In 2006, a survey of 1573 women who’d given birth in a hospital the year before was commissioned by the Childbirth Connection, in association with Lamaze International, called Listening to Mothers II. A previous survey, Listening to Mothers I, was commissioned by those same groups in 2002, with similar bottom lines, to the extent the Executive Summary of LTM II can be compared with the LTM I full report. (Links may require free registration at http://www.childbirthconnection.org)
If the first LTM survey is any indication, the group of women surveyed was whiter, older, richer and better educated than most US women (some of this holds even after statistical weighting – see Appendix B). Namely, the demographic that is most likely to choose “natural” childbirth out of ideological reasons. However, both LTM surveys, despite the obvious spin by the advocacy organizations who summoned the studies, show that women overwhelmingly rate their maternity care and caregivers highly, and accept birth “interventions” willingly (only a small minority of women in LTM II felt they were pressured to receive interventions – 11% for labor induction, 7% for epidural, and 9% for CS. Whether or not they were actually pressured, or just felt that way, is also a matter for speculation).
Going by the full text of LTM I, most women tried non-pharmacological pain relief, but 63% opted for epidurals, which they rated highest in terms of effective pain relief. The most effective non-pharmacological method of pain relief was immersion in water, and the least likely to be rated “very helpful” were, interestingly, the components of the Lamaze and Bradley methods: Mental strategies, breathing techniques, and position changes (see table 3, page 28/67 of the LTM I report).
Though in LTM II, a mere 2% of women “experienced all the Care Practices that promote normal birth and are endorsed by Lamaze International”, it doesn’t seem that anybody is concerned about this other than the Childbirth Connection, Lamaze International, and other “natural” birth advocates. It’s also not clear what gives Lamaze International the right to be the arbiter of what constitutes “normal birth”, as opposed to, say, the ACOG. But I digress…
Judith Lothian, a prominent member of Lamaze International, associate professor in the College of Nursing at Seton Hall University (NJ), and co-author of The Official Lamaze Guide, has a very interesting take on LTM II. In particular, Lothian laments the fact that not only are fewer women attending prenatal classes and relying more on other sources of information (books, the internet, healthcare providers and their loved ones), those classes apparently don’t deter women from having the “abnormal births” she so deplores (emphases mine):
Women have an interesting story to tell about the impact of childbirth education classes. Eighty-eight percent of those who took classes felt that, as a result, they had a better understanding of their maternity-care options; 77% felt they were more confident in their ability to give birth; and 70% were better able to communicate with their caregivers. However, something else apparently happens in childbirth classes, too. Sixty percent had greater trust in their hospital, and 54% had greater trust in their caregiver. Especially troubling is that 58% reported being less afraid of medical intervention, which is reflected in an 81% epidural rate for first-time mothers with a vaginal birth and a 48% medical induction rate for first-time mothers with a vaginal birth. Only 41% of first-time mothers—the women who are most likely to attend childbirth classes—believed that birth should not be interfered with unless medically necessary.
Ultimately, it appears that the women who attend childbirth classes, regardless of whether they want a natural birth, gain confidence in their ability to give birth, have a better understanding of their options, and are better able to communicate with their caregivers. However, the women’s greater trust in caregivers and becoming less afraid of medical interventions probably override their increased confidence, knowledge, and skill when it is time to actually labor and give birth and they enter the maternity-care birth system.
Judith Lothian apparently views prenatal edcuation classes as a vehicle with which to bludgeon mothers into being afraid, or at least wary, of the medical system, and not as a way to, you know, get educated about birth. Somehow, better education about birth and methods of pain relief (all of them) is a bad thing. It seems many mainstream women agree with her perception of childbirth classes as propaganda, when they’re looking for something entirely different:
In another study, also in December’s Journal of Perinatal Education, sociologists observed 11 Seattle-area childbirth courses and interviewed the teachers. They found mismatched expectations, says researcher Christine Morton. Educators lamented that students wanted quick, “just-the-facts” classes and were not interested in non-drug methods of pain relief. They thought many students saw the classes as burdens.
The teachers blamed busy schedules but also noted “a backlash from women saying ‘Don’t make me feel guilty because I want an epidural (spinal analgesia) … Don’t make me feel guilty because I want a cesarean (surgical delivery),’ ” Morton says.
LTM II confirms that 82% of women attending prenatal classes were seeking information about labor and birth; only 37% were specifically preparing for “natural” birth. Maybe instead of worrying about how childbirth classes may “sabotage” women, Lothian should actually listen to mothers: most of them are, apparently, no longer interested in the view of childbirth she’s peddling.
Once upon a time, so the “Natural Parents” tell us, women used to talk about birth, witness it, and receive support from their extended families (who all lived with them on one big homestead, of course). A generation or two ago, women who were interested in staying awake during childbirth had virtually no where to go to get this information: most of their mothers, after all, gave birth completely unaware and thus were of no help in describing what birth is like. Hence, the proliferation of childbirth education classes. These days, however, the generation of 40- and 50-something women often do have birth experiences to share with their daughters, nieces and younger cousins – experiences that don’t always fit the “natural” childbirth script, however:
“Lamaze sucks. I did it once…useless!”
“You know, my C-section wasn’t all that bad.”
“Natural birth? Give me a break. It was like trying to poop out a watermelon. A really big watermelon.”
“Epidurals? Heaven. I was in agony using the breathing techniques until I got one!”
And other such heresies.
Other welcome developments are the vast Information Superhighway (though this, as we know, can be a double-edged sword), the advances in patients’ rights which required healthcare providers to drop their paternalistic stance and spend time explaining birth issues to patients, and the increasing numbers of female providers – who could often speak from their personal experiences as well.
Given the immense changes in in-hospital birthing options over the last couple of decades, including dropping episiotomy rates, “walking” epidurals, or the availability of jacuzzis and birthing balls on L&D wards, I think it’s appropriate to ask – who’s really listening to mothers?
It certainly doesn’t seem to be Judith Lothian or Lamaze International.