Canadian women receiving extra ultrasounds: maternity report
Last Updated: Tuesday, March 24, 2009 | 3:55 PM ET
CBC News
About 80 per cent of women surveyed said their experience with labour and birthing was positive. (CBC)Canadian mothers are satisfied with their labour and birthing experience, but they could be receiving more ultrasounds and fetal monitoring than necessary, says a federal study released Tuesday.
The Public Health Agency of Canada's Maternity Experiences Survey involved 6,421 women and was based on interviews by Statistics Canada.
About 80 per cent of mothers who were interviewed between five and 14 months after giving birth said the overall experience was either "very positive" or "somewhat positive."
Nearly all, 99.8 per cent, said they had at least one prenatal ultrasound, and the average was three per pregnancy.
For a normal pregnancy, guidelines in Canada support a single ultrasound to be offered at 18 to 19 weeks in conjunction with a discussion of its benefits, limitations and safety. The World Health Organization recommends ultrasound on indication only, or one at about 18 weeks.
More than 90 per cent of the mothers interviewed reported having some fetal monitoring during labour and two-thirds reported continuous monitoring, despite evidence supporting intermittent monitoring for normal labour, the report's authors said.
"A number of interventions for which current evidence recommends use 'on indication' but not routine use are being reported with considerable frequency by women in Canada," they wrote in an executive summary.
Other such procedures including episiotomies, inducing labour and speeding labour, were also routinely reported.
Mothers also reported birthing practices such as shaving, enemas and stirrups that are no longer supported by clinical evidence.
Other findings included:
- Half of those surveyed said the timing of their conception was just right, while 23.4 per cent said they would have preferred to conceive earlier, 20 per cent later, and 7.1 per cent not at all.
- 89.7 per cent of women took folic acid supplements during the first three months of pregnancy and 57.7 per cent took the supplements in the three months prior to conception.
- More than one-third of women had a high body mass index before pregnancy, with 21 per cent considered overweight and 13.6 per cent as obese. Six per cent were classified as underweight.
- More low-income women (92.3 per cent) than higher income women (88.2 per cent) reported drinking no alcohol during pregnancy.
- 97.2 per cent of births occurred in hospitals or clinics.
- 69.6 per cent of births were attended by an obstetrician or gynecologist, 14.6 per cent by a family doctor, 4.7 per cent by a nurse or nurse practitioner, and 4.3 per cent by a midwife.
- Breathing exercises (74.1 per cent) and changing position (69.5 per cent) were the most commonly used medication-free techniques for pain management among women with a vaginal birth or who attempted a vaginal birth.
- Most women, 81.1 per cent, who had an epidural or spinal anesthesia believed it was "very helpful."
- 26.3 per cent of women had caesarean births.
Territorial differences
Under the heading "Emerging issues," the report's authors highlighted that although women in Nunavut made up a small proportion of participants in the study, these mothers reported less smoking, more abuse and more symptoms pointing to postpartum depression, and less satisfaction with their maternity experience and less folic acid supplementation before conception.
It's not known how much factors such as younger age, poverty and geographic isolation contributed to these findings, the report's authors said.
On the other hand, mothers in Nunavut reported relatively high rates of skin-to-skin contact within five minutes of birth and exclusive breastfeeding for six months after birth.
Use of medical interventions and technology, such as electronic fetal monitoring, labour induction and medication-based pain management in labour and birth, was higher in the provinces than in the territories.
The agency also produced a booklet summarizing the results and relevant research for women as part of the study.
In January, several Canadian medical groups released a policy statement saying medical interventions like caesarean deliveries shouldn't be routinely done for low-risk pregnancies.
