Listening to Mothers in California

A new report, Listening to Mothers in California, was released last week and there is valuable information for both consumers and birth professionals to be found from this research.  Listening to Mothers surveys are not new.  Childbirth Connection, a part of the National Partnership for Women & Families, has released three national surveys on the childbearing year before this new state one, the first in 2002 and the last national survey in 2013.  Listening to Mothers surveys describe women’s childbearing experiences from before pregnancy through the postpartum period, and their views about these matters. This is the first survey done on a state level and examines the desires, experiences, and outcomes of families who gave birth in California in 2016. This state-level study was done in collaboration with the California Health Care Foundation and the Yellow Chair Foundation.

How was the survey conducted?

The survey pool of 2,539 mothers was a subset of all people who gave birth between September 1 and December 15, 2016. Respondents needed to be birthing in a hospital, be 18 years old or older, birthing a single baby who was living with their mother and the mother resided permanently in California.  Black women, people with a midwife and those desiring a VBAC were oversampled by the researchers in order to better understand the experiences of the people in these smaller groups. People could respond to the survey online, or by phone with an interviewer.  It was available in both English (81% responded in English) and Spanish (19% responded in Spanish) and took around 30 minutes to complete. You can read the entire survey by following this link.

What were some of the key findings?

• While the vast majority of women used an obstetrician for their prenatal care and births, over half of the women said they would definitely want (17%) or would consider (37%) a midwife for a future pregnancy.
• Three-quarters of California’s childbearing women agreed that childbirth is a process that should not be interfered with unless medically necessary. Black and Latina women, and women with Medi-Cal coverage held this belief most strongly.
• Four in 10 women reported that a health professional tried to induce their labor (starting labor before it started on its own). Three-quarters of women who felt pressured by a health professional to have their labor induced had the intervention.
• Only 1 in 7 women with a prior cesarean had a vaginal birth after cesarean (VBAC), despite nearly half of women with repeat cesareans reporting interest in VBAC. Women with prior cesareans reported that providers disproportionately focused discussions and recommendations on having a repeat cesarean birth.
• One in 5 California women reported symptoms of anxiety, and 1 in 10 reported symptoms of depression during pregnancy. Across race/ethnicity groups, Black women were on the high end of the range for symptoms of anxiety and depression, during and after pregnancy.
• About 1 woman in 3 planned to stay home with their babies. Within 4 months of the birth, more than 4 in 5 women with a paid job at the time of the survey reported they were working for pay. Among women who assumed a paid job, fewer than half said that they had stayed home as long as they liked.

Black families experienced more interventions

Additionally, it was heartbreakingly clear from the survey results that People of Color, in particular, Black parents were more likely to receive more interventions and less care associated with best practice along with more disrespectful care.  For example, Black parents were less likely to be skin to skin with their newborn immediately, more likely to feel that they received unfair treatment from providers, were less likely to be exclusively breast/chestfeeding at six months, experienced higher rates of cesareans, had less choice of providers for their care, and much more.  Health inequities that unfairly target Black families played a large role in both the type of care received and what they experienced during the childbearing year. From the report website, you can access Issue Briefs that further report on the experiences of Pacific Islanders/Asians, Latinas, and Black families. 

Childbirth education was not examined

Childbirth education was not assessed in the Listening to Mothers in California survey. This is a missed opportunity to connect childbirth education preparation with outcomes and determine if those families who received perinatal education through online or in-person classes achieved different results.  It would be great to see this examination in both future national and state-level studies.

Learn more in an upcoming webinar

The Listening to Mothers in California survey is an amazing repository capturing the experiences of pregnant, birthing and postpartum people in California. To meet the needs of the diverse number of people who are interested in the survey results, they are available through many resources, including: data snapshot of highlights (and grab and go data snapshot charts), full survey report in PDF and interactive digital formats, infographic on overmedicalization, issue briefs on experiences of women of color, facts sheets (on care arrangements, cesarean birth and maternal mental health), brief videos and overview of survey methodology. Start here to access all this material.

The Listening to Mothers in California team is offering a webinar on Thursday, September 20, from 12–1:00 PM (PST) in order to discuss key findings from the survey. Presenters will include Carol Sakala, PhD, director of Childbirth Connection programs at the National Partnership for Women & Families, and Eugene R. Declercq, PhD, professor of community health at Boston University, who led the survey team. The event is designed for anyone interested in the health and health care of childbearing women and infants. You can register for this webinar here

Interview with Survey Lead Dr. Sakala

I conclude my coverage of this fascinating survey with an interview with Survey Lead Researcher, Carol Sakala, PhD, to answer some additional questions and share some custom insight of interest to our blog readers.  Please look for this interview on Thursday, September 20, on the blog.

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