In May 2013, Listening to Mothers III: Pregnancy and Birth was released, followed by Listening to Mothers III: New Mothers Speak Out in June 2013. The Listening to Mothers surveys “compare actual experiences of childbearing women, newborns, and families with mothers’ values and preferences, as well as with evidence-based care, optimal outcomes, and protections granted by law.” The gaps that are identified between women's experiences and preferences can be used as opportunities to improve care for mothers and infants. This editorial provides an overview of the Listening to Mothers III study and a few of the findings that stood out in my initial read of the reports.
Listening to Mothers III was an online survey completed by 2400 mothers aged 18 to 45 years who gave birth to a single newborn in a US hospital from July 1, 2011 through June 30, 2012. The data were adjusted to be representative of US mothers who had a singleton hospital birth in 2011 and 2012; age, race/ethnicity, parity, birth attendant, mode of birth, and other factors were comparable. A follow-up survey was completed by 45% (n = 1072) of the original participants. This is the third in the series of Listening to Mothers studies. The Listening to Mothers I and II surveys were conducted in 2002 and 2005, respectively.
The Listening to Mothers III: Pregnancy and Birth report focuses on planning for pregnancy, the pregnancy experience, women's experiences giving birth, being home with a newborn, choice, control, knowledge, and decision making. The Listening to Mothers III: New Mothers Speak Out report focuses on maternal well-being, child well-being, family and relationships, employment, maternity leave, child care, health insurance, and views of maternity care quality and engaging in maternity care. In addition to reporting the survey findings, both reports examine variations in experience by demographic characteristics (eg, parity, mode of birth, race/ethnicity, payor source) and evaluate trends across the 3 Listening to Mothers surveys.
The fact that almost all of the mothers (98%) had at least one ultrasound during pregnancy is not surprising, but I was astonished that 70% had 3 or more ultrasounds and 34% had 5 or more ultrasounds. The proportion with 5 or more ultrasounds increased by 48% from Listening to Mothers II (23% in 2005) to Listening to Mothers III (34% in 2011–2012). While appropriate use of ultrasound during pregnancy is generally felt to be safe, one cannot assume that it is completely harmless. There may be effects that have not yet been identified, especially as the number of ultrasounds women receive increases. I believe that clarifying appropriate use of prenatal ultrasound and conducting studies with long-term follow-up of children exposed to multiple ultrasounds deserve attention.
Interventions in labor and birth were common. Overall, 41% of respondents said their care provider tried to induce labor and 31% had a cesarean. One of the most compelling figures in the report is a graphic representation of findings that demonstrate what is commonly referred to as the “cascade of interventions” (Figure 1). The incidence of cesarean in nulliparous women who had their labor induced and had an epidural was more than 500% higher than in women who had neither a labor induction nor an epidural (31% vs 5%, respectively). This figure translates a clinical concept into clear and convincing numbers that are easily understood, and it is a valuable illustration to use in patient education.
While the persistent, and in some cases increasing, frequent use of interventions in pregnancy and birth can be disheartening, there are encouraging findings in the study. One of these is that the majority of the women (58%) agreed strongly or somewhat with the statement, “Giving birth is a process that should not be interfered with unless medically necessary”; only 16% disagreed with this statement. The proportion of women that agrees with this statement has risen with each Listening to Mothers survey, from 45% in Listening to Mothers I to 50% in Listening to Mothers II to 58% in Listening to Mothers III. I hope what appears to be shifting attitudes will result in women beginning to question the common use of interventions and their implications.
These results are just a few of the extensive and interesting findings from Listening to Mothers III. Interspersed throughout the reports are quotations from women that illustrate the findings and leave me excited to read the forthcoming analysis of the qualitative data collected in the surveys. All of the Listening to Mothers full survey reports along with the survey questionnaires and data briefs are available at www.childbirthconnection.org/listeningtomothers. The datasets from the surveys are publicly available for researchers and students to use. The Listening to Mothers reports are a rich source of information about the experiences of childbearing women in the United States and essential reading for all midwives and other clinicians who provide maternity care.