This IS a thread about a thread

(99 Posts)
Mintyy Wed 16-Jan-13 19:00:34

but I am doing it because I don't want to upset the op of the other thread, and I don't want to hijack what she has started.

But can we please de-bunk the myth that anyone can have a lovely birth as long as they are PREPARED and have the right mental attitude! It is extremely damaging psychologically for women to feel that they have failed (if they had interventions/caesarian/still birth) because they were not properly tutored or well-read enough in childbirth.

The healthiest, most physically and mentally perfect women can have things go mildly wrong or catstrophically wrong in childbirth. All the birthing classes in the world cannot fix that.

Am v angry!

InNeatCognac Wed 16-Jan-13 19:01:25

Message withdrawn at poster's request.

Mintyy Wed 16-Jan-13 19:11:55

Very damaging and very annoying and very ill-informed and a very silly thing to put about on a parenting website where, by its very nature, many many women who have had traumatic births will be present.

Hmmmppphhh.

nicki1978 Wed 16-Jan-13 19:22:16

I agree.

My birth plan consisted of (I was being induced): Go to hospital; have a baby (by whatever means); and come home. My midwife kept insisting I produce a "proper" birth plan so I'd get what I want! I'd get what I want with my birth plan! A Baby!

For me, you can only be "prepared" (in the loosest terms) for so much. You just never know what is going to happen. If you go with a birth plan that you've put your heart and soul in to and everything must be just so, you spend more time worrying about that than the job in hand.

In my circumstances any so called "proper" birth plan would have gone out the window. After contractions were forced to start I quickly moved on to the epidural. To cut a long story short, I ended up with an emergency c section as DS got stuck and his oxygen levels dropped.

I do feel that some midwifes put too much on ladies and the birth plan.

McPhee Wed 16-Jan-13 19:24:30

I agree, no idea about the thread though

I went in to hospital to be induced, ended up being induced painfully 5 times, finally finishing in a crash section,

I'm still not over it sad

hazeyjane Wed 16-Jan-13 19:35:16

I agree, people often talk about an elective cs as a way of avoiding that 'anything can happen' feeling, talking about being calm, prepared, knowing what is going to happen.

I had an elective with ds, because of damage caused by my previous 2 births. It was the worst of all 3, and I still can't bear to think about it. I lost a lot of blood, had a reaction to the drugs, which left me shaking uncontrollably and vomiting, I couldn't hold ds, and then the mw realised that ds was unable to feed or suck and was struggling to breathe so was rushed to nicu.

All births are different, there is no guarantee to a trouble free birth. Shit just happens.

Yes yes yes!!

My birth plan only had that I wanted my partner to be there. Nothing else.

In fact, I was really against using the pool. First thing I did upon arrival..? Jump in the pool.

clabsyqueen Wed 16-Jan-13 19:44:53

Hear hear! I spent many a day on the wards during my daughters 3 month stay in neonatal watching mums come and go in pieces because their birth didn't go to plan. Expectations = disappointment. I thought about pointing out that I'd happily swap my 28 weeks arrival, 3 neonatal blood transfusions and a serious stomach infection for their forceps delivery! Would have just sounded bitter! Seriously though, a plan to leave hospital with a healthy baby by hook or by crook has just about got to be the best thing any woman can have. Seemed a shame that women with just that thing left hospital feeling devastated by minor things like not being able to have a water birth. Jeez, where do I start?

BillyBollyBrandy Wed 16-Jan-13 19:49:00

My friend is due her dc1 any day and was telling me that she wants a totally natural birth, no drugs, and to breastfeed immediately.

And I have told her that's great, fingers crossed it will all go smoothly, but it is also perfectly normal to be negotiating with the midwives over the strongest painkillers they can legally give you, and that sometimes breastfeeding isn't as easy as shoving a newborn on your boob. But that sometimes it is.

And that any which way is fine.

PastaDee Wed 16-Jan-13 20:49:22

Hear hear. I had a failed ventouse and forceps delivery. Just to clear up a few myths I did NCT, I laboured in water, I didn't have an epidural and I was upright and active throughout.

I also had a extremely distressed baby who needed to be delivered immediately once I'd already started pushing. She needed to be resuscitated when she was born. She would have died if the Dr hadn't been able to deliver her as quickly as he did.

I still feel like a failure and as though people think I should have done something differently. It's an awful feeling when I should be proud i delivered a beautiful baby.

Of the 6 women in my NCT group not one of us had a straightforward birth. 2 instrumentals, 2 retained placentas, 3 episiotomies, 2 EMCS. Speaks volumes for how first births can go.

Mintyy Wed 16-Jan-13 20:54:31

I had 6 in my NCT class too.

We had 3 planned home births: 2 transferred in to hospital where one had an emcs and the other had venthouse delivery. The third delivered fine at home but had retained placenta so had to be transferred in to hospital anyway for delivery of the placenta.

Of the 3 who started off in hospital, 1 had venthouse, 1 had straightforward delivery (but she had actually delivered a stillborn baby before, so it was her second labour and birth sad) and me, who had a crash c/section where mum and baby where minutes from death.

I wonder what the odds are?

OpheliasWeepingWillow Wed 16-Jan-13 20:56:56

Yup, from someone who wanted natural with G&A and ended up with pitocin, pethidine, water pool, epidural, G&A, morphine and ECS.

PastaDee Wed 16-Jan-13 22:02:38

Probably higher than we think Minty. The stats that you look at show figures for all women. I'm sure we'd be quite shocked at rates of intervention if first time mothers were counted separately. I still think it would be a good thing as it may make people adjust their expectations accordingly??

inadreamworld Thu 17-Jan-13 09:28:21

I don't know the thread you mean but I agree with you completely Mintyy and I am glad you and your little one are OK. All the natural childbirth advocates forget how many mothers and babies died before modern medical advances.

I was induced for DD at 40+8 as waters were leaking and I didn't go into labour naturally. Of course a friend who was into everything being natural told me not to accept the induction and wait for labour to start - but there is a risk to Mum and baby after 24 hours so I accepted the induction.The drip makes contractions very painful so I had an epidural which was wonderful and thankfully DD was born naturally after a 12 hour labour - had a post partum haemmorrage (over 1 litre) so I felt a bit rubbish for a few hours afterwards but my labour and birth were far from traumatic compared to stories I have heard (and read on MN). I am all in favour of medical interventions as they save lives.

At 41 weeks with baby 2 it looks as if I am not going to go into labour naturally again so am booked for induction on Monday and will very very likely be having epidural again. I don't understand why so many women are so keen to have 'no pain relief and no interventions' as if it is a badge of honour.

fraktion Thu 17-Jan-13 09:43:29

"anyone can have a lovely birth as long as they are PREPARED and have the right mental attitude! "

If they think that they aren't prepared. Being prepared means having researched the shit that can happen and coming up with realistic ways you'd prefer it to be dealt with. I just do not comprehend women who refuse to consider the possible outcomes because it would make them feel negative/impact their lovely hypnobirthing preparation/they've done everything right so it won't happen and you don't need to think about it.

I say as someone who had what many would consider a lovely natural birth (G&A, 2nd degree tear) and an easy breastfeeding experience (despite thrush and upper lip tie which was only recently diagnosed at 18months).

BitBewildered Thu 17-Jan-13 09:54:31

I had an awful birth the first time. The second time I woke up on ITU minus my uterus and with a transected ureter and 16 units of transfused blood. I had done research. I am related to two midwives and work in a doctors surgery. It's not like I wasn't prepared.

I know very few women who have given birth with no trauma to either themselves or their DC.

Whyriskit Thu 17-Jan-13 09:55:11

I think I was as prepared as possible for the births of both my DSes.
I'd done NCT, read up on everything, stayed fit and healthy, antenatal yoga, everything.
I was not entirely prepared for the stop/start 53 hours of labour, the failed augmentation, the EMCS where I got a backwash from the anaesthetic and stopped breathing.
Attempted VBAC with DS2, ended up vomiting over myself while having another section.
Because DS2 nearly died from an undiagnosed heart defect 10 days later, now that I'm pg with DC3, genuinely all I want is a healthy baby.
I care not how it arrives. Or for anyone else's views on my choices.

notamomtokids Thu 17-Jan-13 09:57:20

I think we generally put far to much pressure on ourselves in many aspects of our lives and it is so very unnecessary. It does, however, take a long time to look at it like that.

I like what clabysqueen wrote, '...by hook or by crook.' The objective is to produce, safely, the wonderful child that has been inside your body for a while; the method is irrelevant.

I used to get like this over Christmas dinner (sorry about the unimportant analogy!!!) If I knew I had cut corners or had not done things in the way that I had wanted to, I found it hard to relax and enjoy the meal, everyone else would be having a great time and filling bellies. It took me a while to get over this obsession of doing things how I planned them and to learn that the end result is what is important, not how I get there.

Ladies, don't beat yourselves up over it!! The gorgeous children are here and that was always the goal. Failures you are not.

FirstTimeForEverything Thu 17-Jan-13 10:07:27

Message withdrawn at poster's request.

FirstTimeForEverything Thu 17-Jan-13 10:10:33

Message withdrawn at poster's request.

Overreactionoftheweek Thu 17-Jan-13 10:39:49

Thank you Mintyy for this thread...the other one made me cross too.

I had a horrendous birth, still feels like a miracle that I have a healthy child after it. He's 14 months now and I'm still not sure I'll ever put myself through it again for a second. I had awful PND afterwards.

I feel like it's my duty to be honest about how hard it can be, and not perpetuate the myth of "ideal motherhood" - I don't want to scare anyone, but I'd also hate to lie and make someone else feel crap because they found it tough too

inadreamworld Thu 17-Jan-13 13:35:28

BitBewildered you poor thing that sounds really really horrendous. Thank God you and both your babies were OK in the end.

From reading other peoples experiences on MN and talking to frends in real life I think my birth experience was more or less 'average' - some interventions ie needing to be induced and needing an epidural (what did women ever do without them!) - also losing over 1 litre of blood but not needing a transfusion thankfully. DD also had a trace on her head but luckily was never in any distress.

I do think there is far too much emphasis on this natural birth experience stuff which only works for a minority of women. Why put yourself through agony if an epidural is there to ease the pain?

With my 2nd child (birth imminent am 41 plus one, induction likely on Monday) I will be thankful for a healthy baby and that I come out of it not feeling totally crap and with all my body parts still in working order.

Oh and I couldn't do breastfeeding either....lasted 10 days - may have been the pph or the stress of the birth but I really was producing hardly any milk. Yes breast may be best and more natural but bf doesn't work for everyone.

BitBewildered Thu 17-Jan-13 13:51:11

Cheers InaDreamWorld, we're all fine now, but if someone dared to imply that any of it happened because I failed in some way I'd verbally blast them off the planet!

Where is the other thread? I've been immersed in the crazy MIL one in AIBU grin

inadreamworld Thu 17-Jan-13 14:00:20

BitBewildered I want to find the other thread too..?? No one could think you failed in any way at all and I am so glad you are all OK.

mayhew Thu 17-Jan-13 14:08:14

When I am asked for advice about preparing for birth, I say its a bit like preparing for marriage. Its really helpful to have thought about whats coming and what is likely to be a priority for you but unrealistic to only plan for perfection. Good birth preparation should help you deal with the process if its straightforward but also some strategies for getting through the non-straightforward.

If I end up with a woman who has a difficult experience, I always try to say something positive about how she dealt with it eg how she managed to be funny when she talked to the anaesthetist, or pushed really well with the ventouse or was holding the baby right after the cs. That sort of thing. I don't want to deny that the experience was hard but want to implant some positive perceptions from the beginning.

AnEventfulEvening Thu 17-Jan-13 14:25:15

In the thread in question, the OP was particularly vulnerable and posted in a similar vain some months ago something similar. I think its someone who is genuine. So it really needed/needs a particularly sensitive approach and why it is probably better to keep this debate here rather than link to it.

The responses that sparked this thread were made by another poster who seems to be a strong natural birth advocate with three home births under her belt, and no clue whatsoever.

BitBewildered Thu 17-Jan-13 14:41:07

Thanks, poor other thread OP sad. I'll try to find it anyway Eventful, not to bring this discussion with me hmm, but because I am interested.

herethereandeverywhere Sun 20-Jan-13 18:45:26

For me it's not just the success/failure element but the utter shock that half the complications were even possible.WHY can't we get statistics for the likelihood of having interventions during a 1st labour/birth? WHY didn't I know that it was possible for an episiotomy to break down? WHY didn't I know that the Keillands forceps delivery I had was nothing like the "gently pull" experience described on the NHS website? WHY aren't we explained the likelihood of urinary/faecal incontinence - both temporary and permanent? My NCT teacher couldn't give me stats for the likelihood of having stitches and only gave information on how to look after a stitches/painful bits after I pressed the issue. I feel I was denied the truth and the facts about childbirth and I'm sure that had I been armed with this information my birth would have felt less traumatic and my ability to recover mentally and physically would have greatly improved. It's not as if anyone said "you're not getting a full realistic picture from NHS antenatal appts and NCT, if you want the facts look on the internet - in fact you're discouraged from reaching for google and finding "horror stories".

t few days of her life.

inadreamworld Sun 20-Jan-13 20:41:31

DD2 born yesterday morning - 4 hour labour, no interventions. Arrived at hospital just in time fully dilated and 3 pushes and she was out. I didn't get the epidural I said I would never do without. BUT I am still in favour of drugs and interventions, they save lives, and no one knows what kind of birth/labour you will get. It is stupid of some women to say just because they did it without drugs that everyone can - depends on all kinds of factors eg size of baby, complications eg cord around neck etc. It is not fair to say cause one women did it naturally then everyone else can. My labours were totally different and the first is mostly the hardest.

DD only 7lb 1 oz with a smallish head circ. I dread to think what could have happened if we had been 10 mins later and she had been bigger and got stuck. My ist labour was induced with epidural and I am grateful for a healthy baby. Pain and doing things naturally is not a badge of honour - I had no choice about it but would have taken anything to get rid of the pain.

herethereandeverywhere Sun 20-Jan-13 23:23:38

* Oops, not sure what happened re: the random few words at the bottom of my post!

Yes. I agree op. I think it helps to be informed about labour but all the hypnobirthing in the world won't stop the fact that things go wrong. People who have natural, lovely births are just lucky.

Londonmrss Mon 21-Jan-13 19:01:31

I agree. I want scared of labour. I really thought that because we have perfectly evolved to do this, I would just breathe my baby out.

72 hours of agonising contractions in my back and 2 failed epidurals later, I had my baby.

I still don't know why my latent phase was so long and painful. I don't know why all the passion was in my back (not a back to back baby).

for a long time I felt like my body had failed me.

MayTheOddsBeEverInYourFavour Mon 21-Jan-13 19:17:49

Fantastic thread OP, I couldn't agree more

I had four fairly normal 'easy' deliveries so imagine my shock at my last two babies being born by crash c section. My body gives birth very well but what good is that when there is something wrong that could be fatal for the baby, I couldn't have predicted the cord accidents my babies had and there was no way to prepare. If left I could have given birth with no drugs and no intervention quite quickly, but the babies I gave birth to wouldn't have survived

Preparation and positive mental attitude can really help in childbirth but there are always elements completely out of our control and anyone who doesn't 'get' that is naieve at best

BitBewildered Mon 21-Jan-13 19:26:40

Exactly. Preparation helps. Unfortunately medical accidents and unforeseeable complications happen anyway. This is not a case of mind over matter.

cravingcake Mon 21-Jan-13 19:36:25

Another one agreeing.

My birth plan was fairly simple and was more a list of preferences for certain circumstances and was more for my DH benefit than anyone else. i.e. if I ask for pain relief give me the darn pain relief, would prefer vontouse to forceps, if for any reason we had to be separated DH is to stay with baby rather than me etc. We ended up having a very traumatic time, I specifically heard the consultant say 'baby will need resus' before he was even out. We had forceps, episiotomy, shoulder dystocia, 4th degree tear and a pph and an over an hour in theatre being stitched up after. No amount of planning could have prepared me or my DH for this.

I will admit I was fairly naïve and thought 'it wont happen to me' and that I would have a reasonably textbook normal birth but I did do a small amount of looking at what can happen but there are so many ifs, buts and maybes its impossible to think of every single scenario.

After speaking to other new mums, out of about 15 of us, only 2 or 3 had the 'textbook' birth, everyone else ended up with emergency C-section or assisted delivery (forceps/vontouse).

PoppadomPreach Mon 21-Jan-13 19:41:46

100% agree OP.

I had one EMCS and one ECS and I feel like I've won the lottery as I have two beautiful and amazing children. THAT to me is the only success factor - a baby at the end of the journey. Yes having a lovely journey is all well and good, but it's the destination that's the key factor (and obviously having an not-too traumatic journey).

I'm not sure what the other thread is, but maybe It can help to change some terminology.
Instead of "Birth Plan" You could say "Birth Preferences" which leaves things a bit more "open" in your mind.

Instead of "Natural Birth" It could be "Positive Birth"
Some women have a traumatic "natural birth" because they felt left, not listened to, and very very afraid. Other women have a positive difficult birth, because every step of the way they felt cared for, and listened to.

I think many "natural birth advocates" as you call them just want women to have positive empowering experiences, and often, women are not given the kind of care and information that leads to a positive experience. (whether that be "natural" or more medicalized)

Birth Trauma is real, and women who are upset after a traumatic birth should be listened to and not told that "all that matters is a healthy baby". It's not about having "failed", it's about having to recover from something that was very difficult to go through. A women experiencing birth trauma (from any sort of birth) is experiencing it because of what happened, not because there are a bunch of "natural birth advocates" trying to make her feel bad.

Loislane78 Thu 24-Jan-13 19:27:30

Don't know about the other thread but totally agree with you minty and all previous posters.

My birth was probably middle of the road, easier than many but DD was not breathed out by any stretch: G&A (x lots), epidural at full dilution due to anterior lip/poor positioning, 2 hrs pushing and 2nd degree tear.

However I had v little expectation and just tried to stay calm and go with the flow as and when things happened - what more can any of us do than that? I feel happy when I think of my labour; epidural, catheter, stitches and all. My baby is healthy and we both survived. Helps I felt I was treated respectfully and with dignity.

YoSaffBridge Thu 24-Jan-13 21:40:24

God, yes. Your body will do what it wants to do, your baby will be in the position it wants to be, and you and your baby will be as healthy or unhealthy as it is going to be. All the healthy mental attitude in the world won't help in most situations.

All that matters is having a healthy baby and, hopefully, mum coming out of the experience as well as possible.

A year on from our babies birth, one of the NCT mums had a big competitive chat as she was the only one to have an unassisted vaginal birth. I was flabbergasted when she kept dig, dig, digging to the rest of us about our c-sections. Apparently I was "ok" because my baby was very poorly so my c-sec was acceptable shock The poor other mums whose babies were in an odd position.

The implication that if you don't have a vaginal delivery then you have done something 'wrong' is just unacceptable.

AmberLav Fri 25-Jan-13 13:37:09

I went into childbirth being fairly certain I'd have a big baby (I was 9lb 12ozs, and DH was 9lbs 6ozs), and also being suspicious that I might tear (big sis had). Both those things happened, and so I was probably the most relaxed person in the room about the fact that I had to go up to theatre after to be fixed. Other than that I did manage to have a good positive experience, but I do put that down to luck. (and not letting the midwives sew me up, as that had messed my sister up big time - follow-up surgery 10 months later!)

At all the follow up appointments, everyone seemed to think I'd been through some sort of trauma, and I spent the next 6 months, and then this pregnancy again, saying that it wasn't that bad that I hadn't had the "perfect" natural experience. The Health professionals seem to be the worst proponents of the "perfect" birth.

Of my NCT group, all the other 4 had ventouse/forceps, and of the 3 that had epidurals, 2 had the leaking brain fluid "mishap" (stats say this is a 1:80,000 chance!)! No c-sections though, which I think is fairly unusual... Ironically, I got the most follow-up, despite being the least traumatised!

Got no idea what will happen this time! But I'll go with the flow and see what happens...

shagmundfreud Fri 25-Jan-13 14:49:15

I agree. Sort of.

Look at the figures.

Normal birth (that's birth which starts spontaneously, with no c/s, no instruments, no syntocinon, no episiotomy) figures for healthy first time mums who have their baby in hospital: 46%

I think it's very important to say to someone who REALLY wants an uncomplicated birth that WHERE you have your baby and HOW you're looked after is vastly more important in determining outcomes than anything you can do for yourself.

It's also reasonable to point out that more than 2/3rds of healthy, first time mums who give birth away from hospital DO have a completely normal delivery. smile

BitBewildered Fri 25-Jan-13 18:52:30

I think it's very important to say to someone who REALLY wants an uncomplicated birth that WHERE you have your baby and HOW you're looked after is vastly more important in determining outcomes than anything you can do for yourself.

That must be where I went wrong, Shagmund, I didn't REALLY want an uncomplicated birth enough. hmm

stargirl1701 Fri 25-Jan-13 18:55:22

Agreed. A trouble free birth is just luck. I had a lovely water birth but I know I was just lucky and the next one (here's hoping!) could be totally different.

SoYo Fri 25-Jan-13 19:15:13

This is a brilliant thread, well done OP.

This is a thread that's actually here to empower women that no matter how your baby is born, you've done something amazing by bringing them into the world and you've got them here as safely as possible because at the end of the day delivering your baby is about having a safe mum and baba at the end of the process, not about what pain relief you used or assistance was needed or what music was playing at the time!

About bloody time everybody started talking like this and made more women realise it's just as amazing to let somebody stick a pair of forceps up their floo and risk all sorts of badness just to get their baby out safely when their distressed as it is to have a 2hr labour in a pool and that which of those is your birth story is just luck!

Rant over, well done all of you!

SoYo Fri 25-Jan-13 19:15:58

They're, not their, was too busy ranting and raving to notice that!

MrsBungleBear Fri 25-Jan-13 19:28:24

Totally agree.

My first birth went wrong, ended up being traumatic and a baby who had to be resuscitated. I was well prepared, ante natal classes, hypnobirthing etc. Made no difference to the outcome.

Second birth, my baby was in an excellent position and I was only in labour for under 2 hours, out in 5 pushes. I did zero preparation (apart from being shit scared and assuming it would all go wrong again).

I must have REALLY wanted a good birth the second time but not the first? hmm

YoSaffBridge Fri 25-Jan-13 19:31:35

Shag, you're kind of suggesting that you do think it is partly down to a woman's attitude. Can I ask if this is what you really believe and, if so, can you explain any more?

To me, the 46% says that more mums don't have a 'normal' birth than do - ergo it's not actually normal.

RobinSparkles Fri 25-Jan-13 19:43:12

COMPLETELY agree.

Some people are lucky and have wonderful births, some don't. I think it is down to LUCK.

Before I had DD1 I couldn't have given two shits how she came out as long as she did. I didn't care whether I had pain relief, a csection - whatever, I just wanted my beautiful baby.

I ended up with 65 hours of contractions, back to back baby and I had an epidural, episiotomy ending with a drip as I was starting to haemorrhage.
At the time I didn't care - I had my lovely DD. It is only since then that I've been made to feel a bit shit about "not being able to hack the pain" and giving in to having an epidural. And it's purely other women who have made me feel like that! angry

chocoluvva Fri 25-Jan-13 19:43:28

What a sensible thread.

And please would someone tell my SIL to stop going on about how her incredible breathing skills and zen like calm were responsible for her amazingly easy births (thereby implying that my emergency section which left me feeling like a failure could probably have been prevented if only I'd been more like her) angry

RobinSparkles Fri 25-Jan-13 19:52:39

And I must add:
There was no positive thinking on my part when I was pregnant with DD2. I panicked the whole way through that she would be bigger than DD1. I went begging the consultant for a CS. I was crying in her office but she declined. I thought on the bright side I could have an epidural.

Had a FAB birth, absolutely wonderful. My luck had changed for the second one!

Signet2012 Fri 25-Jan-13 20:06:50

I was forced into doing a birth plan that wasn't even looked at by anyone.
I was induced at 40+9. Then never got a single contraction but dd heart rate went down to 36 and then back up. I was ran through the corridors whilst nurses stripped my clothes off and put a gown on me all the time smiling false smiles saying it was all ok. Then her heart rate went back to normal. It dropped again numerous times before going back up almost immediately. There was talk of breaking my waters etc the next morning I finally got off the monitor at midnight (9 hours after first pessary) then they rechecked me at 330 am and nothing... After a lot of searching and a room full of medical staff they found her heart beat at 34 beats per minute. Position change got it up to 76. I was in theatre by 430 and she was born at 525.

I had all these grand ideas and not one single part of my birth plan followed the path I wanted it too.

But I didn't care a jot. I got a healthy baby. That's all I wanted.

shagmundfreud Fri 25-Jan-13 22:17:55

"Some people are lucky and have wonderful births, some don't. I think it is down to LUCK."

Sometimes.

But if only 46% of low risk first time mums giving birth in obstetric units have normal births as compared to 71% of similar women giving birth in free standing birth centres, then I'd say that how you're looked after is possibly just as or more important than luck.

"Shag, you're kind of suggesting that you do think it is partly down to a woman's attitude. Can I ask if this is what you really believe and, if so, can you explain any more?"

I'm saying nothing what so ever about a mum's attitude.

I'm talking about where she has her baby and how she's looked after (ie - the pattern of care).

"To me, the 46% says that more mums don't have a 'normal' birth than do - ergo it's not actually normal."

You are dead right. In hospital 'normal' births for first time mums are not the norm.

However, outside of obstetric led units (ie in birth centres or at home) normal births are... err. normal!

SoYo Fri 25-Jan-13 22:53:30

Shagmund I think you're forgetting that those aren't comparable populations. The outside hospital units only accept low risk women, obstetric units have all high risk women, planned sections, prems & some low risk. If you look at the figures in more detail & compare just the low risk women in obstetric units the results might be an eye-opener for you!

TwitchyTail Fri 25-Jan-13 22:57:52

^^ But surely this overlooks the obvious point that women who have homebirths are already a selected group at particularly low risk? At least, those who do not go against medical advice to do it?

I am pregnant with my first, but have complications with the placenta that means that if I try for a natural delivery, I will need to be on continuous monitoring with high risk of intervention/C-section. For this reason, no doctor or midwife in the world would support my having a home birth. So I will be delivering in hospital, and will probably contribute to the 54% of first-time hospital births that require intervention.

Cause and effect needs to be considered here.

TwitchyTail Fri 25-Jan-13 22:58:16

Cross-post with SoYo making the same point grin

shagmundfreud Fri 25-Jan-13 23:02:43

"Shagmund I think you're forgetting that those aren't comparable populations. The outside hospital units only accept low risk women, obstetric units have all high risk women, planned sections, prems & some low risk. "

No SoYo, those figures are from the Place of Birth Study 2011, which only looked at low risk healthy mothers, matched for risk at onset of labour, and assessed according to planned place of birth, rather than actual place of birth. So those mothers who started off in birth centres but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!).

46% of healthy, first time, low risk mothers giving birth in obstetric units had a normal birth.

71% of healthy, first time, low risk mothers giving birth in free standing birth centres had a normal birth.

That tells me that having a normal birth is often a lot more to do with how you're cared for than anything else.

shagmundfreud Fri 25-Jan-13 23:04:02

"So those mothers who started off in birth centres but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!)."

Sorry, that should read: So those mothers who started off having home births but ended up in an OU having a forceps delivery or c/s comprise the c/s or forceps statistics for home birth (because you can't do forceps or c/s at home!)."

blondieminx Fri 25-Jan-13 23:18:00

YY Mintyy, I absolutely agree.

Stats from my antenatal class cohort for anyone interested:

1 v prem delivery at 28wks - parents didn't even get to the first NCT class
1 EMCS at 34wks - preeclampsia
1 planned CS brought forward to at 37 wks due to BP issues
1 EMCS at term - cord prolapse
1 hospital birth (home birth requested but mw declined to attend due to icy weather though apparently it's fine for a labouring woman to go out in such weather to get to the hospital hmm) - mother did antenatal yoga
1 home birth with 3rd degree tear
1 hospital birth - mother did antenatal yoga but overnight stay req due to BP issues (me!)
1 home water birth
1 home birth with transfer to hosp due to 4th degree tear

We are all alive with healthy babies. That is all that really matters.

shagmundfreud Fri 25-Jan-13 23:34:37

"We are all alive with healthy babies. That is all that really matters."

The stats I've quoted suggest that thousands and thousands of new mums are having avoidable surgery every year in the UK. I'm always amazed at how accepting women are of this.

blondieminx Sat 26-Jan-13 09:20:09

Well shagmundfreud I'm always amazed when people think that the NHS would spend time/resources doing "avoidable" operations given the budget issues they're battling (though that's a whole other thread!).... Funnily enough all midwives and doctors want as outcomes are live mums with live babies hmm

Hypnobirthing can't prevent post-partum haemorrhage. Breathing exercises can't solve a cord prolapse. Antenatal yoga won't stave off preeclampsia.

<rereads the OP> I still agree wholeheartedly with Mintyy on this one! Yes...There are things you can try to get a good birth BUT some women and some babies will have medical issues which mean intervention is necessary to save the mum or the baby from serious harm or even death. Many mums are on these boards are still alive thanks to interventions during birth!

chocoluvva Sat 26-Jan-13 09:42:25

How are the midwives who do out of hospital births selected?

Are they required to be more experienced?

screamingeels Sat 26-Jan-13 09:54:25

When I had my first, my lovely waterbirth at home plan went out the window due to high blood pressure. I was bitterly disappointed and completely unprepared to deal with hosp staff who ran roughshod over me. The one thing that made me feel better was that a few weeks earlier my ante natal yoga class had been taken by a teacher just back from maternity leave, after excessive pestering from us first timers she reluctantly related her birth story - 24hrs of extremely painful labour at home on so much g&a her nose swelled up followed by transfer to hosp cascade of intervention and eventual section. It can happen to anyone!

givemeaclue Sat 26-Jan-13 10:23:34

Where is this thread of which you speak

shagmundfreud Sat 26-Jan-13 10:54:05

Blondie - Drs and midwives do the best they can to keep mothers and babies safe, but there is absolutely no doubt that something is happening to women's labours in hospital that is resulting in many more mothers and babies needing 'rescuing' with medical intervention.

Things like cord prolapse (1 in 500), or baby which is presenting so poorly that it is simply undeliverable can happen to anyone anywhere, but the two most common reasons for emergency c/s are 'failure to progress' and 'foetal distress'. Statistically, even healthy, low risk mothers are more likely to experience both these things if they choose to give birth in an obstetric led unit.

BTW - the reason I'm posting on this thread is because I feel that it's not quite fair to suggest that all mothers everywhere are at equal risk of having a complicated birth. The research shows that some low risk mothers are really quite a lot more likely to have a difficult labour involving lots of interventions than others, and that's healthy mums giving birth in OU's.

Yoga, hypnosis and antenatal preparation don't seem to make a huge difference to mode of birth (though there's been some recent research showing yoga in pregnancy for high risk women is associated with fewer early births, lower rates of pre-eclampsia and better fetal outcomes...). However choice of place of birth IS - strongly!

shagmundfreud Sat 26-Jan-13 10:58:47

Midwives who do out of hospital births may be part of a dedicated home birth team, or they may just do them on rotation. Inexperienced midwives may work on home birth teams or in the community. TBH what you want at a home birth is someone who's experienced in normal physiological birth in a non-medical setting. Experienced hospital midwives who are only used to caring for women in high tech settings where the are very high levels of routine interventions may not have the skills needed to manage a safe home birth.

MerryCouthyMows Sat 26-Jan-13 11:10:05

With my DD, I wanted to use the birthing pool, and have a drug-free delivery. To be able to walk around, not to be continuously monitored, and not have to have any needles. To take a healthy baby home.

When I was actually in labour?

I was induced nearly 6 weeks early due to pre-eclampsia, and therefore wasn't allowed to use the birthing pool. 15 years ago, if you were induced you had to stay on the bed and have continuous monitoring.

It fucking hurt, so I begged for pethidine and G&A. I stopped progressing so they started prepping me for a C-Section. I have birth to DD whilst being wheeled down to theatre!

And then DD needed to stay in SCBU for a week.

With my subsequent 3 DC's, the only thing I insisted on was intermittent monitoring and being able to get off the bed and walk around if I wanted.

Births don't always go to plan. I ended up being induced with my first 3 DC's, and even though I went into labour myself with my 4th DC, I still ended up on a syntocinon drip because DS3 got stuck.

Shagmund, please stop saying 'normal birth'. In this day and age there's no such thing, there's a huge spectrum of possible ways to give birth. Separating them into normal and abnormal births is not helpful.

Also, I still think those stats are skewed. I was considered low-risk yet still was made to go to hospital unit, because DS was huge. And yes, I did end up with a CS. You can't assume low-risk means no risk factors whatsoever.

The only way you could compare the two low-risk populations properly is if they were somehow randomly assigned to either hospital or non-hospital. But there are additional considerations guiding where women are sent and these are primarily based on risk (even within low-risk women).

wreckedone Sat 26-Jan-13 11:29:54

Yes Yes Yes. My birth plan was an intervention free waterbirth, natural delivery of placenta and home after 6 hours. In the event, I was strapped to a bed and continuously monitored for 74 hours, was lucky to avoid forceps and baby was whisked off to NICU. I felt like a failure and as though I'd been cheated of my perfect birth-what I should've felt was that I was blessed to have my baby alive and well (sort of).

shagmundfreud Sat 26-Jan-13 12:04:08

Dreaming - 'normal birth' is used in medical circles to mean 'physiological birth'. Like 'normal breathing' means breathing without the need for drugs or a respirator, 'normal walking' means walking without the need for crutches or calipers.

It absolutely IS helpful to have a reminder that although interventions are common, the majority of healthy women ARE able to have a physiologically normal birth, and where this can be achieved and still end up with a well baby this is the most desirable outcome for most women, and ought to be something that health care providers should be striving for.

As for your belief that the stats are 'skewed' based simply on your personal experience, I think you'll appreciate that this isn't a logical or reasonable argument.

And of course 'low risk' doesn't mean 'no risk'. Surely all sensible adults know that?

As for randomising - you know that this is pretty much impossible with research into birth in a country like the UK. The Place od Birth study is well constructed and has been carefully scrutinised by midwives and doctors.

Re: 'additional considerations' accounting for the different outcomes for OU's and out of hospital births - I urge you to READ THE RESEARCH before coming to a conclusion about the validity of its findings. It's widely available (full text) online and there has been a lot of discussion of it on this board. All I can re-iterate is that in the Place of Birth study women in all arms of the trial were low risk at the start of labour and were carefully matched, so as to minimise confounding factors.

I appreciate that if you personally were advised to go to hospital because of the size of you baby then it's absolutely understandable that you would follow this recommendation. However I would like to point out that many midwives are happy to OK mothers for home births who are known to be carrying large babies - it's not an absolute or a 'rule' that all mothers believed to be carrying big babies will be 'made' to deliver in hospital. I was 'ok'd' to deliver a baby believed to be over 10lbs at home (he was 11lbs) and made this choice as I felt in my personal circumstances it was best for me and my ds. The point I'm trying to make is that inflexible protocols don't always optimise women's chances of having a happy, healthy and uncomplicated birth, and that women need to know that these things generally make much more of a difference to what happens during their birth than any amount of yoga, reading or hypnotherapy during pregnancy.

shagmundfreud Sat 26-Jan-13 12:40:24

Wanted to add something else about whether there is anything mums can do to boost their chance of an uncomplicated birth, because it does seem that the consensus on this thread is that there is NOTHING you can do which will make any difference to your birth outcome.

There was a study into outcomes for mums who were cared for by an independent midwife a few years back, comparing the outcomes to mums delivering in the NHS. 77% ended up with a normal birth, compared to only 54% of similar women cared for by NHS midwives.

What they found was for low risk women, they had exactly the same likelihood of taking home a well baby as healthy women cared for by NHS midwives but all other outcomes were better. See below:

"In the IMA cohort, spontaneous onset of labour was more common in the IMA group (96.6% (1405) v 74.5% (5365); 10.43, 7.74 to 14.0), Prematurity (4.3% (63) v 6.9% (498); 0.49, 0.35 to 0.69), low birth weight (4.0% (60) v 7.1%) (523); 0.93, 0.62 to 1.38), and rate of admission to neonatal intensive care (4.4% (65) v 9.3% (667); 0.43, 0.32 to 0.59) were all higher in the NHS dataset.

I think it's very sad and telling that women who have one to one care from a midwife they know all the way through pregnancy are less likely to be induced, less likely to need a c/s, less likely to have a premature baby, less likely to end up with a baby in special care. And it's not just true of women who are able to pay for midwifery care - these results are replicated in the NHS where women have case-loading care (ie they have one allocated midwife all the way through pregnancy and birth).

In other words - it's WRONG to have this discussion with the underlying assumption that there's nothing anyone can do to influence (not guarantee mind, just 'influence') the chance of a healthy, normal birth. There is!

- try to access case loading care
- consider a birth center or home birth
- consider hiring a doula
- consider mother/midwife ratio and rate of normal births at local hospitals if you live in an area where you have a choice

I'd also add, that if you're keen to avoid complications in labour, if you're offered an induction for 'post-dates' pregnancy where there are no other risk factors, it might be worth getting a second opinion from an experienced and senior midwife.

smile

Well first off, the study itself says that a birth without medical intervention is sometimes referred to as a quote-unquote 'normal birth'. So I don't think it's imperative to use the phrase yourself, especially in a forum where you know women have very strong feelings about their experiences.

I'm not using my own experience as the basis for my argument. You seem to be saying that the planned location of birth is a determining factor of outcomes, but this ignores the fact that planned location is decided in part based on risk factors that will also affect outcomes -- even within the low-risk cohort.

I note the study does not include large baby size as a risk factor, even though this is a potential reason for a woman to have to go to an OU and can contribute to the need for medical intervention. This is the only reason why I mentioned my own experience.

Finally, if you want women to be fully informed, why not mention some of the other study results? Like, "For women having a first baby, a planned home birth increases the risk for the baby", or the fact that around 40 percent of first-time mothers giving birth in midwifery units will have to be transferred to obstetric units anyway.

What I get out of this study is that there's still an awful lot of luck involved. Nearly half of first-time mothers giving birth at home end up going to hospital. So how important is that choice really? It's still 50/50 whether you wiill go to hospital or not.

Actually, Shagmund, according to that study, considering a homebirth if you're a first-time mother will increase the chances of something going wrong:

For women having a first baby, a planned home birth increases the risk for the baby: For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.

So you might want to be a bit more careful in your advice there.

blondieminx Sat 26-Jan-13 13:55:20

Thanks for those further statistics dreamingbohemian - very interesting!

Thumbwitch Sat 26-Jan-13 14:12:30

Completely agree, Mintyy (and glad that you and your baby were ok).

I did prepare, I did hypnobirthing, I had Ideas about how I would like things to go - but the Most Important bit of my preparation, IMO, was knowing that it could all change at any point and the chance of things going according to my preconceived ideas was next to none. THAT was the most important thing to know.

Yes, the hypnobirthing helped. Yes, I think the raspberryleaf tea helped with stage 2. But aside of that, I was lucky that I had a good birth with DS1.

I would have liked to have had as good a birth with DS2 but it wasn't to be - he was oblique transverse/unstable lie, I had polyhydramnios, and I needed interventions that I hadn't needed before. I railed against them, told the doc I Wasn't Having That but had it anyway because the alternative was CS. At any point, it could have gone wrong and I knew that - I was soooooo lucky to get away with delivering DS2 "normally" - I was just about to be prepped to go to theatre when they turned me onto my back and he dropped clear of the anterior lip and shot out of me in 2 quick pushes.

I'm never doing it again, for several reasons, but one of which is I think I've had my share of the luck. I'm not pushing it.

shagmundfreud Sat 26-Jan-13 14:33:48

"Well first off, the study itself says that a birth without medical intervention is sometimes referred to as a quote-unquote 'normal birth'. So I don't think it's imperative to use the phrase yourself, especially in a forum where you know women have very strong feelings about their experiences."

No - it's not imperative. But it's a standard medical term. The Royal College of Midwives even have a website called 'Campaign for Normal Birth' with information for midwives on midwifery practices that increase the likelihood of mothers having births without complications.

That said - I'm happy to substitute a different term to describe birth without complications. What would you suggest? Are you unhappy with the term 'normal' used in relation to any other aspect of having a baby? Do you object to the term 'normal conception' to indicate a conception which takes place without medical intervention?

" You seem to be saying that the planned location of birth is a determining factor of outcomes, but this ignores the fact that planned location is decided in part based on risk factors that will also affect outcomes -- even within the low-risk cohort."

With respect - it's not just me who is saying that planned location of birth appears to determine outcomes. The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are saying it too:

"Maternal intervention rates were much higher in births planned for OUs with lower ‘normal births’ and spontaneous vertex deliveries." (comment by the president of the RCOG in response to the findings of the Birthplace study)

"Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit." (statement by the RCM in response to the Birthplace study).

"I note the study does not include large baby size as a risk factor"

Only low risk women were included in the study. A woman who was identified as carrying a large baby would not be classified at 'low risk' as macrosomia is an identified risk factor for a range of complications in birth. That's not to say that some women in ALL arms of the trial wouldn't end up delivering very large babies.

"Finally, if you want women to be fully informed, why not mention some of the other study results? Like, "For women having a first baby, a planned home birth increases the risk for the baby", or the fact that around 40 percent of first-time mothers giving birth in midwifery units will have to be transferred to obstetric units anyway. "

Yes - transfer is an issue. And yes - homebirth seems to increase the risks to the baby for first time mothers. However, birth outside of hospital (ie in a free standing midwifery led unit, with no access to doctor care without transfer) is not associated with poorer outcomes for babies. To me that suggests it's not birth away from a medical setting which puts the babies of first time mothers at increased risk, but issues surrounding the way care for women birthing at home is managed.

"What I get out of this study is that there's still an awful lot of luck involved. Nearly half of first-time mothers giving birth at home end up going to hospital. So how important is that choice really? It's still 50/50 whether you wiill go to hospital or not."

But even though half the first time mums in the study were transferred as a group they STILL had a MUCH lower rate of emergency surgery than women who'd opted to go to hospital in the first place, and I think this is very important!

"So you might want to be a bit more careful in your advice there."

If the RCM and the NHS are happy to recommend home birth as a 'safe' option for first time mums (they are - birth at home is still considered very safe as over all poor outcomes were rare), then I don't see what's wrong with encouraging those women who are keen to avoid an emergency c/s to 'consider' it? Obviously 'considering' it means taking all important factors into account.

shagmundfreud Sat 26-Jan-13 14:39:26

I think the bottom line is this. First time mum who is low risk, healthy and has a choice of birth setting?

46% of first time mums who give birth in an OU have a normal birth.

71% of first time mums who give birth in free standing midwife led units (with no immediate access to medical care) have a normal birth.

The outcomes for the babies of first time mums in both these groups are the same.

That is a MASSIVE difference.

IMO you can't have any sort of sensible discussion about realistic expectations of birth without acknowledging the impact of setting on birth outcomes.

LaVolcan Sat 26-Jan-13 15:03:34

- I was soooooo lucky to get away with delivering DS2 "normally" - I was just about to be prepped to go to theatre when they turned me onto my back and he dropped clear of the anterior lip and shot out of me in 2 quick pushes.

For me your statement highlights an important issue - should that just be put down to luck, or should it be considered as a result of competent midwifery?

shagmundfreud Sat 26-Jan-13 15:10:11

Wanted to add, re: the term 'normal' - this from the BirthChoiceUK site (the main source of information for mothers about individual maternity services in the UK):

"The term normal birth is not meant to be judgmental in any way. We are instead trying to produce some measure of how much technological intervention is currently used in birth. These statistics of course do not tell us anything about a woman's experience of birth which is likely to be of far more importance to her than whether she was induced or had an epidural or had her waters broken. It is hoped that every woman can have a fulfilling and positive experience of birth regardless of the interventions she has received. This is, of course, much harder to measure!"

Because this thread is about expectations of having an uncomplicated birth, and the actual likelihood of having an uncomplicated birth.

I agree it's really important to acknowledge that a birth doesn't have to be straightforward to be fantastic and fulfilling. I know this from my own experiences.

1. Yes, I do think it's good to avoid the word 'normal' in most cases, given that 'abnormal' is often seen in a negative way. 'Intervention-free' works and is more precise anyway.

2. I had a large baby and was still considered low-risk. That's the whole point of my story.

3. I don't see the study saying location determines outcome. It's saying interventions differ across location. Given that the two populations are not entirely similar/randomly assigned, you can't say definitively it's just down to location. Correlation is not causation etc.

4. Sorry but I do think it's slightly irresponsible, given how knowledgeable you seem to be about this study, to say 'If you want to influence your chances of having a normal birth, consider a homebirth', when you know that for first-time mums there is a higher risk of complications with homebirth.

5. Obviously location can make a big difference. What seems problematic to me is being predictive about the difference, to say -- especially to first-time mums -- that one location will be better than another. Maybe it will, maybe not. I think a 40-50% chance of having to transfer to hospital anyway means that predicting anything for first-time mothers is pretty problematic.

shagmundfreud Sat 26-Jan-13 15:45:11

"I had a large baby and was still considered low-risk. That's the whole point of my story"

I don't get it. You were clearly NOT considered 'low risk' if you were 'made' to go to hospital.

A baby is not considered 'large' (or 'macrosomic') unless believed to be over 9lbs 15oz. If a mother is believed to be carrying a baby which is macrosomic she will be advised to have her baby in hospital and will no longer be considered 'low risk'.

"Yes, I do think it's good to avoid the word 'normal' in most cases, given that 'abnormal' is often seen in a negative way. 'Intervention-free' works and is more precise anyway."

So would you refuse to say you could 'breath normally'? Had a 'normal conception'? Can you not see that in medical terms the word 'normal' has an important meaning?

"I don't see the study saying location determines outcome. It's saying interventions differ across location. Given that the two populations are not entirely similar/randomly assigned, you can't say definitively it's just down to location. Correlation is not causation etc."

There is no study in the world which can compare two completely identical populations, other than those who use identical twins. Do you reject the findings of all other trials on the same basis as you are rejecting the findings of the Place of Birth Study? Even those which like the POB study are pretty rigorous in their attempts to match the subjects in different arms of the trial?

Why is it that the RCOG and the RCM have released statements saying that birth out of hospital has 'very significant benefits for mothers' because it appears to 'increase the likelihood of a normal birth', but you can't accept this?

Honestly - when someone is flatly dismissing really good quality evidence which is widely accepted by experts in that particular area, then I usually think they have a vested emotional interest in denying the reality which is staring them in the face.

"What seems problematic to me is being predictive about the difference, to say -- especially to first-time mums -- that one location will be better than another. Maybe it will, maybe not. I think a 40-50% chance of having to transfer to hospital anyway means that predicting anything for first-time mothers is pretty problematic."

Except I didn't say 'one location WILL be better than another', but 'planning a birth in a MLU or at home is associated with a significantly lower rate of complications.

And it is!

shagmundfreud Sat 26-Jan-13 15:55:49

"Given that the two populations are not entirely similar/randomly assigned, you can't say definitively it's just down to location"

Just to play devils advocate, there have been suggestions that the reason women who plan birth centre and home births have fewer complications in labour than similar mothers who plan an OU birth is because they have more confidence in their ability to cope with labour and more belief in the normality of birth, and that this increases the likelihood of a straightforward birth. In other words it's the psychological characteristics of women who choose out of hospital births which makes a difference as to the likelihood of their labours being straightforward. But that would completely contradict the ideas expressed here in the OP, that what your labour is like is affected by nothing more than physiological factors - the size/position of your baby, how efficiently the uterus contracts, the presence of infections etc.

I have suggested that how a mother is cared for in labour makes a difference to the outcome, but you can't seem to accept that this is true, or that the mother's own personality or confidence matters.

What do you think accounts for the huge difference in intervention rates across birth settings? Because they are pretty marked aren't they? And it's not just in this study that they're found - it's also the case that these same things have been found in study after study after study.

I'm not flatly dismissing it. I'm not saying it's wrong or invalid. I just think these kinds of studies can't capture the complexity of childbirth in a way that lends itself to making strong predictions.

I don't know what to tell you about my case. I very much wanted a homebirth or MLU but my midwife said no, I had to go to the OU. But she also insisted that she still considered me low-risk. I think it was a 'better safe than sorry' situation.

I don't think I'm alone? I know I have read on threads here where women were technically considered low-risk but because of family history or other things which might potentially cause problems they were assigned to OU.

Hence, my thinking that there may be other differences, in addition to location, accounting for outcomes. If low-risk women are being sent to OUs based on sort of informal criteria, that could also help account for differences.

I have absolutely no agenda, by the way. I could care less where women choose to give birth. I just think the situation is far more complicated than X percent do this and Y percent do that so you should do X instead of Y.

SusannaB Sat 26-Jan-13 16:02:25

You can't just take that stat out of the NPEU Birthplace Study, though. Women considering a homebirth need to be aware of all the facts, summarised nicely here:

www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-results-npeu-birthplace-study

What the study doesn't take into account is the wishes of the women who are choosing each of the different units. There are some women who actually ask for intervention; induction of labour, instrumental deliveries, caesarean section, who would have been entered into the study and deemed low risk.

In addition, what most people don't realise is that, if you choose to deliver in an obstetric led unit, it doesn't mean you're automatically under the care of the obstetricians. In most units, women who have had no medical intervention (and that includes low risk women who have chosen epidural analgesia) remain under midwifery led care, unless they request to see a doctor, or develop complications in labour.

x-post

I think there are many factors that affect whether a woman has intervention or not. I think there are many factors that affect where a woman gives birth, that cannot be neatly captured in the data.

I think you have sort of illustrated why I think the intense focus on location is problematic -- because location often becomes a proxy for psychological factors, like confidence and relaxation. So when people emphasise the importance of location, it is not long before they are talking about confidence and relaxation (as indeed, you have done) and then we are back to what the OP is talking about, which is attributing outcomes to a woman's state of mind instead of the condition of her body.

I'm not saying psychological factors don't matter at all. I just think at the end of the day it's really quite difficult to predict or even explain afterward why things went well or not.

shagmundfreud Sat 26-Jan-13 16:25:39

"There are some women who actually ask for intervention; induction of labour, instrumental deliveries, caesarean section, who would have been entered into the study and deemed low risk."

Emergency c/s, forceps, ventouse deliveries are only ever done in NHS hospitals where there is a clinical indication that they're needed. They would not ever be done on a low risk mother on request when there was no clinical indication. Some low risk mothers request planned c/s. They would not have been included in the study.

The place of birth study only included women who were deemed low risk at the start of labour.

It did not include women who had planned c/s or planned inductions.

"I just think these kinds of studies can't capture the complexity of childbirth in a way that lends itself to making strong predictions."

Joint statement by the RCOG and RCM:

"There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3"

OK - 'ample evidence'. You may think the evidence is weak. Experts in this field clearly don't.

"I very much wanted a homebirth or MLU but my midwife said no, I had to go to the OU. But she also insisted that she still considered me low-risk. I think it was a 'better safe than sorry' situation."

Were you not aware that you are 'allowed' to have your baby anywhere you choose? hmm Your midwife was guilty of coercion and if she'd been overheard telling you that you 'had' to go to hospital then she would have been pulled up on it by her line manager. That is not ethical behaviour. My midwife and I knew I was carrying a very large baby and wanted a home birth. She contacted a consultant midwife at a large teaching hospital and asked for advice. Then she sat down with me and went through all the possible risks and benefits of labouring at home with a large baby. She made it clear that whatever I decided it was my decision to make, and that her responsibility was to make sure I understood what the issues were. TBH I'm quite shocked that midwives are STILL telling women they 'have' to go to hospital, particularly if they're low risk. It really does go against all accepted guidelines on good practice.

Are you still not aware that midwives and doctors are supposed to be giving evidence based recommendations and advice?

"that so you should do X instead of Y"

I don't tell women where they SHOULD give birth. That's for them to decide, based on their feelings and beliefs about birth, and on the particularities of their health and their pregnancy. 'Should' only comes in to it as far as I'm concerned in the sense that women 'should' be given information about maternity care based on the evidence that we have, and a sensible discussion of the research should form part of the decision making process.

Waffle, coercion and ill-informed speculation is what needs to be left out of the decision making process about where and how you have your baby.

shagmundfreud Sat 26-Jan-13 16:33:02

"I'm not saying psychological factors don't matter at all. I just think at the end of the day it's really quite difficult to predict or even explain afterward why things went well or not."

It depends whether you're talking about groups or individuals. In the case of groups, it's not that difficult to be honest.

I would be happy to put a year's salary on saying that over the course of a year, low risk women who pitch up in spontaneous labour at my local MLU will have lower rates of emergency c/s than similar low risk women who pitch up on the labour ward in spontaneous labour.

I honestly don't think any bookie would give me reasonable odds on it going on the last 10 years figures.

Every single study done on birth outcomes in the past 4 decades has found that women who book to give birth in MLU's and at home have lower rates of complicated labours than similar women who opt for OU's.

But that's a dangerous generalisation isn't it, that statement? Because for first-time mothers, homebirth is not more safe. The study makes that very clear. This is my point, I'm not saying there isn't evidence, but it's not a good idea to generalise or predict based on it.

I did see a consultant as well, he agreed that I was not high-risk but preferred to have me in the OU. I think both of them said the fact it was my first was a factor. I did not feel coerced, they were just saying what they felt was best for me, and having considering everything I went along with that advice (I was also not super-close to a hospital, which concerned me). And they were right as in the end I had a CS and the surgeon said that for physiological reasons DS never would have come out naturally.

I agree evidence is important but too often evidence slides into speculation (so that evidence on location gradually evolves into speculation about confidence). It's that jump that I think can be unhelpful, as it neglects the role of luck in all of this.

x-post

But what determines whether those women go to the OU or the MLU? Do you not think that what drives them to one or the other also has some bearing on outcomes?

I mean, why do you think women go to the OU versus the MLU? Do you think it's purely the woman's choice? My whole point is that low-risk women can still be influenced to go to the OU because of possible risks that are not necessarily reflected in their low-risk status.

Yes, there may be fewer CS in the MLU cohort. But what do you think is dividing women into the OU/MLU cohorts, if they are all low-risk?

LaVolcan Sat 26-Jan-13 16:46:19

Were you not aware that you are 'allowed' to have your baby anywhere you choose?

Not quite so shagmund - they can turn you down for an MLU if they decide you don't fit their criteria. But apart from that yes, there are still a lot of women being told that they have 'got' to do this that or the other, not being told that they are being offered advice but that ultimately it's up to them to say yes or no.

I completely agree with the original post. By the time I had my third and fourth, my birth plan was basically 'get the babies out alive, with me surviving the process'. Anything else I decided as I went along, as circumstances evolved.

SoYo Sat 26-Jan-13 16:49:34

Shagmund do you not think that maybe this thread isn't the place for your views. You obviously have very strong opinions and there's lots of papers and evidence out there that can be viewed in different ways, but this isn't a thread about arguing the toss, it's about empowering women who didn't end up with their ideal birth situation that they weren't at fault at all for this and to ensure they are not made to feel like failures. I don't see how you coming in here trying to force your views and opinions and making people feel like different decisions would have changed their outcome is helping anyone. It might be time to just appreciate that we as a collective obviously have different opinions to you and that your knowledge and opinions would be better served elsewhere.

Birth choices, decisions and outcomes are always going to be an opinion filled and emotive issue but surely we're better placed with supporting each other rather than trying to force people to sharing your opinions. There are plenty of mumsnetters and threads that would love to hear your knowledge and views and share similar ideals.

LaVolcan Sat 26-Jan-13 16:51:05

What determines whether women go to the OU or MLU?

One reason would be that there isn't an MLU within reasonable distance. Another would be that the pregnant woman (especially for the first time) goes along to her GP who says 'I will book you in for XX hospital' and doesn't know that there are alternatives.

shagmundfreud Sat 26-Jan-13 16:51:12

"I think both of them said the fact it was my first was a factor. I did not feel coerced"

"I very much wanted a homebirth or MLU but my midwife said no, ^I had to go to the OU^"

"I was considered low-risk yet still was made to go to hospital unit"

I'm sorry my friend, but to me that sounds like coercion.

"it's not a good idea to generalise or predict based on it."

Midwives have a responsibility to give mothers information that will help them make a decision about where they will have their baby.

One piece of information they should give them is that based on multiple large scale studies, low risk women who opt for out of hospital births and MLU's appear to have significantly lower likelihood of interventions than similar mothers giving birth in OU's. And apart from in the case of first time mums giving birth at home, have as good outcomes for babies.

Is all. Would you be OK with women being told this?

I'm quite with you in not predicting in the case of individuals what sort of birth they will have. We can't do this and nobody is suggesting it's a good idea.

shagmundfreud Sat 26-Jan-13 16:55:51

"it's about empowering women who didn't end up with their ideal birth situation that they weren't at fault at all for this"

Yes - and one of the MOST empowering things is to be told that sometimes the way birth is managed by health professionals is the thing which is responsible for things not turning out as hoped.

In other words - it's not you, your body or your baby which is at fault. It's the way you were looked after which might have made things harder, more painful or more frightening than they needed to be.

And to give information about ways of reducing the likelihood of having a repeat experience next time round.

What could be more empowering than that?

(or alternatively we could all just sit here and say nobody has control over anything and it's all just fate, despite there being so much evidence pointing to the fact that how you are cared for in labour sometimes making a HUGE difference. Is it just me, or is that the most disempowering and frightening thing to tell a pregnant women? hmm)

shagmundfreud Sat 26-Jan-13 16:57:41

"Birth choices, decisions and outcomes are always going to be an opinion filled and emotive issue"

Yes - which is why there's always a place for a few facts in these debates. wink

They have their place alongside emotions and opinions.

I can see why you might get that from my choice of words but honestly no, I did not feel coerced. I really wanted a homebirth until I talked to the professionals and they gave me their opinion, which made me see things differently and in the end I agreed.

I still wonder what you think separates women into these different groups with different outcomes. If you think it's just clinical indications and it's not influenced by informal criteria on the part of health care professionals doing a sort of risk analysis, then I'm not surprised we disagree. I think that once you accept women are being steered on one path or another based on variables that aren't reflected in the data, the evidence seems less deterministic.

I have had babies in the delivery suite, the midwife-led unit, the operating theatre, and the special room for mothers delivering a baby that has already died in utero. Each was right for the situation, and in each I was empowered as much as possible and helped by amazing staff. I feel lucky to be living in a place and time where all of these different types of delivery were possible.

peanutdream Sat 26-Jan-13 17:33:17

This is a really important thread even if people agree/disagree . there is lots of food for thought.

i think the care you get is paramount, not necessarily in affecting outcomes (although it makes sense that to some extent, it would) but in how you feel about it in the end.

It is also really interesting that where you plan to have your baby appears to affect the outcome in some ways that could make a difference to some women, and that is surely important information to have. So just wanted to say thanks, particularly Shagmundfreud for providing info and dreamingbohemian for questioning it grin

shagmundfreud Sat 26-Jan-13 17:44:38

"I still wonder what you think separates women into these different groups with different outcomes. If you think it's just clinical indications and it's not influenced by informal criteria on the part of health care professionals doing a sort of risk analysis, then I'm not surprised we disagree."

I think some mothers ARE more likely to request a home birth and are more likely to be steered towards a home birth by birth professionals. Older mothers are more likely to request a home birth, as are educated women.

But the point is that the study matched women up according to age, parity, social class and risk factors at the start of labour.

Perhaps it is the case that some low risk women were steered towards the labour ward rather than into an MLU - not on the basis of any evidence based protocol - but because of a 'hunch' on the part of the midwife or because of the midwife's own prejudice or ignorance, but that doesn't fit with what I know of the midwives I work with. They are very keen that mothers who want to go to an MLU have the opportunity to realise their preferred setting for birth, and it's quite unusual for midwives to do what YOUR midwife did and lead mothers to believe they don't have a choice, or make suggestions that are not based on good clinical evidence.

In any case - it's a bit of a long shot isn't it? Thinking that midwives are regularly steering low risk women into OU's without any basis in protocol and that this accounts for such massive differences in birth outcomes between settings, in study after study on place of birth? And you have absolutely NO evidence or research which backs up your view.

"I feel lucky to be living in a place and time where all of these different types of delivery were possible."

I watch programmes on birth in the USA and other countries and also feel very, very grateful that we have the choices we do in the UK.

But it's still the case even in the UK that there is under provision of midwifery led units (MLU's) in much of the country and many women don't have a choice as to where to have their baby. It's also the case that lots of women aren't really aware of the clinical evidence on the safety and benefit of birth outside of medical settings, and I think this is something we need to work on.

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