Session: Women's Choices in Childbirth: Access to Care

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APHA Scientific Session and Event Listing

5178.0: Wednesday, November 08, 2006: 2:30 PM-4:00 PM

Oral

Women's Choices in Childbirth: Access to Care

The cesarean rate in the U.S. reached an all-time high in 2004 of 29.1%. Maternal request cesareans have been proposed as a major contributor to the high cesarean rate with an NIH State of the Science Conference held in March, 2006 entitled, “Cesarean Delivery on Maternal Request.” However there is very little direct information on mother's attitudes toward cesarean birth. This presentation will examine data from Listening to Mothers II, a national survey of 1574 mothers who gave birth in 2005.This session will address a number of issue that affect women's rights in child birth and the trends that are happening currently. The White Ribbon Alliance (WRA) is an international coalition of organizations who advocate for increased public awareness of safe pregnancy and delivery. Following Katrina, the group focused its efforts on what lessons could be learned in caring for pregnant women, new mothers and fragile newborns in a crisis or emergency. The WRA has developed the Women and Infants Service Package, or WISP. The WISP is a set of guidelines that outline the minimum, initial actions needed to respond to the essential health care needs of pregnant women and new families in a natural disaster, epidemic, or terrorist event. The WISP is not just equipment and supplies; but a set of activities implemented in a coordinated manner by appropriately trained personnel. This session will study synthesized research findings from 40 qualitative studies. The interpretation of the collective studies revealed a dynamic construction of the practice of midwives in the United States. It reflects the conflict between two socially and culturally defined world views of birth and women’s role in the process. The conflict between the worldviews sets the stage for barriers to the midwifery profession, including legal and financial threats to autonomous practice and the support of normal birth. The conflict is managed by skillful maneuvers of the midwives aimed at constructing a practice that articulates with the majority perspective, while artfully preserving and protecting the philosophical stance of midwives.

Learning Objectives: 1. Describe the special challenges that face pregnant women, new mothers and fragile newborns in a crisis or emergency. Describe the Women and Infants Service Package as developed by the White Ribbon Alliance.2. Participants will be able to identify risk factors for mothers choosing elective cesarean sections Participants will be able to list attitudes toward maternal request cesareans and how they vary by key subgroups. 3Participants will be able to identify The current cesarean surgery rate is acceptable and that an optimal rate cannot be determined, elective primary cesarean surgery is as safe or nearly as safe as planned vaginal birth. Participants will be able to: 4. Articulate the findings of a metasynthesis on modern US midwifery;Describe the effects of practice conflict on the profession of midwifery;Identify specific examples midwives across the studies to manage practice conflict; Discuss how their examples of practice conflict can influence day to day practice for the participants in the audience; Strategize potential avenues to establish a solid future for the profession.

Organizer(s):

Barbara Levin, MD, MPH
Carol A. Nelson, LM, CPM
Ceclila Wachdorf, CNM, PhD

Moderator(s):

Barbara Levin, MD, MPH

2:30 PM

Introductory Remarks

2:35 PM

Myth of the Maternal Request Cesarean: Exploring Mothers Attitudes Toward Cesarean Birth
Eugene Declercq, PhD

3:00 PM

White Ribbon Alliance:Women and Infants Service Package(WISP): Planning for Emergencies