What Are the Problems?

Evidence-based care and shared decision making may be the watchwords of best medical practice, but neither is the case when it comes to typical medical management of labor. 

Problem #1: Women do not receive optimal care—care that produces the best outcomes with the least use of medical intervention given the individual case. How do we know this? 

One in three U.S. women (32%) gives birth via cesarean surgery with all that entails in terms of pain, recovery, and risk. Studies show that the sweet spot for cesarean rates is around 10% and should not exceed 15% because as rates rise above this, so do maternal and newborn morbidity and mortality rates. 

All interventions into the normal process have potential harms as well as benefits. When used routinely or frequently or when lesser measures such as walking or upright positioning or just having patience would do, women are exposed to the harms with no counterbalancing benefit. Listening to Mothers III, a national survey of U.S. women having babies in 2011 and 2012, found that few women give birth without experiencing at least one major medical intervention with potential adverse impact on their or their baby’s health. Nearly two out of three (63%) experience two or more of them.

Lamaze International recommends six “Healthy Birth Practices” based on World Health Organization recommendations. Here’s how Listening to Mothers III’s findings stack up against them:

Let labor begin on its own. 

• 41% of all participants had labor induced, actually at least 46% of women planning vaginal birth because some women weren’t sure and others had planned cesareans, according to a follow-up report. 

 Walk, move around, and change positions in labor.

• Only 43% were mobile after being admitted to the hospital, and only 40% used position changes and movement to increase comfort. 

Bring a loved one, friend, or doula for continuous support.

• While 99% had at least one labor companion, only 6% had a doula, a woman trained or experienced in labor support. Studies show that having one-on-one continuous labor support from a doula has many benefits, including reduced likelihood of cesarean. 

Avoid interventions that are not medically necessary.

• 83% had pain medication, including 67% having an epidural or spinal.
• 62% had an IV.
• 31% had labor strengthened with oxytocin (Pitocin or “Pit”).
• 36% had the bag of waters broken (artificial rupture of membranes or amniotomy).
• 60% didn’t drink liquids during labor.
• 79% didn’t eat during labor.
• 17% of women having vaginal birth had an episiotomy (snipping the perineum, the block of tissue between the vagina and the anus, to enlarge it for birth).
• Only 54% gave birth by their own efforts (31% had a cesarean, and 15% of women having vaginal birth had an instrumental delivery). 

Avoid giving birth on your back and follow your body’s urges to push.

• 68% having vaginal birth gave birth on their backs.
• Only 29% pushed according to their own urges.*
• 25% had a health professional press on their belly to help expel the baby.* 

*According to the follow-up report to Listening to Mothers III. 

Keep mother and baby together; it’s best for mother, baby, and breastfeeding. 

• Only 47% had their babies mostly in their arms during the first hour.
• 33% of babies were with hospital staff during the first hour.
• 40% of babies didn’t room in with their mothers.
• 49% of women planning to breastfeed exclusively were given formula samples or offers.*
• 29% of newborns were supplemented with water or formula during their hospital stay.* 

*These practices also impact breastfeeding adversely. 

Problem #2: Women aren’t being given the information they need to make informed decisions—decisions based on complete and accurate information on the potential benefits and harms of all their options. How do we know this? 

Listening to Mothers III found that: 

• The majority of women were incorrect or weren’t sure when asked facts about induction of labor and cesarean surgery. They were no more likely to be correct if they had undergone the procedure.
• Despite the fact that inducing labor for suspected big baby is not supported by the research evidence, more than half (60%) the women said their care provider talked to them “some” or “a lot” about the reasons to induce while nearly two-thirds (63%) heard not at all or only a little about reasons not to induce.
• Only 14% of women had a vaginal birth after cesarean (VBAC). This is despite studies showing that most women could birth vaginally, the balance of risks between planned vaginal birth and elective repeat cesarean, and the escalating risk of severe complications in succeeding pregnancies and deliveries with each repeat cesarean surgery. 

How Will Childbirth U Work? 

At low cost, pregnant women and others will be able to purchase narrated slide presentations either individually or as many as desired via a yearly subscription. An accompanying PDF of references cited in the lectures and links to selected internet resources will be part of each lecture’s package. Lectures will use the best medical research to debunk common obstetric practices and policies and lay out what constitutes optimal care, and lectures will be updated periodically. 

Why Childbirth U? 

Childbirth educators may be silenced. A recent Lamaze webinar was entitled: “How to Teach Evidence-Based Childbirth Classes and Still Keep Your Job.” The reasons behind controlling what educators tell students include entrenched erroneous beliefs about appropriate management, perverse economic incentives, and the practice of defensive medicine. Childbirth U will not be dependent on the approval of any outside entity, and therefore content will not be subject to outside influence.

Most women seek information on pregnancy and childbirth on the internet, but they’re less inclined to trust it than information from their care providers. Childbirth U solves the credibility problem too. Sources will be provided for all information in the lectures, and those who are interested will be able to access mini-reviews of the research evidence. This will give women a means of evaluating other sources of information, including what their care providers tell—or don’t tell—them, thereby enabling them to choose or switch to a care provider who practices optimal care.