What women want during labor may surprise you.(Obstetrics)

SAN FRANCISCO -- How women rate their childbirth experience and how health care workers view childbirth frequently diverge, Tekoa L. King said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

The disparity points to "a communication chasm that may underscore some of the current malpractice epidemic," said Ms. King, a certified nurse-midwife and a member of the ob.gyn. faculty at the university. Clinician ratings of labor pain matched patient ratings only 51% of the time in a study of 255 patients and their caregivers that was published in 2000, she noted. Clinicians also regard C-sections more favorably than do pregnant women, other studies have shown.

Ms. King discussed the results of two studies that highlight this problem.

One study polled pregnant women prior to labor to determine their expectations. The women expected that 21% of the nurses' time would be spent in technical direct care (such as changing bed sheets or moving the mother to the delivery room). The women expected another 21% of the time to be used for indirect care (such as talking to physicians or checking intravenous lines).

In addition, they expected that the nurses would spend the majority of their time (53%) in activities such as emotional support, attention to their physical comfort, providing information, or advocating on their behalf.

The second study, which categorized 616 interactions between laboring women and nurses, described a setup for disappointment. Only 9.9% of the nurses' time was devoted to supportive activities. Forty percent of their time was devoted to technical direct care and 42% was spent in ...