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Background: This study investigated the surrogates' birth experiences, their levels of emotional struggle at relinquishment, how often they thought about the surrogacy children, and the surrogate–parent relationship dynamics during pregnancy and post‐birth. Methods: Data were collected from 06/2016 to 02/2017 using an anonymous questionnaire. Participants were Canadian gestational surrogates who had completed the process with or without a successful live birth, and who were at various stages of an ongoing surrogacy. For this paper, only a subgroup of cases with a successful live birth was selected for analysis. Results: The data set included 131 births involving 90 surrogates who delivered 157 babies (105 singletons and 26 sets of twins). Their mean age at the time of surrogacy was 31.7 ± 5 years (range: 21‐47y). More than one‐third (37.4%) of the cases were for intended parents who were same‐sex male couples and single men. Surrogates assisting Canadian‐resident intended parents had an overall better birthing experience compared with those assisting nonresidents. There was none or very little struggle with the relinquishment of the baby in 96.9% of cases. Continued contact with parents after the births was reported in 93.0% of cases. Surrogates were significantly more likely to have frequent post‐birth contact with same‐sex and single fathers compared with heterosexual parents and single mothers (76.6% vs 54.3%). Conclusions: Same‐sex male couples and single men can develop a long‐lasting relationship with their surrogates even when no intended female partners are involved. The development of institutional practice guidelines in standardizing surrogacy birth practice is paramount in optimizing surrogates' care. [ABSTRACT FROM AUTHOR]

Attitudes drive practice, perhaps more than evidence The objective of this study was to determine if the new generation of Canadian obstetricians has attitudes differing from those of their predecessors. Employing a cross-sectional, Internet, and paper-based survey, we conducted an in-depth study of obstetricians responding to the Canadian National Maternity Care Attitudes Survey. Of the 800 Canadian obstetricians providing intrapartum care, 549 (68.6%) responded. Participants were stratified by age less than or equal to 40 years compared with those over 40 years; 81 percent of those 40 years or younger were women versus 40 percent over 40 years of age. Younger obstetricians were significantly more likely to favor use of routine epidural analgesia and believed that it did not interfere with labor or lead to instrumentation; were more concerned and feared the perineal and pelvic floor consequences of vaginal birth compared with cesarean section; and were significantly less supportive of vaginal birth after prior cesarean section, home birth, birth plans, routine episiotomy, and routine electronic fetal monitoring as providing maternal or fetal benefits. They were less positive than the older generation about a range of approaches to reducing the cesarean section rate, the importance of maternal choice and role in their own birth, and peer review, and they were more likely to believe that women having a cesarean section were not missing an important experience. No significant generational differences were found for ambivalent attitudes to vaginal breech birth. Younger obstetricians were more evidence-based for some issues and less for others. In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth. (BIRTH 38:2 June 2011) [ABSTRACT FROM AUTHOR]

Background Rates of interventions in labor and birth should be similar across a country if evidence-based practice guidelines are followed. This assumption is tested by comparison of some practices across the 13 provinces and territories of Canada. The objective of this study was to describe the wide provincial and territorial variations in rates of routine interventions and practices during labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods A sample of 8,244 eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census. The sample was stratified by province and territory. Computer-assisted telephone interviews were conducted with participating birth mothers by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took an average of 45 minutes and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Results Provincial and territorial variations in rates of routine intervention used during labor and birth are reported. The percentage range of mothers' experience of induction (range 30.9%), epidural (53.7%), continuous electronic fetal monitoring (37.9%), and medication-free pain management during labor (40.7%) are provided, in addition to the use of episiotomy (14.1%) or 'stitches' (48.3%), being in a 'flat lying position' (42.2%), and having their legs in stirrups for birth (35.7%). Wide variations in the use of most of the interventions were found, ranging from 14.1 percent to 53.7 percent. Conclusions Rates of intervention in labor and birth showed considerable variation across Canada, suggesting that usage is not always evidence based but may be influenced by a variety of other factors. ( BIRTH 39:3 September 2012) [ABSTRACT FROM AUTHOR]