Labor and delivery: 10 surprising things you need to know
In an effort to better understand women's birth experiences and develop ways to improve these experiences, the Maternity Center Association created the Listening to Mothers survey. This is the first time that women in the U.S. have been systematically polled at the national level about their maternity experiences. The survey focuses the discussion of maternity care in the U.S. on the people who care about it most: mothers. Find out what birth is like for moms today.
1. Technologically intensive labor is the norm. Though 45 percent of women agreed that "giving birth is a natural process that should not be interfered with unless absolutely medically necessary," a majority of women reported having each of the following interventions while giving birth: electronic fetal monitoring (93 percent), intravenous drip (86 percent), epidural analgesia (63 percent), artificially ruptured membranes (55 percent), artificial oxytocin to strengthen contractions (53 percent), bladder catheter (52 percent) and stitching to repair an episiotomy or a tear (52 percent).
2. Natural childbirth has virtually dropped off the radar screen. While 20 percent of mothers indicated that they used no medications for pain relief, there were virtually no "natural childbirths" among the mothers surveyed. Even mothers having a vaginal birth experienced a wide array of medical interventions including: being attached to an electronic fetal monitor continuously or nearly so throughout labor (93 percent); being connected to an IV line (85 percent); having their membranes artificially ruptured (67percent); being given artificial oxytocin to start or stimulate labor (63 percent); having a gloved hand inserted into their uterus after birth (58 percent); using a catheter to remove urine (41 percent); getting an episiotomy (35 percent); and having pubic hair shaved (5 percent). Less than one percent of mothers gave birth without at least one of these interventions, and almost all of these came from the very small group (also less than one percent) of home births in the sample.
3. Obstetricians provide the majority of prenatal care. Although midwives received very high ratings in terms of the quality of this care, obstetricians still provided prenatal care to three-fourths (77 percent) of mothers and delivered 80 percent of the babies of survey mothers. Midwives provided prenatal care to 13 percent of mothers and attended 10 percent of the births. Family physicians provided prenatal care for seven percent of our respondents and attended four percent of their births. While a small number (five percent) of women relied on doulas (trained labor assistants), this type of caregiver was rated highest in terms of quality of supportive care during labor.
4. Labor induction is skyrocketing. Almost half (44 percent) of all mothers and half (49 percent) of those giving birth vaginally reported that their caregiver tried to induce labor, most commonly through the use of artificial oxytocin. Almost one-fifth (18 percent) of mothers cited a nonmedical explanation as the only reason for the attempted induction, and another 16 percent cited a nonmedical reason along with a medical indication as the reason for the attempted induction. Five percent reported choosing labor induction to be able to give birth with the caregiver of their choice. In four out of five women, the induction did in fact cause labor to begin.
5. Epidural anesthesia is the pain-reliever of choice. Almost two-thirds of the mothers in this survey used epidural analgesia, including 59 percent who had a vaginal birth. Mothers gave high ratings to the ability of epidurals to relieve labor pain (78 percent), but many (38 to 83 percent) were not aware of potential risks of this pain relief method. Three out of ten women reported being given narcotics, such as Demerol or Stadol, while a small number of moms had general anesthesia (five percent), nitrous oxide (two percent) or a local block (two percent). Eighty-eight percent of mothers used at least one "drug-free" method for pain relief. Most commonly used were breathing techniques (61 percent) and position changes (60 percent). Three out of ten women used hands-on techniques, such as massage, stroking or acupressure, and the same number used mental strategies, such as visualization, relaxation and hypnosis. Two infrequently cited techniques, immersion in a tub or pool (six percent) and taking a shower (eight percent), were rated most helpful by their users.
6. Eating and drinking is rarely permitted during labor. Just one woman out of eight in the survey (12 percent) had anything to eat during labor, and one in three (31 percent) had anything to drink at this time. Far more women expressed an interest in drinking and/or eating, and many reported that their caregivers did not permit eating and/or drinking, even in the case of vaginal births.
Learn more about fasting during labor.
7. Most women labor in bed and give birth on their back. Once contractions were well-established, most mothers (71 percent) did not walk around, primarily because they were hooked up to instruments, could not walk because of pain medications or were told by their caregivers not to walk around. Three out of four (74 percent) women who give birth vaginally reported that they were on their backs while pushing their baby out and giving birth. The rest were either in an upright position (23 percent) (such as propped up, squatting or sitting) or lying on their side (three percent). Learn more about birthing positions from Lamaze.com.
8. Fetal monitoring has become standard. Nearly all women in the study had electronic fetal monitoring (EFM) some time during labor (93 percent) to record their baby's heartbeat. Most women using EFM were monitored continuously and most had only external monitoring around their bellies. Only six percent of the mothers were not attached to a fetal monitor. Their babies' heartbeats were checked using a handheld device, such as a "doppler" or stethoscope.
9. One quarter of women give birth by cesarean. Almost one fourth (24 percent) of mothers had a cesarean delivery. About half (51 percent) of these were planned, predominantly among women with a previous cesarean delivery. Compared to women who gave birth vaginally, those with cesareans were less likely to "room in" with their babies and breastfeed at one week, and more likely to experience several health concerns after the birth, including abdominal pain, bladder and bowel difficulties, headaches or backaches. For women who had a cesarean, pain in the area of the surgical incision was the leading postpartum health concern, with five out of six of these mothers citing it as a problem in the first two months and one in fourteen citing it as a problem at least six months after birth.
10. VBAC is becoming less available as an option for women. Of women with a previous cesarean, about one in four (26 percent) had a vaginal birth. About two in five (42 percent) women with a previous repeat cesarean were denied the option of a VBAC, with that figure increasing to 58 percent for mothers who had given birth most recently, during the year before the survey. Medical concerns (unrelated to the uterine scar) and caregiver unwillingness were the leading reasons for denial of a VBAC. A smaller proportion reported hospital unwillingness. The willingness of caregivers and hospitals to permit vaginal birth after a previous cesarean birth declined substantially for women who had given birth within 12 months of the survey, as compared to those who had given birth from 12 to 24 months earlier.
Source: The Maternity Center Association's Listening to Mothers survey
A version of this story originally appeared on iVillage.