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Is no patient education to blame for bad birthing experiences?
Most pregnant want more information about childbirth, but poor patient education is limiting their options for a good maternity care experience.
Patient education during pregnancy and childbirth is sorely wanting, leaving pregnant people disempowered in their options for a good maternal health experience, according to a new Harris Poll.
The third iteration of the "State of Maternal Health 2025" report was based on survey responses from 2,370 adult women, representing a mix of individuals who have and have not been pregnant/given birth.
Overall, it found that the maternal healthcare experience has significant room for improvement. In addition to the 72% of respondents who said maternity care is designed for the health system and not the patient, 40% said they felt like "just another number" at their OB/GYN or midwife's office.
Meanwhile, getting adequate access to care was a fight, with 41% of respondents saying they experienced a pregnancy/birth care access barrier and 62% saying they had to "fight to get the medical care" they ended up getting. That all comes as pregnant people face more health complications during pregnancy, with 61% saying they were diagnosed with at least one condition while they were pregnant.
Many of the biggest patient experience hangups can be linked back to limited patient education, according to Christina Lojek, a research manager at the Harris Poll.
"Too many women have gone through the pregnancy journey without the proper information, support, and follow-up care they so rightfully deserve, and I say this as one of those women," Lojek said in a statement. "Findings show the current system is gravely failing to meet the needs of expectant mothers, and this is especially true in regard to mental health, postpartum care, and general education around childbirth."
With the U.S. having the worst maternal mortality rates in the developed world, it is incumbent upon industry experts to reconsider strategies to support pregnant and birthing people. Better care access and patient education will be essential to empower pregnant individuals in a more positive maternal experience, but as the Harris Poll shows, those resources are scant.
Maternity patient education left wanting
When it comes to pregnancy and the birthing experience, women aren't getting the information they say they want and need.
According to the survey, 45% of women didn't get enough information about counting kicks, something experts says can help prevent stillbirths. Another 34% said they didn't get information about the labor shortages affecting many birthing teams.
Notably, 53% of women said they didn't get enough or any information about less invasive pain management options, which can have a direct impact on the birthing experience, while others said they were left in the dark about other labor and delivery decisions that can affect outcomes.
This is notable, as most healthcare experts agree that patient education is the core driver of patient empowerment. Birthing people who do not have enough information about their options and their potential outcomes are not able to participate in their ideal birthing experience.
For example, discussion about birthing position is often left by the wayside. Certain birthing positions, such as laying on one's back, can come with complications such as reduced blood flow to the baby, but only 66% of respondents knew this. Around half (54%) of women said they didn't receive enough or any information about birthing positions.
As a result, most respondents who've given birth (75%) have done so laying on their back, despite evidence that there could be more optimal positions.
Patients left unprepared for their births
The lack of information provided during pregnancy has contributed to poor birthing experiences. Six in ten women who've been pregnant said they felt unprepared for their first birth, and 56% said they'd make different choices if they could have their first pregnancy again.
This is, in part, because women aren't getting the right amount of patient education as part of their maternity care.
But it's also because many don't feel as though they have an advocate during the care journey. Thirteen percent said they didn't feel heard by their provider during their visits, and 30% said they didn't feel in control of their labor and delivery. For 17% of respondents, the labor and delivery process would have been easier if they had someone who would've listened to and heard them.
Notably, patients who visited with a midwife as part of their care team had a better experience. Compared to those solely seeing an OB/GYN, patients seeing a midwife were more likely to say their provider explained all aspects of labor and delivery and that they were aware of the risks and benefits of certain interventions.
These findings could indicate a need for better care team integration. Policies for collaboration between the OB/GYN team and midwife/doula team can vary by hospital. Meanwhile, different states have varying policies regarding midwife/doula reimbursement, meaning cost could prohibit access for some.
But it's not just access to different types of care team members. OB/GYNs might integrate some of the patient advocacy and relationship-building strategies that make connections with a midwife meaningful. Moreover, better policy standards to enable OB/GYNs to forge these deeper relationships will be essential.
Patients report limited support in postpartum period
Although patients largely give middling reviews of their maternity care experiences, the postpartum period is an outlier -- and not in a good way. Around a quarter said their postpartum care was less than adequate and 43% said it was only adequate.
That's because many postpartum patients said they don't get enough support from the healthcare system. Specifically, 77% said there isn't enough focus on healthcare for new mothers, and two-thirds said they feel forgotten after birthing their child. Another 84% said they want more follow-up care during the postpartum period.
What's more, mental health during the postpartum period might be reaching a crisis point, the survey authors added. More than half of respondents who've been pregnant said they didn't have enough information about postpartum depression. And although two-thirds of women who've given birth experienced postpartum depression, 56% said they had subpar or no support.
This trend was particularly pronounced in those visiting with an OB/GYN.
Promoting a better maternal health experience
If healthcare wants to support better maternal health experiences and outcomes, experts will need to create better support for patients, the survey revealed. Indeed, the number one factor that could've improved experiences was having an advocate listen to and speak up for them.
Better patient education will also be crucial, as birthing people express a need to have more autonomy and empowerment during their labor and delivery experience.
"The data compel a profound reevaluation and restructuring of maternal healthcare practices in America in order to drive significant improvements in the outcomes for mothers and their children," the report authors concluded. "More comprehensive, patient-centered care models are needed that encompass mental, physical, and educational support throughout and beyond pregnancy."
Sara Heath has reported news related to patient engagement and health equity since 2015.
