Webinar — Key findings from the Listening to Mothers in California Survey

The webinar, led by Stephanie Teleca from the California Health Care Foundation, introduces the 'Listening to Mothers' survey focusing on maternity care in California. It seeks to improve maternity care by understanding women's preferences and amplifying their voices through a statistically valid survey. Key preliminary findings indicate a lack of healthcare system attentiveness to women's needs and highlight disparities in listening to Black women, affecting their health outcomes.

Dr. Carol Sakala and Dr. Jean de Klerk, leaders of the research, are introduced. The survey is the first-of-its-kind state survey in California, building on national experiences. It employed rigorous methodologies, including using birth certificates for sampling and data weighting. Over 2,500 women were surveyed to collect comprehensive data reflecting their maternity experiences. The results are intended to guide improvement in maternity care and policy.

The survey explores information-seeking behaviors and provider choices. Many women sought information about care providers and hospital cesarean rates, but few understood that maternity care quality varies significantly. While most women used obstetricians, a notable number, especially among different ethnic groups, considered midwives and doulas for future births, highlighting a gap between interest and actual access to high-value maternity care options.

Findings reveal an untapped interest in midwives, doulas, and alternative birth settings like birth centers and home births. Discrepancies between current use and potential interest suggest opportunities for expanding and promoting these care models. Despite preferences for midwifery and doula support, access remains limited, indicating a need to increase system capacity and availability to align with women's preferences for less invasive, more personal care.

The discussion on medical interventions during childbirth shows a high rate of procedure-intensive experiences, contrasting with women's preference for minimal intervention births. Procedures like labor induction and epidurals are common, yet preference for drug-free pain relief and non-medical interventions like mobility during labor remains high among women, indicating a significant gap between preferred and actual care practices.

Data is presented on cesarean births, highlighting areas for potential reduction, such as promoting vaginal births after cesarean (VBAC) and delaying hospital admissions. High cesarean rates, particularly among black mothers and those with Medi-Cal, signal areas needing attention. Shared decision-making is identified as lacking, with more emphasis placed on repeat cesarean discussions rather than exploring VBAC options.

Focus on disparities reveals that black and other minority mothers report higher incidences of feeling treated unfairly due to race, language, or insurance type. Disrespectful treatment remains a significant issue, with black mothers notably reporting the highest levels of unfair treatment. There is strong provider pressure to accept interventions, leading to medical outcomes not necessarily aligned with mothers' preferences.

The survey also delves into postpartum experiences, highlighting disparities in postpartum visit attendance, especially among Medi-Cal beneficiaries. Many women lack emotional and practical support, impacting their postpartum recovery and experiences, with black and Latino women reporting the lowest levels of support. Breastfeeding rates vary significantly, with white mothers more likely to breastfeed exclusively for six months compared to black and Latino mothers.

Maternal mental health issues are common, yet inadequately addressed, with significant gaps in receiving necessary counseling or treatment. Although high levels of anxiety and depression are reported both during and after pregnancy, access to mental health support is limited. Black mothers are particularly affected, underscoring the need for improved screening and treatment options for maternal mental health conditions.

Resources related to the survey are presented, including detailed reports, data snapshots, issue briefs focusing on specific ethnic experiences, and other materials aimed at policymakers and health professionals. These resources aim to facilitate the adoption of practices that are more aligned with women's preferences and improve overall maternity care quality.

The Q&A session addresses audience questions on topics such as low awareness of midwife and doula services, potential improvements in provider-patient communication, and disparities in treatment and care. Insights into the systemic and cultural barriers that prevent women from accessing preferred care options highlight the complexity of maternity care issues and the need for broad systemic reforms to address identified gaps and improve outcomes.