Executive Summary: Emerging Issues: What Mothers Say: The Maternity Experiences Survey

Executive Summary - Emerging Issues

In general, most Canadian women in this survey reported a positive overall experience of labour and birth. They also reported high levels of satisfaction with the care they received from their health care providers throughout pregnancy, labour and birth, and with the care that they and their baby received after the birth. Canadian women’s reports of their maternity experiences have also underscored a number of important issues. These include:

Pregnancy, Labour and Birth Interventions

A number of interventions for which current evidence recommends use “on indication” but not routine use are being reported with considerable frequency by women in Canada. For example, most women had more than one prenatal ultrasound and many women reported continuous use of electronic fetal monitoring despite evidence supporting intermittent auscultation in normal labour. Episiotomies, as well as starting and speeding up labour, were also frequently reported. In addition, some practices were reported that are not supported by clinical evidence, including a supine position for birth and the use of stirrups, enemas, shaving and pushing on the abdomen to help push the baby down during vaginal birth. Increased implementation of evidence-based clinical practices is required to address the overuse of these procedures.

Breastfeeding

Exclusive breastfeeding rates for the first six months after birth, as per Canadian public health recommendations, are much lower than desirable. Preparation of mothers for breastfeeding and breastfeeding initiation rates are relatively high. However, these occur alongside practices that are not consistent with the BFHI, including providing mothers with free formula samples, giving pacifiers to babies, schedule-feeding babies, not following optimal rooming-in recommendations and initiating breastfeeding too early after the birth. Greater effort to support breastfeeding is required, including promoting adherence to the BFHI, which has been shown to increase breastfeeding duration and exclusivity.

Regional Variation

The MES findings show marked differences among the provinces and territories regarding several aspects of women’s experiences during pregnancy, birth and postpartum. For example, the use of medical interventions and technology, such as electronic fetal monitoring, labour induction and medication-based pain management in labour and birth, was higher in the provinces than in the territories. Further research is required to determine whether this is due to health care policies in these regions, local practices or beliefs that promote or discourage more traditional/less interventionist births, variation in the availability and distribution of health care resources, sociodemographic characteristics or other reasons.

Mothers in Nunavut

Women in Nunavut constituted a small proportion of all the women who participated in the MES. Nevertheless, a number of the findings for Nunavut are of concern. For instance, women in Nunavut reported having less information on pregnancy-related topics, more smoking, more abuse, and more symptoms suggesting postpartum depression than other women. They reported less satisfaction with their maternity experiences, less folic acid supplementation in the periconceptional period and less use of a supine sleep (back to sleep) position for their baby. Women in Nunavut were also less likely to have a husband or partner present during labour and birth, or to report that their baby was in excellent health. The extent to which factors such as younger maternal age, lower socio-economic status and geographic isolation contribute to these findings is as yet unquantified. At the same time, some maternity experiences reported by women in Nunavut are encouraging. For instance, they reported relatively high rates of maternal-infant contact and skin-to-skin contact within five minutes of birth as well as exclusive breastfeeding at six months after the birth. Given the lower than anticipated MES response rate in Nunavut, further study of women’s experiences in this territory is needed to validate and explore these findings.

Younger Mothers (15–19 years) and Mothers of Low Socio-economic Status

Also of concern are younger mothers, mothers with lower educational levels and mothers living in a household at or below the low income cut-off. For instance, compared with other women, these women frequently reported less favourable maternity experiences, such as abuse, stress during pregnancy and symptoms suggestive of postpartum depression. Women in these groups were also more likely to report not having enough information about maternity-related topics. Younger mothers and mothers with low socio-economic status should be given particular attention when developing maternal health policies and programs.

Awareness of Healthy Practices

Compared with before pregnancy, lower reported rates of smoking, alcohol and street drug use during pregnancy indicate that women in general are aware that these behaviours pose a risk to their developing baby. Women were also well informed about sudden infant death syndrome and placing their baby to sleep on their back. In contrast, more than one-third of women had a high body mass index before becoming pregnant, and women seemed less informed about the benefits of folic acid supplementation prior to conception in reducing some birth defects. Women need to continue receiving information and support in these areas.

 

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