Survey HighlightsTechnology-intensive labor the norm. A majority of women reported having each of the following interventions while giving birth: electronic fetal monitoring (93%), intravenous drip (86%), epidural analgesia (63%), artificially ruptured membranes (55%), artificial oxytocin to strengthen contractions (53%), bladder catheter (52%), and stitching to repair an episiotomy or a tear (52%).
High levels of satisfaction with care. An overwhelming proportion of mothers were pleased with the care that they received noting that they generally understood what was happening (94%), felt comfortable asking questions (93%), got the attention they needed (91%), and felt they were as involved as they wanted to be in making decisions (89%).
Frequency of labor induction. Almost half of all mothers reported that their caregiver tried to induce labor, most commonly through the use of artificial oxytocin. More than one-third of those mothers cited a non-medical factor as at least partially the reason for the attempted induction. The drugs or techniques used actually caused more than one-third of all labors to begin.
Popularity of epidurals. Almost two-thirds of the mothers used epidural analgesia, including 59% who had a vaginal birth. Mothers gave high ratings to the ability of epidurals to relieve labor pain, but between 26% and 41% of mothers were unable to respond to questions about side effects associated with epidurals.
Unknown birth attendant. Almost three in ten mothers said they had never, or had only briefly, met the person who delivered their baby before the birth. In about 4% of hospital births, mothers said that either a nurse who wasn't a midwife or a physician's assistant delivered their baby. Five percent reported choosing labor induction to be able to give birth with the caregiver of their choice.
Postpartum depression. Almost one mother in five was probably experiencing some degree of depression in the week preceding the survey, on the basis of the Edinburgh Postnatal Depression Scale, a validated screening tool.
Myth of the pain-free cesarean. For women who had a cesarean, pain in the area of the surgical incision was the leading postpartum health concern, with five out of six of these mothers citing it as a problem in the first two months and one in fourteen citing it as a problem at least six months after birth.
Highly rated pain relief methods rarely used. Although immersion in a tub, showering, and use of "birth balls" received high ratings for their help with labor pain, these approaches were used by 8% or fewer women.
Highly rated labor support of doulas and midwives. Doulas and midwives were the most highly rated providers of labor support, yet were used for this purpose far less frequently than other types of providers (5% and 11% respectively).
Limited support for "elective cesareans." By a margin of more than five to one mothers thought it unlikely that they would choose a cesarean for non-medical reasons for a future birth. Only 6% of women whose most recent birth was vaginal indicated that they would be likely to choose cesarean birth in the future.
Declining access to VBAC. The willingness of caregivers and hospitals to permit vaginal birth after a previous cesarean birth declined substantially for women who had given birth within twelve months of the survey, as compared to those who had given birth from twelve to twenty-four months earlier.
Differences in vaginal and cesarean birth experiences. Compared to women who gave birth vaginally, those with cesareans were less likely to "room-in" with their babies and be breastfeeding at one week, and more likely to experience several health concerns after the birth, including abdominal pain, bladder and bowel difficulties, headaches, and backaches.
Differences between first-time and experienced mothers. Compared to first-time mothers, experienced mothers were less likely to: attend childbirth education classes, use pain medications and various other labor interventions, report negative feelings during labor, have a physician as birth attendant, or give birth by cesarean. Experienced mothers also reported feeling more confident as parents, despite being as likely to report feeling "fatigued" and "disorganized" as first-time mothers.
Major Survey Findings: Women's Prenatal and Birth ExperiencesPlanning for pregnancy. More than one-third (38%) of our respondents wanted to become pregnant at a later point or had planned to never become pregnant. Less than one in three (30%) mothers said they visited a health care provider to plan for a healthy pregnancy.
Maternity care provider. Obstetricians provided prenatal care to three-fourths (77%) of mothers and delivered 80% of the babies of survey mothers. Midwives provided prenatal care to 13% of mothers and attended 10% of the births. Family physicians provided prenatal care for 7% of our respondents and attended 4% of their births.
Familiarity with provider. Fifteen percent of mothers said four or more people took the lead in providing prenatal care. Nineteen percent indicated that they did not meet the person who delivered their baby until they were in labor and another 10% said they met the person only briefly. In 4% of hospital births, mothers said that either a nurse who wasn't a midwife or a physician's assistant delivered their baby
Childbirth classes. While 70% of first-time mothers said they took childbirth education classes, only 19% of mothers who had given birth before did.
Place of birth. Nearly all births (97%) of survey mothers took place in hospitals.
Supportive care in labor. Virtually all women (99%) reported having received some type of supportive care while in labor, most commonly from husbands/partners and nursing staff.
Use of doulas, support from midwives. While a small number (5%) of women relied on doulas (trained labor assistants), this type of caregiver was rated highest in terms of quality of supportive care during labor. Midwives provided supportive care to the next smallest proportion of women (11%) and received next highest ratings in terms of the quality of this care.
Induction of labor. Almost half (44%) of all mothers and half (49%) of those giving birth vaginally reported that their caregiver tried to induce labor, most commonly through the use of artificial oxytocin. Almost one-fifth (18%) of mothers cited a non-medical explanation as the only reason for the attempted induction, and another 16% cited a non-medical reason along with a medical indication as the reason for the attempted induction. In four out of five women, the induction did in fact cause labor to begin.
Fetal monitoring during labor. Nearly all women had electronic fetal monitoring (EFM) some time during labor (93%). Most women used EFM continuously, and most had only external monitoring around their bellies. Just 6% of the mothers reported that a handheld device, such as a "doppler" or stethoscope, was used exclusively to monitor their baby during labor.
Medical interventions. While 20% of mothers indicated that they used no medications for pain relief, there were virtually no "natural childbirths" among the mothers we surveyed. Even mothers having a vaginal birth experienced a wide array of medical interventions including: being attached to an electronic fetal monitor continuously or nearly so throughout labor (93%); being connected to an IV line (85%); having their membranes artificially ruptured (67%); being given artificial oxytocin to start or stimulate labor (63%); having a gloved hand inserted into their uterus after birth (58%); using a catheter to remove urine (41%); getting an episiotomy (35%); and having pubic hair shaved (5%). Less than 1% of mothers gave birth without at least one of these interventions, and almost all of these came from the very small group (also less than 1%) of home births in our sample.
Use of epidurals. Most mothers (63%) reported using epidural analgesia for pain relief during labor, including 59% of those having a vaginal birth and three-fourths (76%) of those with a cesarean birth. Mothers receiving an epidural generally rated them as very helpful (78%) in relieving pain. However, from 26% to 41% of the women were unable to respond to several statements about potential drawbacks of epidurals.
Use of drug-free pain relief techniques. Mothers used a variety of "drug-free" methods for pain relief, most commonly breathing techniques (61%) and position changes (60%), but two infrequently cited techniques, immersion in a tub or pool (6%) and taking a shower (8%), were rated most helpful by their users.
Walking in labor. Once contractions were well-established, most mothers (71%) did not walk around, primarily because they were hooked up to instruments, could not walk because of pain medications, or were told by their caregivers not to walk around.
Eating and drinking during labor. Just one woman out of eight (12%) had anything to eat during labor, and one in three (31%) had anything to drink at this time. Far more women expressed an interest in drinking and/or eating, and many reported that their caregivers did not permit eating and/or drinking, even in the case of vaginal births.
Position in a vaginal birth. Three out of four (74%) women who give birth vaginally reported that they were on their backs while pushing their baby out and giving birth. The remainder were either in an upright position (23%) (such as propped up, squatting or sitting) or lying on their side (3%).
Method of vaginal birth. Almost two-thirds (64%) of mothers had an "unassisted" vaginal birth. Another 11% of mothers had a vaginal delivery that was "assisted" with either vacuum extraction or forceps.
Cesarean delivery. Almost one fourth (24%) of mothers had a cesarean delivery. About half (51%) of these were planned, predominantly among women with a previous cesarean delivery.
Vaginal birth after cesarean (VBAC). Of women with a previous cesarean, about one in four (26%) had a vaginal birth. About two-in-five (42%) women with a previous repeat cesarean were denied the option of a VBAC, with that figure increasing to 58% for mothers who had given birth most recently, during the year before the survey. Medical concerns (unrelated to the uterine scar) and caregiver unwillingness were the leading reasons for denial of a VBAC. A smaller proportion reported hospital unwillingness.
Major Survey Findings: After the Baby is BornBaby's location after birth. In the first hour after birth, most babies were either in their mother's arms (40%) or her partner's arms (13%). Of those babies with hospital staff, most were there for routine care (69%) and the rest for some type of special care (30%). During the hospital stay, most mothers (56%) said they had the baby with them all the time ("rooming in").
Breastfeeding. About three in five mothers (59%) were exclusively breastfeeding at one week. This was slightly fewer than the two-thirds (67%) who had intended to breastfeed exclusively at the end of their pregnancy. Most said that the hospital staff had encouraged their breastfeeding, though even among those intending to exclusively breastfeed, 80% were given free formula samples or offers, and 47% of their babies were given water or formula to supplement their breast milk.
Feelings about care during labor and birth. Most mothers felt quite positive about their birthing experience, noting that they generally understood what was happening (95%), felt comfortable asking questions (93%), got the attention they needed (91%), and felt they were as involved as much as they wanted to be in making decisions (89%).
Treatment by caregivers. Mothers generally felt their doctor or midwife had been "polite" (93%), "supportive" (89%) and "understanding" (87%). The most common concern was that their doctors or midwives seemed "rushed" (16%). Assessments of nursing care were similar.
Descriptions of labor and birth experiences. Mothers' descriptions of how they felt during labor and birth ranged widely with most feeling "alert" (82%) and "capable" (77%), but many also said they felt "overwhelmed" (48%) and "weak" (41%). Experienced mothers were much more likely to express positive feelings about their birth experience than first-time mothers.
Cesarean birth and postpartum health. Among women who had a cesarean, pain in the area of the incision was the most commonly identified health problem (83%) in the first two months after birth; 25% of these mothers cited this as a major problem, and another 58% cited it as a minor problem. For about 7% of mothers with a cesarean, this problem persisted at least 6 months after birth.
General postpartum health. Among all mothers, the most commonly cited postpartum problems were physical exhaustion (76%), sore nipples/breasts (74%), lack of sexual desire (59%), backache (51%), or painful perineum (44%). The problems most likely to persist for at least six months were lack of sexual desire (16%) and physical exhaustion (11%).
Emotional health after birth. The Edinburgh Postnatal Depression Scale was administered to the survey participants, and 19% scored 13 or higher, indicating that they were probably experiencing some degree of depression in the week preceding the survey. Just 43% of this group had consulted a professional about their mental health since giving birth.
Competence as a mother. The overwhelming majority of respondents felt "very" (86%) or "somewhat" (12%) competent as a mother.
Feelings after birth. Mothers, presented with a list of words describing positive and negative feelings in the weeks and months after birth, had mixed feelings about this period. Most felt "tired" (93%), but "rewarded" (85%), "supported" (84%), "contented" (74%), and "confident" (73%). Although positive feelings predominated overall, at least one woman out of four selected each of the seven negative feelings offered in a list, including "unsure" (39%) and "isolated" (35%).
Major Survey Findings: Looking at Some Important Variations in ExperienceDifferences in vaginal and cesarean birth experiences. Compared to women who gave birth vaginally, those with cesareans were less likely to "room-in" with their babies and be breastfeeding at one week, and more likely to experience several health concerns after the birth, including abdominal pain, bladder and bowel difficulties, headaches, or backaches.
Differences between first-time and experienced mothers. Compared to first-time mothers, experienced mothers were less likely to: attend childbirth education classes, use pain medications and various other labor interventions, report negative feelings during labor, have a physician as birth attendant, or give birth by cesarean. Experienced mothers also reported feeling more confident as parents, despite being as likely to report feeling "fatigued" and "disorganized" as first time mothers.
Mothers' reliance on personal experience. Mothers who had given birth before relied primarily on their own experience as an information source on labor pain relief, while first-time mothers relied on a mix of sources, most frequently childbirth classes, their prenatal caregiver, and friends and family members.
Major Survey Findings: Attitudes about Birth and Understanding of Maternity RightsAttitudes toward cesareans. When asked a hypothetical question about choosing a cesarean in the future, even if there were no medical reason, by a margin of more than 5 to 1 (83% to 16%) women preferred a vaginal birth. Women who had recently had a vaginal birth were much less likely to prefer a future cesarean (93% to 6%), while those who had most recently had a cesarean were evenly split.
Attitude toward medical interventions in birth. A plurality of women (45%) agreed that "giving birth is a natural process that should not be interfered with unless absolutely medically necessary," while 31% disagreed with that statement and the remainder (24%) were undecided.
Maternity rights. About one woman in three either had a limited understanding or none at all about her legal right to clear and full information about any offered procedure, test, or drug, and her right to accept or refuse such care. Over one in three reported that she would have liked to have known more about this and other legal rights when receiving maternity care. Learn more about the rights of childbearing women.
Most recent page update: 9/11/2012
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
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Listening to MothersSM III is the third national survey exploring women’s experiences in pregnancy and childbirth. Commissioned by Childbirth Connection, conducted by Harris Interactive, and funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave birth in U.S. hospitals from 2011 to 2012. Results show that medically intensive experiences are typical, and evidence-based practices are underutilized. Childbearing women need better support and knowledge to navigate their maternity care.
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