New Statewide Study: Which Childbirth Services Do Women Want?
Nearly four million women give birth in the U.S. each year, and it is the number one reason for all hospital admissions. But hospital satisfaction surveys generally don't include specific questions about women's experiences with their care in labor and delivery, according to researchers at Cedars-Sinai.
"No one was asking pregnant women what was important to them when they came to the hospital to have their babies, or if they even received the care they needed or expected," said Kimberly D. Gregory, MD, MPH, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology.
The project began two years ago when 2,700 pregnant women who — before giving birth — were asked about their values and preferences for their childbirth experience.
Next, Gregory and her team followed up with 800 of those women to see if their expectations and healthcare needs were met.
"We asked them two questions: Did you get what you wanted? And how important was it to you that you got it?" said Gregory, director of Maternal-Fetal Medicine at Cedars-Sinai.
"If hospitals and healthcare providers hear from women about what could improve their childbirth experience, then they are likely to provide better care tailored to their needs while still providing appropriate medical care during labor and delivery."
Now, those findings are being tried at Cedars-Sinai and eight other California hospitals. Hospitals participating in the study run the gamut of diverse patient populations in the nation's most populous state, and include hospitals in urban and rural areas—as well as large academic medical centers and smaller community hospitals.
"If hospitals and healthcare providers hear from women about what could improve their childbirth experience, then they are likely to provide better care tailored to their needs while still providing appropriate medical care during labor and delivery," said Sarah J. Kilpatrick, MD, PhD, chair of Cedars-Sinai's Department of Obstetrics and Gynecology.
One area where changes are being investigated include pain management. The survey results suggested that asking a discharged mother if her pain was well-managed may not be the right question.
"There is always going to be some level of discomfort during childbirth," said Gregory. "Our surveys suggest we should be asking women if they felt they got good help in coping with their pain, rather than if their pain was eliminated during their hospital stay."
Breastfeeding is another topic important to women who leave the hospital with a newborn. While healthcare providers are enthusiastic about the established benefits of breastfeeding, Gregory says the surveys suggest a one-size-fits-all approach may leave some new mothers dissatisfied.
"We found there is a core group of well-informed women who have all the facts and already made a decision not to breastfeed. Some of them feel their choice is not always honored or that they are being harassed or judged by well-intentioned lactation experts," said Gregory.
The Patient Centered Outcomes Research Institute (PCORI) provided $1.13 million in support for the childbirth experience surveys and new pilot project in the hospitals.
Lisa Korst, MD, PhD, and Moshe Fridman, PhD, of Maternal Metrics are research collaborators with Gregory on the study design, implementation and data analysis. The questionnaire was developed by Nielsen, the prominent marketing research firm.
In approximately 18 months, investigators will look into whether any changes that were implemented increased patient satisfaction among new mothers.
"Helping patients have a happy, healthy experience at the hospital is tremendously rewarding work," said Gregory.
DISCLOSURE: Co-investigators Lisa M. Korst and Moshe Fridman own 50% of Maternal Metrics which has filed a preliminary patent application for analytics being used in the study. They could receive future royalty income from intellectual property related to this research. Principal Investigator, Kimberly Gregory, MD, has no financial conflict of interest.
PCORI: PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.
Photo by Cedars-Sinai: Kimberly D. Gregory, MD, MPH, talks with a pregnant patient and her partner about the mother-to-be's healthcare needs.