Are Pregnant Women Getting the Information They Need? A New Survey Says No

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When I was pregnant with my first child, in Atlanta, Georgia, I was excited to go to prenatal appointments. I looked forward to seeing other pregnant women in the waiting room, finding out my weight, and talking about my hopes and fears for the upcoming birth.

Instead of being elated, I left the prenatal appointments depressed and discouraged. I was so upset after one that I sobbed in the car in the parking lot. “I can’t stand this,” I wailed to my husband, whose brow was creased with worry.

It wasn’t just the interminable wait in the waiting room, or the way the health care providers (we started off with midwives but switched to the doctors because we actually found the doctors less judgmental) raced through appointments.

It wasn’t just how we were asked, “Do you have any questions?” by a doctor whose tone made it clear she was hoping the answer would be no.

We didn’t feel cared for.

We didn’t feel listened to.

Our pregnancy was magical to us: a life-changing event that would alter the world forever.

But our questions were at best a nuisance and at worst a challenge to our providers: an annoyance that meant they had to spend time with us when all they wanted was to get to the next patient.

But as a new survey reveals, I'm far from the only woman who has had a negative experience with the health-care system during her pregnancy. In a survey of 1,252 women between the ages 18 and 45 from a variety of cultural backgrounds across the United States, released by the American College of Nurse-Midwives (ACNM), 62 percent of pregnant women said they did not have conversations with their health care providers about how to stay healthy during pregnancy; 80 percent said they did not discuss how to prepare for motherhood.

The survey also found that 60 percent of women said they would agree to an unnecessary Cesarean and 90 percent would agree to have their labor induced, even if there was no medical reason.

“...[Women] need the opportunity to discuss and make decisions on all of their care options with their provider, especially during pregnancy and childbirth,” said ACNM President Dr. Holly Powell Kennedy, a professor of midwifery at the Yale University School of Nursing, in a press release, “and they shouldn’t settle on care that is not right for them.”

That’s what we did. Even though we were receiving rushed, impersonal care, we continued with the same providers.

It felt like we had no options: our insurance wouldn’t pay for any other practice.

Though I was healthy and fit and gained only twenty pounds during pregnancy, nothing during labor went right. After more than 10 hours of intense contractions that were less than five minutes apart, a nurse gave me a rough vaginal exam, announced that I wasn’t dilated at all, “not even a dimple,” peeled off her glove, and left the room.

The doctor on call (the only one we had never met and the only male) told me I was being “selfish” for wanting a natural childbirth and “making my family wait.” He insisted I accept an epidural to speed things along.

I gave birth flat on my back with a catheter inserted into my urethra. The nurses refused to stop my epidural even though I didn't want one. The baby was small (7 pounds, 1 ounce) and I have wide hips but I suffered from a vaginal tear so severe I needed multiple stitches; I had painful, bleeding hemorrhoids that lasted for over a year; and one of my legs remained partially numb from the medication for weeks afterwards.

“Things are happening every day that shouldn’t be happening,” says Lorrie Kline Kaplan, executive director of ACNM who has been working in health care advocacy for twenty years. “Women are feeling disempowered. A lot of hospitals don’t have midwives. A lot of women are being induced when they aren’t ready to go into labor and that’s unsuccessful. Then they end up with major abdominal surgery that wasn’t necessary.”

I had a healthy beautiful baby and I felt I shouldn’t complain. I somehow managed to avoid a Cesarean. Still, I felt terrible. I blamed myself and my body for failing me. At first I thought the doctors had helped me. It wasn’t until our daughter was four months old and a no-nonsense midwife said to me matter-of-factly, “Animals in nature who feel threatened stop laboring and try again later,” that I realized things could have gone differently if I had received a gentler, less abusive kind of care.

It’s not just often psychologically traumatic to give birth in America, it’s sometimes physically dangerous. Most people don’t realize that we have among the highest maternal mortality rate in the industrialized world and that while birth has gotten safer worldwide America’s maternal mortality rates have risen over the past twenty-five years. As worrisome, there are nearly 34,000 near misses (events so dangerous that the woman almost dies) every year during childbirth.

Kaplan tells me ACNM is working to educate women about birth options, reduce the dangerously high C-section rate in the United States, promote vaginal birth, stop elective inductions before 39 weeks, and make birth safer for every American woman and her baby.

Although the percentages of midwife-attended births seem to be going up (in New Mexico over 24 percent of births are attended by midwives), the vast majority of laboring women are attended by doctors in America. As Marsden Wagner, M.D., former director of Women’s and Children’s Health for the World Health Organization, has famously said, having a highly trained obstetrician attend a low-risk birth is like having a pediatric neurosurgeon babysit your toddler. It’s no wonder that over 32 percent of babies being born in America are born via Cesarean section, many of them medically unnecessary, and that our system is failing our pregnant women and laboring moms.

Kaplan points out that midwives help their clients avoid Cesarean sections and episiotomies.

ACNM believes the way to improve our system is for more women to be cared for by midwives, and for midwives and obstetricians to work as a team.

“The education of nurse midwives and certified midwives is focused on listening to women, caring for women, and having a deep understanding of women’s bodies and women’s health to facilitate the best outcome,” Kaplan says. “Obstetrics is a surgical specialty. We believe every woman deserves to have a midwife and access to an obstetrician if she needs it. We see the system working best when midwives and doctors work hand and glove with mutual respect. We can increase the vaginal birth rate and reduce prematurity.”

After interviewing doctors, midwives, pregnant women, health professionals, and government officials both in America and Europe for the book I’ve been writing, as well as touring hospitals and attending births in both the United States and Scandinavia, I agree with ACNM that we need more competent midwives who have excellent training and who work as equal partners, not lesser beings, with obstetricians. 

We also need to remember birth is not an accident waiting to happen but a joyous awe-inspiring event. We need to listen to women, help them move through their fears, and celebrate their strengths. And we need to stop falsely vilifying home birth and arresting home birth midwives, but instead give every woman the option to have a baby how and where she wants.

Jennifer Margulis, Ph.D. is the mother of four (three of whom were born at home) and a Senior Fellow at the Schuster Institute for Investigative Journalism. She is the author of a forthcoming book about pregnancy, childbirth, and the first year of life (Scribner, April 2013), The Business of Baby. 

Credit Image: © Leonard Ortiz/The Orange County Register at ZUMAPRESS.com

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