Childbirth rights- are you pro-choice?

(94 Posts)
Feminist5 Thu 23-May-13 18:30:39

I am sure majority of the ladies who post on the women's rights forum are pro-choice, and support a woman's right to terminate a pregnancy.

My question is more about the woman's rights when she chooses to continue with the pregnancy. Should she have full control over how she gives birth?

I'm not talking about outrageous requests like demanding that a doctor perform IVF and get you pregnant with sextuplets or that a doctor perform an appendectomy or chop off a limb during pregnancy just because the woman wants it.

However, childbirth is a slightly different situation because the baby will come out somehow and I feel liken the woman should have a voice in how and where that happens. It is also quite common for doctors to be biased towards fetal rights and override what the woman feels more comfortable with.

So I am therefore referring to a woman's right to choose how she should give birth, as I happen to think this is a feminist issue.

Do you think women should be able to choose the following (as long as they are fully informed about the pros and cons)?

A home birth?

An elective cesarean?

An epidural?

An elective induction?

Or do you think that a doctor should be able to force a woman to give birth in a way that she doesn't feel comfortable?

Despite the NICE guidelines saying that it is ultimately the woman's choice if she wants an elective cesarean or a home birth, women are still having to fight for these unconventional choices.

Just as it can be disempowering to be forced to stay pregnant against your will, it can also be disempowering to give birth in a way that you don't want

Feminist5 Thu 23-May-13 18:36:46

I forgot to include a VBAC!

JedwardScissorhands Thu 23-May-13 18:38:14

There is very little I agree with on the feminism boards, but choice in pregnancy is fundamental to equality for me. Choice whether to continue to be pregnant, at any stage and for any reason, and choice when and how to give birth. The only caveat would be that resources. Maternity obviously needs adequate funding but that doesn't mean facilitating every precise choice. So you may have to wait for the epidural, and you may nit get an attended homebirth if the midwife isn't free.

Bunnylion Thu 23-May-13 18:44:00

I'm pregnant and haven't come across any pressure as to where and how I can give birth.

Everything I've come across with the NHS has been put to me with the aim of providing information with the full understanding that all of the options are 100% my choice. Hearing from friends who have very recently given birth have had the same experience right through to beyond birth.

In answer to your original question, yes - all women should have 100% control on making an informed choice how they birth their babies.

VivaLeBeaver Thu 23-May-13 18:44:02

I think all women should be able to choose a home birth.

Elective induction I'm not so sure about. Induction is expensive for the nhs and if there's no medical need I don't see the point.....just because someone's a bit fed up with been pregnant, etc. research shows that induction is often the start o a cascade of intervention. And where do you draw the line? If a woman wants an induction at 33 weeks pregnant (which I've seen been asked for) do the doctors agree because its her choice/her body?

I think everyone should be able to have an epidural......but the problem again is lack of resources. Most women can have one if the anaesthetist is available, they may have to wait for the anaesthetist to be available. But apart from waiting for a dr I don't think women should be put off an epidural if its what they want. In an ideal world there would be 2 or 3 Drs per labour ward but its not going to happen.

Elective ceaserean, yes I do think women should be able to make an informed choice over this. If they understand risks, etc and still want one then yes. Though again there is an increased cost to the nhs but like its been said before. If someone ends up with a vaginal birth against their wish then there is more chance of pnd, etc which has its own cost implications.

Feminist5 Thu 23-May-13 18:53:08

I think resources are critical to the discussion, but then that isn't limited to just maternity. That would be true for abortions and any other medical treatment.

Abortions cost the NHS money as well, yet we don't oppose it on those grounds.

The lack of resources can also lead to a different feminist debate on why is it that maternity wards seem to most understaffed and underfunded? Why is it that it's so easy to have pain relief for even the most minor procedures in hospital but not during labour?

VivaLeBeaver I battle with the questions you've asked as well. I have heard so many women state that abortion should be allowed up until 39 weeks. Then the same ones turn around and say that elective inductions and cesareans shouldn't be allowed and that is what doesn't make sense to me. It just sounds hypocritical to say that it's OK to compel a doctor to give a fatal injection to a 39 week old fetus, but it is not OK to request a cesarean or induction.

Personally, I don't think anyone should have an induction at 33 weeks. However IME maternal rights are given far, far less importance than fetal rights and this seriously disempowers women. I think we need a system where a woman is considered the final word on what happens to her body even if she is pregnant.

Feminist5 Thu 23-May-13 19:00:08

Bunnylion Congratulations on your pregnancy smile
I know that there are women who have very positive experiences and I am always glad to hear them. Unfortunately, not everyone has an experience similar to the one you have had so far. The women I know for instance have had completely different experiences where their wishes weren't respected at all.

Feminist5 Thu 23-May-13 19:03:24

Viva Don't you think the resource argument can be used against home births as well then? In most hospitals there should be two midwives per labouring woman. Yet in reality there is often one midwife taking care of three women at the same time. Is it then always fair to send two midwives to attend someone's home birth?

I think that the argument about resources can be used against almost any birth choice from a VBAC to a home birth to an elective cesarean.

I think a good feminist cause might be to work towards a way of ensuring that women can choose whatever way of giving birth they prefer without resources being a hindrance.

VivaLeBeaver Thu 23-May-13 19:20:11

Home births actually work out cheaper than the majority of hospital births as they're more likely to be straight forward. Therefore no dr involvement, no paed, no overnight stay.

Feminist5 Thu 23-May-13 19:56:50

Women can give birth in hospital without a doctor being involved and can be discharged 6 hours later (no overnight stay required). A straightforward birth will be cheaper no matter where it happens.

In any case, I don't think money should be the deciding factor here at all. I think the decision needs to be based on what is best for the lady in question both physically and emotionally.

VivaLeBeaver Thu 23-May-13 20:12:22

Hence why the only thing I'd argue against is induction on demand. There are definite benefits to being able to choose a csection, epidural or home birth. What's the benefit of early induction? It's the same method of delivery, with greater risks just because someone is impatient?

A straightforward birth will be cheaper no matter where it is but a woman has more chance of a straightforward birth at home where there can't be interference from a dr. Once they're on a labour ward the Drs start prowling. If a woman has only gone from 3cm to 4 cm in 4 hours they're telling the midwife to break the waters and put synto up. The midwife tries arguing that the woman wasn't in established labour for the first of those two hours but Dr wins. Wouldn't happen at a home birth.

I agree that money shouldn't be an issue but in reality it is, it totally is. Accountants make the overall decisions. Not the individual ones but the ones like some trusts now won't offer repeat sections for previous section. You have to have a vbac whether you want one or not. That blanket ruling was down to money.

You talk about what's best for the woman both physically and emotionally - but who says what's best. A lot of Drs might say a section isn't best for a woman physically so therefore refuse her one.

Feminist5 Thu 23-May-13 20:21:09

But Viva that is the point. I am arguing that it isn't for anyone else to decide what is best for the woman. She is the only one who can determine what might be suitable for her.

For example, I concede that a cesarean is risky. But if I prefer the risk of infection to that of a third degree tear, then those are my preferences which the doctor may or may not identify with. But since it is my birth experience and my body and I have to live with the consequences of decision, shouldn't it be my choice and no one else's?

Feminist5 Thu 23-May-13 20:24:11

I find it appalling that some trusts are forcing women to VBAC angry How can they force someone to take the associated risks???

This is what I mean when I say that pregnancy disempowers women. There are plenty of other areas where the government can cut costs. I find it disgusting that they choose to take away a pregnant woman's right over her body.

Feminist5 Thu 23-May-13 20:27:40

If the woman they have forced to VBAC turns out to be one of the unlucky ones to have a uterine rupture will they take responsibility?

Salbertina Thu 23-May-13 20:27:48

Clinical risk must be a factor too. Not only did i not have to fight for a home birth, I was persuaded towards one by an NHS consultant and midwife. Much yhknking around this is far too black and white and simplistic.

Feminist5 Thu 23-May-13 20:30:29

Like Viva said, home birth is cheaper. That may have been why you were persuaded into one?

Women who want repeat cesareans or epidurals DO have to fight for it. Some even have to fight for a home birth.

VivaLeBeaver Thu 23-May-13 20:31:02

Yes, totally agree. It should be the woman's choice and its very condescending and probably patriarchal for Drs to be of the "silly woman doesn't understand the risks, I know best" opinion.

But if it comes down to the woman wanting an option which costs 3k more then should she have a choice? Nhs trusts are fast running out of money which is what's behind the vbac only decision at a trust I know.

You can argue that higher rates of pnd, etc will cost the nhs as much but the hospital doesn't give a toss as they won't pay out the obstetric budget for pnd treatment. They likely won't pay for it at all as it will come out the GPs budget.

I suppose if a man had a condition that could be treated two ways and one was more expensive the nhs may well tell him he has to have the cheaper one no matter what his preference is.

VivaLeBeaver Thu 23-May-13 20:33:41

If the woman has a uterine rupture Maybe she has a good case. Maybe the trust though would argue the risk is very small and the risk of section complications is actually higher.

If a dr/hospital can back their treatment/care up as evidence based then I think the woman may struggle claiming. The dr says he chose the best of both options, both had risks, the woman was unlucky.

TeiTetua Thu 23-May-13 20:40:13

You can imagine a doctor saying "silly woman doesn't understand the risks, I know best" and of course that's wrong. But then what if it's a case of "patient who has no medical qualifications wants to do something which imposes a risk on her or her baby"? I think we must accept that at some point medical ethics require a doctor to say "No, I won't do this because I feel it would be wrong". And then there's the issue that when resources are scarce, the doctors have to consider the cost of whatever treatment the patient wants as part of the decision.

The doctor should always respect the patient. But I can see there might be times when the patient's wishes can't be followed.

Feminist5 Thu 23-May-13 20:40:44

I am not fully convinced. Firstly, a cesarean costs £800 more, not 3k.

Secondly, maternity is a women's rights issue. Men do not have to give birth, nor do they have to go through any such major life event which can change their body and impact their health for the rest of their lives.

If this was a dental treatment or a stomach bug and they wanted to use the cheaper option, I wouldn't care. Pregnancy and childbirth is not a trivial matter and treating it as though it was, is misogynistic.

If the NHS want to cut costs then there are plenty of other areas they should look at first instead of making maternity their favourite choice for cost cutting.

The VBAC only decision is so unfair that it has me shaking with anger. It is also illogical- even one VBAC gone wrong can end up costing the NHS trust millions in damage control.

Do you mind telling me which trust this is? (You can PM me if you don't want to reveal it on here).

VivaLeBeaver Thu 23-May-13 20:43:03

To some extent, yes. Which is why I said that been able to demand an induction or section at 33 weeks would be very silly and should never happen.

But if its something fairly straightforward such as vbac vs section at 40 weeks.....then the Dr could argue that the section is slightly riskier. But the mum would be right in saying there's a small risk of uterine rupture which perhaps she isn't prepared to take.

VivaLeBeaver Thu 23-May-13 20:43:53

Sorry, last message was in rely to teitura.

BearsInMotion Thu 23-May-13 20:45:29

Even inductions aren't black and white. I was fed up of being pregnant. I'm disabled and pregnancy exacerbated my condition. Also no-one knew whether I'd be able to manage labour, and one suggestion was an induction alongside epidural was the best chance of a vaginal delivery. So we discussed the options, and that was what I decided. Worked out perfectly smile

Feminist5 Thu 23-May-13 20:47:08

Viva I have no doubt that the doctor will find a way out of trouble even if the VBAC ends up with disastrous results. They usually always have an excuse.

I'd advise all women to insist (prior to consenting to this forced VBAC) that the hospital sign on a piece of paper which states that she will not suffer a uterine rupture and that if she did, they would take responsibility for the risks involved. It should also go on record that the woman did not consent to the VBAC and was concerned about a uterine rupture.

There will always be a debate about which childbirth option is safer, even amongst obstetricians. Two doctors might have a different opinion on the same case. That is why it has to be the woman who ultimately says what is best for her.

You can argue that a section is riskier based on your perception of risks, but I may find a VBAC worse. Since either way I will be the one to ultimately bear the brunt of whatever happens, shouldn't I get to decide?

VivaLeBeaver Thu 23-May-13 20:47:40

Feminist, I've sent a pm.

Feminist5 Thu 23-May-13 20:49:49

A section at 40 weeks is riskier than a VBAC? hmm

Isn't a VBAC associated with 4 times higher perinatal mortality and a 1-2% risks of uterine rupture? I'm not saying it's a bad option, I am just saying that the risks associated are severe enough that they can't be forced on anyone.

The risks of a planned cesarean are mainly for the mother and as an adult she can decide herself if she is prepared to take them.

VivaLeBeaver Thu 23-May-13 20:50:26

bears, I agree. I see some women having inductions for reasons such as severe spd and I can totally see the need for such inductions. Glad yours worked out well.

As a midwife I always try and remember that I'm there as an advocate for women. So I will support them and fight their corner even if personally I disagree with what they want. Unless its wanting a section at 33 weeks because they want to go on holiday to Ibiza. grin

Feminist5 Thu 23-May-13 20:54:21

Oh you're a midwife! Nice smile

I wish NHS trusts would just tell women to pay the extra money for a repeat cesarean then instead of forcing them to do something with their bodies that they don't want. Denying the choice altogether is so outrageous.

VivaLeBeaver Thu 23-May-13 20:59:09

Saying vbac has a 4 times higher perinatal morality rate is slightly misleading. That figure is 4x a very small number, so the actual risk still isn't very high.

Afaik, newer research is increasingly finding vbac to be safer than first thought. Women used to have to fight for vbac and now its gone full circle. They now think risk of uterine rupture is more like 0.5%, mad that risk is the same even for two previous sections! However where I work if you've had two sections you're not "allowed" a vbac even though its as safe as a vbac after one section.

VivaLeBeaver Thu 23-May-13 21:01:59

And when the Drs are counselling women about vbac they are definitly saying that vbac is the safer option. But like you say, it's different risks and the woman may not be as bothered about some of the section risks such as infection, etc.

But the dr may well be thinking about the higher incidence of haemorrhage at a section compared to a vbac. Also they may consider possible future pregnancies more. If you have two sections and then want a third then the section can be more difficult, more risk of things like placenta accreta.

Feminist5 Thu 23-May-13 21:04:25

Well, saying that women are two times more likely to die after a cesarean is equally misleading because even that is statistically a very small risk. I know that the overall risks are small, but risks are still risks and nobody can guarantee that the woman being forced into a procedure won't be the one to have that complication.

Forcing someone to have a repeat cesarean is as unfair as forcing someone to have a VBAC. I disagree with both policies.

Feminist5 Thu 23-May-13 21:07:22

From my understanding, according to both the RCOG and the ACOG, women are less likely to have a PPH after a planned cesarean than after a vaginal birth. So I am not sure why a doctor would counsel a woman about the higher risk of PPH after a repeat cesarean, unless they were following outdated research.

Furthermore, while future pregnancies are definitely a concern, they aren't even applicable to everyone. If someone only wants two children and she has already had one by cesarean then it's a bit silly to force her into a VBAC for fear of what will happen to future pregnancies...

Salbertina Thu 23-May-13 21:15:29

@feminist- why are you so suspicious of doctors- people who have chosen to work in their demanding & competitive field and devoted years of study to that end? Quite ridiculous to presume they want the worst for their patients or just to " get out of trouble". Such reductive nonsense is the type of thing the NCT has been known to advocate in its classes (certainly in mine!) which does it a great disservice....

Far better to partner WiTH rather than against clinicians to bring about safe, sustainable change with women's interests paramount

Feminist5 Thu 23-May-13 21:31:43

Salbertina I am sorry that that is the impression you have! I have nothing against doctors or midwives. I do feel however that they shouldn't be able to override a woman's informed choice about her own birth (unless it's something ridiculous like an elective cesarean at 33 weeks because she wants to go to Ibiza).

I also happen to think that given the cost cutting measures being used by the NHS, they often don't have much of a say themselves.

AmandaPayneNeedsANap Thu 23-May-13 21:31:54

I would support all of them bar induction on demand.

Starting with the most black and white, it is barbaric that any woman be denied pain relief they request (whilst recognising that they might have to wait for anaesthetist).

Home birth/elective section/VBAC, these matters should be totally the choice of the woman. I do think that there are caveats - like ensuring that decisions on elective section are fully informed, and ensuring that the availability of that choice doesn't lead towards women being pushed that route rather than issues like counselling for birth phobia if that is what the woman would prefer.

Induction. That one is more difficult for me. On balance I think not. Just like the decision to prescribe a particular drug (for an illness) ultimately lies with the clinician, I think induction should be ultimately a clinical decision, even though I think that the views of the woman should be taken into account and added to the equation. This includes those views being given due weight.

What I struggle to articulate is why, at an intellectual level, I think induction is different from, say elective section, where the clinician's view might differ from the woman's. I think that ultimately it's about degree. Section, etc are about the fundamental mechanisms of giving birth, and in those I think a woman's views should be paramount. I'll keep thinking on that last bit.

Bunnylion Thu 23-May-13 21:32:23

feminist5 thank you.

I honestly don't think the NHS ever "forces" a VBAC or anything else on a woman. A doctor may well say that they very strongly recommend it but if the woman still says no then that is actually tantamount to assault if anyone goes against her wishes.

Pressuring is different to forcing.

Pressure obviously isn't nice but as long as the woman is informed, empowered and has a good midwife and birth partner with her then the hospital has to respect her wishes.

I do agree that procedures and protocol are followed and often consent is speedily asked and presumed throughout a labour, but a woman can clearly say no to any of them. I read a lot of women over on the pregnancy section saying they've been booked in for an induction/sweep etc and don't want it, but they don't seem to realise that they can just say no thank you and instead have the hospital monitor the baby and and wait if they have gone past due date.

The problem - as I see it - is the empowerment of women during their pregnancy and labour to actually question and speak against any standard protocol.

Salbertina Thu 23-May-13 21:36:32

Clinical risk must always be paramount and then the wants of the woman. Clinicians have to be the final arbiter on this for obvious reasons so there have to be limits to individual choice.

Feminist5 Thu 23-May-13 21:40:14

Bunnylion Viva (who is an NHS midwife) has just stated herself on this very thread that women are being forced into VBACs.

My own sister was denied an elective cesarean despite having suffered a fourth degree tear during her previous birth.

I've read quite a few threads on mumsnet about women with tokophobia being denied cesareans and/or epidurals by the NHS.

So I can assure you that it is entirely possible for women to be denied choices on the NHS.

Saying no to procedures is generally less of an issue, because patients have unlimited 'negative' rights.

"The problem - as I see it - is the empowerment of women during their pregnancy and labour to actually question and speak against any standard protocol."

Completely agree! I think the empowerment is happening. The voices are being raised, but they are not being heard.

scottishmummy Thu 23-May-13 21:41:13

you're language is v loaded and frankly anti-professional.
pragmatically clinicians manage risk and work with mums to collaborate on outcome
resources aren't limitless, nor are choices.there is no absolute wish list

AmandaPayneNeedsANap Thu 23-May-13 21:43:38

Bunny - I honestly don't know if the ever NHS 'forces' a woman to VBAC. But a VBAC is very different to all the other things you have mentioned in your post because it's the default. If the hospital does nothing, a VBAC is what will happen. That isn't the case with a sweep or an induction. I certainly do know of women who have been 'forced' to do without epidural - because if the anaesthetist simply doesn't show up, you give birth without. If all that happens is that, every time you ask, and your birth partner asks, they say she's in theatre and she'll be there soon, that's what happens.

Also, I agreed to things in labour I would never have agreed to in normal life. I hadn't slept in more than 48 hours before we even arrived at the hospital, and basically neither had my husband. We were in no position to resist 'pressure'. Pressure was almost entirely equivalent to forcing, and I suspect that's an issue for many labouring women.

Feminist5 Thu 23-May-13 21:44:25

Salbertina I disagree. It is human nature for personal bias to enter such decisions. If I am making an informed choice to have a VBAC, but my provider is against them (as many of them are) because he places maximum importance on the risks of uterine rupture then is it fair for me to be denied my choice?

My doctor may think the worst possible risk is an infection and I may think it's a fourth degree tear. I'll request a cesarean till I'm blue in the face and he'll continue to refuse because he sees things differently.

It isn't always about absolute risk, it is often about different perceptions.

I cannot condone women being forced to give birth in ways that they aren't comfortable with.

This is as bad as a doctor refusing a woman an abortion because he/she feels that it is immoral.

Feminist5 Thu 23-May-13 21:46:52

scottishmummy I am not advocating limitless choice hmm

I am advocating very basic simple decisions that women should be allowed to make on their own, such as a repeat cesarean v/s a VBAC or a home birth v/s a hospital birth. I don't think this is unreasonable at all.

Do you actually condone doctors being able to force women to have VBACs or doctors being able to deny tokophobic women cesareans?

scottishmummy Thu 23-May-13 21:49:48

your language is loaded,emotive,you're globally critical of professionals
you're trying to make me answer I question that I didn't pose
don't try to digress into a topic I wasn't addressing

Feminist5 Thu 23-May-13 21:53:02

Yes, I do understand that resources aren't limitless. If they were, we would all give birth in jacuzzis with mood lighting and champagne afterwards. wine grin

Alas! This is not the case.

The way I look at it, most women who give birth on the NHS have paid decent money into that system for a good number of years. It is highly unreasonable to deny them some form of treatment because it costs some £800 more.

Feminist5 Thu 23-May-13 21:55:11

scottishmummy I am not digressing. I am actually trying to address the topic this thread was originally about- choices in childbirth. It isn't about trusting doctors because we all have our own opinions on that based on our life experiences. This is more about women being able to have more of a say in how they give birth.

Salbertina Thu 23-May-13 21:56:38

Clinicians are held accountable and therefore cannot just follow their "personal bias" (and, btw, obstetricians are FAR more likely to be a she than a he!) They have evidenced-based protocol to follow and for a reason.

Safety -of the mother and baby/ must be paramount and therefore choice at times is secondary.

There is no way a high risk woman should have a home-birth (and i speak as someone who had a homebirth!)

Feminist5 Thu 23-May-13 22:01:31

Salbertina Gender is irrelevant. It could be a he or she, it honestly doesn't matter!

Clinicians are held accountable but many decisions are in a grey area. Such as the decision on how a woman with one prior cesarean should give birth. Or how a woman with tokophobia should give birth. There is no right or wrong answer here and even clinicians amongst themselves might disagree on these issues. Therefore, it is entirely possible for there to be a conflict of opinion between doctor and patient and it may be very difficult to say who is right and who is not.

I agree with you that ideally high risk women should not have a home birth. But would you advocate a high risk woman being forced to have a hospital birth against her will? Or would you advocate a woman being forced to have a VBAC/repeat cesarean?

Doesn't that sort of system reduce women to incubators who have no say in what happens to their bodies?

Feminist5 Thu 23-May-13 22:04:53

Also, like Viva pointed out protocol is also cost based, not just evidence based. Secondly, in many areas of childbirth we do not yet have enough evidence to be able to say with certainty what is best.

Whatever happens, good or bad, ultimately the woman has to live with it. Therefore, the decision should ultimately be hers.

badguider Thu 23-May-13 22:04:59

I support a woman's right to choose but I also support any individual hcp's right not to be involved in something they believe is very dangerous.
If I was a MW or doctor (I'm not) I would not be able to support somebody choosing a course of action I believed to be deadly - but if all hcp's refuse to support a choice then really the woman doesn't have that choice. It's a conundrum I have no answer for.

scottishmummy Thu 23-May-13 22:06:29

you quite simply have an agenda that you're sticking too irrespective of contrary pov
women as incubators might sound really right on in socialsciencetatic essay
but it's hollow quip with no substantive basis

Feminist5 Thu 23-May-13 22:09:49

scottishmummy It might be more productive if you participated in the discussion instead of posting cryptic messages which are aimed at criticising.

What is your POV? Do you think women should be able to choose how to give birth or not?

VivaLeBeaver Thu 23-May-13 22:10:39
scottishmummy Thu 23-May-13 22:10:46

actually no the woman doesn't just have to live with it whatever happens
trained staff are accountable,have professional regulatory bodies who investigate poor practice
your grasp of health care,resource and risk,and professional responsibilities is woeful

Feminist5 Thu 23-May-13 22:11:44

badguider Exactly. I struggle to answer the same question myself. The situation with regards to abortion is very similar in many American states. Abortion is legal, but since their is no willing provider women who can't pay to have it done elsewhere have no choice but to continue with the pregnancy. And this, unfortunately, does reduce them to incubators.

Feminist5 Thu 23-May-13 22:15:03

scottishmummy hmm

So let's say I am refused a repeat cesarean and effectively forced into a VBAC. The VBAC results in uterine rupture and my baby dies. Will I not be the one to live with it?

Let's say I am tokophobic and I am refused an elective cesarean. If I suffer PTSD and a fourth degree tear, will I not be the one to live with it or will it be someone else?

The health risks of any mode of delivery are faced by the woman at the end of the day, not the person treating her. So obviously she is the one who will have to live with what happens.

Feminist5 Thu 23-May-13 22:15:50

In the above two scenarios an investigation into the matter after the fact will be little consolation to the woman.

VivaLeBeaver Thu 23-May-13 22:16:46

I know of a really, really high risk woman who had a home birth against advice. She was about as high risk as it gets. Drs told her she was risking the life of her baby and possibly her own.....they weren't exaggerating.

She had a home birth.....it's the one thing a dr can't stop. The woman can just decline to come to hospital. She was well supported my midwives in her decision, once it was realised that's she was sticking by her decision. At the end of the day it was her choice.

Feminist5 Thu 23-May-13 22:17:10

scottishmummy Your grasp of reality is woeful.

Feminist5 Thu 23-May-13 22:18:34

Viva But at least she was supported by midwives. Imagine if they had refused to attend the home birth! As long as it was an educated choice, it was her decision and I support it.

Is she alright though?

VivaLeBeaver Thu 23-May-13 22:20:45

Yes, I'm very glad she was supported by midwives. And she had a lovely home birth! grin

Feminist5 Thu 23-May-13 22:23:12

Yay! grin

JedwardScissorhands Thu 23-May-13 22:34:11

I had an induction at just over 33 weeks actually. I had a risk of a complication from a previous pregnancy recurring, which ultimately could have lead to still birth or severe disability as a result of hypoxic brain damage.

The obstetrician was very against this, wanted me to go full term, and I had to fight to be allowed to do this. The likelihood of the recurrence was very small, but the outcome much worse than problems associated with late prematurity. I preferred the higher risk of a less serious outcome.

The obstetrician thought I was bonkers; should I have been denied the right to make this decision because she disagreed with my logic? Rational adults can come to two different but equally rational and valid conclusions on the same set of facts.

Cost not an issue as I would have been induced at 39 weeks anyway, the disagreement was only about timing.

Feminist5 Thu 23-May-13 22:40:10

jedward I am glad you made the choice you felt was best. smile

As I said, you are the one who has to live with the outcome so how can it be someone else's decision?

Salbertina Fri 24-May-13 07:14:00

Clinicians have to make decisions all the time -in all areas of health not just childbirth- the consequences of which other people have to live with! To question that is at best faintly ridiculous. Any operation etc would normally be on the basis of informed consent- as in informed by the expert clinician not google/some half-baked pressure group

scottishmummy Fri 24-May-13 07:38:07

no.its not only the woman in the clinical decision making,she'll be supported by team
this is most definitely not a singular decision.its a health decision facilitated by info hcp provides
of course the decision is shared as its assisted health intervention.the mother,the staff,the institution

VivaLeBeaver Fri 24-May-13 07:50:39

If a woman asked a Dr for a procedure/operation which wasn't the safest choice and he agreed to do it as she was making an informed choice, if there was a bad outcome the Dr would still be held accountable and could potentially get Into trouble.

scottishmummy Fri 24-May-13 07:56:30

hcp,drs are accountable for interventions.this isn't a case mum singularly bear consequence
health interventions outcome affect the individual,the staff,the child
I think op grasp of health,and decision making is woeful,but she's got a line she's sticking too

Finallygotaroundtoit Fri 24-May-13 08:09:59

Jedward I'm glad it went well but cost would come in to it if your baby needed special care.

Some babies don't get the care they need due to lack of cots. If a woman's right to choose means some one ele's baby suffers is that not a feminist issue?

Circaea Fri 24-May-13 08:35:29

This is a very interesting thread. I'm still in two minds, having read all of your comments.

I think part of the dilemma comes from birth being both medical (complications) and non-medical (normal low risk birth). And disagreements about where the line is. I don't think there is enough evidence about risk in pregnancy for anyone to be categorical about many situations (although some are clearer) - as people have pointed out the policy on VBACs has changed recently.

So, it's a grey area. And also a sensitive area, with new life involved. And also the only major involvement with the healthcare system many people will have until old age. So 'healthy' people are rightly resentful of being 'medicalised' when they may not feel it's warranted.

Clearly, where the intervention of medical professionals is required they must be allowed to follow clinical procedure - they're trained after all and those procedures are designed to keep us safe. However, the standard rules of informed consent apply just as they would for any other medical intervention.

But I think the above circumstances have to be taken into account - it's unreasonable to expect women to go along with medical advice blindly, a higher level of information is required. It's not like breaking your leg, which is more clear cut. And with that goes greater choice about the outcome.

Do I think women should have absolute choice? Difficult.

To refuse treatment, yes. That's the right of anyone offered medical treatment.

To be supported in a natural birth in order to avoid medicalisation of birth, if medicalisation is not justified? Yes.

To demand treatment? No, as that goes over the line into the medical sphere where I think we need to live by the rules of healthcare provision (unless by exercising the choice to go against medical advice, we waive the right to complain/seek compensation if something goes wrong). There's obviously also a cost lens, funds are not infinite for healthcare.

However, all risk factors being relatively equal, women should certainly have a choice between medical options. And much more needs to be done to take the wishes of women more seriously - there are too many stories of women not being heard when they say their pain is unbearable, or they feel that something is wrong with their labour, or that they are terrified of birth.

I think it's an important debate, because approximately half the population will experience this at least once in their lives and it does have a lot of undercurrents about the wider position of women in society. I don't think the current situation is ideal, so I think we need to keep poking things to improve the situation.

I've only scanned the thread, and this is my first time on the woman's rights boards!

Women should be able to make an informed decision. They should be given the knowledge to make their choice. None of this 'c-section is twice as likely... '4 times more likely to die'. Proper facts, with proper statistical numbers. PPs have already shown that by using the 'twice as likely' statement, the actual facts can get twisted, when in reality, it's only 0.4% more risky.

I don't know about 'demanding' certain things....it's not a very positive word is it? But on the other hand, if a woman has been given all the facts, and decides she would like a c-section, why should she be forced to give birth vaginally just because her dr disagrees?

VivaLeBeaver Fri 24-May-13 10:17:55

With Jedward's case as well there was a reason why she could argue the early section was warrented. After fighting the Obs agreed to it and everything went well - good outcome which is great.

But imagine a similar scenario if things hadn't gone well. A woman in such a situation may well have turned round and sued/complained. The Drs could say "oh well its what the woman wanted and we thought about it, told her the risks but in the end agreed as there was a reason"

A good lawyer in court would pull a Dr to bits over such a decision. They'd have expert witnesses lined up to say no way would they have done a section at 33 weeks, too much of a risk, blah, blah. That they'd have waited for more signs of the preveious complication repeating itself. They'd have found research to say that the chance of the medical condition been repeated was lower than the chance of the baby being really poorly, etc.

Obviously I don't know the ins and outs of Jedward's history at all so I'm using her case as a loose example.

I've seen sections done at 38 weeks for SPD where the baby has had respiratory distress and spent a long time in NICU. There's research saying that elective sections shouldn't be done prior to 39 weeks unless medically indicated. Again if something goes wrong a lawyer would argue that SPD isn't a good reason. The woman may then turn round and say the SPD wasn't that bad, they would have been happy with stronger analgesia but the Dr offered a section so she assumed it would be safe, etc.

JedwardScissorhands Fri 24-May-13 11:57:09

Actually, my baby did have respiratory distress and spent time in NICU. This risk was explained to me. I chose to accept it as being preferable to the risk of still birth, even though the risk of still birth was much lower.

It can't be right that my choice should have been restricted because of a risk I was prepared to take.

JedwardScissorhands Fri 24-May-13 11:58:21

Plus the feminism angle here is that my then unborn baby was not the patient. I was.

Is there not some sort of 'waiver' form that you would have to sign if you wanted to go against the Doctor's advice?

I know I had to sign a waiver when I didn't want me and 3 day old baby to stay at hospital (weight loss/BF not being established). After arguing that I would probably find BF easier at home than on a ward with 13 other women and their babies, and the fact that the hospital was a 120 mile round trip for my bloke - I had to sign a waiver saying I was aware of all the facts and if anything happened to the baby it would be 'my fault'.

JedwardScissorhands Fri 24-May-13 12:54:16

No, I didn't sign anything.

PeaceAndHope Fri 24-May-13 14:34:50

It is pointless to argue about whether or not doctors can be forced to perform a procedure because that will never happen.

Should women have absolute control over how they give birth? YES.

I have had a miserable vaginal birth that I was forced into and it killed a part of me emotionally. I felt like I had no control over my body and the health care professionals had stripped me of my autonomy and rights. I felt violated and objectified.

My planned c-section in contrast was a peaceful, calm and empowering experience. It felt amazing to be able to choose how I would bring my baby into the world and to take ownership of that decision.

I don't mind doctors getting women to sign waivers if they aren't fully on board with whatever treatment the woman is requesting. Referring the woman to another doctor is also an option. There are ways to work around disagreements! Denying the lady a choice in such a life-changing event is never an option.

It amuses me when women who are pro-choice about abortion say that there is no right to 'demand' treatment. So women can 'demand' abortions but not epidurals/c-sections/etc? Why? Abortions aren't exactly risk-free and doctors can have medical or moral issues with performing an abortion as well.

I've skimmed through the thread and it seems that some people can't understand that doctors can all have different opinions on the same thing.If every doctor was 100% correct and ethical and unbiased then there would never have started the concept of a second opinion.

Doctors are human-they are not God. They can make mistakes and they can be biased for or against a certain kind of birth.

My SIL wanted a VBAC. The first consultant she asked refused because he felt that the risk of rupture was too serious and shouldn't be taken. She persisted and was referred for a second opinion after much drama. The second consultant agreed without a fight because he believed that VBACs were better.

Does that mean either doctor was unethical/wrong? No ! They just had different perceptions of risk and different interpretations of the existing evidence.

JedwardScissorhands Fri 24-May-13 15:08:49

Totally disagree with that. Unless the procedure would involve the doctor breaking the Hippocratic oath, it is irrelevant what their preference or view is. What a load of paternalistic rubbish.

PeaceAndHope Fri 24-May-13 15:17:35

Sorry, was that in reference to my post? I don't think it matters what a doctor's preference is either to be honest. Unfortunately our healthcare system will always tip the balance of power more towards a doctor than the patient. The next best option is to have the right to a second opinion or a waiver. I am not saying denial of preferred treatment should ever be an option.

NiceTabard Sat 25-May-13 16:57:58

I think that women should be given the facts (risks etc) and then allowed to choose (within reason).

I also think that there should be much more information and support around post birth difficulties inc trauma, mental health, continence issues, sexual function probs and all of the myriad of things I have read about on here. At the moment there seems to be a culture of women thinking they have to "put up" with stuff which they wouldn't normally, because it is related to giving birth.

PeaceAndHope Sat 25-May-13 21:33:00

Viva, it seems that planned c-sections are considered safer than VBACs.

www.bbc.co.uk/news/health-17353803

(I know this is a derail but I'm sharing the link because the topic was discussed earlier on in the thread)

VivaLeBeaver Sat 25-May-13 21:46:19

Peaceandhope, the Drs I work with definitly tell women that vbacs are safer. The research in that link just looks at the risk of uterine rupture which are obviously going to be higher in vbacs, therefore stillbirths also higher. But if you look at the actual figures its a v small risk.

Drs also generally consider other risks of sections, so higher risk of pph, higher risk of dvt, higher risk of sepsis. Sepsis and dvt are the two highest direct causes of maternal death in the last two CMACH reports so not to be treated lightly.

Then there's the risk to future pregnancies, higher chance of scar rupture, higher chance of placenta accreta or previa.

NiceTabard Sat 25-May-13 21:55:29

I was told when I was deciding between vbac / elcs for child no. 2 that vbac carried slightly higher risk for the child and elcs carried slightly higher risk for me. So meh really.

What gets on my nerves is that possible post birth recovery difficulties with cs are told in detail yet similar risks for vb are ime not mentioned at all. I know so many women who have been utterly unprepared for the long term damage wreaked on their bodies by vb and I also know lots of women who held back from getting help as vb is "natural" and so the after-effects are as well so don't make a fuss type thing.

PeaceAndHope Sat 25-May-13 23:39:46

Viva, ELCS doesn't have a higher risk of PPH smile In fact a planned c-section has a much lower risk of PPH than a vaginal birth. (This is what the latest research by NICE indicates). The impact on future pregnancies will not be applicable to every woman, because not every woman goes on to have more than 2 children. It's misleading to say that the risk of stillbirth is a 'small' risk and nothing to worry about. When it does occur the consequences are devastating. The risk of DVT and embolism is equally small with an ELCS, yet we are happy to scare women with that. There has to be a balanced debate for women to be able to make empowered choices.

I would be very reluctant to trust any doctor who told me that a VBAC was safer. It would be rather obvious that this was being said to parrot trust policy or to cut costs. It's fine to have a discussion on the pros and cons of either mode of delivery but to categorically call one safer is wrong IMO.

NiceTabard, I am inclined to agree that a VBAC is most certainly riskier for the baby. I am not sure what is riskier for mum- a pulmonary embolism is as bad as a uterine rupture, but less likely to occur. Only the lady herself can decide between the two options.

"What gets on my nerves is that possible post birth recovery difficulties with cs are told in detail yet similar risks for vb are ime not mentioned at all. I know so many women who have been utterly unprepared for the long term damage wreaked on their bodies by vb and I also know lots of women who held back from getting help as vb is "natural" and so the after-effects are as well so don't make a fuss type thing."

I absolutely agree with this! The risks of a VB are rarely mentioned to women even though the consequences of a VB can be far more devastating than those of a CS. (I have a friend living with incontinence caused by anal sphincter damage during a forceps delivery).
It irks me when all these pregnancy brochures insist that VB has a shorter recovery. It does not always.I have had a VB that took me 18 months to recover from and an ELCS that took 2 weeks.

tungthai Sun 26-May-13 08:48:23

I wanted a VBAC for ds2 and the midwives and Doctors were both very supportive of that. However I stated that if the labour was not progressing well I wanted a c-section I didn't want a forceps delivery.

I had a long labour, longer than they agreed they would let me go but all three parties were in agreement to let me continue. Then the labour stopped, the contractions just faded away. The midwives told me that I was going to have a forceps delivery despite my wishes not to. The registrar and senior midwife had an argument next to my bed as the registrar was of the view that a c-section was safer. Then the registrar examined me and said that I wasn't fully dilated which didn't surprise me as I didn't have any urge to push. Cue more arguments between the registrar and midwife before the consultant came along and whipped me off to the theatre for a csection.

Up until this point I was extremely satisfied with my care but then I felt that my wishes and my safety were being put at risk because midwifery staff are in favour of natural births.

PeaceAndHope Sun 26-May-13 14:36:12

I've noticed most ladies who are saying their choices were supported wanted a VBAC. We if you want what they want you to have, then obviously they will be enthusiastically support that choice.

There are so many threads on mumsnet itself about women who want repeat c-sections are being refused. sad

Tungthai, your experience is not at all unusual. In fact you are lucky that the consultant at least favoured a c-section. I know two women who had forceps against their wishes- one ended up fecally incontinent and one had a brain damaged baby. I think forceps are medieval tools of torture and I genuinely think they shouldn't be used as often as they are.

PeaceAndHope Sun 26-May-13 14:37:05

The second sentence was meant to read like this-

"Well if you want what they want you to have, then obviously they will enthusiastically support that choice."

Ushy Tue 28-May-13 12:05:01

Well said Peace but what I find so odd is that natural birth is seen as a feminist issue when it is nothing of the sort.

I could understand it in the days when women were forced by male obstetricians to give birth on their back and be subjected to a variety of instruments of torture to extract babies.

I think what the feminist movement missed was exactly the point you are making so well. It has never been about 'natural' birth. Feminism should be about respecting women and the choices they make - the imposition of natural birth is as much misogyny as the paternalistic obstetrics practiced in the past.

The tricky thing is that in the past it was mainly men doing it to women. Now it is just as often women imposing it on other women.

But then, women in their thousands opposed women suffrage...so nothing new I guess

PeaceAndHope Sat 01-Jun-13 17:36:36

Ushy

I agree with everything you have written.

Certainly a woman who chooses a natural birth should be supported (and IMO most of them are supported within reason). However, women who want ELCS and epidurals should equally be supported and it shouldn't be up to government funding bodies or health care professionals to take that choice away from us.

AmandaPayneNeedsANap Sat 01-Jun-13 18:05:19

I agree that feminism should support women's choices.

However, I disagree that it is routine that women are supported to have a natural birth if that is what they want. I wanted a natural birth for DD1. What I got was little support for the pain I was in, a dismissive attitude (because I wasn't in active labour. Never mind the fact that I was into my third day without sleep and felt like I was being kicked in teh back by a horse) and pressure to accept interventions that I didn't want. I think natural birth is supported in much the same way breastfeeding is supported - lots of talking about what a good thing it is but very little in the way of solid knowledge and support for women who find that difficult.

Similarly women are encouraged to VBAC in many areas, yet they are also hamstrung by so many procedures and rules that many of them will never succeed (some would obviously have not done anyway, and those who want planned sections should be supported 100%) because they are clock watched and tied down. Other ways to ensure safety are available -but they need better equipment and more staff.

Feminism should be about every woman being properly supported in her birth choices, whilst recognising that sometimes every plan needs to change. Sometimes that means a theatre full of people to help deliver your baby surgically. But equally a natural birth may need support and it shouldn't mean one disinterested locum drifting in for 10 minutes every 2 hours.

I could weep when I think of all the women I know who have had unnecessarily traumatic birth experiences because of the chronic under funding and the failure to truly listen when women speak - both before and during labour. I don't buy the 'well the NHS is underfunded' argument either. You wouldn't perform even fairly minor surgery without all the people that surgery required present and correct in theatre- so why we let women labour in that way is beyond me.

Justfornowitwilldo Sat 01-Jun-13 18:17:19

Women should be supported in the choices they make about how they want to give birth. Whether that involves an elective c section or a quiet room with a birth pool and candles. Give them the information, allow them to choose and back up that choice.

You can be bloody sure that if men gave birth we wouldn't have hospitals pushing them into vaginal births after previous birth trauma, routinely performing sweeps and internals without expressed consent and refusing effective pain medication.

PeaceAndHope Sat 01-Jun-13 18:42:55

AmandaPayneNeedsANap, I don't dispute what you're saying at all. I was merely speaking from my experience. My friends who have wanted natural births have been encouraged and supported by NCT and NHS midwives. I always wanted an ELCS or at the very least an epidural. I was first denied the choice and then shamed, guilted and judged for my preferences.

I think the system is so broken that nobody is getting what they want. They seem to think that encouraging a VB or breastfeeding is the same as forcing it on women who have made informed choice not to do it. All the while women who want to have natural births and breastfeed somehow end up not doing it.

Like yourself, I don't buy the "nhs is underfunded" argument either. There is no excuse to treat pregnant women badly and to deny them choices over their own bodies. If this isn't a feminist issue, I don't know what is.

AmandaPayneNeedsANap Sat 01-Jun-13 19:16:47

Sorry Peace, I wasn't disagreeing with you exactly. I was mostly responding to Ushy's comment that "I find so odd is that natural birth is seen as a feminist issue when it is nothing of the sort", which was a follow on from what you'd said. Sorry if I wasn't clear.

On your second paragraph, I also think that there is a lot of encouraging natural birth and not much enabling of natural birth. Much like breastfeeding. And the women who 'fail' at natural birth are also guilted and judged in some quarters (though possibly not as openly) . I agree, it is a broken and misogynistic system.

Ushy Sat 15-Jun-13 19:38:25

Amanda what I meant by natural birth not being a feminist issue is that
there is nothing feminist in browbeating women into something that some women don't want.

The genuine feminist cause is enabling women to have the choice that they want - whether that is caesarean or an 'enabled' natural birth.

I agree with you though, a broken and misogynistic system.

AmandaPandtheTantrumofDoom Sat 15-Jun-13 22:18:03

Ah, sorry I misunderstood. Totally agree with that - there is nothing feminist about railroading women.

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