Frederick Leboyer on Woman's hour today on childbirth without intervention

(123 Posts)
queenceleste Tue 31-May-11 20:11:01

listen again here.

Amazing considering he's a man, he was one of the first promoters of waterbirth.

Jane Garvey obviously totally disagrees with him but it's all in her tone...

claireandmattsmum Tue 31-May-11 23:54:42

I heard the last five minutes of this man talking twaddle. I found myself shouting at the radio at one point. What was it he said about babies in breech position? Something about the mother not being relaxed enough? And that if she was more relaxed the baby wouldn't be in breech position? Try telling that to cows and ewes that present with a breech position calf or lamb. This is a short part of the interview. See if anybody can make head or tail of what this man is saying:

Jane Garvey: I had two elective caesareans because both my babies were breech babies.

Leboyer: That’s a complete mistake. Breech is normal.

JG: So what should have happened?

L: But what is wrong with breech? – it is a normal physiological posture of the child during the last month of pregnancy…. but If the woman is too tense and too much afraid then the child cannot move…the thing to be done would be to make the woman free from her fears. If she would face her fear instead of running away she would say yes I’m afraid….if she would look her fear in the eye it would vanish.

JG: But we know hundreds of thousands of women, all over the world, some in very poor countries, die in childbirth.

L: No that’s not true! That’s a lie, a lie. What you’re saying now is a sort of excuse for what you’ve been doing but there’s no guilt. Fear plays such a great part. All I’m telling I learned it from women. Childbirth is a secret garden of women.

JG: Is there in yr opinion any case for medical intervention?

L: Only when it goes wrong! But first you’ve got to try. At a certain point of labour woman is experiencing death and because she’s been able to face death she becomes free from the fear of death.

JG: Is there anything positive about our current experience?

L: No there is nothing positive it is all wrong. Completely wrong. If you’ve decided you’re not going to take any risk then you are really in danger. And childbirth is complete risk. You are put on your mettle. Either you take the challenge or you chicken out.

I mean, what??? It's a LIE that hundreds of thousands of women in very poor countries die in childbirth? Isn't that what used to happen in this country before medical intervention became the norm for women having problems?

queenceleste Wed 01-Jun-11 01:30:58

He is right at the outside of the non intervention end of the spectrum, Ill give you that!

But, I do think the truth is somewhere in the middle of our massively intervened hospital births and a supported home birth. Obviously women would range between the two extremes but it would be nice if there could be more flexibility in the system.

Of course we all want help when things go wrong but what is now hard to see are the problems created by intervention rather than solved by them. There is a lot of intervention that is probably unnecessary because of risk aversion from parents and professionals. That is where we are, but many would argue that something precious is lost in that exchange. For some that's fine, for others it's tragic.

Breech births used to be treated as normal and medical staff were good at delivering them, my sister was a mw and breech births were not automatic cs. Statistical risk has led almost all breech births to be automatic c sections so the skills are lost from what I understand.

I agree he sounds odd in his language but I think what underlies his position is that the woman is far more powerful in the whole process. Having delivered my dd virtually on my own after falling out with my mw and the obs I sort of know what he means in my case. I wanted to be supported to have the baby where I was comfortable but they wouldn't let me! I've met many women who have had homebirths and they most talk about how being in charge of their space made a profound difference to the experience. I also have a friend who had two waterbirths at home with and independent midwife who is also a close friend. She described an almost ecstatic experience. So I sort of know what this man is getting at. He's saying that the usual hospital birth is a million miles from what it could be in many cases. I must say I broadly agree with him ime. But there's no criticism of anyone in this system, we have the benefits and the losses inherent to it. And more live births per 1000 is a massive benefit of course! But it comes at some cost to the interference with very many potentially normal births.

Spudulika Wed 01-Jun-11 08:46:42

"I mean, what??? It's a LIE that hundreds of thousands of women in very poor countries die in childbirth? Isn't that what used to happen in this country before medical intervention became the norm for women having problems?"

No. The maternal death rate in the UK was very low in the 1940's and 1950's, when most women were still giving birth at home and when the c/s rate was less than 5%. Women who die in childbirth in developing countries don't just lack access to doctors. They will often lack access to the most basic screening in pregnancy, the care of midwives, and decent nutrition. Some already have health problems when they become pregnant because of lack of prior medical treatment. That was true in the UK in the very early part of the last century, but even then our maternal mortality rates were never remotely as bad as they are in Afghanistan today...... sad

queencelest, I'm with you. I haven't listened to the whole interview but I understand what Leboyer is referring to in the bit quoted by the OP - about female power and autonomy in childbirth.

ajmama Wed 01-Jun-11 09:22:53

The remarks about breeches really rile me. My first Ds was breech and it was due to him being completely tangled up in his cord and we have both been dead without the evil EC!

AitchTwoOh Wed 01-Jun-11 09:26:32

i thought he sounded a bit bonkers however i remember hearing a r4 doc about a scottish midwife who had delivered gazillions of children in the 30s, 40s and 50s and as an old woman she wept at what she had had to do to women when birth started to move into hospital.

Spudulika Wed 01-Jun-11 12:01:03

I think anyone who's read about the type of midwifery they practice on The Farm, and looked at Ina May's stats will find it hard not to arrive at the conclusion that millions of women are being unnecessarily damaged in childbirth in our current system.

"The remarks about breeches really rile me. My first Ds was breech and it was due to him being completely tangled up in his cord and we have both been dead without the evil EC!"

The thing is ajmama - there are NO certainties in childbirth. If you go back through historical documents and look at midwives' records from the last century you see that there are some midwives who delivered over a 1000 women - including all sorts of difficult cases like breech and twins, and never lost a mother. Ina May's statistics are amazing - I think they've got a 1.5% c/s rate at her birth centre (over 2000 deliveries) and they've safely delivered twins, breech babies, face and brow presentations (considered 'unbirthable' vaginally everywhere else) with lower infant mortality rates than hospitals.

Not arguing that all babies can be delivered safely vaginally, but I suspect a good number of babies currently being born by c/s could be born safely vaginally, if doctors, midwives and mothers were not so risk averse. (not saying they shouldn't be risk averse - totally understandable, but it's the fear of a poor outcome that's driving the rising tide of surgery, not the fact that 27% of babies are currently unbirthable vaginally)

queenceleste Wed 01-Jun-11 13:05:38

my sister was a mw in the 80s and saw an Egyptian obstetrician deliver a face presenting baby (that's not accurate term but it's a description) and my sister said he was amazing, he'd learned to deliver every kind of baby and was incredibly confident because he'd done so many.

How can any midwife or dr in our system ever learn any of these specialist skills when the system is in its very bones risk averse? I'm not saying they shouldn't be, I'm just saying there are other losses.

And women who tear badly (some would argue through inappropriate intervention, poor care, poor education) and are repaired poorly, then what price do you put on your future sex life? There are so many variables here and the cost is hard to calculate. But I know if I had been younger and braver I would have loved to have had a homebirth, I know there is great risk but hospitals produce their own massive risks as well!

queenceleste Wed 01-Jun-11 14:06:32

of course, I want to add, c sections are absolutely necessary for many births. But there's no question that we have a c section rate that reflect medical risk aversion rather than statistics for women who all need this level of intervention! I don't think anyone would disagree with that.

Boogiemumma Wed 01-Jun-11 14:14:59

If the aim is that both mum and baby are healthy and alive after delivery then medical itervention is fine. I think women should be helped to have the birth that they want - whether this is natural or otherwise. Always wary of people who have not personally experienced birth providing a dictate to those who have. It is a personal experience for which most women are aware of risks and impact of interventions.

WidowWadman Wed 01-Jun-11 14:25:29

Are Ina May stats clean from reporting bias etc, though?

queenceleste Wed 01-Jun-11 14:27:18

Yes but it isn't that simple.
The Portland Hospital at one stage had the highest maternal death rate of any London hospital hmm... interesting.
I know that's partly because they have no AandE there and are oddly staffed in some ways but it isn't as simple as you say.
The structure of risk aversion precludes other forms of childbirth ipso facto other problems are created and yes, some fatalities probably happen because they are avoiding fatalities.
The obstetric and surgical professional community have everything to gain from making childbirth an entirely manageda experience removing even lowrisk mothers from homes and birth centres and away from mw support.
It's really hard to have a home birth now because of staffing.
It's really hard to use a birthing suite in a hospital because of staffing.
If you're a surgeon or obstetrician you're still holidaying in Tuscany while mws lose their jobs and women find it harder and harder to have more natural births supported at all except in a very few places. It is, in my opinion, an effectively misogynistic system if no intentionally so.
This Frenchman has a point and remember he says very clearly that his knowledge is based on what women have told him plus countless births attended and from a medical perspective. He's not some Know Nothing.

WidowWadman Wed 01-Jun-11 14:40:21

Also, you can only find out retrospectively whether a vaginal birth of an awkward presentation would go right. The risk aversion is, in my opinion, not just a thing about not wanting to be sued. Of course doctors don't want to be sued - but behind every lawsuit for a birth gone wrong is a damaged or dead baby and/or mother. Isn't it natural to want to avoid such outcomes.

If a CS is statistically safer than a VB for breech, is there really any value in holding on to the breech VB, or is it just nostalgia?

To say "but it's the fear of a poor outcome that's driving the rising tide of surgery, not the fact that 27% of babies are currently unbirthable vaginally)" sounds rather cold to me and glossing over the fact that "poor outcome" means "dead or badly disabled baby". I'd say a good outcome should be the No 1 priority.

ajmama Wed 01-Jun-11 15:20:39

Totally agree with Boogiemumma. It is all down to personal choice, I could not think of anything worse than having attempted a breech delivery or by a midwife like Ina May but the choice should be there for those that do. Most of my friends like myself delivered at the Portland and all of us who had breeches were offered a trial of labour and one successfully had a vaginal breech birth.

Spudulika Wed 01-Jun-11 15:27:20

Widowers an, Ina May Gaskin is such a high profile midwife, and The Farm is the most famous birth centre in the US. I think if her records were really unreliable someone would have unearthed something by now. It wouldn't take much. I suspect she's a hate figure in some US obstetric circles as she's been so critical of American maternity care. I'm sure if there was dirt to dish on her it would have been done by now.

queenceleste Wed 01-Jun-11 15:28:36

Ok for the sake of argument say that you now supported a totally homebirth based system well staffed and with high funding for taking any difficult births into hospital.
If the consequence was women had fewer interventions, far less traumatic births, happier mother baby bonding, better chance of supporting bf for those who want it, massive cost savings. etc etc.
I wonder whether there would be that many more maternal and infant deaths? And if there was a big improvement in the physical and mental health of our infant and maternal population maybe that would have a comparable value to a tiny shift in infant/maternal mortality?
I just think childbirth for most women can be normal if treated as such and approriately supported.
obviously this is only a sketchy hypothesis but it's amazing how positive women are about births which they were allowed to manage themselves with support.
I'm not suggesting there should be no csections or interventions but there should be far fewer imo. Particularly as we know that the more you intervene in labour the more interventions there will be in each case. this has been proven fairly clearly I understand.
But it's all academic, we are where we are and everyone seems to be sacking midwives, I guess that hurrah for the obs and surgeons, but tragic for the vast numbers of women who are low risk, imo.

Spudulika Wed 01-Jun-11 15:39:20

Ajmama Im not sure that free choice exists in a system dominated by fear, an entrenched tradition of medicalised birth, and restricted by insufficient resources. An example of this would be the issue of homebirth. Most women in the uk see hospital as the safest place to have their baby, despite the lack of good evidence that this is the case, and the mounting body of evidence that women are more likely to have longer, more painful and more difficult births in these settings.

Women are not 'free' to choose a homebirth if they've been indoctrinated from childhood to believe that the only safe place to give birth is in hospital.

ajmama Wed 01-Jun-11 15:56:51

Spudulika, anyone can have a homebirth in the UK if thats what they want, OK its not ideal if you have to pay an independent midwife but the choice is there. We are all grown ups when we have babies and it is ridiculous to say that most women have babies in hospital because it has been indoctrinated into them that its the safest since childhood. You only have to look at the childbirth threads on here to see that scores of women want an EC and are looking for support in getting one. I dont want to get into a home/hospital argument but through maternal choice a majority of women still want a hospital birth with medical back up and we are very lucky in the western world to have choices. Ask a woman in Africa with a fistula or a PPH if she would like a homebirth the next time. The choices are there for us and we should just all shut up and respect an individuals choice.

"The choices are there for us and we should just all shut up and respect an individuals choice."

Sorry, but when the "choice" is being pushed into something unnecessarily (in my case ELCS which I resisted and in the end was told I didn't even need after being told for weeks I "had" to have one) means that nobody in the same situation ever gives birth vaginally anymore, so that there are NO medical staff who know how to hande it, there IS no individual choice. Feeling as though you can't give vaginal breech birth a try because nobody will know how to deal with it means your ELCS isn't really a choice now, is it?

The various registrars and consultants I've dealt with couldn't even give me the statistics of women giving birth with low-lying placenta (my condition) because it's blanket policy for the hospital to require an ELCS for it. I took one look at the risks for ELCS vs. what the medical journals and even RCOG had to say about my low-lying placenta and said no thanks. And a few weeks later, here I am planning the homebirth I wanted in the first place. Could have done without all the fear-mongering and stress though.

Making decisions based on blanket policies rather than individual women's situations surely makes a mockery of this so-called "respect" for "an individual's choice" don't you think? I'm all for choice, but it needs to be true choice, based on the individual's need, not because the system can't handle it, the staff doesn't have the experience, the doctors are afraid of getting sued, or some policy-maker came up with an arbitrary cut-off mark for whatever condition they're dealing with.

In my experience that's not what happens. I went into this pregnancy very hopeful and open-minded and I've been left feeling mistrustful of the medical system and doctors after being told one too many contradictory and patronising things. Haven't even given birth yet! So yeah I'm a bit angry about it. The kind of crap I've gone through shouldn't happen.

Spudulika Wed 01-Jun-11 18:07:20

"Spudulika, anyone can have a homebirth in the UK if thats what they want",

So the fact that only 2% of women nationally have one is indicative that the rest are a) aware that homebirth is as safe for low risk mothers as hospital birth b) confident that it's a reasonable choice?

Because when I had my first nobody mentioned it to me as a possibility and I was of the view that it was a very radical, 'fringe' choice that only a certain 'type' of person would go for, and that person wasn't me.

What changed my mind about homebirths was meeting a midwife who was supportive and proactive about birth outside hospital. Also knowing other women who'd had their babies at home.

"OK its not ideal if you have to pay an independent midwife but the choice is there"

What, even for mothers on benefits? hmm

"but through maternal choice a majority of women still want a hospital birth with medical back up"

But that's because homebirth is still seen as a radical choice, and most women believe that hospital is safer. It's not a choice rooted in an objective understanding of the facts. Women are being influenced in their birth choices by prejudice, fear, and by tradition.

Oh, BTW, women who have their babies at home have 'medical back up'. In choosing a homebirth you're not signing off your right to an epidural, to a c/s or to help from medics, should you end up needing it.

"Ask a woman in Africa with a fistula or a PPH if she would like a homebirth the next time"

Oh come on - you're assuming hospital birth as the 'default mode'. What women in developing countries want is good quality, affordable care, and that may well be the sort of care that comes from a properly trained midwife in their community with back up obstetric services. You're assuming that what we should be striving for in these countries is what we have here - 98% of women giving birth in hospital and high rates of intervention. What a disaster that would be - because it would be unaffordable and would be throwing the baby out with the bathwater.

Spudulika Wed 01-Jun-11 18:14:45

Would add, the homebirth rate varies from 0.2% to more than 10% nationally.

That variation alone points to inconsistent strategies being used to make homebirth more widely available.

The Healthcare Commission survey which was done in 2007 found collossal differences in what choices women were presented with when it came to place of birth.

In South Devon 92% of women were made aware of the choice of homebirth.
Compared to other hospitals where just over a third of mothers were told about this option.

queenceleste Wed 01-Jun-11 18:18:21

New York midwives lose right to deliver in the home:

here

Hungarian midwife, champion of homebirth, sentenced to two years in prison.
here

If you think the obstetric community want to support homebirth then read the above. This represents a much wider hostility to the midwifery profession and consequently for uninterfered with labour.

WidowWadman Wed 01-Jun-11 18:33:34

Queen Celeste - in the US midwife doesn't neccessarily mean the same as midwife in a UK context, there's different types, and not all of them are trained/qualified to an adequate standard. It's a bit more complicated than just an evil obstetricians vs good midwives thing.

As far as your points regarding bonding, breastfeeding, mental health are concerned - they are all important, but promoting vaginal birth as the only or best way to achieve this, is in my opinion barking up the wrong tree.

Why are women made to feel like failures when they need help in the shape of instrumental delivery or CS? I don't want to downplay that an emergency situation in which this is needed is traumatic, I'm sure it is, but I also think often too much emphasis is put onto the method of delivery.

If you tell a woman often enough, especially in a vulnerable postnatal stage, that she missed out on something and that you feel sorry for her, rather than celebrating the fact that she had a healthy baby, than I'm sure that won't do her mental health any good.

If you tell someone that a CS affects bonding negatively and makes breastfeeding difficult, then they might start believing it. How about just providing breastfeeding support (if wanted/needed) without any reference to how the baby has been born?

queenceleste Wed 01-Jun-11 18:37:28

I don't think we should build natal services around the feelings of one group of women who have a particular outcome.
We surely shouldn't be aiming for 100% c section deliveries should we? I can't believe we could afford that as a nation!
But seriously no one should make a woman feel at all inadequate for what happens but if that means we're not allowed to talk about the benefits of bf for example than that's a bit mad isn't it?
I think, and no disrespect to anyone who has had a cs, that there are many advantages to a vaginal delivery if it's appropriately supported.
It is how we were designed to give birth, or is it not ok to say that?

Spudulika Wed 01-Jun-11 18:46:25

"in the US midwife doesn't neccessarily mean the same as midwife in a UK context, there's different types, and not all of them are trained/qualified to an adequate standard. It's a bit more complicated than just an evil obstetricians vs good midwives thing."

All midwives entering training in the UK will now do 'direct entry'. In the past many did a 3 year nurse training followed by an 18 month midwifery specialism.

In the US most states ban direct entry (or the US equivalent) from being the lead professional in the birth, despite the fact that it's a normal pattern of care in the UK and across much of Europe, Australia and New Zealand.

The only way to practice midwifery in most states in the US is to be 'nurse midwife' certified.

How can it be that the majority of midwives in the UK would not be deemed properly qualified to work in the US system?

And that women who are having the most expensive care in the world from doctors are having such poor outcomes compared to women having much cheaper care, provided by midwives in other countries?

"Why are women made to feel like failures when they need help in the shape of instrumental delivery or CS?"

Who makes women feel like a 'failure' if they need help in childbirth? Pointing out the institutional failings that are leading to phenomonally high numbers of women needing medical assistance to give birth is doing the exact opposite - taking the blame off individual women, who are all doing their simple best during what for most of us is a very difficult experience, to get a healthy baby born, however that happens.

" I don't want to downplay that an emergency situation in which this is needed is traumatic, I'm sure it is, but I also think often too much emphasis is put onto the method of delivery".

I completely disagree. When unnecessary and avoidable major surgery is being done on helpless new mothers because of the structural and economic ideosyncracies of the system of healthcare they are using, then we all ought to be flagging it up as a concern.

WidowWadman Wed 01-Jun-11 18:51:05

What the heck do the benefits of breastfeeding have to do with mode of delivery? And who said a 100% CS rate is desirable?
And what do you mean by "I don't think we should build natal services around the feelings of one group of women who have a particular outcome. " when you earlier argued that a few dead babies and women might be a price worth paying for the allegedly improved mental health of women who give birth without intervention?

queenceleste Wed 01-Jun-11 19:55:43

whoah!
I do think vaginal birth is the best way to have a baby. A csection is for a high risk birth or for another medical reason, or for a mother who elects to have one.
Of course a normal delivery should be the aim of maternity services for economic reasons at the very least. Csections should be for the births that need it, not for low risk or births that have no need of it.
But there is if you look at the stats a steady and worrying increase in csections in the developing world.
Of course no woman should be blamed or criticised for having had a csection.
I just think policy should be based on what's best for the majority.
Highly medicalised maternity services have great costs imo, it's hard to talk about the benefits of natural childbirth if people are taking it personally.
I don't blame any woman for what she chooses to do or what is done to her.
I just think that there are massive benefits which we have lost through the present system.
There are maternal and infant deaths in the present highly medicalised system too and babies who have all sorts of post natal problems and problems related to interventions.
It's not that hospital = risk free
Home = massive risk
But that is how it looks from the medical point of view.

queenceleste Wed 01-Jun-11 19:58:38

Re bf. I have repeatedly been told that bf is more challenging for women who have had cs because of the milk partly being triggered by the process of labour.

The whole process of intervention can militate against the kind of calm beginning that can contribute to early bf.

Again, no criticism of anyone who does not bf. I happen to think that it can be very beneficial for mother and child.

ajmama Wed 01-Jun-11 20:25:52

I successfully breastfed for a year after a CS.
How on earth can a mother being in agony and out of control facilitate a calm beginning for baby?
If thats what the mum wants then fine, she should be supported but please stop knocking women who want medicalised births in a hospital with pain relief.
I have little experience of the NHS maternity services but I have never met anyone denied a homebirth if they want it within the NHS, in fact those who have wanted it have had really enthusiastic midwives and have had a great experience.

Ormirian Wed 01-Jun-11 20:33:29

I understand his POV to the extent that modern childbirth practices start from the premise that medicalisation is neccessary and desirable, rather than the last resort in exceptional cases. I can also understand why he might seem a little extreme in putting his case, as he must feel as if he is fighting a losing battle. However I think it is not a good idea to say that anything is bad or wrong when it comes to a process that is so personal to an individual woman.

mouseanon Wed 01-Jun-11 21:40:57

Re bf. I have repeatedly been told that bf is more challenging for women who have had cs because of the milk partly being triggered by the process of labour.

I had no problems BF DD after a cs, but lots BF DS after a VBAC.

Tangle Wed 01-Jun-11 22:15:30

WidowWadman
"If a CS is statistically safer than a VB for breech, is there really any value in holding on to the breech VB, or is it just nostalgia?"
I looked into this issue a lot when DD1 was stubbornly breech. The big RCT research that, almost overnight, drove the change to recommend CS for breech throughout the Western World because it was "safer" has been widely discredited and it is now generally accepted that the conclusions (primarily that CS should be recommended for all babies presenting breech at term) should be ignored.^

The guidelines written based on this research have yet to be updated - and if things don't change soon the midwifery/obstetric skills that make vaginal breech an equally safe option to CS will become lost. At which point CS will be the only safe option.

Is there value in holding onto the skills for VB? As 1/2 babies presenting breech at term are undiagnosed, yes - I would consider those skills invaluable. Such babies are often only diagnosed when the MW looks at the baby "crowning" or feels the presenting part and realises its not a head coming out. At that point there isn't always time to do a CS and knowing how to support a VB is a potentially life saving skill.

(sorry - steps off soapbox blush - just something I've reason to feel passionate about)

ajmama
"I have never met anyone denied a homebirth if they want it within the NHS, in fact those who have wanted it have had really enthusiastic midwives and have had a great experience."
If you've only talked to me through the internet does it count as having "met" me?

I was always interested in a HB for DD1 (DC1). The CMW was not supportive, and told me hospital was a much better place for a HB as "we don't know what your pelvis is like". Our GP (we have shared care) said we should just book a hospital birth as "even if you book a HB there might not be a MW available so you may have to go in anyway". When we insisted on booking a HB, our CMW did not become anymore supportive, but used the HB booking/visit to run through all the ways she lacked training and/or confidence (hadn't had training in waterbirth so we could only do that if the 2nd MW had experience. Couldn't remember the last time she'd sited a canula so better hope the other MW was good at that too...). We never got to find out whether she'd have been wonderfully supportive at the birth (supported by a team of about 50 MWs form 4 areas, so "you'll have to be very lucky to get me") as by then we were so fed up with the negative attitudes and confidence sapping approach that we opted out and booked IMs (and we appreciate just how lucky we are that we were able to afford that).

WidowWadman
"Why are women made to feel like failures when they need help in the shape of instrumental delivery or CS? I don't want to downplay that an emergency situation in which this is needed is traumatic, I'm sure it is, but I also think often too much emphasis is put onto the method of delivery.

If you tell a woman often enough, especially in a vulnerable postnatal stage, that she missed out on something and that you feel sorry for her, rather than celebrating the fact that she had a healthy baby, than I'm sure that won't do her mental health any good."

I agree with you here up to a point - however, from my personal experience the friends I have that have suffered most mentally didn't have the most intervention ridden labours and nor did they have labours where it all went pear shaped in a big hurry - they had labours where they felt ignored and/or not listened to and/or unsupported. Making a woman feel like she's failed is unforgivable - but if she feels traumatised by the birth then telling her none of that matters as she has a healthy baby is equally bad IMO.

BagofHolly Wed 01-Jun-11 22:48:58

Ina May's statistics are amazing - I think they've got a 1.5% c/s rate at her birth centre (over 2000 deliveries) and they've safely delivered twins, breech babies, face and brow presentations (considered 'unbirthable' vaginally everywhere else) with lower infant mortality rates than hospitals."

But surely aren't the patients who go to Ina May Gaskin essentially self selecting? She isn't getting local general referrals, she's a private practitioner, and the women who choose her aren't like to be those who are even ambivalent about c sections, never mind the significant numbers who request ELCS. So perhaps her low CS rate isn't quite so remarkable afterall...

Spudulika Wed 01-Jun-11 23:06:33

"But surely aren't the patients who go to Ina May Gaskin essentially self selecting?"

Yes, they are. She's getting mainly low risk women at her birth centre. Though she does get a lot of older mothers, first time mothers and VBACS. Also breech and grand multips (the Farm serves a community of Quakers I think - they have very big families).

But then the majority of women in the UK would also be categorised at 'low risk' at the end of their pregnancies.

The emergency c/s rate in the uk is 14% overall, and c/s rates for birth centres are not massively lower than for consultant led units.

"please stop knocking women who want medicalised births in a hospital with pain relief."

I don't think anyone is doing that here are they?

"I have little experience of the NHS maternity services but I have never met anyone denied a homebirth if they want it within the NHS"

I have a lot of experience of NHS maternity services and I have met MANY women who have felt completely unsupported in their wish for a homebirth.

Spudulika Wed 01-Jun-11 23:08:41

"when you earlier argued that a few dead babies and women might be a price worth paying for the allegedly improved mental health of women who give birth without intervention?"

But actually it's not such a cut and dried issue. Far more women can give birth without interventions than are currently doing so without increasing the infant or maternal mortality rates. Most obstetricians and midwives believe this to be true.

BagofHolly Wed 01-Jun-11 23:34:53

My community midwife (who presumably went into midwifery because Traffic Warden school was full) said "We don't support homebirths in this area." End of discussion. My friend DESPERATELY wanted a homebirth and decided to just sit it out at home and call the midwife when she thought things were far along. Midwife turned up, said "We don't support homebirths" and phoned an ambulance to hospital, where my now knackered and scared friend had a totally normal delivery which she could have had in her own bed. But the midwife didn't support her and at that moment she didn't feel confident enough to argue. Such a shame.

queenceleste Thu 02-Jun-11 08:40:05

Where I live a homebirth is almost impossible because of staffing.
I have heard twice in the last year of women being taken into hospital because the midwife is needed. Homebirths seem to be always overruled by labour ward's needs.
The women I know who have had homebirths talk of themselves as 'very lucky' because everyone knows it's a staff issue.
I think it's great if you've bf successfully but I think that the amount of medical intervention in labour and birth is thought to decrease one's likelihood of successful bfing statistically. Obviously there will be exceptions.
I think the problem with this debate is that somehow there is a perception that it is an 'achievement' somehow to have a 'natural' labour or to have a homebirth and that in some way is a judgment on the women who have interventions, need interventions or choose interventions.
I would argue that it does take courage and determination to have a homebirth or to resist medical intervention.
Of course it's courageous because the whole system uses fear to persuade women to conform even very low risk women are pressured to conform. This is the way systems work but it doesn't have to be a comment on anyone else. It seems to me that it is brave and it is an achievement of those women to go against the system.
Making it into a competition is just wrong in my opinion.
And like it or not, it does take real courage to go for labour without pain relief when you're in a unsupportive environment, I really think it does!

ajmama Thu 02-Jun-11 09:30:31

Tangle, I am only talking about friends in real life. Maybe in my area there is more support for homebirths as I can off the top of my head name half a dozen ladies who have had homebirths and 2 who did not intend to but ended up with homebirths.

BalloonSlayer Thu 02-Jun-11 09:39:41

I have heard twice in the last year of women being taken into hospital because the midwife is needed. Homebirths seem to be always overruled by labour ward's needs.

- but they are not "labour ward's needs," they are the needs of other labouring women, who happen to be in the labour ward.

wolfhound Thu 02-Jun-11 09:50:51

Planning a homebirth for DC3, due next month (though have to be cleared by consultant for it next week due to age). DCs 1 & 2 were hospital births, fairly straightforward (just gas & air and quite quick), though I did tear (I think through being told to push when I didn't have the urge).

I've done a lot of reading up about homebirth over the last months, and I understand where supporters like this French doctor (disclaimer - I haven't read/heard his particular views) - are coming from. I think that the hospital environment and experience disrupts the natural physiological process and makes birth harder and interventions more likely. So, for low-risk pregnancies like mine, a home birth may well be a better experience (and statistically have just as good outcomes for babies, and better ones for mothers). However, I also think that for problematic pregnancies, all the hospital care and intervention is life-saving.

In the Netherlands, 30% of births are homebirths - it is a normal process for low-risk pregnancies there. I do think that the entire process has become too medicalised - I didn't think of home birth as being a realistic option until my doula this time talked it through with me and I began looking into it. It is something the mother has to initiate and drive, rather than being an option that's explained and supported from the start.

Still, don't want to tempt fate by talking up home birth too much at this point, will wait a month till after I've had (or not had!) mine...

Spudulika Thu 02-Jun-11 10:33:50

Balloon slayer - hospitals can always snaffle staff from antenatal or postnatal to cover labour ward, and bring in bank or agency staff to fill their shoes. It's simply a matter of money. Anyway, Mums need one to one care whether they're on the labour ward or at home. It's completely unreasonable to expect women to expose themselves to the risks that come with labouring on an understaffed labour ward when they have planned to stay at home. the only responsibility a labouring mum has is to herself and her baby. (funnily enough you rarely if ever here these sort of arguments used against epidurals, despite the fact that some labour wards will be sharing their anaesthetists with ITU, and despite the fact that epidural use places big additional pressures when it comes to staffing levels....)

eastegg Thu 02-Jun-11 10:43:36

Re bfing and intervention. I had lots of intervention in the form of an instrumental delivery, never had any probs with bfing and did it for 14 months.

I think that the idea that intervention/cs makes bfing harder is an outdated myth. Even my mum, who had her babies by CS 40 years ago, has been poo pooing this for ages. She was up against old-style general anaesthetic CSs, and the unfashionable image of bfing in the 70s, and still bf'd successfully.

Spudulika Thu 02-Jun-11 11:22:30

eastegg, if babies born after c/s are more likely to go to special care than babies born after a straightforward vaginal birth (they are), and babies born after assisted deliveries are more likely to be fractious and jaundiced in the first week, you can see how it might interfere with establishing breastfeeding FOR SOME WOMEN, especially in the absence of good quality help and support, which is often the case for UK mums.

Mums are more likely to be unwell following surgery - it's not beyond the bounds of reason to see that if this happens then bf is going to be more of a challenge for her.

WidowWadman Thu 02-Jun-11 11:44:22

Spudulika - I think you're getting things arse about face here, though - it's not the CS which neccessitates SCBU and causes feeding difficulties, but it's the underlying conditions which make the CS neccessary.

Or do you reckon those sick babies would probably alright and problem free if they had been birthed vaginally?

I don't deny that there are iatrogenic problems, but not it's not true for every birth.

Other than that, breastfed babies are more likely to be jaundiced than bottlefed babies, but I've never seen that uses as an argument against breastfeeding.

Personal anecdote - breastfed with no problems first child for 18 months after EMCS, and now am feeding no 2 after ELCS a week ago. The only trouble I currently have is too much milk, despite a good latch and frequent feeds.

And the solution to breastfeeding issues is not altering the mode of delivery, but supplying proper support. I had a midwife spending hours with me getting the latch right, demonstrating hand expressing with a fake boob etc first time round.

As for 1-1 care - would be great in an ideal world - (although surely it's 2 mw's per mother in homebirth?), but we don't live in one and there are finite ressources. I guess it's probably easier to run a labour ward economically than making sure that there will be enough midwives to tend to all women who might go into labour at the same time at home.

How likely you are to get a homebirth depends on your local NHS trust, I guess. In my area they're very pro homebirth - which I don't think is a bad thing. However, one of my friends had to beg her midwives to transfer when she felt she didn't want to be at home anymore, and they refused until her husband called an ambulance himself. I guess the hospital is not the only place where a woman can be made feel powerless.

BalloonSlayer Thu 02-Jun-11 12:00:26

But don't home births have to have two midwives, Spudulika?

Spudulika Thu 02-Jun-11 12:13:08

"I don't deny that there are iatrogenic problems, but not it's not true for every birth"

No. I agree! I didn't say or imply that this was ALWAYS true, I'm just reflecting on some of the stories I've heard from people who have struggled with breastfeeding after difficult/operative births.

"Other than that, breastfed babies are more likely to be jaundiced than bottlefed babies, but I've never seen that uses as an argument against breastfeeding."

I'm not using the higher rates of jaundice found in babies born after instrumental births as an argument against instruments being used in birth.

"And the solution to breastfeeding issues is not altering the mode of delivery."

No, of course not.

"As for 1-1 care - would be great in an ideal world"

No - not an 'ideal world'. Some hospitals are already managing this. I agree there are finite resources, but that's never used as an argument for restricting the availability of epidurals for labouring women, despite the fact that epidurals are not linked to better clinical outcomes (worse actually), whereas providing one to one care is linked to better clinical outcomes for mothers and babies, which decreases overall costs to the NHS.

"(although surely it's 2 mw's per mother in homebirth?)"

The second midwife usually only stays an hour or so for the actual birth. You also have to factor in that mothers who labour at home have about half the rate of c/s, compared to similar low risk mums labouring in hospital. They're also less likely to need an epidural. Both these things mean that homebirth has economic benefits for local providers of maternity services.

" I guess it's probably easier to run a labour ward economically than making sure that there will be enough midwives to tend to all women who might go into labour at the same time at home."

It's easier to continue with dangerous levels of understaffing if you have all the women in one place. I would prefer for the government to accept that it's unacceptable for staffing levels to be so low that women and babies are put at risk, and do something about it.

Have to say, this issue is of real interest to me at the moment. My local maternity unit is currently being investigated following 3 maternal deaths in the space of 8 weeks last summer. At least one of the deaths is known to be the result of malpractice, and the Quality Care Commission has flagged up dangerously low levels of staffing at the hospital as being part of the problem. sad

As for homebirth provision in our area - we have a specialist caseloading team who only do homebirths. Women here who opt for this pattern of care are IMO making a very rational decision for themselves and their babies, given the poor provision currently available at our hospital.

metalelephant Thu 02-Jun-11 14:53:55

I have friends that have had lovely experiences during a homebirth, and also some that absolutely hated it or couldn't cope and went to hospital.

For me, what really puts me off a homebirth is feeling that it's not just about me labouring, it's about a baby who might need urgent help and will probably be better off in a place where there are relevant facilities and trained staff.

And, most importantly, that in a hospital there are lots of trained professionals, midwifes, doctors and nurses rather than the two midwifes I would get quite randomly at home. I have met lovely midwifes and some not so lovely ones, I wouldn't trust my or my baby's live in their hands.

At least at hospital I can have more choice over who is with me, theoretically ask for a different individual if it's not working out, and also opt for pain relief if I can't cope. Those options make me feel far more relaxed and probably will help me give birth in a positive spirit.

With my first, due to umbilical problems I was advised to be monitored and get an epidural so they could give me an EMCS if he got distressed. He did get a but distressed but I pushed him out without any instruments so it was as natural as it could be. I had a lovely midwife, a really nice anaesthesiologist, a couple of obs and a paediatrician in hand. They were not pushy, they wanted to avoid an CS, they helped deliver my son in a most caring and non patronising way. I prefer that over two midwifes, and I hope it's a choice any woman can make.

Spudulika Thu 02-Jun-11 16:16:41

"For me, what really puts me off a homebirth is feeling that it's not just about me labouring, it's about a baby who might need urgent help and will probably be better off in a place where there are relevant facilities and trained staff."

Are you suggesting that women who opt for a homebirth are putting their baby at increased risk?

"At least at hospital I can have more choice over who is with me, theoretically ask for a different individual if it's not working out"

In theory. In practice it's rare for women to do this. And at home you're more likely to have a confident and experienced midwife, because the less confident ones tend to steer away from doing homebirths as they find the responsibility worrying.

"and also opt for pain relief if I can't cope".

Fair enough, as long as you realise that the bargain you strike in opting for a hospital birth is: easier access to pain relief + greater likelihood of needing it.

And of course, the flip side to the benefit of marginally easier access to medical care is that there's greater likelyhood you're going to need it (because births are more likely to become complicated in hospital than they are at home)

In a similar vein, quicker access to SCBU when you book a hospital birth goes hand in hand with the higher likelyhood that your baby will need special care (babies born at home are less likely to have low APGAR scores and to need to go to SCBU).

" Those options make me feel far more relaxed and probably will help me give birth in a positive spirit."

Anyway, each to their own. I think it's hard to be hard-headed about these things. If you don't feel safe at home (despite knowing that it's as safe for you and your baby as going into hospital) it's probably not going to help you labour well.

Spudulika Thu 02-Jun-11 16:21:21

"They were not pushy, they wanted to avoid an CS, they helped deliver my son in a most caring and non patronising way. I prefer that over two midwifes, and I hope it's a choice any woman can make."

If I had an epidural in situ and was marooned on a bed for my labour, I'd certainly want a paediatrician and an obstetrician on hand for my delivery. Epidurals turn a low risk labour into a high risk one - hence the need for the additional monitoring and ready access to doctors. You'd certainly not want to be in this position at home (even if it were possible, which of course it isn't!).

WidowWadman Thu 02-Jun-11 16:30:28

"In a similar vein, quicker access to SCBU when you book a hospital birth goes hand in hand with the higher likelyhood that your baby will need special care (babies born at home are less likely to have low APGAR scores and to need to go to SCBU)."

Surely that is not because of the hospital birth, but because these babies have already been risked out from being born at home.

Spudulika Thu 02-Jun-11 16:43:43

"Surely that is not because of the hospital birth, but because these babies have already been risked out from being born at home."

No - these figures come from large studies which match mums who've opted for a homebirth with similar mums who've chosen to give birth in hospital.

The largest and most influential study in the past decade has included in the homebirth arm the outcomes for those babies whose mothers transferred into hospital PRIOR and DURING labour, who would be expected to have poorer outcomes as a group.

Read here:

here

metalelephant Thu 02-Jun-11 16:55:59

Spudulica, I have read your posts before and appreciate your passion as it shows to me that you care but if I'm honest I find your tone slightly patronising.
Fair enough, as long as you realise that the bargain you strike in opting for a hospital birth is: easier access to pain relief + greater likelihood of needing it.
Yes, I like to know it's there as an option, and when I had my first baby somebody had taken that away, I would have been rather angered.

My friend had a midwife in her homebirth that left her to go to the bathroom to refresh her makeup! I imagine she was a one off but why should I depend on such a random person? I have no more plans to give birth to anymore children after the one I'm expecting, so I want to avoid taking chances as much as possible.

As to your earlier question on whether I'm implying that women who give birth at home put theor babies at risk, I find it slightly inflammatory. The importnant thing is to judge on an individual level and listen to what the professionals are saying as well. If your ob or midwife advise you to give birth in hospital and you ignore them... then yes, maybe you are putting your baby at risk. Otherwise, if they say it's fine, home might be the best place.

I'm talking about MY experience and MY wishes, hopefully we will continue to have choice over the subject rather than put ourselves under danger or stress just to prove somebody else's idea of the perfect birth.

metalelephant Thu 02-Jun-11 16:57:16

Yes, I like to know it's there as an option, and when I had my first baby IF somebody had taken that away, I would have been rather angered.

Spudulika Thu 02-Jun-11 17:21:58

"Yes, I like to know it's there as an option, and when I had my first baby somebody had taken that away, I would have been rather angered."

Taken what away? The option of an epidural if you really need one? Gas and air? Both are available for a mum who books a homebirth, should she need them, though the first will require transfer. And of course booking a hospital birth is no guarantee of access to an epidural as a proportion of women who request an epidural won't get one because of inadequate anaesthetist cover on some labour wards.

"but why should I depend on such a random person?"

For the same reason you'd be depending on a random person in hospital! I know people who've had unassisted birth in hospital because the midwife has been off down the corridor caring for another mum. Actually it happens regularly in UK hospitals. Seriously - look at the facts. Women who have their babies in hospital are MUCH less likely to get one to one care from a midwife, and are much less likely to get continuous care from a single midwife. 80% of women who give birth in hospital don't know their midwife - have never seen her before. That's a massively higher percentage than among mums giving birth at home.

"My friend had a midwife in her homebirth that left her to go to the bathroom to refresh her makeup!"

Women who've had their babies at home usually find that it alters the whole dynamic of the relationship between them and their midwife, compared to the way things are in hospital. Most of what midwives do at home is simply watchful waiting. And many women don't want someone to sit there goggling at them.

I really can't understand why anyone would object to their midwife nipping off to freshen herself up at a homebirth, unless they were in the process of actually pushing their baby out or having complications which required her to keep close watch? My midwife slept across the end of my bed at times during my labour at home, which went on for two full days. She was tired. But I knew she was there for me if I needed her, and not with her hands up another woman in the room next door!

"I want to avoid taking chances as much as possible. "

With respect - it's slightly inflammatory to imply that opting for a homebirth is putting your baby at risk, and that's EXACTLY what you're doing here!

And of course things are different if you have medical complications in your pregnancy that put you at increased risk of needing a medical help.

I think the thing that I find difficult about these threads is that while it's fair to acknowledge that these things have to be decided on individual feeling and circumstance, there's also a lot of assumptions being made about what actually goes on in hospital or at home which aren't born out by the facts.

metalelephant Thu 02-Jun-11 17:49:46

I guess my own experience of two high risk pregnancies (currently due in October) makes me feel quite grateful to the way the NHS has cared for me. For me, homebirth has never really been an option.

To be honest, I feel a lot less scared of the unknown with this second pregnancy, so feel very excited about what my plan is: a hospital waterbirth with gas and air. I feel confident in that choice and all the medical staff I have met so far have been very nice and attentive. If it goes wrong and the baby doesn't want to come out, I won't face a scary ride to the hospital. That's all.

Spudulika Thu 02-Jun-11 19:29:50

Lucky for you that you have access to such a good hospital, and are low risk - and are therefore eligable for a waterbirth in a MLU.

My local hospital doesn't always provide good care and maybe that's one of the reasons I felt safer at home - despite being supposedly 'high risk' (I hate the 'high risk' label, the way it's applied generically - as though someone with a borderline high BMI is somehow in the same category as a morbidly obese diabetic with pre-eclampsia........ but that's the way the NHS works mostly - clumping women into categories and restricting their choices on grounds of protocol sad)

metalelephant Thu 02-Jun-11 20:22:25

In the hospital I'm going to give birth in, i've been assured that I can have a water birth in the main hospital, ie not the MLU.

I guess it's down to our own experiences, I had (in a different hospital) a great labour but the ward afterwards was pretty ghastly... I think that's where you are let down, in the aftercare.
(I am under consultant care as I have hypothyroidism, no placenta worries in this pregnancy yay!)

I do hope you get the birth you want Spudulica, and that it's a positive experience as it makes such a difference to how one copes with all the surprises ahead. I really am not anti homebirth, I just know it's not for me.

Besides, in the country I'm from, it's unthinkable to have an opinion about tour birth, cesaereans are encouraged as they allow obs to manage their timetables nicely, breastfeeding is undermined and women in l abour are often treated like children.

So I appreciate the much more "natural" spirit here, and feel my voice is heard much more.

metalelephant Thu 02-Jun-11 20:24:16

Apologies for misspelling your name Spudulika...

Allegrogirl Thu 02-Jun-11 20:29:22

Back to the OP and the actual interview on R4. Frederick Leboyer says amongst other things that there is no place for fathers at the birth, mother and baby only. Midwife should be 'in the kitchen making the coffee'. The mother should be alone with no pain relief (pain relief prevents the mother from bonding with the baby). Childbirth is a womens greatest sexual experience and we shouldn't avoid risk but be brought close to death in child birth.

Just what I need to hear when I'm finally getting over the fact that I had two induced births and wasn't able to have my planned homebirth. All my fault for being too risk averse. And actually both the births were fine, second one without epidural so bloody painful, but it's never good enough.

Ormirian Thu 02-Jun-11 20:40:32

I had 3 hospital births for varying reasons. First one was over-managed because I was totally passive and felt that somehow someone should make it ok. Which of course they couldn't/wouldn't totally. I ended with Lethe one and then episiotomy and difficulties establishing bring.

2nd and 3rd time I got on with it. I didn't need the mw tbh because there were no complications. But I can see how easy it would be to allow the medical people to take over and make a labour into an operation with or without the use if a scalpel and anaesthesia.

Spudulika Thu 02-Jun-11 20:57:37

"I do hope you get the birth you want Spudulica"

Just a lurker metal - not pregnant! I did get the birth I wanted but I had to pay an independent midwife. Don't begrudge it though - it was worth every penny. I do begrudge the months of anxiety I experienced before I booked with her though........

Spudulika Thu 02-Jun-11 21:04:21

"but it's never good enough."

If it was good enough for you, it's good enough!

I understand where Leboyer is coming from. He's looking at the role of instinct and the hormonal cascade of labour. He's singing from the same songsheet as Michel Odent really. I appreciate these radical voices - I think they enrich the debate surrounding childbirth.

I would love to see some good research done into men's presence at births - whether it impacts on outcomes. Don't see it would be possible to do it though.

Metalelephant, meant to say, I think the discussion of these issues here on mumsnet is GREAT - such a range of voices and experiences. smile

TheFowlAndThePussycat Thu 02-Jun-11 21:06:10

I find it hard to be objective about this because dd2 and I absolutely would have died left with no medical intervention. I had grade 4 placenta previa & therefore there was no other way out for her than cs & I then lost 7.5l of blood. We both ended up in intensive care. I find it difficult to consider myself and my daughter just unfortunate statistical outlayers. I didn't hear the whole interview but surely Leboyer doesn't think that women like me should be left to get on with it?

Also I think (inevitably) that all that stuff about not bonding is sh*t. I barely saw dd2 for 2 days & if he wants to come round and explain to me how my relationship with my daughter has suffered then I'd be pleased to hear him out kick his ass

(don't worry, I wouldn't really kick a 92-yr old's ass grin)

metalelephant Thu 02-Jun-11 21:08:31

Couldn't agree more Spudulika, I have learned so much here, the discussions are priceless! Apologies for thinking you were pregnant by the way smile

Sioda Thu 02-Jun-11 21:38:53

"In a similar vein, quicker access to SCBU when you book a hospital birth goes hand in hand with the higher likelyhood that your baby will need special care (babies born at home are less likely to have low APGAR scores and to need to go to SCBU)."

Surely that is not because of the hospital birth, but because these babies have already been risked out from being born at home."

WidowWadman, when NICE reviewed that Chamberlain study they concluded that the hospital group in it was indeed higher risk than the home birth group. Sorry can't remember where i read that.

Spudulika Thu 02-Jun-11 22:37:21

"I didn't hear the whole interview but surely Leboyer doesn't think that women like me should be left to get on with it?"

You'd hope not wouldn't you? shock

"when NICE reviewed that Chamberlain study they concluded that the hospital group in it was indeed higher risk than the home birth group"

They acknowledge this on the Homebirth UK site:

"There are probably other, unmeasurable subtle differences too. The home birth group had less incidence of high blood pressure between recruitment for the study, at 37 weeks, and the birth - which could be because midwife antenatal care was less stressful than hospital antenatal care, but could also be because women who developed high blood pressure before 37 weeks (and transferred their booking to the hospital) would not be included in the home birth group, but would possibly be included in the hospital group (although they would presumably still have to be considered low-risk, to be an appropriate matched pair)."

However, the most common birth injury noted in the study was bruising, which you would assume would be mostly down to the higher rates of assisted delivery in the hospital arm of the trial (which may well have something to do with epidural use). Babies born following assisted deliveries may well be more likely to be admitted to SCBU

cory Thu 02-Jun-11 23:31:27

Leboyer claims that "At a certain point of labour woman is experiencing death and because she’s been able to face death she becomes free from the fear of death."

Does that go for all facing-death experiences, or is it just labouring women who are supposed to get stronger from it? I wonder what Leboyer would have to say to my grandmother who was so traumatised by her homebirth in remote village with village midwife that she could never contemplate the idea of another pregnancy. I am sure she had every opportunity to face the thought of death without any worrying pain relief or medical back-up getting in the way. Shame it didn't make her feel any stronger. But hey, what right had she to decide on her own feelings like that without consulting the Men Who Know?

Leboyer annoys me in the same way that I feel annoyed by same male consultant preaching the benefits of a medicalised birth: it's a male expert telling me what I should be wanting and feeling as a woman in a situation he has never been in and never can be in, telling me whether I should want my partner present or not, telling me what I should be concentrating on- because of course poor fluffy-headed little women can't be trusted to develop their own opinion on anything.

TheFowlAndThePussycat Fri 03-Jun-11 07:19:01

Yes, speaking as someone who faced death whilst giving birth, it ain't all it's cracked up to be.

My point is that some women are always going to need medical intervention. People like Leboyer delegitimise that sort of birth experience & in doing so devalue women's real experiences and also manage to imply that their relationships with their children are damaged. I think it's pretty misogynist tbh.

I am absolutely pro home birth, I really wanted one for myself & many of my friends have had them. However I think sometimes we are in danger of forgetting that there is genuine & real pain & danger associated with birth, and IMO women have the right to manage those risks in whatever way they choose.

Boogiemumma Fri 03-Jun-11 08:48:15

Agree with TheFowlandThePussyCat
It could be easy to forget where healthcare is so readily available that we in the developped worls are fortunate to have these interventions and they are imo not used without due cause - they are costly and of no benefit to mother or baby if used uneccessarily.
As an example, mothers in developping countries in Africa have a 1:16 chance of dying in childbirth compared to 1:4000 in any developed country. A large proportion of these deaths are related to complications in childbirth such as haemorrhage, infection and obstructed labour. Tell these African women that they aren't "relaxed" enough. Add to this an infant mortality rate of up to 1:10 in these countries and "natural" birth appears to be a quite a risky business.

WidowWadman Fri 03-Jun-11 09:08:35

I agree with Fowlandthepussycat, it sounds all rather misogynist to me.

Out of interest, is there actually any sound supporting evidence to the validity of Leboyer's theories?

cory Fri 03-Jun-11 10:06:34

I am all for providing better access to homebirths/relaxed birth/labouring-women-in-control births.

But a 70yo bloke telling me that I have to eschew pain relief so I can have a great sexual experience and be close to death- how is that putting the woman in control of her birth?

First, I'd like to know how often he goes out and courts pain and near-death experiences just for the sake of it.

Secondly, if he thinks this is the greatest sexual experience of a woman's life, I'd wonder what he's like in bed.

We had a bloke like this in atante-natal class, talking loudly about how women didn't need pain relief because it was a natural process. His wife looked pale but didn't get a word in edgewise. Didn't look very empowering to me.

It strikes me that the reason I was so anxious to have dh present when I gave birth was that he is not in any way like Leboyer.

Spudulika Fri 03-Jun-11 11:08:32

Natural birth certainly is a risky business for impoverished and malnourished women who have had no antenatal screening for conditions like placenta praevia; may have severe anaemia related to malarial infection; have had their external genitalia removed and their vagina sewn up with a dirty thread or thorns; may be 13 and only barely embarked on puberty, or be 35 and expecting their tenth child. Poverty, pre existing illness and lack of basic midwifery care is what's mostly behind the shameful figures for maternal deaths in these countries, not the intrinsic risks of normal childbirth, which are very low among populations of healthy women in receipt of basic midwifery care in pregnancy and around the time of birth.

Spudulika Fri 03-Jun-11 11:11:30

The only supporting evidence is a very clear reduction in c/s rates for mums who have doulas at the birth. Assume most women who have a doula also ha e their dh's present too though.

BagofHolly Fri 03-Jun-11 12:10:41

Spudulika, how can there be evidence of a reduction in cs in women who have a doula? It's impossible to know whether these women would have had a cs or not, surely? And same as my point re Ina May, there has to be an element of self selection for the women choosing to deliver with doulas - if a woman has had a high risk, highly medicated pregnancy, she's unlikely to step away from the same medic's advice and chose a doula. I suspect that women choosing doulas are much more likely to be confident in their bodies anyway, and having a high risk pregnancy sadly erodes that confidence.
(not being deliberately picky BTW, am finding this thread v interesting!)

fruitybread Fri 03-Jun-11 12:18:11

Cory, I love your posts. And I agree with TheFowl. Reducing women to a bunch of hormones, and then dictating to them what their experience of birth should be on that basis is very disempowering, and misogynist. His tone is very dictatorial, and, like all strong advocates of ANY kind of birth (someone else has drawn a comparison with consultants pushing very medicalised births), his message is ultimately about restricting choice in birth.

[disclaimer - this doesn't mean I am anti-homebirth, and I think learning about the physical and physiological processes of pregnancy and birth is very useful. But I think that behind Leboyer's comments are a whole host of assumptions about a woman's role and status. If you buy into those, then fine, you'll probably find what he says palatable. I don't.]

TheFowl was your placenta previa missed or misdiagnosed? Because from all I've read, grade 4 (covering the cervix) is one of the very definite conditions requiring a c-section and in fact was the cause of mortality of the woman in childbirth for many years. Mine is grade 1/2 but if it had been grade 3/4 I would not have hesitated to go for an ELCS even though what I really want is a homebirth. I could not have justified the risk of bleeding.

In my mind, something like grade 4 PP is exactly WHY we need medical intervention! And why I'm thankful it's available to us though obviously we all hope we'd never need it.

Back to the OP, having just read Juju Sundin's book where she hammers home the idea that labour pain isn't "bad" pain like from a toothache or kidney infection, I can understand the theory of where Leboyer is coming from. It does seem at times that our society acts as if childbirth is by definition something to be controlled and monitored like it's something WRONG and unnatural (and metalelephant's post above about how her country treats women in childbirth sheds some light on that).

The biggest problem I see with the current attitude of the medical community -- as experienced by me with the NHS -- is that it's very hard to know whether you're being told something is a real risk, or an intervention is really necessary FOR YOU, or whether whatever they are saying is based on policy or protocol and you're lumped into a statistical group, as spudulika said.

Good thread btw.

TheFowlAndThePussycat Fri 03-Jun-11 14:18:03

No, my pp wasn't missed, I was in hospital for 7 weeks before dd2 was born. But they do get missed. My experience there is that it's the registrars and house officers who are obsessed with protocol etc because they are frightened of getting things wrong. The senior consultants are very sensible & prepared to discuss options. But unless you are 'high risk' it's difficult to see someone senior enough to have a sensible conversation with.

But tbh I'm a bit hmm about this good pain/bad pain stuff. Pain is pain & people have different tolerances and choose to manage it in different ways. I don't think you should have to bear something which to you is unbearable, or even unpleasant, just because someone else tells you it's 'good'.

What really riles me that no-one would suggest to anyone other than a labouring woman that pain is 'good'. I think we (as a society) are in danger of fetishising birth.

Boogiemumma Fri 03-Jun-11 14:39:09

Mnay of the antenatal interventions such as screening for placenta previa etc were not available when Leboyer was an obstercian and he was still an advocate of birth without interventions. I'd maintain that women in developped countries are fortunate that differnet birthing methods are available and we should stop bleating about how we're forced into sterile environments, CS and instrunmental deliveries. We do have choice it is up to us to exercise it, the medical professiona are there to guide.
This man is frankly deluded and expresess quite dangerous opinions, a crying baby at birth not natural? birth being akin to the greatest sexual experience a woman can have etc? Come on girls if sex was the equivalent in any way to birth, very few of us would be here!

Spudulika Fri 03-Jun-11 15:20:02

" and we should stop bleating about how we're forced into sterile environments, CS and instrunmental deliveries"

What - even if they're avoidable and sometimes the result of substandard care? And cost the health service an absolute fortune, and in the case of c/s may be implicated in some cases of stillbirth in subsequent pregnancies? And finally draw resources away from women who have the greatest need for medical care during childbirth?

Are you kidding?

What is the value of these things if they make births more painful and more dangerous for women and babies and not safer?

In what other branch of medicine would you accept that it's ok to have high rates of avoidable surgery taking place that put people at risk of infections and more likely to end up in ICU? Jeez - and new mums at that!

"how can there be evidence of a reduction in cs in women who have a doula?"

Actually this reseach comes from a very wide range of sources and is considered reliable enough to form the evidence base for one of the very few recommendations made in the NICE guidelines on caesarean section: "Women should be informed that continuous support during labour from women with
or without training reduces the likelihood of CS".

NICE

If you look at the Cochrane review it gives more detail on the research on continuous support in labour:

"The review of studies included 21 trials, from 15 countries, involving more than 15,000 women in a wide range of settings and circumstances.

"Women who received continuous labour support were more likely to give birth 'spontaneously', i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. Their babies were less likely to have low 5-minute Apgar Scores. No adverse effects were identified. We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial. Support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience."

And I think many of the studies were done in hospitals where women were randomly chosen for this type of birth support - ie, these were not women who had bought their doula's in with them.

"a crying baby at birth not natural?"

It was traditional in the past to hang babies upside down from their feet and strike them to make them cry at birth - to clear their lungs. It also used to be standard practice to separate mothers and babies at birth, to put drops into babies' eyes and to remove all the vernix from them by washing them with soap. Thank god for Leboyer - probably more than any other doctor this century his views have made birth more humane by drawing our attention to the fact that like any other mammal, human babies need gentle handling and to be with their mothers as much as possible at birth.

Spudulika Fri 03-Jun-11 15:30:03

"What really riles me that no-one would suggest to anyone other than a labouring woman that pain is 'good'".

But pain in labour isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's body - responding to it can help her get her baby born. Have you not heard of the concept of 'pain with a purpose' in labour?

And on a personal note - I found experiencing extreme pain during my three labours was enriching for me. I've never been pushed to that extent before and come out smiling. Going through my labours was an emotional adventure and gave me confidence in myself and deepened my relationship with my husband - not just because we were having our baby, but because it was the first time in our life together that I felt entirely vulnerable and broken down. I needed him in a way I hadn't before and haven't since, and he was fantastic. I was on a MASSIVE hormonal high after giving birth - particularly after my third labour which was very long. You don't get that high without a shed-load of endorphins, and you don't get the endorphins without the pain. Those feelings of ecstasy will stay with me forever - it definitely enhanced the brilliance and meaningfulness of those first few days with my second and third baby. I didn't have it with my first, as I had an epidural. Yes, it was still beautiful to have her in my arms, but I now know I missed out on the intense euphoria that comes iwth a body full of endorphins, that would have made that first day or so even more special.......

Boogiemumma Fri 03-Jun-11 15:49:22

NO one is suggesting a natural birth where possible isn't a good thing. What I do disagree with is the notion that the medical profesion deliberatley instrumentalise and medicalise birth uneccessarily. Good for you if you found the pain enriching, many don't! No one forces an epidural on women, it would be assault. And it's absolutely possibly to get the endorphins without pain, oxytocin is generated by the skin to skin contact of your child so to suggest women who don't expereince this pain (and I'm sorry if you didn't Spudulika) don't get this is insulting.
Yes some medical practices in this country have been historically misguided such as seperation from the mother - we have come on leaps and bounds since. No one is saying a westernised birth is the perfect experience and non interventional births are undoubtedly quicker and less traumatic for both mother and baby however Leboyer seems to be sugesting that intervention is given as a matter of course. I don't believe this, I do believe that although his views about careful handling, closeness to the mother after birth are true that his other views about how the expereince of birth "should be for women" and his complete anti-interventionalist stance are misguided.

Gosh I'm spending way to much time on this thread! I need to prepare for my much anticipated completely interventionist birth by ELCS next week! I'm pretty certain that after the traumatic experience of my 1st birth I won't be short on endorphins when I meet my daughter. It's been interesting.
Ciao x

CrapolaDeVille Fri 03-Jun-11 15:51:21

It's too annoying to comment anymore than to say it is every woman's right to birth, within reason, how she likes. It is not her right to have a homebirth when there is any risk to the baby.

CrapolaDeVille Fri 03-Jun-11 15:52:40

Boogie....Have you planned your music? Got flannels in prep for the terrible itchig when your skin comes alive again? and vasleine for your nose? I always found myself sooooooooo itchy.

WidowWadman Fri 03-Jun-11 16:23:35

Re "pain with purpose" - pain's usual purpose is to tell you that something is wrong.

For example. when my kidneys hurt like buggery, it was very purposefully telling me to get myself into hospital asap. So it's good that they hurt, so I could get some intervention (including prophylactic steroids for my baby's lungs, but thankfully the infection didn't start labour). But whilst the pain had done its purpose to warn me of a serious state, it didn't make me enjoy it.

Neither did I ever enjoy contractions, I vividly remember when I had them with my first child shouting that I wanted them to stop,whilst stupidly having been too scared of the 'chain of intervention' to allow painkillers. I could have saved myself a lot of unneccessary pain there (and purposeless pain at that, she was never coming out that way)

Tangle Fri 03-Jun-11 16:46:19

CrapolaDeVille
"It's too annoying to comment anymore than to say it is every woman's right to birth, within reason, how she likes. It is not her right to have a homebirth when there is any risk to the baby."

Yes - it is every woman's right to birth, within reason, how she likes.

However, the one absolute in birth is that there is risk - to the mother and to the baby. The risks of being at home are different to the risks of being in hospital, so trying to compare the two directly is extremely hard if not impossible. Being in hospital will mitigate some of the risks of being at home - but it will increase others.

As is probably clear, I'm quite pro home birth - but I'm more pro informed choice. There are circumstances where, IMO, it would be foolhardy for a woman to choose a homebirth - but there are man instances where the NHS would advise against it but, IMO again, going against that advice may be the right thing to do for an individual woman.

Boogiemumma
"We do have choice it is up to us to exercise it, the medical professiona are there to guide."
That's true - but too many medical professionals seem to "guide" by dictating to women how things are going to be. That is not an environment that facilitates women being active participants, even if they don't want to be the leaders, in the decision making process.

I've experienced it first hand. I know that the consultants have no legal authority to dictate my care - but the two I was seeing were quite dictatorial and wouldn't let me get a word in edge wise such that a discussion was impossible, and I got so frustrated I was almost in tears. Which is a shame, as I now feel like it will be hard to involve them in a decision (which I'm sure they would contribute valuable information to) as they do not respect that its my decision to make.

CrapolaDeVille Fri 03-Jun-11 16:49:22

I have had five c sections....I am pretty much pro alive baby and mother.

Chynah Fri 03-Jun-11 16:56:24

But pain in labour isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's body - responding to it can help her get her baby born. Have you not heard of the concept of 'pain with a purpose' in labour?

But pain with toothacher isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's mouth - responding to it can help her get the treatment she needs. Have you not heard of the concept of 'pain with a purpose?

Personlly think why the hell should you hence both mine were ELCS which was fantastic each time. Each to their own.

Spudulika Fri 03-Jun-11 19:48:25

Endorphins and oxytocin are two different things. Like it or not women who have unmedicated vaginal births will have massively higher levels of both post birth than women who have c/s. Doesn't mean you'll love your baby any less, but it does mean you are likely to feel different.

I also agree that medics and midwives are usually keen forwomen to have a straightforward birth if possible. Our very high rates of intervention are not the fault of individuals but have grown from a risk averse culture and a protocol driven and underfunded healthcare system.

I also agree with the sentiment 'each to their own'. Some people will prioritise control and pain relief. I was more concerned getting through the birth with my abdomen and perineum intact. And of course we're all primarily focused on the well-being of our babies so that's one thing which unites us.

TheFowlAndThePussycat Fri 03-Jun-11 19:52:15

You can get a body full of endorphins by running a marathon spudulika but most of us still aren't going to do it. It's great that you enjoyed your labours. I had an unspeakably dreadful time. Your version was more pleasant for you, but it wasn't intrinsically more 'right' than mine & I resent the implication (more Leboyer's than yours) that the manner of dd2's birth has had a negative impact on my relationship with her, in fact I love her all the more for what we went through together.

I think the problem is that when someone has a wonderful experience they feel (rightly) that they want to share it. But just because it was wonderful for you doesn't mean that it wouldn't be horrifically terrifying & unbearable for someone else. People might read & understand & take into account all of the research you quote & still take the completely legitimate decision to have an epidural or an elcs. What we all object to I think is pressure of any kind being put on women to take decisions they are not happy with.

There is no good birth or bad birth. We all feel differently about our births, we may have positive or negative feelings about it, but we should never feel ashamed (I can't bear it when I hear women say "unfortunately I had to have a c-section") every experience is equally legitimate.

TheFowlAndThePussycat Fri 03-Jun-11 19:53:29

Sorry x-posts.

Highlander Fri 03-Jun-11 20:01:23

Ina May stats have bias, simply becasue the women who see her are super-keen to have a VB.,the centre has a much higher ratio of midwives:mothers, and the midwives are super-skilled at VBs. (yes, this should be the norm)

I'd like to see her birth injury stats.

Both Ina May and the intervention-free loon are paternalistic. If I went to them, professing my love of CSs, they would be hellbent on persuading me to have a VB, probably being dishonest about the risks. They would do their best to remove my CHOICE.

Spudulika Fri 03-Jun-11 22:50:57

"Ina May stats have bias, simply becasue the women who see her are super-keen to have a VB.,the centre has a much higher ratio of midwives:mothers, and the midwives are super-skilled at VBs"

You've made me laugh Highlander.

You are absolutely right - the good outcomes at this particular birth centre probably are largely down to highly skilled midwifery and one to one care. No 'bias' there!

But it's also true that the attitude of the women she looks after probably does make a difference as they're very motivated to avoid having epidurals - more so than the majority of mothers going to ordinary birth centres I should think.

"Both Ina May and the intervention-free loon are paternalistic. If I went to them, professing my love of CSs, they would be hellbent on persuading me to have a VB, probably being dishonest about the risks. They would do their best to remove my CHOICE."

Have you read any of her books? I'm wondering where you get the idea from that she promotes bullying of women when it comes to birth choices, because I've read all of her books and I don't get that impression AT ALL. And actually, far from being a 'loon' she's a highly respected midwife who, as a speaker packs out midwifery conferences around the world. Her books are on every student midwife's reading list and she's one of the few midwives to have had an obstetric manouvre named after her.....

Re: birth injury stats - vastly more mothers who deliver at The Farm give birth over an intact perineum than is the norm in the US (or for that matter here). Their rates of 3rd and 4 degree tears compare very favourably too.

"You can get a body full of endorphins by running a marathon spudulika but most of us still aren't going to do it."

Not sure what point you're making here.

"It's great that you enjoyed your labours."

No -'enjoy' is the wrong word. I found my labours very, very, very painful and at times frightening. I experienced a lot of nausea, pain in my bowel and back-ache throughout labour. Two of my labours were over 24 hours long. During my third I got stuck at 8 cm for 12 hours, which was deeply unpleasant. However, I did have very, very good care in my second and third from my friend and colleague, who is an independent midwife. It made a very difficult experience bearable.

" but it wasn't intrinsically more 'right' than mine"

Not sure what you mean by 'right'. I don't think I've made any claims for having a 'more correct' labour than you have I?

"& I resent the implication (more Leboyer's than yours) that the manner of dd2's birth has had a negative impact on my relationship with her, in fact I love her all the more for what we went through together"

Ok. I'm happy to admit that the first 48 hours with my dd, who was born after a difficult forceps/epidural birth WERE affected by the birth we had - it affected the way I felt within myself and impacted on our experience of breastfeeding. I think I had to work harder to fall in love with her than with my other two, where I was swimming in a sort of hormonal soup of love and bliss for the first few days. It makes sense to me that disrupting the normal hormonal physiology of labour might impact on the very delicate endocrine mechanisms that are at play in early mother/baby interactions. Is this implying that women who have epidurals/c/s don't love their babies as much or don't bond with them as well? That's not the way I see it. I just see it as part of a package of incidental things that can affect our experience of life with our new baby, along with postnatal illness, poor postnatal care, problems with feeding. These things don't stop us loving our babies but they might impact subtly on our experience of motherhood in the first few weeks of life. After all - we are mammals, and we (to a certain extent) give birth like mammals. We know that there are many things which happen around the time of birth which can profoundly disrupt the relationship between mother and newborn in the animal world. Why should we of all mammals be the only ones who're entirely immune to these disruptions?

"People might read & understand & take into account all of the research you quote & still take the completely legitimate decision to have an epidural or an elcs"

Yes - that's true. I understood and took into account all the possible drawbacks and risks of opting for a homebirth when I had risk factors that made a homebirth on the NHS almost impossible to arrange. I very much accept women's right to make their own INFORMED choice when it comes to childbirth, given my own experience in this area.

"the two I was seeing were quite dictatorial and wouldn't let me get a word in edge wise such that a discussion was impossible, and I got so frustrated I was almost in tears. Which is a shame, as I now feel like it will be hard to involve them in a decision (which I'm sure they would contribute valuable information to) as they do not respect that its my decision to make."

Same here. In my case, I've gotten so many contradictory answers and false information pushed on me that I don't know who to trust anymore. So I've turned back to trusting myself. Sad because, like you, I'd appreciate the knowledge of an unbiased professional but no longer believe I can get that.

What I have learned is the gap between what they say and what they do is directly related to the difference between perceived and real risk. Every single time I was told "you'll bleed to death if you go into labour" I asked "so if that risk is so high, why don't you just admit me right now then?" only to get a blank look and a sheepish shake of the head. They are used to spouting hyperbole and being believed because of their position of authority.

But pushed to carry through with what they say, the ones I've dealt with will back down -- and the ones that don't are the only ones I would take seriously now. The day that someone looks me right in the eye and calls MY bluff is the day that I defer to that judgement. But I suspect a lot of women would just believe most of what they're told at face value and do what the good doctors want. Conflict with authority figures is difficult for many people and they go out of their way to avoid it. That's how we're raised in our society, that's how the medical system is set up, and surprise surprise that's how things turn out for better or worse.

Glad that the people who have chosen c-sections or pain relief or homebirths or any of the other many options available to us -- and I repeat, I believe we are fortunate to have so many choices, to suit every women's individual situation -- are happy with their decisions. It's just too bad that getting informed enough to make those choices has to be so difficult sometimes.

queenceleste Fri 03-Jun-11 23:22:02

I just think that people should stop being defensive.
I had a grim time twice in hospital, I was too high a risk to have any kind of homebirth, birth centre, or even birthing pool in hospital. I was induced twice, incredibly painful, horrible midwife the second time fell out with her so ended up basically labouring alone until the last moment when the vile cow caught dd and sorted her out. Neither of us spoke to each other again. It was horrible to have so much anatagonism and lack of support during labout.
Imo this woman should never have been employed as a mw. But what can you do?
Luckily the rest of the staff were fantastic.
But hospital is a grim, uncomfortable unpleasant place to labour in my experience. i'm sure there are loads of exceptions but that's how I found it.
I know several women who have had homebirths and they never talk much about the pain.. That is interesting isn't it?

Spudulika Fri 03-Jun-11 23:46:11

"I believe we are fortunate to have so many choices, to suit every women's individual situation"

Do you really think that most don't want to know the midwife who'll be delivering their baby? And don't care if they don't get one to one care?

I don't think we have a lot of choices. I think most people take what they're given.

My choice would have been to see the same midwife throughout my pregnancy and to have had her deliver my baby. I wanted a homebirth. I wanted intensive support with breastfeeding - not just 2 half hour visits in the first week from someone who may have had little expertise in this area, and then nothing afterwards.

None of this was available to me, so I went out and paid for a private midwife instead.

Checkmate Sat 04-Jun-11 00:35:07

This is a really interesting debate

I'm due imminently with dc5 and for the first time am experiencing a homebirth, and a mw who has done my ant-natal care, will be there for the birth (unless I have to transfer) and do my postnatal care. This is an Nhs midwife, and just luck of the draw. (She told me that her community mw colleagues moan that she gets to do more homebirths than them, and their supervisor says "that's because she's signed a contract to be there at her own women's births, and her women love the thought of getting a mw they know rather than a stranger, so more choose hb.")

I'm very interested to experience the difference between the hospitalised (bad in some cases highly medicalised) births I've had in the past, and this one at home. I haven't had a problem bonding with any of my babies, but I did have severe pnd after my 1st, whose birth had been very traumatic, and I think I had PTSD, looking back.

I wanted a homebirth with dc4, and was talked into hospital by consultant. Dc4 caught a hospital acquired infection from our overnight stay, and was in the children's hospital for 2 weeks after that. It really brought home tome that there are risks at hospital as well as at home.

Spudulika Sat 04-Jun-11 07:47:44

Good luck with your homebirth Checkmate. Hope all goes smoothly! It's great knowing who's going to be with you at the birth isn't it? For me this was the main thing in helping me relax and to prepare for labour. Bet your midwife loves her job!

TheFowlAndThePussycat Sat 04-Jun-11 08:03:23

Can I first say that I totally agree with everyone about the difficulties of challenging people in authority. I always advise people to insist on answers to their questions, & to keep going up the chain until they will find someone who talks to them straight. But it's not easy. All choices should be fully informed.

spudulika
My point about the marathon was a bit flippant, it's just that the appeal of a fabulous rush of endorphins isn't enough to make most of us run a marathon, it's probably not enough to encourage many women to have an intervention free labour & go through what you describe in your post.

On the subject of 'right'ness, Leboyer clearly states that the only 'right' way to have a baby is intervention-free. He actually told Jane Garvey that she felt guilt over her c-sections. Of course he meant that she should feel guilt. I'll say it again, misogynist. She did well not to expel him from the studio with a swift boot up the bum. I'm sorry if I wrongly associated you with this opinion.

I think Leboyer & others send the message that if you go through labour 'properly' you are rewarded by a unique experience and a better relationship with your child. It's like a reward for your achievement.

But birth isn't an achievement. Birth is something that happens at the end of a pregnancy, your body will deliver your child whether you want it to or not and whatever the health implications for you or the baby. With good support and information and the chance to make good choices you can manage this process well and make it an occasion to look back on with joy. Believe me, I wish nothing less than this for every pregnant woman. But the truth of the matter is that even with good advice, support and information things might not go to plan and you might end up with a whole lot of interventions that you didn't want in the first place. But this is not because you didn't do it 'right' and your relationship with your baby is not doomed because of it.

I don't quite get this point about endorphins. If mws gave all mothers a shot after the birth which sent them high as a kite would that be a good thing? It's your hormones that send you crashing down at day 3 or 4 too, that's not something that many people rejoice in. Many people, regardless of the manner of the birth struggle to bond with their babies. This is because of another pernicious lie, that you will automatically, instantaneously fall in love with your child. You might, you might think you do because you are high as a kite on endorphins, but in reality it's a relationship like any other, built on time and patience and shared experiences.

Anyway, this is a truly epic post. I really honestly do understand where you are coming fromspudulika and I really wish that every woman had the option of a birth like you advocate and a genuine chance to explore all the options available. But Leboyer and his ilk turn it into a discussion about the right and wrong way to give birth and I utterly totally object to that.

Checkmate Sat 04-Jun-11 10:01:37

QueenCeleste what I really want to know, is was Babar a good birth partner?

WidowWadman Sat 04-Jun-11 10:04:26

"she's one of the few midwives to have had an obstetric manouvre named after her..... "

She's named it herself after herself after learning it from somebody else. Also, from what I understand it's very hyped, however actually not used as much nor more successful in comparison to McRoberts.

Spudulika Sat 04-Jun-11 11:35:07

Maybe - doesn't change the fact that she's generally seen as an inspiration and a highly principled person by midwives and bythose of us who have actually read her works.

It makes me sad that there are people out there who are so keen to demonise her and other natural childbirth pioneers, without having read her work or knowing very much about her.

queenceleste Sat 04-Jun-11 11:53:22

checkmate
He was rubbish, he smelt of coffee and fags and made me feel sick.
I slung him out of the room both times telling him to go to hell and not come back!
We made it up very quickly once labour was over!
grin

BagofHolly Sat 04-Jun-11 12:00:45

"What I have learned is the gap between what they say and what they do is directly related to the difference between perceived and real risk. Every single time I was told "you'll bleed to death if you go into labour" I asked "so if that risk is so high, why don't you just admit me right now then?" only to get a blank look and a sheepish shake of the head. They are used to spouting hyperbole and being believed because of their position of authority."

I asked the same question and my Cons Obs said "I was just coming to that. Your husband needs to go home and get your bags." shock

WidowWadman Sat 04-Jun-11 12:58:41

Spudulika - how do you know how much those who aren't awed with her have read? That's your presumption.

Checkmate Sat 04-Jun-11 14:47:00

Yes, QueenCeleste you must have made up since you've had 3(?) DE's with him! grin

Back to the debate; weren't the research of both Ina may and Frederick Leboyer in the forefront if getting the system changed from what it was like in whT it was in the past. My mother speaks with loathing of being shaved for a vaginal delivery, given an enema, having me taken off her immediately and only brought to her 4 hourly for feeds, being treated like a loon for breast-feeding.

The system has got better since then, women are more aware of their options, even though there isn't really a full choice for most women, as I think there should be.

queenceleste Sat 04-Jun-11 19:57:28

grin no just two dc!

I can't imagine having a child on my back in stirrups?

I mean I was up on my knees like a keening primate bawling at the moon, slinging everyone out. But using gravity to help, I mean why would you not use gravity to help?? You wouldn't try to wee or poo or vomit standing on your head would you?
Seriously would you?
I wish I could have been down on the floor on super clean sponge flooring in a darkish room with no one near me smelling of anything but it being clean and somewhere comfortable to rest in between contractions..... hm... OH that's what a HOMEBIRTH could be like!
But the worst thing is those birthing tables, you feel six feet up in the air, who's that to help? And it hurts your knees to kneel on them. Madness. Don't get it. Sadists designed those tables or at least Not Women.

Spudulika Sat 04-Jun-11 20:02:47

"Spudulika - how do you know how much those who aren't awed with her have read? That's your presumption."

It's a presumption based on the fact that the assumptions they make about her practice and her attitudes aren't born out by any published information about her or her work.

Have you read her books WidowWadman?

"The system has got better since then, women are more aware of their options"

I agree.

Funnily enough though, the organisations and individuals who have been the driving force for changes in the way women are treated during birth are often the focus of sneering and derision by the public for being 'extremist' and natural birth 'loons' - people like Wendy Savage and Sheila Kitzinger, the NCT and AIMS.

But at the same time that there has been - in theory - a move towards more autonomy in childbirth, there's also been an ENORMOUS decrease in the number of births that don't involve interventions, and, at least for the last decade, no decrease in the stillbirth rate. sad That can't be right.

Spudulika Sat 04-Jun-11 20:08:59

"I can't imagine having a child on my back in stirrups?"

Nationally more than 1 in 4 women in the UK still gives birth in stirrups.

That rises to 44% in some hospitals shock.

30% will be flat on their backs.

WTF?

Spudulika Sat 04-Jun-11 20:11:16

"My mother speaks with loathing of being shaved for a vaginal delivery, given an enema, having me taken off her immediately and only brought to her 4 hourly for feeds, being treated like a loon for breast-feeding."

My mother was slapped round the face by the midwife for making too much noise in labour with my brother. She was in a lot of pain because she had a slipped disc. Which of course doesn't make pushing out a 9lb baby out while lying flat on your back much fun. Midwife said 'Be quiet! You're upsetting the other mothers!"

WidowWadman Sat 04-Jun-11 20:55:31

Actually I have, spudulika. So there.

Noellefielding Sat 04-Jun-11 21:02:11

My friend was shouted at by a mw at the Royal Free 15 years ago using the same line!
You're upsetting the other mothers!

I was induced at night in the labour ward and had to sit and listen to a harridan at the central mw station outside my side ward. She had a really loud bellowing voice and spent what seemed like hours moaning about the staff really loudly and then slapping around with her slappy shoes and generally shouting like she was a strumpet in a medieval Inn. This was 3 am and I was lying in tons of pain very close to this storm of noise.
My mw told me she was the most senior midwife in the hospital.
God help anyone who's been in pain listening to that woman.
I meant to complain but never did, I should have, I know!

BagofHolly sounds like you really were in a risky situation then! That's why I said what I did, and if a cons had turned around and told me straight up that I had the same risk, I would listen.

I've just been annoyed by the amount of crap thrown around in an attempt to get me to just "shut up and do what we want already". Give me real facts, real information, not nebulous threats and rhetoric please.

I actually questioned a registrar on the risks of ELCS for low-lying placenta mothers, based on what I read here.

quote:
Serious risks include:
Maternal
In all women with placenta praevia:
- emergency hysterectomy, up to 11 in 100 women (very common)
In women with placenta praevia and previous caesarean section:
- emergency hysterectomy, up to 27 in 100 women (very common)

She pulled out her iphone to calculate the statistics of women at my hospital who had had ANY type of c-section and had to have a hysterectomy. As if that was somehow the local equivalent to the numbers I quoted to her from that specific document. hmm

That was when I said "you need to get someone more senior in here, I'm done talking with you".

Spudulika Sat 04-Jun-11 22:05:13

WidowWoman - which book have you read? What particularly concerns you about IMG practice and/or approach?

I don't think she suggests anything that isn't pretty mainstream UK midwifery practice.

Spudulika Sat 04-Jun-11 22:09:34

"and then slapping around with her slappy shoes and generally shouting like she was a strumpet in a medieval Inn"

grin

I remember the midwife at my first birth slapping around like that. She'd trodden down the backs of her shoes, so she could shuffle around like she was wearing slippers. What else do I remember about her? That she strongly encouraged me to have pethidine and when I said 'I'm worried it'll make me sick', confidently said it wouldn't, because she'd give me an anti-emetic with it. And then she watched me being sick for the next 4 hours.

Noellefielding Sat 04-Jun-11 22:36:43

one of my mws stank of some kind of coconut hair product that actually made me heave when she came near me.
Also she really told me off when she couldn't get her fat fingers inside me to see how dilated I was (let's draw a veil over how earth shatteringly painful that examination was, I'm sure there are vets who are more digitally tender with cows than that cow was with me).
Then a tiny like obstetrician came in with tiny little fingers and she checked how dilated I was with little discomfort and without telling me off and huffing and puffing at me as if I was getting in the way of her and a night out on the town. slag.

grin I hated her so much.

BagofHolly Sat 04-Jun-11 23:13:02

"slag"
PMSL! grin

Noellefielding Sat 04-Jun-11 23:14:53

you can see why I have tender fantasies about homebirths where there are no monsters!
wine
brew

BagofHolly Sat 04-Jun-11 23:43:54

Barelyutterly I quite agree about questioning. In fact, I dispensed with my local midwife because she couldn't answer what I think are reasonable questions eg;
Me -"you're testing for antibodies. Antibodies to what?"

Her -"Things."

I asked her what she was going to do about the fact that she had dipped my urine 3 times and each consecutive appointment I tested positive for glucose. She said she wouldn't do anything as the hospital would pick it up. So I said "Then why test?" And she said she had to test for lots of "things" and this was just one and if it bothered me she would cut off the glucose bit off the bottom of the test strip. FFS.

BagofHolly Sat 04-Jun-11 23:47:27

Barelyutterly I quite agree about questioning. In fact, I dispensed with my local midwife because she couldn't answer what I think are reasonable questions eg;
Me -"you're testing for antibodies. Antibodies to what?"

Her -"Things."

I asked her what she was going to do about the fact that she had dipped my urine 3 times and each consecutive appointment I tested positive for glucose. She said she wouldn't do anything as the hospital would pick it up. So I said "Then why test?" And she said she had to test for lots of "things" and this was just one and if it bothered me she would cut off the glucose bit off the bottom of the test strip. FFS.

Noellefielding Sun 05-Jun-11 10:24:08

spudulika
it must be because that position suits the professionals mustn't it?
I mean, that can't suit a single woman on the planet can it?
I mean unless there is some sort of physiological problem with her being upright.
But what kind of sadist would not use gravity to help?
Has anyone had a baby on her back or in strirrups who would recommend it?
I'd love to hear it, I'm happy to believe I'm wrong.
It just stinks to me of the history of men taking over obstetrics from women.
I mean sure, let's improve maternal and infant mortality but lord, what's wrong with gravity?

cory Sun 05-Jun-11 15:33:45

Wonders if I am that only single woman on the planet...blush

My midwife kept encouraging me to stay more upright and walk around but I found it hard as I was very tired (after weeks of being unwell in hospital).

No shouting or slapping about, they were very kind and only made gentle suggestions, but I did find it physically hard to stay upright and was more comfortable lying down.

I still gave birth with only gas and air, but did ask for an episiotomy towards the end (and got it, but managed to tear just before they made the incision).

Noellefielding Sun 05-Jun-11 16:05:55

Thanks, Cory, but that makes sense, if you've been unwell that makes total sense.

PeaceAndHope Sun 07-Apr-13 21:55:24

Spudulika

Just a note.

It sickens me that you -a WOMAN- are supporting a misogynist like Leboyer. Women don't need a white, privileged MAN telling them that they have to grin and bear the pain of childbirth in order to be called good mothers and strong women. That is pathetic in ways I can't even explain.

The premise of Leboyer's arguments has been that labour should only be about the unborn baby and not the mother. He viewed women as incubators who had no autonomy or rights- their only responsibility was to bear the pain of labour in order to be considered good mothers.

And yes, home birth is risky. You come across as brainwashed and silly if you try and deny it. I fully support a woman's right to choose a home birth but to ignore the risks associated with it is dangerous denial. If you have a shoulder dystocia which isn't resolved by McRobert's or asphyxia or a severely obstructed labour, your baby can die. If you have a PPH and don't make it to hospital in time you can die. It is entirely your choice to have a home birth, but please make sure you don't read selective research from clearly biased sources and instead make a truly informed decision.

A movement and philosophy that is based on trivialising women's pain by calling it "pain with a purpose" is misogynistic and disgusting. Pain is pain- purpose can be assigned to any pain, but to call someone's extreme pain good is inhumane. If you had any concept of science and biology, you'd know that all pain is processed by the body in exactly the same way. Shaming and guilting women out of epidurals and denying them pain relief is cruel and paternalistic.

You have some guts talking about "autonomy" in childbirth, all the while supporting a philosophy that doesn't even support a woman's right to choose pain relief or a c-section. What kind of autonomy is that?Or is this one of those hypocritical things where you say "your body and your choice- as long as I agree with your choice".

And ^cite your sources^- You claim that the maternal mortality rate was lower when the c-section rate was 5%. That's rubbish and you know it, so cite your sources. Prove your claims.
Did it strike you that back in 1940's, the NHS wasn't as shortstaffed? There wasn't as high a proportion of immigrant population? Obesity wasn't as widespread?

You whine and whinge that people resist the NCB ideology, but that's rubbish. How much more mainstream do you want it to become?
Hospitals nowadays offer more birthing balls and water births than epidurals. It's a herculean task to get a c-section or an epidural on the NHS. The RCOG has blatantly come up with guidelines to reduce the number of c-sections and epidurals. How will they do that? By denying women the right to choose. What does this mean? You and your NCB buddies win.
The fact that skin to skin and breastfeeding is forced on women whether they want it or not is all thanks to the ideology that you cry is not accepted.
The fact that hospitals no longer have nurseries to allow the mother to rest and rooming in is essentially compulsory, is all thanks to the NCB ideology. I have two kids and I have to tell you, I would have given anything for someone to have taken them to nursery so that I could sleep for just an hour.

Do you even realise how patronising and pompous you sound when you say that you found the pain 'enriching' and that it made you 'stronger'? Maybe nobody else can see the guilt trip that you are trying to send women on, but I can.
It's ironic that you speak of empowerment and then talk about how much you enjoyed being vulnerable and dependent on your husband while you were giving birth. Because that's the purpose of empowerment isn't it? To make you dependent on a man while you are whimpering and in pain.

I hope you realise just how ridiculous it is to patronisingly announce that you chose a home birth because you wanted an "intact perineum and abdomen." Location aside, an intact perineum can NEVER be guaranteed with a vaginal birth no matter what Ina May Gaskin has brainwashed you into believing.

You dislike hospitals and support home birth. Fair enough. STOP making other women feel like there is something wrong with them for preferring hospitals. There are distinct advantages to giving birth in a hospital and women are fully capable of making this choice themselves.

Your disregard for women's pain and your refusal to accept choices different from your own is staggering.

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