The document summarizes key findings from three national surveys on mothers' experiences with pregnancy and childbirth. It finds that while many mothers use online sources for information, they rate their healthcare providers as the most trustworthy sources. However, many mothers report not receiving sufficient information and guidance from providers about options for procedures like cesareans and inductions. The surveys also identify gaps in mothers' knowledge about issues like breastfeeding recommendations and complications of different birthing methods. Overall, the surveys provide insights into how to better support informed decision-making and improve the quality of maternity care in the US.

1. transform.childbirthconnection.org | www.childbirthconnection.org
Health Care Consumer Information Sources:
Lessons for Advocates from a Two-Stage
National Survey
Carol Sakala, PhD, MSPH
Childbirth Connection
Consumers United for Evidence-based Healthcare
2013 Annual Membership Meeting
July 26, 2013
Washington, DC

2. transform.childbirthconnection.org | www.childbirthconnection.org
Childbirth Connection
• National non-profit organization in New York City
• Since 1918, working to improve maternity care quality on
behalf of women and families
• Mission is to improve the quality of maternity care
through consumer engagement and health system
transformation
Learn more: http://www.childbirthconnection.org/pdfs/90-year-timeline.pdf

3. transform.childbirthconnection.org | www.childbirthconnection.org
National Listening to Mothers
Surveys
All 3 sponsored by Childbirth Connection, conducted by Harris Interactive
Core continuing investigator team: Eugene Declercq, Carol Sakala, Maureen
Corry, Sandra Applebaum
Core methodology
• online (and in LTM I and LTM II telephone) participation of eligible women
• programmed computer interface with quality control checks
• data weighting
• propensity score for propensity to be online
• using demographic targets derived from national birth certificate files
http://www.childbirthconnection.org/listeningtomothers/
http://transform.childbirthconnection.org/reports/listeningtomothers/

4. transform.childbirthconnection.org | www.childbirthconnection.org
Listening to Mothers Surveys
Surveys collectively provide opportunity to monitor trends over time
with core continuing questions and explore timely new subjects
Survey
Year(s) of
births
Number of
Participants*
Participation
Method
Included
Settings
Follow-up
Survey
LTM I 2001-2002 1583
Online and
phone
All
settings**
No
LTM II 2005 1573
Online and
phone
Hospital
only
Yes
LTM III 2011-2012 2400 Online
Hospital
only
Yes
* All: 18-45, could participate in English, singleton birth living at time of survey
** Included 1% who gave birth in a birth center and 1% who gave birth at home

5. transform.childbirthconnection.org | www.childbirthconnection.org
Valuing and Trusting Information
Sources

6. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Ratings of Recently Used Pregnancy and
Childbirth Information Sources as “Very Valuable,”
by Childbearing Experience

7. transform.childbirthconnection.org | www.childbirthconnection.org
Value of Selected Online Resources as Sources
of Information About Pregnancy and Birth

8. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Ratings of Trustworthiness of Possible
Pregnancy and Childbirth Information Sources

9. transform.childbirthconnection.org | www.childbirthconnection.org
Electronic Information Channels

10. transform.childbirthconnection.org | www.childbirthconnection.org
Electronic Devices Used by Mothers During Typical
Week, and Ratings as Source of Pregnancy and
Childbirth Information
Device
% using during
typical week
Base: all mothers
n=2400
Of those using,
% rating as
“excellent” source
Base: varies
Laptop or desktop computer with Internet
access
82% 64%
Smartphone with Internet access 64% 43%
Tablet computer with Internet access 35% 46%
Regular mobile phone with text messaging
capability and Internet access
33% 22%
iPod Touch with Internet access 21% 42%
Used none of the above in a typical week 1% n.a.
(choose all that apply)

11. transform.childbirthconnection.org | www.childbirthconnection.org
Information Sources

12. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Reasons for Choosing
Maternity Care Provider or Group

13. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Reasons for Choosing
Hospital for Giving Birth

14. transform.childbirthconnection.org | www.childbirthconnection.org
Childbirth Education Classes in Recent and Any
Past Pregnancies, by Childbearing Experience
First-time
mothers
n=977
Experienced
mothers
n=1423
All mothers
n=2400
Yes in current pregnancy 59% 17% 34%
No, not in current pregnancy 41% 83% 66%
No, not in current pregnancy
but took class before
n.a. 32% 19%
No, never took classes 41% 51% 47%
* p < .01 for difference between first-time and experienced mothers

15. transform.childbirthconnection.org | www.childbirthconnection.org
Provision of Information on Key Topics,
by Type of Birth Attendant

16. transform.childbirthconnection.org | www.childbirthconnection.org
Shared Decision Making after
Cesarean?
Base: had had 1-2 c-sections and provider mentioned having repeat c-section
Talked with maternity care provider about the reasons to schedule another
cesarean “some” or “ a lot”
77%
Talked with maternity care provider about the reasons not to schedule another
cesarean “some” or “ a lot”
38%
Maternity care provider explained that there were choices in how to give birth
after a previous cesarean
73%
Talked with maternity care provider about the option of planning a vaginal birth
after cesarean (VBAC) “some” or “a lot”
38%
Maternity care provider expressed an opinion about whether or not to schedule
another cesarean
72%
Maternity care provider thought mother should schedule another cesarean
(among those who expressed opinion)
88%
Maternity care provider asked whether or not mother wanted to schedule
another cesarean
76%
Made the final decision whether or not to schedule another cesarean
(% mother’s decision/% provider’s/% shared decision)
40/21/39
Knowing then what you know now, would definitely make the same decision
about whether or not to schedule another cesarean
63%
Percent of mothers in series who gave birth by repeat cesarean 93%

17. transform.childbirthconnection.org | www.childbirthconnection.org
How Much Provider Talked About Reasons
to Have and Not to Have Repeat C-Section
3%
40%
20%
23%
35%
18%
43%
20%
Reasons for repeat cesarean Reasons against repeat cesarean
A Lot
Some
A Little
Not At All
Base: had 1 or 2 prior cesareans and provider mentioned possibility of having a repeat
cesarean n=322
See: Fowler et al. How patient centered are medical decisions. JAMA Intern Med 2013:1215-21

18. transform.childbirthconnection.org | www.childbirthconnection.org
Impact of Information

19. transform.childbirthconnection.org | www.childbirthconnection.org
Impact of Searching Online for Health
Information During Pregnancy

20. transform.childbirthconnection.org | www.childbirthconnection.org
Knowledge Assets and Deficits

21. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Awareness of Breastfeeding
Recommendations from the American Academy
of Pediatrics

22. transform.childbirthconnection.org | www.childbirthconnection.org
Attitudes Toward Maternity-Related Tests
and Treatments

23. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Identification of Earliest Week in
Pregnancy When It Is Safe to Deliver a Baby
Absent Complications Requiring Earlier Delivery

24. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Knowledge of Cesarean
Section Complications
Increases the chance of
serious problems with the
placenta in any future
pregnancies
n=1200
Lowers the chance
that a baby will have
breathing problems at
the time of birth
n=1200
Disagree strongly 8% 14%
Disagree somewhat 15% 18%
Not sure 38% 37%
Agree somewhat 24% 18%
Agree strongly 15% 12%
A cesarean section…

25. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Knowledge of Labor
Induction Indication
If a baby appears to be large at the
end of pregnancy, it makes sense to
induce labor
n=1200
Disagree strongly 12%
Disagree somewhat 17%
Agree somewhat 32%
Agree strongly 24%
Not sure 15%
How much do you agree or disagree with the following statement
concerning medical induction of labor, that is, using drugs or other
methods to try to cause labor to begin?

26. transform.childbirthconnection.org | www.childbirthconnection.org
Mothers’ Ratings of U.S. Maternity
Care and Health Care Quality

27. transform.childbirthconnection.org | www.childbirthconnection.org
Knowledge to Action?

28. transform.childbirthconnection.org | www.childbirthconnection.org
Maternity Care Practices:
Information and Choice

29. transform.childbirthconnection.org | www.childbirthconnection.org
Key Points
There are many dimensions to health care consumer
information sources
These may vary across clinical areas and consumer groups
There is great potential flux over time
Valid up-to-date surveys can provide valuable insights
This knowledge is crucial for strategy of advocacy groups

30. transform.childbirthconnection.org | www.childbirthconnection.org
Thank you
Carol Sakala, PhD, MSPH
Director of Programs
Childbirth Connection
sakala@childbirthconnection.org
http://transform.childbirthconnection.org/reports/listeningtomothers/