Re-thinking Maternity Care Systems

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... fewer than 30 per cent of women approaching their first birth attend prenatal classes, and books and the Internet are their primary sources for information about birth.

Women attending obstetricians were more favourable to the use of birth technology and were less appreciative of women's roles in their own delivery. In contrast, women attending midwives reported less favourable views toward the use of technology and were more supportive of the importance of women's roles ...

Even late in pregnancy, questions about epidural analgesia, Caesarean section and episiotomy solicited the most "I don't know" responses from women who took the survey. But women attending midwives appeared more knowledgeable on these issues.

"Our findings suggest that obstetricians, midwives and family physicians are caring for different populations of women, with different attitudes and expectations towards childbirth," ... "But regardless of the type of care providers they attended ... many women reported uncertainty about benefits and risks of common procedures used at childbirth. This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers."

A second study, published last month in the journal Birth, compared the attitudes toward birth technology and women's role in their childbirth between the younger generation of obstetricians and their predecessors.

Klein and colleagues surveyed 800 Canadian obstetricians who include birth delivery in their practice. Out of 549 respondents, 81 per cent of those 40 years or younger were women (vs. 40 per cent over 40 years of age) ...

... younger obstetricians were significantly more likely to favour the use of routine epidural analgesia and were more concerned about the perceived adverse effects of vaginal birth ...

... the younger generation sees Cesarean section as a solution to many labour and birth problems, and incorrectly sees C-section as safer for both mothers and babies ... younger obstetricians are more likely to choose C-section for themselves or their partners, and are less likely to believe women missed out on an important experience by having a C-section.

... "This study shows it's generation, not gender, that affects obstetricians' views about procedures like C-sections," ... "this could present a challenge to efforts to decrease C-section rates in both U.S. and Canada." As well ... up to a third of obstetricians were not evidence-based in their views. This creates concern about informed decision-making, especially for women who are uncertain about procedures that might be used in birth.

... 75 per cent [of obstetricians] thought home birth was more dangerous than hospital birth ... even though home birth by regulated midwives has been shown to be safe in Canada.

... "These three studies taken together show us that educational leaders and provincial policy-makers need to seriously examine the educational models and experiences that appear to teach the non-evidence-based view that vaginal childbirth is primarily a dangerous activity," ... " ... we need more midwives ... while obstetricians in training will need to have more experience with normal birth, and in the future, restrict their role to that of consultants to midwives ... In this way they can maximize the appropriateness of their surgical training.

"This means rethinking the design of the entire Canadian maternity care system. Finally, if women are to be empowered with the information that they need to dialogue with their providers, new forms of accurate information transfer will need to be developed."