Who’s listening to mothers?

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.

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8 Responses

  1. I am standing up applauding you! Love this post. I agree. When I am listening to Mothers they usually want to know “when can I get MY epidural?” However, I think the hospital should be more considerate of folks who do want a NCB. I guess we should ask “Hey this is your birth. What are your wishes?” And then we should accept them. We may not agree with them. We may not be able to grant them. But accept them. And I try try try to respect them……Which can be tough especially when they give me research from Ricky Lake…

  2. I attended a co-opted ‘lamaze’ hospital childbirth class- which wasn’t even supposed to use the lamaze name because they weren’t teaching lamaze at all…
    Anyway, the nurse went on to tell mothers that labor stresses the baby and if you have a c-section it’s for the baby. She told the moms that epidurals don’t have any risks and pitocin is just like oxytocin…lie after lie. Trust you doctor, don’t trust yourself is what she taught these first time moms. No wonder this hospital has a 40% c-section rate!
    Judith must be trying to get to the point that these hospital based classes teach “this is what we are going to do to you” instead of preparing moms for childbirth. The problem is that these hospital based classes do not teach informed consent and informed refusal to these moms. LTM also found that new moms didn’t know all the information they needed to make informed decisions, they didn’t know the risks associated with the procedures they had! I know Judith knows that women may want THEIR epidural but they have to know the risks, too.
    Also, the fear that is perpetuated about birth in this country is rotten. Any pregnant women is a target for bloody horrific stories from stranger and thoughtless family members. To make it worse mothers watch TLC and ER and think that that is how it is supposed to be.
    How can you listen when your mind is already made up? Don’t TRY. DO.
    Ask them why they want what they want and respect that. It’s not your birth, it’s theirs.

  3. “How can you listen when your mind is already made up? Don’t TRY. DO.
    Ask them why they want what they want and respect that. It’s not your birth, it’s theirs.”

    I suggest you take your own advice.

  4. Liz,

    Really? Or did the instructor actually say something to the effect of “epidurals are very safe”, and you interpreted that as “having no risks”? Seriously, I see it all the time in the vaccine debates…some anti-vax type asserting that doctors tell patients there is no risk, which no doctor would say.

    The other two “lies” you quote are actually not lies at all: Labor definitely can stress the baby, and CS’s are often done to spare the baby the stress of labor if it’s thought labor would compromise them, or if it actually does compromise them.

    Pitocin and/or Syntocinon is identical in chemical structure and physiological function to natural oxytocin, and neither can pass the blood-brain barrier:

    “The pharmacologic and clinical properties of Syntocinon® (oxytocin) are identical with the naturally occurring oxytocic principle of the posterior lobe of the pituitary.”

    If you tell your clients otherwise, it is you who is misinforming them, not doctors.

    As for what Judith Lothian thinks, she says it quite clearly in the article she wrote: she’s displeased that not enough parents are scared into “natural” birth – while acknowledging that they do have “a better understanding of their options” . They may not remember that epidurals are associated with maternal fever (which is what was asked by the LTM surveyors), and I agree that’s a pity. But is it really better if they were “informed” that they’ll feel numb the the experience of birth and not bond with their babies if they have an epidural? I don’t think so. And is the chance of maternal fever – though I agree it should be known – really going to stop women from having effective pain relief? I don’t think so.

  5. “To make it worse, mothers watch TLC and ER and think that’s how it is supposed to be.”

    Liz, why don’t you tell us all how it’s really “supposed to be”?

  6. 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.

    I’ll go along with that one: If the birth is preceding normally and there’s no problem, why intervene? However, I would consider severe pain to be a complication requiring intervention. It is so considered in any other area of medicine, why not in labor and delivery?

  7. Because it’s a pain with a purpose, silly. (rolling eyes). And you’ll have an abnormal birth if you have an epidural.

  8. And you’ll have an abnormal birth if you have an epidural.

    Hmm…I had an epidural and had an extremely abnormal delivery. Indeed, delivering a live child and surviving, given where I started (meconium stained amniotic fluid, malpositioned head, high fever, ineffectual contractions, and excessive pain) was probably the most unnatural, abnormal thing I’ve ever done. But in this case, I’d say that the unnatural, abnormal outcome was the prefered one.

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