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Childbirth Today

Childbirth is the female equivalent of a war story: Once you’ve been through it, you never forget the details. But in spite of everything we hear about difficult labors, the vast majority of women have very satisfying memories of their deliveries, according to a new survey conducted by Harris Interactive for the Maternity Center Association (MCA), a nonprofit organization dedicated to improving maternity care, in partnership with the Johnson & Johnson Pediatric Institute.

Of the nearly 1,600 women surveyed around the country:

96 percent say they’re satisfied with the health care they received
94 percent feel they were treated with kindness and understanding
87 percent say they were free to make their own decisions

Here’s what’s happening in the birthing suite that’s made labor and delivery such a rewarding experience for so many women:

Who helps out

The happiest moms get physical and emotional support during labor and delivery from a cast of people  -- including friends, relatives, and nurses  -- but dads seem to give most of this comfort:

Doulas and midwives have a slight edge over dads when it comes to the quality of care provided. "If you’re very motivated to have a low-intervention birth, or if you think your partner won’t be particularly helpful, a doula can be wonderful," says Lauren Streicher, M.D., an ob-gyn at Northwestern Memorial Hospital, in Chicago. "But if you have an involved partner, know you want an epidural, and are at a hospital that provides one-on-one nursing, you don’t really need one." No matter who provides comfort, it’s crucial. While 82 percent of the women surveyed report that they felt alert during labor and 77 percent felt capable, nearly half were overwhelmed and 39 percent were frightened.  

92 percent got support from their partner or husband
83 percent from the nursing staff
53 percent from a doctor
50 percent from another family member or a friend
11 percent from a midwife
5 percent from a doula

How Babies Are Born

In line with national averages, 76 percent of the women surveyed gave birth vaginally and 24 percent via cesarean section. While 31 percent of first-time moms had a c-section, only 19 percent of third babies were born that way. Still, many medical experts are concerned that women aren’t offered the option of a VBAC  -- vaginal birth after cesarean  -- as often as they should be. Forty-two percent of the respondents weren’t given that choice  -- 36 percent because their caregiver wasn’t willing and 12 percent because the hospital wasn’t.

"Three out of four women who’ve had a prior c-section could probably deliver vaginally. Yet doctors and hospitals are eliminating this option because of a lack of clear national guidelines and the threat of malpractice," says Michele Lauria, M.D., associate professor of obstetrics and gynecology at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire.

Recent news reports that warned of an increase in uterine rupture during VBACs were misleading, says Dr. Lauria  -- ruptures increased only when prostaglandin gels had been used to ripen the cervix. Otherwise, the risks are quite small. "Women should have a choice about VBACs, just as they have a choice about pain medication," she says.

When Doctors Step In

Most women (61 percent) experienced between six and ten medical interventions during their labor and delivery  -- everything from being hooked up to an IV to being given Pitocin, a medication that jump-starts labor. Just under half (43 percent) had between three and five major interventions, which include inductions, episiotomies, vacuum extractions or forceps-aided deliveries, and c-sections.

Of course some procedures, such as the use of Pitocin, are more common among first-time moms, partly because they have longer, less predictable labors. Still, overall, women don’t seem to mind when medical procedures take over. That’s because they want a healthy outcome for their baby and themselves, says Donald Coustan, M.D., chief of obstetrics and gynecology at Women & Infants Hospital of Rhode Island, in Providence. "The bottom line is that the woman needs to be given the necessary information and be in on the decision."

But some women may doubt their ability to make this type of choice. "When women hear things like ’failure to progress,’ that can be very undermining. They think the problem is with their body, so they’re relieved when the doctor steps in," says Carol Sakala, Ph.D., director of programs for the MCA. "Instead, you need to have a supportive environment so a woman feels confident that her body can handle any problem."

Walking vs. Lying Down

For various reasons  -- either because they were hooked up to electronic monitors, had an epidural, or were advised by nurses or doctors not to walk  -- 71 percent of the respondents did not move around after they were admitted to the hospital. And that’s okay, say experts.

"The biggest benefit to walking during early labor is that it can make the mother more comfortable and help relieve pain," says Dr. Streicher. "But once you’re in active labor, whether you walk or not isn’t going to make much difference, since lying down doesn’t slow your progress."

If you forgo an epidural, which requires continuous monitoring, many hospitals will allow you to roam the halls as long as you check in every hour or so. But many women say they prefer the fetal monitors: "They’re aware of the things that can happen and like the reassurance," says Dr. Streicher.   

When it comes to childbirth, studies  -- as well as the survey results  -- show that it’s not pain relief that affects a woman’s perception of the experience. Instead, here’s what really helps make labor and delivery more gratifying:

1. A good relationship with your practitioner. You need to know your ob or midwife is on your side.

2. Being part of the decision-making process, even when the doctor has to schedule an emergency c-section.

3. Support. Whether it’s a husband, partner, or friend, someone who will make you comfortable  -- emotionally and physically  -- is important.

4. Information. The more you know, the more confident you’ll be throughout labor and delivery.

Comfortably Numb

Has the desire for a drug-free delivery waned? It seems that way: Eight out of ten women had pain-relief medication during labor; that number increases to 91 percent for first-time moms.

"What we’re seeing is that most women want to minimize their discomfort," says Dr. Coustan. "We’ve actually been disappointed that our alternative birthing center, where women labor drug-free and without monitors, has been underutilized."

Midwives acknowledge the trend: "More of the women we see want medication than did those in the past," says Susan Cataffo-Heiland of Bassett Healthcare, a hospital network in Cooperstown, New York.

When it comes to medication, 63 percent of the respondents had epidurals. And doctors say that’s a good choice: The latest research has found no evidence of an increase in the number of c-sections among those who have them. They contain lower doses of anesthesia, which is good for the mother, and none of the drug reaches the baby. And some women who are progressing slowly because they’re tense and in a lot of pain will actually relax and dilate faster after receiving an epidural.

But more medication can also lead to more interventions  -- such as catheters, IVs, and an increase in fetal monitoring, says Sakala. "Women don’t always realize that choosing an epidural is choosing a technology-intensive birth." Cataffo-Heiland tells moms-to-be that she’ll try to make them comfortable without "the big guns. Then, if they’re still feeling bad, we move up the ladder of options."

On the other hand, the need for pain relief actually goes down with subsequent births  -- 78 percent of mothers delivering their second child got some form of anesthesia, while 69 percent of those with three (or more) kids did. Why? Having gone through childbirth once, veteran moms typically have shorter labors and may feel more confident they can handle the pain.

Drug-Free Relief

For women who prefer a delivery without anesthesia  -- or who are unable to use pain medication because their labor is too far along by the time they reach the hospital  -- there’s an increasing array of options to make them more comfortable. "Breathing techniques used to be all the rage, but now we tend to let women find their own pattern," says Cataffo-Heiland. "What we see working best is the Jacuzzi we have at our hospital. Many women get in it and are ready to deliver in an hour."

Besides special breathing (which 61 percent used), the methods tried most during contractions are:

Episiotomies: Not for Everyone

The routine use of an episiotomy  -- a surgical cut in the perineum to make more room for the baby to emerge  -- is declining: Only 34 percent of the respondents who gave birth vaginally received one during their delivery. "That’s one of the real revolutions in obstetrics," says Dr. Coustan. "Most new doctors are trained not to do them if possible."

Episiotomies began to acquire a bad rep when it became clear that they don’t prevent pelvic-floor problems like incontinence  -- the goal they were designed to achieve. While the procedure is occasionally warranted, many experts now believe that most women can do fine without one. And if tearing occurs, it’s usually minor and won’t be as painful while it heals as an episiotomy is.

After the Baby

Though the aches and pains of labor fade fairly quickly after delivery, some women surveyed had lingering emotional issues. A fourth say they felt confused, one in five experienced some degree of depression, and one in six report that they still felt a lack of sexual desire after six months.

But overall, the women were content. Surprisingly, first-timers were just as happy as second- and third-time moms, though when it came to self-confidence, things were easier for the veterans. And what kept these moms so relatively happy? When all is said and done, the gain  -- a healthy baby  -- far outweighs the pain.

"The first few weeks are the real challenge physically and emotionally," says Cataffo-Heiland. "By two months postpartum, the body is pretty much back to normal  -- even hormones are stable again." A quick turnaround, considering how long it took to carry and deliver a baby. But as Cataffo-Heiland says, "Women are powerful; they can rise to any occasion."

Changing positions (from lying down to standing; 60 percent)
Hands-on techniques (such as massage; 32 percent)
Mental strategies (like relaxation or hypnosis; 30 percent)

Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences was conducted by:

Eugene R. Declercq: Boston University School of Public Health

Carol Sakala, Maureen P. Corry: Maternity Center Association

Sandra Applebaum, Peter Risher: Harris Interactive for the Maternity Center Association by Harris Interactive

Visit the MCA on the web at http://www.maternitywise.org.

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