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Evidence Library · How it goes wrong

Nearly half of women hold back, and the commonest reason is the word normal

In a CDC survey of more than 2,400 US mothers, 44.7% held back from raising a concern. The top reason was thinking that what they were feeling was normal.

This is the number the whole of Part 4 rests on. It is the closest thing in the literature to a measurement of what expectation-setting actually does.

44.7%
Held back
From asking a question or raising a concern
28.8%
Thought it was normal
The commonest reason given
21.2%
Were told it was normal
By someone close to them

CDC's own sentence: Approximately one half (44.7%) of all respondents reported holding back from asking questions or discussing concerns. The reasons, in CDC's own words:

Reason for holding back, in CDC's own wordingShare of respondents
thinking that what they were feeling was normal28.8%
feeling embarrassed and not wanting to make a big deal21.5%
having someone close tell them it was normal21.2%
worrying that their maternity care provider might think they were being difficult20.7%

Follow the mechanism. Whatever else expectation-setting does, it sets the level at which you decide a symptom is worth mentioning. Describe more and more as normal, and you raise the bar a woman has to clear before she speaks. That is not a theory. It is the single most common reason American mothers gave for not speaking.

What this survey is, and is notThis is an opt-in consumer panel of US mothers with children under 18, fielded over one week in April 2023. 2,407 responded, a 32% response rate, and 2,402 were analysed. CDC publishes it under its Vital Signs banner, but it is not a probability sample of the country. Describe it as a CDC survey of more than 2,400 US mothers, which is what it is.
Say this out loud"I know this is probably normal. I want it written down anyway."

"I am not asking you to fix it. I am asking you to record that I mentioned it."

"Something feels different from last week and I cannot explain it better than that."
Where this comes from:
253. Mohamoud YA, Cassidy E, Fuchs E, Womack LS, Romero L, Kipling L, et al. Vital signs: maternity care experiences, United States, April 2023. MMWR Morb Mortal Wkly Rep. 2023;72(35):961-967.

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More from Two kinds of expectation

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.