Chapter 2: Executive Summary: What Mothers Say: The Maternity Experiences Survey – Labour and birth

Executive Summary - Findings

Chapter 2: Labour and Birth

Place of Birth

Nearly all births (97.9%) occurred in hospitals or clinics; only 1.2% and 0.8% took place in a private home or in a birthing centre, respectively. Older women and multiparous women had higher proportions of out-of-hospital births.

Travel to Place of Birth

One-quarter (25.6%) of women travelled to another city, town or community to give birth. Overall, 2.5% of women travelled more than 100 kilometres to give birth. This proportion was much higher in the territories than in the provinces.

Birth Attendant

Over two-thirds (69.6%) of women were attended at birth by an obstetrician/gynecologist, 14.6% by a family physician, 4.7% by a nurse/nurse practitioner and 4.3% by a midwife. One-half (49.4%) of women had the same provider during pregnancy and at birth, and the majority (88.4%) of these women believed that it was important to have the same provider. Among women who did not have the same provider during pregnancy and at birth, 42.3% believed that it would have been important to have the same provider.

Type of Birth

About three-quarters (73.7%) of women gave birth vaginally. Cesarean births (26.3%) were more frequent in older women, primiparous women, women with higher levels of education and women living in a household above the low income cut-off. Few women (8.1%) requested a cesarean birth from their health care provider at any point during their pregnancy. This includes 5.3% who were multiparous women with a previous cesarean birth.

Position for Birth

Almost half (47.9%) of women who delivered vaginally reported lying flat on their back at the time of birth. More than half (57.0%) of women with a vaginal birth who were not lying on their side at the time of birth reported having their legs in stirrups.

Starting or Speeding Up Labour

Among women with a vaginal birth or who attempted a vaginal birth, 44.8% reported that their health care provider tried to start their labour with medication or other techniques and 37.3% indicated that their health care provider tried to speed up their labour. Almost two-thirds (65.0%) of women who delivered by cesarean after attempting a vaginal delivery had medication or other techniques to start their labour.

Fetal Heart Rate Monitoring

Among women with a vaginal birth or who attempted a vaginal birth, 90.8% reported having electronic fetal monitoring (EFM) at some time during labour and 62.9% reported having continuous use of EFM. The use of EFM decreased with increasing maternal age and was higher for primiparous than for multiparous women. A small proportion (6.5%) of women experienced exclusive auscultation of the fetal heart rate during labour by stethoscope, Doppler or fetoscope (i.e., EFM was not used at any time during labour).

Shaving, Enemas and Pushing on the Abdomen

Among women with a vaginal birth or who attempted a vaginal birth, almost one in five women (19.1%) reported a pubic or perineal shave and 5.4% had an enema. Thirteen percent (13.2%) of women experienced pushing on the top of their abdomen to help push the baby down during vaginal birth. Primiparous women, women with lower educational levels and those living in a household at or below the low income cut-off were more likely to report these procedures.

Episiotomy and Perineal Stitches

One in five women (20.7%) with a vaginal birth or who attempted a vaginal birth experienced an episiotomy. Two-thirds (64.1%) of women reported having perineal stitches near the opening of the vagina to repair a tear or cut. Primiparous women, women with higher educational levels and those living in one of the provinces were more likely to have these procedures. Just over one-third (35.9%) of women with a vaginal birth or who attempted a vaginal birth reported that they had neither an episiotomy nor stitches.

Pain Management

Among women with a vaginal birth or who attempted a vaginal birth, breathing exercises (74.1%) and changing position (69.5%) were the most frequently used medication-free techniques for pain management in labour or birth. Baths or showers were the medication-free technique with the highest helpfulness rating. Almost 55% (54.8%) of users considered baths or showers to be “very helpful.” Epidural or spinal anesthesia was the most frequent medication-based pain-management technique, reported by 57.3% of women who delivered or attempted to deliver vaginally. Most women (81.1%) who had an epidural or spinal anesthesia believed that it was “very helpful.” There were considerable differences in the use of epidural or spinal anesthesia between the provinces and the territories. About three-quarters (77.0%) of women reported that, prior to labour, they had received enough information on pain-management techniques.

Support in Labour and Birth

The majority of women had their husband or partner with them during labour (94.6%) and birth (92.3%). About one-third (35.5%) of women had a companion other than their husband or partner present during labour or the birth. Younger women (15–19 years) and women living in a household at or below the low income cut-off were more likely to have a companion other than their husband or partner with them during labour or the birth. The majority of women were very satisfied with the support received from their husband or partner, or their companion.

Mother-Infant Contact at Birth

Almost three-quarters (71.9%) of women held their baby for the first time immediately or within five minutes after giving birth. About one-third (31.1%) of women reported holding their baby skin-to-skin at this first contact and fewer than half (45.3%) had the baby in their bed for the first hour after giving birth. Mother-infant contact after birth varied among provinces and territories.

Birth Experiences and Satisfaction with Care

Eighty percent of women reported that their overall experience of labour and birth was either “very positive” (53.8%) or “somewhat positive” (26.2%). More women (71.1%) attended by midwives at birth reported being “very positive” about their overall experience of labour and birth than those attended by other health care providers. About three-quarters of women were “very satisfied” with the respect shown to them (78.5%), the perceived competence of the health care providers (75.9%), the concern shown for their privacy and dignity (75.6%), and with their personal involvement in decision making (72.6%). About two-thirds of women were “very satisfied” with the compassion and understanding shown to them (65.4%) and the information given to them (61.8%) by their health care providers throughout the entire pregnancy, labour and birth.