1 Mothers’ Support Options During Childbirth: A Survey of Hospital Obstetrical Units in the Southeastern Region of the United States Hila J. Spear, RN, PhD, IBCLC Liberty University Centra Health

2 BACKGROUND D espite the longstanding trend for family-centered obstetric care and a national cesarean rate of 27.6%, anecdotal reports indicate that some institutions still maintain rigid policies regarding support options of childbearing women, particularly those who experience cesarean delivery. However, no studies have been done that assess related obstetric care practices across hospitals, regardless of mode of delivery, or that provide evidence for such practices.

3 OBJECTIVE AND DESIGN  To examine mothers’ support options during childbirth and to describe policies, protocols, and related rationales of hospital- based birthing centers regarding the presence of support persons during labor and both vaginal and non-emergent cesarean births.  Descriptive telephone survey.

4 SETTING & SAMPLE  Alabama  Florida  Georgia  Kentucky  Louisiana  Mississippi  North Carolina  South Carolina  Tennessee  Virginia  West Virginia Hospitals located in the Southeastern region of the United States [N=154 - obstetric nurse managers or their designees]

5 RESULTS Selected Demographics [N=154] VariableYes (%) No (%) Lactation Consultants 7426 Baby Friendly 694 Magnet Status 1189 RangeMean Ages of Participants Annual Number of Births Overall Cesarean Rate13%-40%27.7% Epidural Rate40%-99%71.3%

6 RESULTS  Hospitals allowed two to an unlimited number of support persons during vaginal childbirth. A few (11%) hospitals allowed two support persons during cesareans, and some (18%) facilities that permitted only one support person made exceptions if approved by the obstetrician and anesthesiologist.  More than half (58%) of the participants stated they believed mothers should be allowed to two support persons during cesarean births; ten (7%) obstetric units allowed mothers to have one significant other present during her cesarean if general anesthesia was used.

7 RESULTS Rationales for “one support person only” policy during cesarean births KEY: 1.Space limitations in OR 2.Safety/Risk for Infection 3.Tradition/Physician Preference 4.Unknown 5.Other

8 RESULTS Excerpts from Qualitative Data [verbatim comments] I don’t care how many people are in the room. Some want to limit the number of people to only one or two [during labor and vaginal delivery]. Though rare, I’ve assisted two mothers with breastfeeding while they were still in the OR after undergoing a cesarean. Having a baby is a special time. If a mom wants her sister and the baby’s father with her during her cesarean, she should be able to. We do not allow family members to observe open-heart surgery, so we should not allow extra people in the OR during c-sections.

9 RESULTS Breastfeeding support for mothers who experience cesarean births Options AvailableYes (%) No (%) Breastfeeding in Recovery Room7723 Breastfeeding in Operating Room3169

10 SUMMARY/IMPLICATIONS O verall, the results of this descriptive study are encouraging and provide baseline information about maternity care across the southeast region of the U.S. Without exception, participants described their hospital’s maternity services as family centered. Most policies related to mothers’ childbirth support options were family friendly. However, some practices were restrictive from a patient and family perspective and driven by tradition and the preferences of health care providers.

11 SUMMARY/IMPLICATIONS W omen who experienced vaginal births generally received maternity care designed to meet their complex psychosocial and physical care support needs. Considering trends regarding the decline of vaginal birth after cesarean and the rising number of surgical deliveries, it behooves obstetric care professionals to rethink policies that may impede a family approach to care for mothers who birth by cesarean. The American Pregnancy Association recommends that mothers be allowed to have two support persons during the event of cesarean childbirth.

12 RECOMMENDATIONS  There is a need for primary research study regarding current family-centered practices, particularly related to cesareans.  Surveying obstetricians and anesthesiologists about their beliefs and attitudes relevant to mothers’ support options during childbirth is recommended.  Investigations similar to this study that examine maternal support policies and practices of hospital-based obstetrical units in other geographical locales are recommended.