Report: Many Mothers Say They’re Pressured To Have Birth Interventions

(Listening To Mothers III)

(Listening To Mothers III/Childbirth Connection)

It’s Mother’s Day Sunday — a time for high-calorie brunches and pastel-colored bath products — but an even better time to do some listening.

So, just in time, here’s a new report that does just that. “Listening to Mothers III,” produced by the nonprofit Childbirth Connection, is an in-depth look at women’s pregnancy and birth experiences that covers a huge range of topics, from pregnancy weight gain, breast-feeding and postpartum depression to use of pain medication during birth and paying for maternity care.

The report, the third of its kind, is based on online surveys of 2,400 women who gave birth to a single baby from July of 2011 through June of 2012 in a U.S. hospital. There’s a lot to digest here, but for anyone interested in birth, it’s worth spending time wading through the material.

(popularpatty/flickr)

(popularpatty/flickr)

Here, as highlighted by authors of the report, are some of the more salient findings:

–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 — exposed women and their babies to avoidable risk.

Most of the women could not correctly identify risks of labor induction or cesarean section, revealing problems with prenatal education.

One in four who had these procedures reported experiencing pressure from a care provider to do so.

Mothers expressed a high degree of trust in maternity care providers, with nearly half rating them as “completely trustworthy.”

Maureen Corry, Executive Director of New York-based Childbirth Connection, said in an interview that a perfect storm of forces — including pressure on women and complete trust in their provider — could lead to unwanted outcomes.

“The pressure to have an induction or c-section, a lack of awareness about the risks of those interventions and an unqualified trust in their health care providers is a potent combination that could result in women and their babies being exposed to unnecessary risk and receiving care that isn’t based upon the evidence,” Corry said. “You can imagine if providers put a little bit of pressure on and the women don’t have all the facts, they might make decisions that aren’t good for them.”

In the survey, mothers were asked if they felt pressure from a health profesional to have one of three interventions and, according to the report, “notable proportions indicated that they had experienced such pressure. The proportions reporting pressure varied very slightly by intervention: labor induction (15%), epidural analgesia (15%), or cesarean section (13%).”

Here’s more detail from the survey:

We looked at these finding by whether or not mothers had the specific intervention, and there was significant difference in each case. In terms of induction, 25% of mothers who experienced an induction cited pressure compared to 8% who did not have an induction. Most notably, there was a difference in the case of cesarean sections. Of those mothers with a vaginal (not VBAC) birth, 7% indicated they felt pressure while among those who had a primary cesarean 28% said they felt pressure. For those with a prior cesarean, 28% of the mothers with a VBAC and 22% of those with a repeat cesarean indicated they felt pressure. Overall, 8% of mothers who did not have a cesarean experienced pressure for surgery versus 25% of mothers who had a cesarean.

The report also found that many effective pregnancy and birth-related practices that help women weren’t routinely used. From the news release:

In pregnancy, for example, these included help with smoking cessation. Around the time of birth, just a fraction received continuous labor support from a doula, though many would have liked to have had doula care. Half of the women were not exclusively breastfeeding a week after the birth, and many had not received help from a provider for notable symptoms of depression. Many women who would have liked the option of vaginal birth after a cesarean (VBAC) reported that their maternity care provider and/or hospital was unwilling to provide this option, and faced another cesarean and the range of risks associated with repeated surgeries.

“Underused maternity practices tend to be non-invasive, pose few if any risks, and use relatively few resources,” said Dr. Eugene Declercq, the survey’s lead investigator, and a professor of community-health sciences at the Boston University School of Public Health. “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,” he said.

Readers, were you pressured by providers to have one or another intervention during childbirth? Or were there things you wished you could have had (like a doula or breastfeeding support) that were not available to you? Please comment and let us know.

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  • Virginia Reiber PhD

    Thank you for this article. I am writing an article for mental health professionals re: recognizing symptoms of Post Traumatic Stress Disorder vs Post Partum Depression within the first 18 months after childbirth, and in review as prep I found the US obstetric medical and nursing literature to be very sparse. The richest source found was from midwifery journals in both the UK and Australia. (See Kitzinger S 2006 “Birth Trauma”). Invasive medical procedure was found to be a major source of birth trauma for mothers and babies. It would be interesting to interview a sample of local obstetricians, nurses and pediatricians to determine how they assess trauma in the deleivery room, and in post-partum office visits, screen new mothers for their perceptions of difficulties in their deliveries. There are recent guidelines from the MA Department of Public Health to screen for post partum depression in low-income mothers, but it is unclear how far the screening has been disseminated in the general post-partum population.

  • http://www.facebook.com/lcmorse Linda C Morse

    Even though it was a long time ago, I had to fight like crazy in 1987 to have a VBAC. The whole pregnancy was extremely stressful, involved arguing over all kinds of medical testing for previous “c-section” Moms just because I was a c-section Mom – there was no current medical indication. There is some great research out there that I stumbled on 20 years ago that revealed that women who trusted their doctors had more c-sections and interventions, whereas women who did not trust their providers had fewer c-sections and interventions. That is a very sad commentary. Luckily, I had tremendous support in 1986/7 with Cesarean Prevention Movement (now ICAN) and my husband. Overall though, it was a very unpleasant experience during both the pregnancy and the birth. I’m happy to be supportive to any women who are seeking vbacs.

  • Melissa

    My experience left me feeling pressured from both sides. I was informed and educated and planned for a natural birth…written birth plan and all. I then experienced complications late in my pregnancy after a very routine and healthy 8 months. I was advised to have an induction which ended with a c-section at 41 weeks. Honestly, I felt very pressured to have a natural birth experience, knowing all the complications and potential issues that can linger from a highly medicalized birth, not to mention the high cost. But at the time i had to trust my providers. They have the degree in medicine and years of practice experience behind them – I work in insurance. This is a tricky subjective topic. There is pressure from all sides. Fortunately, I did feel respected during labor and delivery and advocated for what I felt was best at the time.

  • Amy Lischko

    I had my children 15 years ago but even back then I heard that this was true. However, if you develop a birth plan ahead of time and share your wishes with the health care team (both during your prenatal care and during the delivery) I found that staff completely respected and supported my wishes. My guess would be that many women do not know how they will feel when in the circumstance and leave these decisions until “in the moment.” When offered or even encouraged to take pain medications or other interventions, they agree. It is true that interventions are more the norm than the exception but you can still have a natural birth in most cases!