mother’s health

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Moms Speak Out: On Improving Childbirth In Boston-Area Hospitals

When we opened up the “lines” for an online chat about quality and childbirth, moms dove in with comments and questions about induction, malpractice and worse results for black women as compared to whites.

We had help answering questions from:
Gene Declercq, a Boston University School of Public Health professor 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, a mom from Needham who had her third child, a boy, in September.
And Rebecca Loveys of Watertown, who delivered her second son in August.

Livechat

First question, from Agnes…
Is there a way we can improve these measures of childbirth by focusing not just on the labor-and-delivery part, whose benchmarks mostly are set by hospital birth, but on childbearing? On a woman’s experience of her pregnancy and not just the outcome?

Dr. Jeff Ecker responds…
I think it would be difficult to do so, as they are such different experiences. A woman can have a perfectly healthy pregnancy, and have a difficult delivery. One does not necessarily affect the other experience.

I agree that it would be ideal to focus on the whole experience of pregnancy, childbirth and post-delivery care. We have, to date, focused mostly on the process of labor and delivery because that is the point at which we most reliably collect data (think: birth certificate). Increasingly we are turning to evaluate patient satisfaction. But I need to tell you that in my experience, much of satisfaction is driven by outcome.

Question from Katie…
To what extent does the fear of medical malpractice dictate a woman’s birth experience?

Gene Declercq responds…
The research on the effects of fear of malpractice on obstetrician’s behavior is somewhat mixed. In terms of whether things like malpractice premiums are directly related to, say cesarean rates, there is not much support for that link. However, in terms of perception of malpractice concerns on obstetrician attitudes it continues to have an impact since the widespread feeling exists that interventions like cesareans are more easily defensible in court.

Cara responds…
As a labor and delivery RN I know that the fear of lawsuit is a huge driving force in the care we provide. I can’t tell you how often I hear docs and midwives say “Well I really should do (insert intervention) because how would it ‘look’ if we didn’t”…..”look” being the operative word and it means when the lawyers review the chart if a lawsuit did happen.

Ecker responds…
Cara, you’re right. Those on labor and delivery spend much time (too much time) talking about lawyers and how they might spin our care. But research is split about how such concerns actually affect care and outcomes. It turns out to be difficult, for example, to demonstrate that a recent malpractice settlement drives care in any particular direction. Don’t get me wrong: I’m no fan of lawyers second guessing good care after the fact but they’re not the only things driving cesarean rates up.

Question from Sarah…
How do doctors decide when during a woman’s labor to recommend a Cesarean section? Do most doctors have their own formula or threshold for deciding when the woman is not making progress that will lead to a vaginal delivery?

Dr. Ecker responds…
There’s no one formula for determining when progress isn’t being made and cesarean delivery is best recommended. Continue reading

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. Continue reading