In one study, immediate mother-to-child skin-to-skin contact, also known as “kangaroo care,” has been shown to faciliate successful breastfeeding early on as compared to births where the infant was taken away to be swaddled or washed.

In a second study, the presence of a midwife, doula or supportive family member throughout labor was shown to reduce labor lengths, reduce the use of pain medications during labor, and increase a mother’s satisfaction with her birth experience.

Snuggling and support — two age old practices — shown through rigorous science to really work! For more information on the two analyses, visit the Newswise press release.

For more information on the Cochrane Collaberation visit www.cochrane.org.

The review entitled, the Evidence Basis for the Ten Steps to Mother-Friendly Care, will be published in The Journal of Perinatal Education and the results will be premiered at the Coalition for Improving Maternity Services (CIMS) Forum today.

Research findings include:

• Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and more likely to end up needing forceps, vacuum extraction and a cesarean surgery.
• Inductions add to the risk of poor outcomes for the health of the baby. Artificially-induced labors increase the rate of fetal distress and a serious complication of labor called shoulder dystocia (when the baby’s shoulders have difficulty passing through the mother’s pelvic bones). Elective induction babies are also more likely to need phototherapy to treat jaundice after birth, and are at higher risk for breathing difficulties and admission to neonatal intensive care.
• Use of electronic fetal monitors is more than 85 percent on low-risk women. They fail to reduce the number of perinatal deaths, the incidence of cerebral palsy or the number of admissions to the neonatal intensive care unit. Continuous fetal monitoring puts women at increased risk for an instrumental delivery, cesarean section and infection.
• Overall 1 in 3 U.S. women give birth by cesarean surgery. The majority of the operations are repeat procedures with no medical indication.
• When compared to women who have a vaginal birth, cesarean surgeries put women at risk for infections, hemorrhage requiring transfusion, surgical injuries, and complications from anesthesia, chronic pain, adhesions, hysterectomy, pulmonary embolism, placental problems with future pregnancies and death. Babies born by cesarean surgery are more likely to suffer from surgical lacerations, respiratory complications, and to require neonatal intensive care.

There are more than 4.1 million U.S. births a year with a cesarean surgery rate more than 30 percent. The health and economic impact of high tech birth is significant. In 2004, hospital costs for deliveries were more than $30 billion. The record high cesarean surgery rate contradicts the national goals of Healthy People 2010 to reduce cesarean surgeries for first time mothers to 15 percent and to increase VBAC (Vaginal Birth After Cesarean) rates to 63 percent. The research also found that harm is caused by routine use of intravenous fluids (IVs), amniotomy (breaking the bag of waters), withholding food and water from women in labor and episiotomy.

###

The Journal of Perinatal Education is the leading peer-reviewed journal for childbirth educators. The Journal is published quarterly by Lamaze International for readers who provide parent education in the areas of childbirth, pregnancy, breastfeeding, neonatal care, postpartum, early parenting and young family development. For more information about The Journal of Perinatal Education and Lamaze International, visit www.lamaze.org.

The prospective study, conducted in Norway, examined 18,653 singleton (no twins or multiples) deliveries occurring in 24 maternity units over the course of six months. The results showed that infants born via planned cesarean were transferred to the neonatal intensive care unit 9.8 percent of the time, compared with only 5.2 percent of babies born vaginally. In addition, 1.6 percent of the infants born via planned cesarean experienced pulmonary disorders—including transient tachypnea and respiratory distress syndrome—compared with only 0.8 percent of babies born vaginally. Apgar scores and neurologic symptoms were similar between the two groups.

Triangle Birth Network Analysis

Many women in the US today believe that while a planned cesarean may be more dangerous for the mother, it is “safer” for babies than undergoing labor and vaginal birth. This study, with a large sample population, clearly demonstrates that this argument is not valid. The vaginal birth process aids the newborn in expelling mucous and fluid from the lungs, an important step for respiratory health. As this study suggests, elective, non-medical cesarean section is more dangerous not only for mothers, but for babies as well.

For the full article, see Am J Obstet Gynecol, 2006 Dec; 195(6): 1538-43.

Additionally, more than four out of ten mothers (41%) reported that their caregiver tried to induce their labor. When asked if the induction caused labor to begin, more than four out of five of those women (84%) indicated that it did, resulting in an overall provider induction rate of 34%. Among all survey mothers whose providers tried to start their labors, 79% cited one or more medical reasons for being induced, while 35% cited one or more non-medical reasons. Overall, 11% of mothers reported experiencing pressure from a health professional to have labor induction, however, among mothers who had an induction, 17% cited pressure compared to 7% who did not have an induction.

Listening to Mothers II was conducted in January and February 2006. It provides health professionals, payors, policymakers, hospitals and women and families with an unprecedented look at experiences of childbearing women and their infants. It also provides opportunities for all of these groups to improve conditions for mothers and babies by comparing their actual experiences to their preferred experiences, to care to which they are legally entitled, to care supported by best evidence, and to optimal outcomes. 2 “The data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. This sounds alarm bells,” said Maureen Corry, executive director of Childbirth Connection. “Few healthy, low-risk mothers require technology-intensive care when given good support for physiologic labor. Yet, the survey shows that the typical childbirth experience has been transformed into a morass of wires, tubes, machines and medications that leave healthy women immobilized, vulnerable to high levels of surgery and burdened with physical and emotional health concerns while caring for their newborns.”

Survey Reveals Gaps Between Actual and More Optimal Experiences and Outcomes

Listening to Mothers II identified many gaps between their experiences, their desires and best medical practice. For example:

• Within this largely healthy population, four labors in ten were started artificially and one mother in three had a cesarean.

• A great majority (85%) felt that a woman who wants a VBAC (vaginal birth after cesarean) should be able to make that decision, but most women who were interested in a VBAC were denied this option by their caregiver (45%) or hospital (23%).

• Virtually all of the mothers asked felt that they should be informed about all (79%-81%) or most (17%- 19%) of the complications related to labor induction and cesarean before deciding to have these interventions, yet the majority of mothers were poorly informed about several complications of labor induction and cesarean section and most had incorrect knowledge or were not sure.

• Among the vaginal birth mothers that experienced episiotomies (25%), only 18% stated that they had been given a choice about it.

Pressure to Accept Interventions

Eleven percent of all survey mothers reported experiencing pressure from a health professional to have labor induction, however, those who had an induction were more likely to have experienced such pressure than those who did not.

Safe and Effective Care Practices Were Under Used

In addition to overuse of interventions, the survey showed a striking under use of several care practices known to be safe and effective, and especially appropriate for healthy, low-risk women. Only a small proportion of women experienced these beneficial practices, including use of highly rated drug-free methods of pain relief (e.g., immersion in a tub, shower, use of large “birth ball”), monitoring the baby with handheld devices instead of electronic fetal monitoring, drinking fluids or eating during labor, moving about during labor, giving birth in non-supine positions, and pushing guided only by their own reflexes rather than caregiver-directed pushing.

“These findings are of particular concern,” notes Judith Lothian of Lamaze International. “The care practices that promote, protect and support normal birth appear to be unavailable to the vast majority of childbearing women in the United States.”

Cesarean Section: Making the Decision and the Implications

Despite considerable media attention to the concept of “maternal request cesarean,” our systematic national sample of mothers found that the phenomenon barely existed in 2005. Less than one-half of 1% (1 woman out of 252) of mothers in the survey who had a first-time cesarean reported that they had requested it themselves. Another contention – that vaginal birth is a threat to a mother’s pelvic floor – also had not been embraced by the mothers in the survey, with far less than 1% of mothers who had either a first or repeat cesarean citing this as the reason for their cesarean.

Study director Eugene Declercq, PhD, of the Boston University School of Public Health, explained, “The survey found scant evidence of maternal request cesareans. Rather, mothers indicated that the primary decision-maker concerning their cesarean was their care provider, either during or before labor. In contrast to an image of doctors pressured by mothers to perform a cesarean, one-fourth (25%) of those mothers who had a cesarean indicated that they felt pressure from a health professional to receive their cesarean. This hardly supports the theory that the rapidly rising cesarean rate is based on maternal request. Research is needed into the complex interplay between mothers and their doctors regarding cesarean decision-making to better understand why the U.S. cesarean rate has risen 41% in the past decade.”

Pain and Its Impact on Postpartum Health

Mothers with cesareans described how abdominal surgery had a big impact on their postpartum health. More than three-quarters (79%) reported pain at the site of the incision in the two months after birth, with 33% citing it as a major problem, and18% of those with a cesarean had ongoing pain at the site of the cesarean scar at least 6 months after giving birth.

Mothers with a cesarean were also twice as likely to report that postpartum pain interfered with their daily life than did mothers with vaginal deliveries with 22% describing that pain interfered “quite a bit” or “extremely” with routine activities compared to 10% of mothers with a vaginal birth.

Missed Opportunities

Given the increased recognition of the importance of the period before and between pregnancies, and the conditions under which women enter pregnancy, the data shows that there are deficiencies in care that could potentially lead to less optimal outcomes for mothers and babies.

Alarmingly, about half of the mothers surveyed had a body mass index considered to be “overweight” (25%) or “obese” (24%) and most did not visit a healthcare provider to plan for a healthy pregnancy.

Less than half (47%) of mothers reported being asked during pregnancy about feelings of depression and only one-third (35%) were asked about physical or verbal abuse. However, more than three-quarters of providers (76%) did discuss signs of premature labor with the women and they reported being confident in their ability to recognize them.

Despite the importance of early contact for attachment and breastfeeding, most babies were not in their mothers’ arms during the first hour after birth, with a troubling proportion with staff for routine, non-urgent care (39%). Although 61% of the mothers wanted to breastfeed exclusively as they neared the end of their pregnancy, just 51% of all mothers were doing so one week after birth, a troubling missed opportunity.

On the positive side, most mothers learned of their pregnancies in the early weeks of their pregnancy, started prenatal care well within the first trimester and saw the same provider throughout the pregnancy. Nearly all mothers (96%) reported having received supportive care (comfort, emotional support, information) while in labor from at least one person, most often husbands/partners or the nursing staff.

Information Seekers

Mothers sought information about pregnancy and birth through a variety of sources, with first-time mothers seeking knowledge from books (33%), friends and relatives (19%), their provider (18%) and the Internet (16%), while experienced mothers relied on their past experience (48%), followed by their doctor or midwife (18%), the Internet (13%) and books (12%). Fully two-thirds (68%) had watched one or more of eight television shows specially created to depict childbirth, with more than half of the viewers regularly watching at least one of these shows. Far more mothers were exposed to childbirth through TV shows than through childbirth education classes. Only one-fourth (25%) of women reported taking childbirth education classes, with a majority (56%) of new mothers taking classes, while only one in eleven (9%) experienced mothers took classes. As women neared the end of pregnancy, most felt confident, but a majority also felt fearful about their upcoming birth.

Mothers and Work

Listening to Mothers II also explored mothers’ experiences with work and childbirth and found mothers under considerable stress to balance work and family obligations. More than half the mothers (58%) reported working during pregnancy, working on average until 10 days before the due date. Only half the mothers who were working full-time received paid maternity leave. Most mothers (57%) who worked during pregnancy returned to work by 12 weeks after the birth of their baby. Less than half the mothers (46%) indicated they were able to stay at home as long as they liked.

More than one-third (37%) of mothers reported having to pay for some of their maternity care costs out-of- pocket with an average expenditure of $1,000.

About the Survey

Harris Interactive® conducted Listening to Mothers II: The Second National U.S. Survey of Women’s Childbearing Experiences on behalf of Childbirth Connection. The survey consisted of 1,373 online and 200 telephone interviews with women who had given birth in a hospital to a single live baby in 2005, with weighting of data to reflect the target population. The weighting includes including propensity scores, to adjust for the propensity to be online, a methodology developed and validated by Harris Interactive. Interviews were conducted from January 20 through February 21, 2006, and the survey took approximately 30 minutes to complete. The Listening to Mothers II survey will also serve as the basis for quarterly issue briefs that will explore in greater detail the key issues described in the report.

About Childbirth Connection

Childbirth Connection is a national not-for-profit organization that was founded in 1918 as Maternity Center Association. Childbirth Connection has grown from a small group of influential community leaders that was successful in reducing maternal and infant deaths in New York City, to a nationally recognized advocacy organization working to promote high-quality maternity care. Childbirth Connection is a voice for the needs and interests of childbearing families. Our mission is to promote safe, effective and satisfying maternity care for all women and their families through research, education and advocacy. More information about Childbirth Connection may be obtained at www.childbirthconnection.org.

About Lamaze International

Since its founding in 1960, Lamaze International has worked to promote, support and protect normal birth through education and advocacy through the dedicated efforts of professional childbirth educators, providers and parents. An international organization with regional, state and area affiliates, its members and volunteer leaders include childbirth educators, nurses, nurse midwives, physicians, students and consumers. More information about Lamaze International may be obtained at www.lamaze.org.

The Triangle Birth Network joins many organizations—including the American College of Nurse Midwives, the Coalition for Improving Maternity Services, American Nurses Association, American Association of Birth Centers, Lamaze International, and the Midwives Alliance of North America—in rejecting ACOG’s statement against out-of-hospital birth.

As ACNM’s response letter (dated 11/21/2006) to ACOG reads, “The troubling nature of this statement places in jeopardy access to a valid, evidence-based system of care. Providers who support evidence-based care have an ethical responsibility to offer access to care at all levels and and in all settings for these families.”