stay, 56 percent of mothers had their babies with them
all the time (rooming in). About three in five mothers (59 percent) were
exclusively breastfeeding at one week, slightly fewer than the 67 percent
who had intended to breastfeed exclusively when asked at the end of their
pregnancy. Among all mothers, the most commonly cited postpartum physical
problems were pain from Cesarean incision (83 percent of mothers who had a
Caesarean), physical exhaustion (76 percent), sore nipples/breasts (74
percent), lack of sexual desire (59 percent), backache (51 percent), painful
perineum (45 percent). Problems most likely to persist for at least six
months included lack of sexual desire (16 percent), physical exhaustion (10
percent), and pain from Cesarean incision (7 percent among moms who had
C-section).

The majority of the women characterized their experiences in the weeks and
months following their baby's birth as positive-they felt rewarded (85
percent), contented (74 percent) and confident (73 percent); but at least
one-fourth of the women selected negative choices such as unsure (39
percent), isolated (35 percent) and confused (25 percent).

Nineteen percent of the women surveyed using a standardized postpartum
depression assessment tool were found to be experiencing some degree of
depression in the week before the survey. The majority in this depressed
group (57 percent) had not seen a professional for mental health concerns
since giving birth.
"Women's need for support does not end with their six-week postpartum
checkup. Most important, we need to encourage women to get the help they
need to address their physical and emotional concerns," Corry says.

Survey Spawns New Childbirth Recommendations

While the "Listening to Mothers" survey revealed good news for childbearing
moms and maternity care at large, it also identified some troubling and
widespread concerns for a smaller proportion. Because there are about four
million births in the United States alone each year, even these few concerns
add up to the potential to adversely impact a large population of women,
babies, and families, according to key findings and recommendations from the
Maternity Center Association.

1. Owing to the fact that so few women never, or only briefly, meet the
person who deliver their baby, research should be undertaken to clarify
whether American women desired greater continuity of caregiver, both
throughout pregnancy and from pregnancy through birth, and, if this is found
to be a concern, policymakers and clinicians should take steps to ensure the
likelihood of this happening.

2. Because a number of labor and birth interventions and restrictions are
experienced by a majority of mothers, professional organizations,
researchers, and agencies should determine whether adequate research has
been done (using an evidence-based maternity care approach) to determine the
necessity and appropriateness of these interventions and restrictions.
Addressing gaps in knowledge about appropriate use of these should be a high
priority.

3. There is an urgent need to better understand the implications of labor
management practices, including the benefits/risk ratio between vaginal
delivery and Cesarean sections, for women's ongoing physical health.

4. Women and caregivers need access to research about pain medications and
drug-free methods of labor pain relief, and women should be supported in
selecting methods according to their preferences.

5. Rooming-in should be the standard of care whenever babies do not require
special care and mothers are able to be primary caregivers.

6. Breastfeeding support should be consistent with the Baby-Friendly
Hospital Initiative.

7. Women should have access for longer than six weeks postpartum to
appropriate care to meet their ongoing physical and mental health concerns.

8. It is crucially important to understand postpartum and maternal
depression (which may persist up to two years after birth), to screen for
it, and to research ways to reduce its incidence.

9. Women should be provided with clear information about their childbearing
rights and choices so they can become informed partners with their health
care providers.

10. Feedback from childbearing women should be obtained and incorporated
into all dimensions of the maternity care system

Jen,

Interesting article. I am pretty sure I don't buy the implied
connection between more hi-tech births, and more happier mothers.
I think there is a snow job being done here.

Please look at the Medscape article that I posted a link to elsewhere
in this newsgroup. Their conclusion was that mother are better off
with continuous care during labor. They theorized in this article
that the higher rates of PPD in recent years is a direct result of
the mechanization of labor as practiced in the hospital environment.

This would seem to fly in the face of more happy hi-tech births! :-)

Larry