Live Chat: Comparing Childbirth At Mass. Hospitals

As part of our series comparing childbirth quality at Massachusetts hospitals, we’re hosting a live chat to answer any of your questions about the data we pulled together, our findings or any other childbirth-related questions you may have.

Our live chat will begin at noon on Tuesday, January 7. You can leave your questions before the chat begins in the comment section below.

Joining reporter Martha Bebinger, who is moderating this live chat, are the following panelists:

Gene Declercq, a professor at Boston University School of Public Health who has studied childbirth practices for more than 20 years.

Dr Jeff Ecker,  an OB/GYN at Massachusetts General Hospital and a member of the Massachusetts Perinatal Quality Collaborative Advisory Committee.

Betsy Deitte had her third child, a boy, in September.

Rebecca Loveys delivered her second son in August.

Live Chat: Comparing Childbirth At Mass. Hospitals
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  • Cristen Pascucci

    (Comment 3/3) I could write a book in response to Ms. Deitte’s statement that women’s expectations on the “birth experience” can be too high, but I’ll keep it short. Women’s expectations in childbirth are not nearly high enough, and it’s one of the reasons we’re in the pickle we’re in.

    Maternity care is in a national crisis, with the vast majority of women receiving care that is not based on what evidence shows is best for women and babies (evidencebasedbirth.com/updated-table-on-the-state-of-maternity-care-in-the-u-s/). If our expectations go any lower, we’re really in trouble.

    Keep up the great work! I’m so thrilled you’re exploring this topic!

  • Cristen Pascucci

    (Comment 2/3) Dr. Ecker’s response to Debbie about consent in the birth process is concerning. I have no doubt that he is speaking what he knows, but as a leading ACOG member, he’s speaking for his colleagues, too. He should be aware of the great variability in the consent process among American facilities. We hear at ImprovingBirth.org from women on a daily basis about the failures of the informed consent process in childbirth, ranging from a simple lack of choice/discussion about whether to have a procedure (like, “OK, hon, we’re going to speed your labor up now.”) to coercion (like the threat of withdrawing care) and even force. (We have been running an emergency hotline for the last year for women seeking legal intervention in such situations, like the story of this first-time mother: ) This is no small problem. It’s widespread and is a massive, silent piece of the maternity care problem, made worse because most women don’t even know they have these rights or that they have been violated. Here is an article from a human rights lawyer about this topic: http://www.improvingbirth.org/2013/07/informed-consent-in-childbirth/

  • Cristen Pascucci

    It’s wonderful to see the ongoing discussion about maternity care on CommonHealth – thank you so much for this series! As someone who has studied maternity care in-depth for the last three years and spoken with hundreds of mothers about their experiences around the country – including in Massachusetts, where three cities participated in ImprovingBirth.org’s 2013′s national Rally to Improve Birth – I had to chime in on just a couple of things.

    The question from Sarah about deciding when it’s time to offer C-section deserves more serious consideration. In fact, the subjective diagnosis of Failure to Progress is the #1 cause of C-sections – so why would we talk about a “communication process” instead of the actual diagnosis? There are clinical definitions and specific guidelines, which were updated in 2012 by ACOG, the Society for Maternal Fetal Medicine, and the National Institute for Maternal and Child Health. This is an excellent, current article on it, written for care providers, by a highly respected researcher and pioneer of translating medical evidence into language that women can understand and use: The bottom line is, if a woman doesn’t meet a clinical definition of “arrested labor” and there are no other complications, it is solely up to her whether or not she wants to keep going.

    Why does it matter? Because this is a great example of when women deserve real talk, not vague answers about communication and collaboration. We know that the vast majority of women will not say “no” when a doctor recommends surgery, even if some of those women have doubts about whether or not it’s necessary or alternatives have been exhausted. Women are continually put in this position when they are not given real information so that they can make informed decisions. The fact is, women have the legal right to accept or decline a Cesarean; they must have meaningful information and discussion in order to make those decisions.

    Cristen Pascucci, ImprovingBirth.org

  • Ann Sweeney,Exec.Director MFOM

    Can the panelists address how the midwifery model of care provides excellent outcomes for both mother and baby, including better communication of birth choices as well as significantly lower rates of surgical birth? Also, I’d welcome hearing from the panelists on how legislation currently under consideration at the Mass. State House–House Bill 2008/Senate Bill 1081—An Act Relative to Certified Professional Midwives–will provide important consumer protections for women and their families and will improve women’s options on where and how they give birth.

  • Nicole Aliberte Altieri

    During the successful campaign to save the North Shore Birth Center, a group of birth center consumers and activists met with administration from Beverly hospital. During this meeting, we were told by a high level administrator (I believe he was the Vice President for external affairs) that is he had “his (my) way, every woman who walked through those doors would have a csection”. How, as consumers of maternity care and change makers do we combat ideas such as these from hospital administration? How do these ideas affect the way in which midwives and doctors make decisions? This quote still haunts me years later as a symbol of what is wrong in maternity care.

  • KellyR

    As the Huffington Post recently reported, we have (re)learned that midwifery has better outcomes (same outcomes as compared to MDs, fewer interventions, higher patient satisfaction). How can we ensure that every woman has access to midwives at every MA hospital? It will require a culture shift at many institutions for sure, but I disagree that women think the end justifies the means. That is old-school thinking in my opinion. Thank you for this discussion!

  • Renee

    Women need more knowledge about what is really happening to their body during labor and childbirth and WHY. I have 4 children that I gave birth to ALL completely natural (and my last one I was 39 years old). I was confidently educated with my body and understood the process. It empowered me as a woman.

    When you have strong feelings about how you hope your experience to be, you can then find a hospital that can be accommodating and supportive of your desires. Being a good advocate for yourself and an informed consumer is a must. Nothing is guaranteed, but you can start with a great birth plan.

  • Dr. Debbie Issokson

    Piggy backing on Christine’s question, I am wondering if the panelists can comment on the fact that outside of epidural and c/section, there is usually no formal consent process for things “done” to a laboring or birthing woman (ie, artificial rupture of membranes or episiotomy). Honest, clear and forthright communication between a health care provider and a birthing woman creates a sense of partnership and goes a long way in contributing to a woman and her partner having a good emotional outcome, regardless of mode of delivery.

  • Katie Barnes

    There seems to be a divide between common birth knowledge and actual birth practice. For example, many studies have shown that continuous electronic fetal monitoring doesn’t improve outcomes, rather it increases cesarean births; however, continuous EFM is often still regarded as standard practice. This same logic also applies to issues like eating during labor, inductions, and what constitutes a “post dates” pregnancy. Is there any value to solid research and ACOG recommendations if they are ignored and replaced with a culture of fear? Also, to what extent does the fear of medical malpractice dictate a woman’s birth experience?

  • Mary S

    Are there huge disparities between the care and expertise provided at community/memorial hospitals vs. big, reputable hospitals in Boston? What are the pros and cons of delivering at a community hospital?

  • Alisha

    I’d be curious to hear more about the issue of time pressure at many hospitals mentioned in today’s piece. I was a textbook case of a labor requiring “a lot of time and effort”: I had two very long deliveries in which everything progressed normally but *very* slowly from 8 to 10 cms. I also pushed for almost 4 hrs with my first child. However, because I was at the Cambridge Birth Center, I was given the space and time to birth vaginally with no pitocin to speed things up: the midwives and nurses were patient, encouraging, and supportive, both babies were completely healthy once they finally came out, and my recovery was relatively easy both times. Considering how many fewer complications mothers tend to have afterwards with this type of slow and steady delivery, does it really pay for OBs to hurry things along?

  • AgnesHoward

    Great conversation about medical interventions’ potential to compromise both outcomes and experience of birth. Often in these discussions, outcome (“just want to get the baby out safely”) is pitted against experience (“having a good birth”). In general I prefer fewer interventions and more choices for the mother. But “good birth experience” is a huge amount of emotional freight to be placed on hours of labor and delivery. It is easily too much freight for stressful, strenuous hours EVEN IF EVERYTHING GOES SMOOTHLY, and especially in cases where problems arise. It’s too much to expect of birth. Solution to the conflict lies not just in rebalancing medical-natural birth practices, but in putting appropriate emphasis on pregnancy. The mother-to-be carrying around a baby is doing amazing work for nine months, (hopefully) having good experience of bearing new life. Understanding that in a practical way helps take some of the load off of the great but complex event of birth.

  • bwglass

    It is so positive to be having these conversations about options/conditions for childbirth. I suggest that the amount of support a women in labor receives from an experienced nurse who is an integral part of the care team and its decisons is a significant factor in C-section rate and exclusive breastfeeding success. The nurse’s availability, participation and influence is measurable and does account for differences in C-section and breastfeeding outcomes.

  • Caroline

    What are hospitals doing to improve and/or measure improvement in patient/provider relations with respect to childbirth? Do they factor at all into these statistics? So much of the experience of childbirth is shaped by these relationships, which in a hospital are sometimes forged only once in labor. Feeling respected, listened to, informed, cared for–being given the opportunity to make informed decisions when safe–having providers who are skilled in these areas makes a huge difference in the whole experience of labor, childbirth, and recovery.

  • Christine

    My question for the panel: Why are women so routinely refused the right to decline a birth-related medical recommendation? Some examples that spring to mind: c-sections for breech/multiples without a trial of labor; inductions for suspected IUGR, “post dates;” OR ‘big baby;’ routine ABX for GBS+. If the science behind such recommendations is questionable, should there not be more room for women to choose whether they prefer to medically intervene or not? I also have concerns around the loss of skill related to delivering complex positions vaginally. C-sections are not always a possibility when a baby is a surprise breech, for example.

  • http://www.irfiction.com/ Victoria Sandbrook

    To what degree should patients be concerned that these numbers reflect instances where a patient’s preferences are overridden at the hospital? Are early conversations with OB/GYNs enough to prevent becoming a statistic? Should we be concerned, for example, that expressing a desire to exclusively breastfeed won’t be supported by the hospital–or worse, will be ignored by the hospital?

  • Chris Just

    I’d like to hear how the panelists think prenatal education fits into the discussion. Did the moms take classes and, if so, did they find the information helpful when making choices and advocating for themselves? I’d also like to hear Gene Declercq and Jeff Ecker review feedback from the Listening to Mothers surveys as well as progress made by the MA Perinatal Quality Collaborative.