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As an aside, it absolutely amazes me at the disparity between Trusts and hospitals in UK. I had C section and DH stayed with me all day and overnight. I did not realise this is not normally the case. My God if they said he had to leave I would have cried and kicked up such a fuss, all their training in dealing with difficult patients would have been needed!!!!
sabire: That's my b! To have my partner able to stay with me at the beginning and at the end for as long as we need each other!
It is SO important to me that it is worth giving up the epidural.
TBH I'm not really sure what the point of an epidural is from my own experience. I wanted to kill myself at 2cm the pain was so bad, but wouldn't have been allowed an epi.
Things were bad, - but never again that bad throughout the rest of the labour!
It was also important to me that my mum met the baby within hours of being born. He was born at 7:30 and my mum arrived by cab at 10pm and stayed until 2am.
"Sadly, a lot of birth centres do seem to have been built with little or no consideration as to the feelings of women about having to be moved."
There's an ongoing debate in midwifery circles about MLU - whether they should be integrated or stand-alone. The issues are quite complex. I haven't quite got my head around it all yet.
Personally I think all women - high or low risk, at home, in birth centres or in CLU's should be given every chance to labour as instinctively as safety allows - freedom of movement, one to one care, birth environments which are set up to promote active birth etc. I wish that telemetry was on offer for all women who need monitoring and that it wasn't only low risk women in birth centres that were offered the option of staying with their partners after birth..... we've got such a long way to go before birth is truly 'civilised' in this country (I do understand the irony of using that term in relation to childbirth by the way!). I honestly think that all these things improve birth for mothers and babies.
'Yes - I did say that to a certain extent it is down to who you get on the night, but if a mums does have the choice of MLU, homebirth and CLU and they don't want an elective epidural - and the evidence supports the safety of birth at home/MLU - why do so many actively choose a CLU where they won't get one to one care and are LESS LIKELY to get good midwifery care focused on supporting physiological birth?'
That's a really interesting question. I am completely in favour of women having the choice. In terms of MLUs, I think the problem can stem from simple geography. An example: the MLU where I wanted to give birth is attached to a hospital with no maternity services! Therefore you know that if there are complications, you will have to be moved to nearest hospital which can take anything from 20 mins to an hour if there's an event on at Wembley. (It's taken me two hours to do a 15 minute drive when the football's on, and I imagine that an ambulance would still be held up.)
I can understand why women are nervous about this and in fact they are now consulting as to whether to close the unit as it's not being used enough. This is a huge shame. I would be very happy to give birth in a MLU where I knew if there was a problem I could be moved quickly, knowing as I do now how quickly the pain can go from being manageable to agony with no space at all between contractions. Sadly, a lot of birth centres do seem to have been built with little or no consideration as to the feelings of women about having to be moved.
"Not sure also why you think a vaginal birth is less complicated?"
I suppose it depends what you mean by 'uncomplicated' really. Most full term, healthy mums can give birth to a healthy baby without having lots of things 'done' to them and without the involvement of half a dozen highly qualified professionals, anaesthetics and antibiotics!
I'm not quite sure what you think I'm saying about c-section and interventions. The point I have been trying to make all along is that most women don't want interventions in their labour if they feel they can achieve a healthy birth without them.
The best approach is one that results in the highest number of happy, healthy mothers. I personally feel that the evidence does not support high rates of routine intervention and highly medicalised births for a large proportion of low risk mothers as the most direct route to this.
But Sabire, when you talk about women 'setting themselves up for things going wrong,' you are basically implying that it IS a woman's fault when she doesn't have a 'normal' birth. This is what I find so damaging.
Yes - I shouldn't have said this. I think what I meant was that 'women are being set up for things going wrong'.
"And all the factors you talk about to avoid an instrumental birth are indeed down to luck. Excellent midwifery care - well, I'm sorry, but that IS down to luck - it entirely depends whether you had a good midwife at the time."
Yes - I did say that to a certain extent it is down to who you get on the night, but if a mums does have the choice of MLU, homebirth and CLU and they don't want an elective epidural - and the evidence supports the safety of birth at home/MLU - why do so many actively choose a CLU where they won't get one to one care and are LESS LIKELY to get good midwifery care focused on supporting physiological birth?
"Tell me how I could have avoided my instrumental birth, then. I couldn't wait for the birth."
But I didn't say that bad luck is never a factor. You have chosen to read that into my post. You were very unlucky and I'm sorry you had such a bad experience.
Sabire I am very positive and feel very positive about my next c section/epi birth. I also feel lucky that it is a consultant led unit. (Not sure why you added busy, emotive language maybe? because in my experience both units are busy!) Not sure also why you think a vaginal birth is less complicated? I went in, an incision was made and it was all over in 20 minutes with no problems and a happy healthy baby. I intend to give myself a better chance of an uncomplicated birth again by following that process. Can't you see that associating a vaginal birth with positive thinking and less complications is just not true? It is so very individual and we should all go in with a positive but open mind and stop being indoctrinated into thinking one approach is better than the other/more positive than the other etc. The UK has average childbirth mortality rates(except in Lincolnshire where they are diabolical), it is not top of the list. Yet there are countries with higher success and intervention rates and vise versa so I do not think that it is necessarily a good yard stick from which to measure the success of birthing in this country.
But Sabire, when you talk about women 'setting themselves up for things going wrong,' you are basically implying that it IS a woman's fault when she doesn't have a 'normal' birth. This is what I find so damaging.
And all the factors you talk about to avoid an instrumental birth are indeed down to luck. Excellent midwifery care - well, I'm sorry, but that IS down to luck - it entirely depends whether you had a good midwife at the time.
Tell me how I could have avoided my instrumental birth, then. I couldn't wait for the birth. I did all the yoga, all the active birth classes. I booked myself into MLU. I was determined only to use gas and air.
What happened? I went into labour too early for the MLU - luck.
My blood pressure nosedived during labour so I couldn't move - I would have passed out. Luck.
The gas and air made me vomit. Luck.
Cord wrapped round my baby's neck twice so he couldn't get out unaided - luck.
The alternative to my luck theory? It was my fault that I didn't have the birth I wanted. I was stupid and cowardly and couldn't stand the pain. It was my fault that I ended up traumatised and hating my baby. I somehow 'set myself' up for things to go wrong. All my fault.
However, I suspect I'm now arguing from a personal rather than evidence-based stance, so I think I'll stop now. I have found it really interesting reading your posts, though, and hearing about your experiences.
"But in the end, a great deal of what happens in the delivery room is, in a large part, down to simple luck, and will be full of variables you cannot have a hand in."
No - this is simply NOT true. These are the thoughts of someone who sees childbirth as USUALLY complicated, whereas MOST healthy women with uncomplicated pregnancies are actually capable of giving birth without needing loads of interventions. And we should be asking ourself the question - why are so many of low risk, healthy women having such difficult and complicated births? And why does the rate of normal birth vary so wildly between hospitals and other care settings?
Where LUCK really plays an instrumental part in childbirth is in the way you're looked after - having a good midwife, and having access to a birth environment where you'll be given the best chance to labour effectively. Even some of this you can control to some extent, if you have the money to pay for an independent midwife, or a choice of birth centre or midwife led unit.
I look back on my last two labours and feel I had many things working against me: I had gestational diabetes, was carrying large babies, in my third labour I had a previous history of shoulder dystocia and was nearly 40, and I had had a previous forceps birth. I also reacted very badly to pethidine. I've also only had one labour that was a normal length. My other two were three times as long as average. In my case the fact that I got through these births in good health, with no perineal damage, no instruments and a healthy baby was down to really excellent midwifery care -not random chance.
"We are all encouraged to think of birth as something we can completely control"
No - you can't control your labour and you shouldn't even try - it's the one thing that is likely to make things go wrong.
But there are things you can do a lot to give yourself a better CHANCE of an uncomplicated birth. Personally I feel that a first time, low risk mum - especially one who wants a natural birth - who books herself into a busy consultant led unit with a high epidural and c-section rate, where she won't get one to one midwifery care is basically setting herself up for things to go wrong.
For me the main benefit of a positive outlook was to get me through all of the things which did not go remotely to plan when I had DD and in fact went tits up. I personally also agree with Krang that a great deal of luck is involved in the process. I read all the books, had sympathetic IM, etc etc but none of that mattered when the first contractions started. I didn't appreciate at all how different the experience could be from my expectations, despite all my investment in 'preparation' beforehand. I don't think anyone is saying that you should just give up and go back to the GA and the stirrups our grandmothers had in hospital. But any discussion about birth plans, for instance, should start with the caveat that is usually found at the end of these talks: God likes to laugh at our plans. I do think fewer women would feel like failures when things don't work out as they hope from reading all the books beforehand.
At the end of the day, if we all simply wanted the greatest chance of a pain free birth, we'd all book consultant led care with an epidual wouldnt we? But the fact is, most births (I think the stats are around 66%)are without epidural. That has to be for a reason, and my gut feeling is that it's not whacky religious reasons, it's not that most women are masochists, it's simply that most women want to avoid interventions in the birth process where possible.
To be fair, I don't think anyone has suggested a natural delivery makes you a 'better' mother!! I think it's been said many times already, that some mums simply want to avoid the risks of interventions during birth as far as possible (given that, yes, some things will be beyond our control). As you rightly say, the birth is one part of the bigger picture of being a parent, and we all try to take steps to eliminate risks and make other aspects of parenting positive. For many women, this starts with how they look after themselves during pregnancy, avoiding things which could pose a risk. The birth is the next stage, and then the major task of parenting really starts! Why should women not want to maintain a positive approach and try to eliminate risks at all stages of the process?I agree, The method of delivery probably won't have a great impact on their life (though there are risks associated with csection, forceps etc) but I think the kind of birth a woman has can definitely have an impact on how she feels.
Personally I would like to add that the birth is such a small part of the big picture of being a parent. I do not understand why we focus so much on a 'perfect' or 'natural' delivery (though I still maintain my epi and c section was natural for me)... Trust me after years of working with children, how 'perfectly' you deliver your child has little impact on the rest of their lives! Nor does it make you a better mother! Why on earth anyone would think they had failed if they had pain relief, a c section etc. is beyond me. The ultimate aim should be to deliver a healthy baby using whatever means are required, if they are required.
Erm, at no point did I infer that infertile women should 'accept it and move on', and or that 'we should give over everything to luck.' That is a complete misunderstanding of what I said.
I have absolutely no knowledge of the effects of positive thinking on trying to conceive and that has nothing to do with what I am saying here. Kindly do not drag a completely different yet equally emotive situation into this debate.
I shall repeat what I said in simpler words. Of course you can do all the aromatherapy, crawling, acupuncture and conventional pain relief you want - why not? But in the end, a great deal of what happens in the delivery room is, in a large part, down to simple luck, and will be full of variables you cannot have a hand in.
Perhaps you are lucky in that you have a sympathetic midwife attending you. Perhaps you are lucky in that your baby comes very quickly. Perhaps you are lucky in that your blood pressure does not drop for no reason in labour. Perhaps you are lucky in that you get on with the gas and air and it doesn't make you sick. Perhaps you are lucky if you don't, as I did, go into labour unexpectedly a few days too early for the birth centre. Perhaps you are lucky because you go full term and don't give birth very prematurely for no reason that anyone can fathom.
These are all factors that you can do nothing whatsoever to change. Hence, luck, or lack of it.
We are all encouraged to think of birth as something we can completely control - there are so many threads on the 'ideal birth' and the 'dream birth' and 'the only kind of birth I want'. I think this is dangerous. I know. I used to think it. Yes, we can control aspects of it. But some, we can't. We just can't.
Totally agree Jaynz. Why would having a positive attitude NOT conducive to a good birth experience? After all, a positive approach towards many other things in life is seen to be a good thing. You wouldn't go for your driving test thinking 'Oh god, it's going to be awful, something's bound to go wrong'. You don't walk into work every day thinking 'Oh well, today might be shit, i'll just have to trust to luck!' Having a positive attitude is essential to cope with all aspects of life effectively. Of course it doesnt wipe out every possibility of something going wrong - but it sure as hell helps. As Jaynz says - what is it that gets a woman through labour without drugs? My first labour wasnt easy, it was long and hard and painful - but I did it naturally. It certainly wasnt down to luck! It was down to being emotionally prepared for the fact that it would hurt but that unless something unexpected happened, there was no reason why I shouldnt give birth naturally. It was also down to having a wonderful midwife in a MLU who was dedicated, passionate and the EXPERT in delivering babies.
<< The problem with the 'positive attitude' thing is this: your labour, really, has nothing to do with your attitude.......What happens in your labour is down to sheer, blind luck. >>
Krang it's sad that your experiences have led you to really believe this. I agree that information is essential, it's important that women know what a pair of forceps are and what a section involves, but to say this is ridiculous.
What do you think it is that gets women through the pain without drugs? Not luck that's for sure. What about women who have decided they do want pain relief and persist until they get what they need? Is this luck? No, it's women having the attitude that they know what they want and how to get it. This is definately positive.
To say that your whole labour is down to luck undermines women's intrinsic knowledge of what they want and need. Should we just give over everything to luck and not crawl around on our hands and knees trying to turn our posterior babies? Or should we resolve ourselves with the section we don't want because our baby is breech and no-one has the skill/desire to support a breech birth, rather than try acupuncture, and ecv, and webster's technique? And how does this attitude affect the rest of our lives? If we're infertile should we just accept it and move on? I should think the hundreds of threads on ttc would disagree that a positive attitude makes no difference in anything.
Of course sometime things happen that you can't control/change, but this is the minority and even in these cases a positive attitude can be an essential coping mechanism.
Yeah, the reason a) is first is that IME that's the primary reasons for most mums - they just don't want the risk of complications if they can help it. The b) can be an added bonus!
That's an interesting theory Trolleydolley, about the religious thing, though I don't know how much weight it carries - I've certainly never come across a woman who cites Biblical reasons for not having an epidural!! As has been demonstrated on this thread, I think most women who choose the natural route, do it because a) they want to avoid the associated risks of intervention (and epidural in itself is an invasive thing, even if you avoid subsequent interventions) and b) because they understand that natural birth is attainable, and they have a desire to experience it. I don't think the analogy with having a tooth out is comparable at all. Childbirth is fundamentally a totally different process.
Like Anagram I have lived in several countries and have only ever heard of epis in a negative light in this country! In my experience MW are very militant on preaching their views and listing all of the reasons for a 'natural' birth. As my Consultant says natural is whatever it takes for each mother to give birth. My DH is a medical person and I asked him to do a lot of research into epi's etc. He was not able to locate any stats that show an epi birth is more complicated etc. I have problems with spine/pelvis from a serious car accident many years ago and had no ill effects after the epidural and c section. Now if I were to tell you how my MW reacted when I told her my birth plan was a C section...but that is another thread. All I can say is that I am having a Consultant lead birth and am so grateful of her open minded approach. I encountered this openess and rational approach during my previous births from the Consultant lead approach also. I sometimes feel MW are trying to compete/outdo Consultants when in reality they should co-exist more as partners...
Sabire -thank you so much for your experience it's good to hear from someone who's had a similar experience. I too was sick on G&A, off my box on pethadine and totally scared out of my wits when having ds 1. When I found out I was prgt with ds 2 they gave me growth scans every 4 weeks from 24 weeks which sometimes showed ds 2 as 4/5 weeks ahead which scared me even more -these scans were supposed to reassure me I don't trust my body at all and I trust my mind even less after having severe PND after ds 1. I really want a dsc 3 but need to be mentally fit for my 2 children I already have so we really haven't made the final decision yet. Having ds 2 has made me feel I can be a mum and a good one at that so I would love to have more. I think I can only do it by a c-section as I feel no trust with the NHS (not all aspects just target setting/budget constaints that effect every decision they make)
It's very sad that that is the only reason I may not have any more children
muppetgirl - I also have big babies (9lbs 6oz - epidural/pethidine/forceps) 10lbs 12oz and 9lbs 3oz. I'm average height and a size 10.
I remember thinking the same as you after my first birth - that I probably would have died in years gone by as my body made babies that were just too big for me to get out on my own.
I was encouraged to see it in a different way by my independent midwife during my second pregnancy. She pointed out that I'd managed to birth a large baby vaginally (albeit with some help) despite having everything going against me: I'd had an epidural which made it harder for me to push and made it difficult for my baby to get into a good position for birth, I was exhausted from not eating throughout a looooong labour, and I was off my box on pethidine. She said that getting a small, poorly positioned baby out under these conditions would be hard - let alone a large one.
I was saddened that she was the only health professional who I encountered during my second pregnancy who talked to me about the things I could do for myself to facilitate birth with a larger baby. She pointed out that if your baby is on the big side you need all your strength and mobility to get him or her out - and to think through our strategies for coping with labour with that in mind. We talked through birth positions before my labour, and what we'd do if the baby got stuck (as he did - shoulder dystocia - but she sorted it out).
I do think it's incredibly intimidating to know you're carrying a large baby, but with the right sort of help it doesn't always have to be an obstetric disaster - as long as your pelvis is big enough to let the baby through (as yours clearly is - otherwise it would have been a c-section for you with your second: forceps are only used once the baby is a good way down the birth canal).
All that said - if like you I'd had a third degree tear and a forceps birth second time around I think it would have hugely dented my confidence - I can understand how an elective would appeal in those circumstances. And I think most consultants would be sympathetic to your request for an elective c-section.
DS 1 G&A - made me sick, then Pethedine - made me sick, then an epidural which wore off just in time to push.
DS 2 G&A then epidural.
I am not brave, I am very proud that I have 2 beautiful boys who I love very much however they popped out of my body.
I made sure that the first thing I asked my midwife about my impending one was whether they discourage epis in Devon as I had my other 2 in london! She said it should be fine! Hmmmmm how encouraging!
Anyway, I am going to try (or cry) my hardest to get one as I know it will be a better birth for me and ultimately my baby that way.
ds 1 induced, G&A pethadine epidural ventouse as baby was distressed baby 9lb 1oz
ds 2 spontanous labour epidural (worked only down one side) G&A forceps as baby stuck 3rd degree tear -baby 1/2 oz off 10lbs
I'm 5 foot 3 and wouldn't consider having another baby unless I could have a c-section due to 2 awful deliveries. (If that means going private then so be it) I seem to grow big baby's that I can't deliver. I am still having treatment for the damage my ds 2 did to me.
Epidurals were a god send in my experience but I think if you can manage without one fab for you, but if you need one like I did, don't be afraid to ask and have one. Don't be put off by the nursing staff if you feel you can't cope I was told you can have one anytime after 3-4cms dilated as then you are definately in labour. People who look down on you I would feel are lacking in some sort of self esteen that they turn something like childbirth into a competion. Childbirth is natural but dangerous if things go wrong and I am under no illusions that 100 years ago I would have probably died in both my births.
Made no difference to me arriving at the hospital. In fact I wished I'd got there a lot earlier. I was sh*tting myself on arrival so couldn't focus and couldn't speak to make my preferences known!!
Suzi Wot about being relaxed because you believe that tis natural and you will cope and then realising that tis too painful to focus on anything BUT the pain!?
Being positive doesn't help then.
Being positive but uprepared can mean that a positive outlook very quickly turns to panick and fear!!
I have to disagree Krang. While positive thinking can't turn a breech baby or stop a pre-eclamsia, I do think it can make a difference to the birth. If you're thinking postively chances are you're more relaxed, less panicky. This means that there will be less of the stress hormones in your system which are known to interfere with normal labour. If your labour starts stalling because of these things then chances are you're more likely to get put on a drip or to get an epidural due to length of labour and then intervention due to epidural/failure to progress. Also, IMO, if you're fairly negative or dwelling on the bad things then you're likely to go to hospital sooner. Then it seems like a long labour when you're in hospital and MWs start niggling about you failing to progress or your labour slows down due to a change of environment.
Being prepared is absolutely essential IMO. But I think being positive and relaxed is also a good thing and does influence labour. My advice would be to think of the birth you want and do what you have to to achieve that. It might not be achievable as there are things out of your control and you have to accept that. But there's no harm (and probably good) in planning and remaining positive.
My top tip is to labour as long as possible at home in your own territory. It always seems much worse when you get to hospital!
Interesting that someone mentioned Northwick Park. I gave birth there - went into labour three days too early to go to the MLU I'd planned to.
It's a horrendous, scary shithole but I was lucky to be there just after they had been put into special measures and I had very good MW care. I see from the papers, however, that three more women have died there since I gave birth there.
Let me try and explain what I mean about 'positive experiences' now I've calmed down a bit.
The problem with the 'positive attitude' thing is this: your labour, really, has nothing to do with your attitude.
You could have the most positive attitude in the world, ever, and you still might have to have intervention to save your life and that of your baby's.
What happens in your labour is down to sheer, blind luck. But many women are not told this. They are told that if they have a positive attitude, they'll get through it fine. They vaguely know about interventions, but hey, that won't happen to them - they have a positive attitude.
Hence, when they are faced with the realities of birth, they are utterly terrified. If they go for intervention - even when it's necessary - they still feel that they've failed.
Here is some interesting research about women's expectations of birth. Women saying they had no idea about the type of pain, how long the pain would last, what they could do about the pain. http://www.biomedcentral.com/1741-7015/6/8
If I had to tell women to have any kind of attitude about birth, I would recommend 'prepared' rather than 'positive'.
I knew I wanted an epidural with my first child and had to ask my midwife three times to be moved to shared care - they were very dismissive of my request. I know that childbirth is 'natural' and therefore the pain is too but I wanted pain relief. (No guarantee of being able to have an epidual in MLU) I wouldn't have a tooth out without pain relief so why the hell would I want to push out an eight pound baby with just gas and air? I waited 24 hours in labour until I was 4cm and practically crying with the pain and then went in for the last six hours and had the epidual straight away - it was wonderful!! Even though my son was back to back I didn't need any intervention and I pushed him out in 15 minutes. No question I am having an epidural next time.
That is where all the 'expert' midwives hang out. They have to be highly trained to know when to call for help!
If you are low-risk in a CLU you are usually looked after by less experience mw with less training (or the cleaner) because the (few) doctors are closer to hand!!
Just wanted to add, epidural was great for me, first time. I was in labout for three days, though (posterior presentation) didn't get it til the last eight hours.
Begged for one the second time, didn't get it because the anaesthetist was bizzy doing a C-section.
So, don't just say "oooh yes I'm going to have an epidural next time" and rely on it happening... that's all I wanted to warn folk about.
I sense a stigma. I had an epidural and it was integral to managing a complicated labour and birth. Yet childbirth is supposed to be natural, so when a woman endures the pain of childbirth, and it all goes to plan, I think she feels more of a woman: I can see in my friends who've all had "natural" second births after epidural firsts, that it boosts their self-esteem no end.
However, every mother's pain threshold is different, and different babies' positions present different levels of pain and different complications.
Years ago, of course many more babies and mothers died in childbirth. I sometimes wonder if DS and I would have become one of these statistics, if it weren't for modern intervention. However, modern intervention - ventouse, forceps, hormone drips to speed up and intensify contractions - can heighten pain to such an extent that an epidural is essential to not becoming completely overwhelmed/traumatised by it.
So I think it's worth remembering that in many cases, epidurals are a valuable part of the modern intervention that keeps many more babies and mothers alive and healthy through childbirth these days.
It's also interesting how there's no stigma attached to being anaesthetised for a c-section, but there is for having an epidural to manage a difficult birth - with much prodding and poking about with forceps and the like - which hasn't quite reached that stage of intervention.
Do mw's advocate pethidine? My midwife was a big fan of gas and air, and so was I by second stage but I wouldn't have wanted pethidine for the same reasons as epidural - potential side effects/knock on effects on the baby.
I have a colleague who worked in an Australian hospital a few years ago where one Christmas all of the consultants were away except one (don't think it was supposed to happen tho!). That meant that only 'true' emergency sections could be done. Their rate went from 30% to 3%! Interesting.
Also interesting to hear so many mw's advocating pethidine. I'm not a fan of epi's but pethidine is even lower on my list.
I do wonder about the high perinatal mortality in the US being used as evidence for the relatively safety of different types of birth. Does it take into account the other factors such as the many women in the US who don't get proper antenatal care? Just wondering who it is who is dying in the US - the middle class women who get the unnecessary sections or the poor (usually black) women who don't get proper care through the pregnancy?
(Am not advocating a US-style system atall, btw, just wondering if there is more to those stats than meets the eye.)
Libra1975, our MLU is in the main hospital, 20 yards away from the CLU on the same corridor - yet I still meet the occasional low risk mum who opts for the CLU over the MLU because they think it'll be 'safer'. I usually point out to them that in the MLU they're actually about 15 feet closer to the operativing theatres than the rooms at the end of the CLU and that they won't see a doctor on the CLU unless their labour becomes problematic.
I understand people's anxiety about free standing MLUs and homebirths. But I think it's important to keep a clear head and look at the evidence on their safety.
If a country like the Netherlands can have almost 30% of babies born at home under the care of midwives and have better infant and maternal mortality than the USA, where almost all babies are born in hospital under the care of doctors then I think one needs to ask some pretty searching questions about what constitutes 'safe' care in labour.
If birth a short trip away from obstetric care was as risky as so many people assume it to be surely you'd expect to see some evidence of significantly increased rates of neonatal deaths linked to homebirth/births in freestanding MLUs?
"it's hard to believe that all those csections are a medical necessity." - I have asked myself questions about this so many times. I just can't bring myself to believe that doctors or midwives would stand by and allow a woman to be taken to theatre if they felt she could safely achieve a vaginal birth. People who work in the NHS tend to have strong principles about these things: they believe that the interventions are necessary to safeguard the health of mother and baby, and it's hard to argue that they're not, in individual cases. You simply can't know, even with hindsight. That's why I've started to feel that there is something about the care that women get in hospital that actually puts them and their babies at risk: they're not having 'unnecessary' interventions - women have problematic births because of the environments they birth in and because of the way their labours are managed. And then of course they need the doctors to sort out the problems that being in hospital has created.
.... I know what I'm trying to say but I think Tricia Anderson explains it better!
sabire you also make a very good point about money. If csection rates didn't run at 20/25% in many hospitals, there would be more money to go around. Epidurals too are expensive, though not in the same league as the costs of major surgery. it IS a vicious circle - those costs won't be reduced until proper staffing enables more women to give birth without so many interventions. But the staffing won't be there while all the interventions are going on! I'm NOT saying women shouldnt have epidurals to save the NHS money. I accept that there are some women who cannot contemplate giving birth without an epidural, though in this country they are a minority. I'm talking about women who have the potential to achieve a natural birth, but who because of all the issues and pressures surrounding medicalised births, end up having all kinds of costly and unnecessary interventions.
I have to say that although it's anecdotal, my experiences have been similar to sabire's. The MLU where I delivered had fantastic one-to-one care. The CLU was chaotic, understaffed and not a conducive atmosphere to having a natural birth. The Csection rate was over 20% - it's hard to believe that all those csections are a medical necessity. I wonder how many are a result of the cascade of interventions .I think Libra makes an interesting point: in some respects, I think doctors and midwives maybe feel threatened by eachother's roles. As I see it, a midwife should be the specialist for any normal, straightforward delivery. A normal birth does NOT need a doctor or surgeon! When I had my dc1 at the MLU, I had some interesting chats with the midwives. They all saw working in a MLU as the 'top' job - many of them had moved from big hospitals because they were fed up of feeling that they were playing second fiddle to the doctors or being there to monitor women with epidurals rather than being able to actively support a woman in achieving a drug free or near drug free birth. They definitely got greater satisfaction out of the MLU role. The fact is, there are never going to be unlimited resources. There will always be a pot which has to be divided among many different things. Ultimately yes, it's a woman's choice. But I think the reality is that MLUs are always going to provide a more homely, natural atmosphere, because once you start having doctors there, you are by definition creating a medicalised atmosphere which will have an impact on how the mother feels.
But the money is there, as you say yourself the MLU you know have well-staffed, comfortable surroundings why this can't be provided in a hospital or at least hospital grounds so the doctors are on-hand ^if neccessary^ I don't understand, surely the MLU money must come from the NHS budget.
I think if docs and midwives stopped seeing each other as the enemy that might help as well. (A generalisation but as you said we can only go on personal experiences and the docs I know aren't usually very complimentary about midwives in general)
I think we both want the same thing we are just coming at it from different directions
Don't know where you live Libra. I'm in London. Most large CLU's around where I am are like my local hospital - very, very busy and understaffed, with high c-section rates and low rates of normal births. There are three MLU's within travelling distance of where I live. They all offer one to one midwifery care, the option of waterbirth and the chance for families to stay together after the birth.
And yes - I shouldn't have generalised in that offensive way about registrars.
I'm only reflecting on my experience and the experience of many of the others I know. And of course being grubby, knackered and not speaking good English doesn't make you a bad doctor.
By the way - I'm sure I didn't say anything about 'natural' birth. I've been talking about 'normal' births - ie, births without interventions.
Unfortunately the money DOESN'T seem to be there to provide the sort of care that women want and need. Perhaps if one in four women didn't end up needing major abdominal surgery to give birth there wouldn't be such pressure on NHS finances.... but reducing the rates of c-section would require increasing staffing levels..... and we can't afford to do that while shelling out for so much surgery..... it's a vicious cycle......
sabire - i don't want to generalise about midwives, i'm sure you're right about some of the reasons why they are anti-epi. there's many factors i'm sure. but sadly i met quite a few who were ill-informed and dismissive.
we all clearly have different opinions about what is best for us and our babies - and can cite evidence pro and against most things! my point is that you should be allowed to choose for yourself and your informed decisions should be respected - not derided - by those caring for you.
"If, once you come into this busy, stressfull environment your labour stalls (as it so often does - most c-sections in labour are due to 'failure to progress') then you will seen by a bleary eyed registrar with stains down their coat - probably one who doens't speak English very well, who doesn't look you in the eye or address you by name."
I actually find this quite offensive knowing a lot of registrars, if I turned round and said I thought all midwives were jumped up non-medics who think they knew more than they do which can cause outcomes much worse than what would have happened under proper medical care you would quite rightly jump down my throat about it. There are bad doctors and bad midwives, there are good doctors and good midwives.
I am sure not every CLU is like yours just like I am sure not every MLU is like yours. I just wish we could have a happy medium where there is access to all medical intervention needed but ALSO enough midwifes and a clean and secure environment for what you call a natural birth. I am seriously bemused why we can't have the best of all worlds on this occasion seeing as the resources are in place for either/or.
Have to say - most mothers I know who choose a homebirth, particularly those who choose a homebirth after having had a birth in a CLU, do so in the belief that staying at home is actually healthier and safer for themselves and their babies. It's not all about having an 'empowering' experience.
"But there are equally some mothers - and i count myself among them - who just want a birth that is safe ....as possible."
Have to say - that part of what most mothers I know who choose a homebirth, particularly those who choose a homebirth after having had a birth in a CLU, is their belief that staying at home is actually healthier and safer for themselves and their babies. It's not all about having an 'empowering' experience.
I'm also not sure I agree with you 100% that midwives are negative about epidurals because they don't want to lose control of the mother's care (though I suspect this may be true in some cases). Many midwives are very concerned by the rapid decline over the past few years in the number of low risk, healthy mothers having normal births (by normal in this context I mean births without the use of forceps, ventouse and c-section). There's a real preoccupation with this issue in midwifery education and debate. Most midwives see increasing rates of epidural use as part of the problem and feel that normal birth rates would increase if epidural rates went down. That doesn't excuse the way they've spoken to you on this issue though - primarily their job is to empower you to achieve the birth you want, not the birth they feel would be healthier for you and your baby.
Re: your midwife's suggesting that you should explain to the midwives providing your care in labour why you want an epidural - I personally don't think you should have to justify your choice to your caregivers or use any sort of persuasion. It's really not right that you should have to do this in labour - it puts too much stress on you. I would suggest the 'broken record' technique as described by Nicky Wesson (I used it with my consultant when I was trying to book a homebirth). Goes something like this: "I would like an epidural now: please can you send for the anaesthetist" Midwife: "Are you sure you need one? You're making really good progress and it could slow your labour down". Mum, "I appreciate your concern but I want an epidural now: please can you send for the anaesthetist." Repeat as necessary. Don't explain and don't justify. That's their job, not yours!
horseshoe - i'm with you 100%. if you want an epidural go for it. i had a very long and painful first labour and requested an epi part way through. (it took 8 hours to get one - but that's another story). I was left traumatized by my birth experience and during my second pregnancy i was very anxious about birth.
i found the mws i met during my pregnancy to be largely dismissive of my wishes which made my anxiety worse as I didn't feel i could trust them as they didn't take my fears seriously. My brother is a consultant anaesthetist and i discussed the issues with him at length. i believe i am well informed and able to make a rational decision about what's best for me and my baby - but time after time mws would be very negative about epidurals and prefer to recommend pethidine etc.
As for why this happens - personally I put some of this down to professional control - if you have an epi then it's a doctor (anaethetist) not the mw who's in charge. I suppose also some mothers take birth very seriously and for them it's part of their self-esteem and identity and they are proud of not needing medical intervention. But there are equally some mothers - and i count myself among them - who just want a birth that is safe and as painless as possible.
I am more than happy for people to have homebirths, do hypno-birthing etc etc it's not what i want but it's up to them - but personally i found labour very painful and scarey and wanted to have an epidural. I don't think this makes me a bad person but there have been many times when midwives have made me feel like this and that makes me very angry.
I wish people would let others make their own choices and not 'look down' on other people's choices about birth. I have 2 kids and IMO i think the important bit is how you look after your kids - not the (hopefully!) short bit when you're squeezing them out!!!
Good luck to you Horseshoe - do whatever feels right for you. (And BTW you need to be 4cm dilated to get an epi - but ask for one asap and make sure it's in your birth plan. Most hospitals have a standard protocol about their provision of epidurals and you can ask them for it if you have any questions or the mw is not taking you seriously.) My mw suggested explaining clearly to any mw treating you why you want an epi if you have strong views as the assumption tends to be 2nd and 3rd time mums won't 'need' one (their words not mine).
When I was "allowed" a HB, the MW assured me that at the first sign of trouble they would have me in an ambulance on the way to hospital. In hospital they tend to moniter you for a bit before making decisions on what to do.
Also for alot of Emergency CS, it takes so long to set up the epi anyway and so while I was being transferred they would be getting it all ready. Luckily I live Very near a hospital.....not sure if I would of considered it if I was farther away.
Wanted to add - don't know what Libra's CLU is like, but I can tell her about ours.
The midwives on our CLU are flying by the seat of their pants the whole time, caring for several women at once. If you go on to the CLU as a low risk mum you are ignored for most of your labour because staff are too busy attending to the higher risk mothers who need their attention.
If, once you come into this busy, stressfull environment your labour stalls (as it so often does - most c-sections in labour are due to 'failure to progress') then you will seen by a bleary eyed registrar with stains down their coat - probably one who doens't speak English very well, who doesn't look you in the eye or address you by name. If things go seriously pear shaped they'll call in a consultant, but they tend to have to go VERY pear shaped first.
The ward is often quite dirty and chaotic. Staff come in and out borrowing bits of equipment. You only get one pillow. You have almost no furniture in the room apart from a bed (which you're expected to lie on most of the time) and a plastic chair for partners. There is nowhere to buy food, but anyway they discourage you from eating in active labour (so you better deliver fast before you run out of energy to push your baby out).
After you give birth you are transferred up onto a dirty, crowded postnatal ward and your partner has to go home.
The MLU on the other hand guarantees one to one care. The midwives who work there are the cream of the crop because competition for jobs in low tech units tends to be fierce. The rooms are quiet, clean and well equipped. There's a kitchen where you can warm up food and prepare hot drinks. Most of the rooms have pools and mood lighting. After you give birth you and your partner can stay together until you're discharged.
The only low risk mums I know locally who opt for the CLU over the MLU are those who want an epidural from the word go.
At the risk of repeating other posts, I would just like to echo the points re MLUs being safe. In our local MLU which has an absolutely fantastic record and reputation you are almost certain to get 1-1 midwife care, quite likely with your own comunity midwife - in hospital this would be very unlikely. The midwives here play it very safe regarding transfer if there are any warning signs. I was transferred to hospital in labour because of a very long second stage (in the end was a natural delivery.)It was a horrid 15 mins in the ambulance but I do not regret it for a second - would much rather have had the majority of my labour in the MLU. Not to mention of course the difference in postnatal support, breastfeeding support etc (available of course to women who've given birth elsewhere.) FWIW, I have hung on to two things I remember being said while pg last time - sorry, no evidence or references, just what I was told! - the number of women who would have an emergency requiring a doctor to be literally 30 seconds away is very, very small -in a MLU, the midwives will be very alert for 'warning signs' throughout labour and transfer women to a CLU in plenty of time - oh and, obstetricians are experts in 'abnormal' birth, midwives are experts in 'normal' birth - both equally important and neither better or worse choices.
Of course it's all about weighing up risks. Every birth has an element of risk. I was not allowed to deliver in a midwife led unit for my dc3 because I'd had a csection with dc2. A CLU was the only option, unless I'd really stuck my neck out and insisted on a home birth which I wasnt prepared to do because of the small risk of scar rupture. So I went to a CLU and tried to keep the experience as natural as possible, though TBH I found the lack of continuity in care, the doctors rushing around and wanting to intervene rather than allowing me to labour naturally, pretty off putting. I had a natural birth, but the fact that the environment was hugely medicalised was not nice. However, you are still missing the point that unless you are fall into the risky category, midwife led units are exceptionally safe. Having a baby is not an illness. For the vast majority it is a straightforward process. It doesnt need a doctor. The doctors who tried to intervene during my 3rd birth were a hindrance, not a help. IME they were far too ready to offer drugs. In contrast, the midwife who delivered my first baby (big baby, first labour, long and painful) was amazing. As sabire describes beautifully, it is an incredible thing to find within yourself the resources to acheive that.
"for a start they only accept low risk cases which is why I have pointed out it really isn't a fair comparison to compare the safety records of a hospital and a midwife led unit."
Actually the research into impact of place of birth on birth outcomes takes this into account. All the good quality studies try to compare like with like - so they look at outcomes for low risk mums birthing in CLU's/at home/in MLU rather than making undiscriminating comparisons.
"my primary reason, which I also stated, for not going to a midwife led unit is IF there are complications during my labour, of which there is ALWAYS a risk, I want a doctor 30 seconds away"
Fair do's - as long as you're aware that according to current research, as a low risk mum you're about twice as likely to end up having a c-section or an instrumental birth if you book into a CLU than if you birth at home with midwifery care and signficantly more likely to need interventions than if you book into a MLU. But if you're not averse to obstetric input into your labour then that probably won't worry you.
Also I have actually really enjoyed this discussion as much as I am aware none of us are going to change their view point. Personally I think we all want the same basic right, our own choice of how and where we give birth in my case it is with a mobile epi in a calm and supportive atmosphere in other peoples cases it is without any intervention in a calm and supportive atmosphere. This is what needs to be worked towards.
No I say it because if something goes wrong I want a doctor there not a midwife.
And a spare ambulance on standby incase you need one?
You stated "When I booked to give birth at home I was aware that there were some instances where having a baby at home would increase the chance of a poor outcome - cord prolapse, placental abruption and shoulder dystocia were three things I was concerned about. Not concerned enough to stop me booking at home though - I felt these risks were fairly remote and in some ways balanced out by the risks associated with hospital births such as infection and higher rates of intervention." I feel the opposite way i.e. I think the risk isn't worth taking re:cord prolapse, placental abruption and shoulder dystocia
Yes I know re:epi and CLU but I do keep pointing out I only want the option, I have no idea if I am going to take it or not.
"Sabire if your childs safety is your most important aspect surely hiring a private obs/gyn doc would be better than a midwife?"
Do you say this because you believe that women delivered by doctors have better outcomes than midwives?
Surprising then that the USA, where almost all babies are delivered by doctors, is 24th in the infant mortality tables, behind many countries where the majority of births are midwife led. And of course the USA has a very high c-section rate compared to many European countries - something that's also linked to obstetricians being involved in normal birth.
Personally if I'd had specific problems that I felt required the expertise of an obstetrician, and the ability to lay my hands on £10 000 I might have considered going private. But as I felt midwife led care was more appropriate for me and my baby I went for an IM instead.
"As for worse case scenario being 10 minutes I think that is a very naive assumption based on the luck of last time."
No - it's based on geography. I live a 3 minute drive away from the hospital - it's less than a mile down the road. There are three back routes to my house from the hospital and no major traffic blackspots or road junctions.
"However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife"
I assume you must have arrived at this decision because you have evidence that outcomes are poorer for both mothers and babies in midwife led units, even those located within CLU's. Would you like to share it with the other women who are reading this thread? At present women in the UK are advised that current 'best evidence' seems to show that for low risk mothers, MLU's and birth at home have similar statistics for infant mortality and morbidity when compared to CLU's, and significantly lower rates of maternal morbidity. (there was a recent study which received much press coverage which seemed to identify higher morbidity and mortality for babies born after a transfer from a homebirth - we've discussed this study here - it may well form part of the evidence when this whole issue is re-addressed centrally, but I don't think it'll influence govt. policy as it's such a poor quality piece of research).
"I also want the option of having an epi, I am not one of the women who think pain is empowering."
No - and if you want an epidural then you need to be in a CLU, so an MLU isn't an option for you anyway.
BTW - it's not the pain itself that's empowering - it's being put under severe duress and discovering that you're stronger than you ever thought possible. You learn about yourself. I also feel that in my case (and I'm sure other people here will have felt the same), the experience of being supported by my partner in labour has brought a different dimension to our relationship. I'll never forget what it felt like to be so vulnerable, or how amazing my partner was in helping me get through it.
And before anyone starts shouting at me - no I don't think that everyone gets this from labour or that everyone should. Each to their own.
"However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife. I also want the option of having an epi, I am not one of the women who think pain is empowering."
I have to say that your post comes across like MW led units are dangerous! Which we all know isn't the case. I hate to say it, but perhaps you're risking your baby by going to an obstetric unit where you may not get the birth you want, may have an overmedicalised birth and may have more risks due to epidural. There are different risks to giving birth in different places. I didn't think pain could be good until DD...
horseshoe I find it interesting that you'd choose an epidural to get 1-1 care from a MW. I never thought of that as an option before. I was 'lucky' when I had DS that there were only 2 of us giving birth at the time so my MW was only away from me for longish periods when I was still coping quite well. Though she left me at one point when I was pushing, out of control on morphine and NEEDED her shoulder to put a foot on. I was screaming at her and terrified when she left the room. I did quite like having 2 MWs all to myself for my homebirth. I was monitored so closely that if there had been anything wrong it would have been spotted far faster than in hospital IMO. I also had some lovely accupressure massage from one of the MWs.
I really hope that you get the birth you want horseshoe. Isn't it a sorry state of affairs that you have to have an epidural to guarantee the care you need?
I doubt it as I agree with most of the points that there are not enough midwife resources and being supported by a good midwife is probably invaluable to a positive birthing experience. I think I made the point several pages ago that I think it would be much better to have lots of midwives and a calm and supportive atmosphere somewhere where there were doctors on hand as well. I already know that my first choice for birth plan is not viable and probably my second as well.
I believe you when you say midwife led units have an excellent safety record, for a start they only accept low risk cases which is why I have pointed out it really isn't a fair comparison to compare the safety records of a hospital and a midwife led unit. There is no such thing as a risk free birth in either hospital or a midwife led unit.
I said I ALSO want the option of an epi, my primary reason, which I also stated, for not going to a midwife led unit is IF there are complications during my labour, of which there is ALWAYS a risk, I want a doctor 30 seconds away not 2 miles away.
Natural birth isn't about suffering and making you prove you're more of a woman for going through it. Far from it. It's about learning about other ways to cope with the pain and discomfort that labour and birth brings. And also avoiding interventions that often do bring unwanted consequences.
Having a doctor about isn't necessarily the best option either. Why do people assume that when you're having a baby, doctors should be about? Are women ill when they're giving birth? Sure there can be complications but not very often and help can be sought for those. I think it's a problem when people start assuming having a baby is a medical problem.
By the way, a crushed baby's skull suggests more than incompetence on the doctor's part, surely? FGS!
Libra, Your last point is about personal choice - you feel you may want an epidural for pain relief - that's fine, given that you have obviously thought about the risks. That's your choice. I don't entirely agree that I would describe natural birth in quite the same way as you do. I didn't find the pain empowering; it was the sense of having found the resources within myself to labour and give birth naturally, without being numbed up. But tbh, this was a secondary issue. The main reason I didnt want an epidural was to avoid the increased risks of other interventions which all carry some risk to the baby. The fact that I felt hugely empowered was a kind of bonus!! What I really object to though, is the misleading comments about midwife-led units, that you are somehow risking your baby. I cannot repeat it enough. Midwife -led units have an excellent safety record.They have to. They would be shut down if they didnt. The awful news stories recently about mothers dying and the baby who was crushed with forceps are about incidents which occurred in large hospitals!!! If you dont want to book into a midwife led unit because you want an epidural then fine, that's your choice, but why not just say so rather than trying to make out that your choice is somehow 'better'.
alfiesbabe - this very much goes back to the orginal question of the thread, that some women do feel they have to suffer pain as otherwise they are somehow less of a woman because they did not have a "natural" birth (Personally I still stick to the feeling that if it comes thru the birth canal it's natural) Also the poor baby who died due to a crushed skull, that was due to an incompetent doctor not necessarily a mismanaged birth.
Sabire if your childs safety is your most important aspect surely hiring a private obs/gyn doc would be better than a midwife? As for worse case scenario being 10 minutes I think that is a very naive assumption based on the luck of last time.
suzi2 - as for being the partner of the doctor, I suppose I have a little advantage in that the hospital he works in I am going to give birth to (completely different department however) so I cling on to the hope that I will be kept relatively well informed on what is going on, but still have the worries that there is not going to be enough midwfe support and I will not be able to have the birth that I want. However I am not going to a MW-led unit because after 9 months of avoiding wine, cheese, pate etc I am not suddenly going to start risking my baby during labour I want a healthy alive baby and my partner wants a healthy alive baby and wife. I also want the option of having an epi, I am not one of the women who think pain is empowering.
"you can't possibly considered a perfect parent unless you have given birth to twins natually - at home - breastfeeding one while gving brth to the other - whilst smiling cerinely - enjoying the experience thoroughly - and cooking organic paella"
Custy - are your comments a hint that you see the issue of pain relief in labour as primarily about little more than competitive parenting?
I don't trust my body at all and I trust my mind even less after having severe PND after ds 1. I really want a dsc 3 but need to be mentally fit for my 2 children I already have so we really haven't made the final decision yet. Having ds 2 has made me feel I can be a mum and a good one at that so I would love to have more. I think I can only do it by a c-section as I feel no trust with the NHS (not all aspects just target setting/budget constaints that effect every decision they make) 
to 3%! Interesting.
