Adam Kay's This is Going to Hurt

I just don't w liege any woman thinks that her birth plan is set in stone - and having a birth plan should never be blamed for shitty support afterwards and trauma experienced. IME women are traumatised after birth due to bad support and dismissive HCP's, not their birth plan

He thinks women are stupid because they assume the stuff in their birth plan will happen, like our tiny little minds cannot comprehend that it isn't the case.

@ThePawtriarchy, no problem. I really do think, though, that if he was a misogynistic arse, in medicine for the money/recognition/ power over women in O&G, he would still be a doctor. It seems to me that he left because he cared, and recognised what an unhealthy life he was in, for him and patients.

If you watch Bodies (and do brace yourself), he does heartbreakingly show a case where a birth went horribly wrong, ruining the life of everyone in the family. It’s so accurate, I find it really difficult to watch. Also plenty of dark stereotypes too!

Plenty of women writing birth plans know they can’t predict exactly what will happen (and so much of writing a plan IS to consider different eventualities and emergencies so it isn’t all a big shock if it doesn’t go straightforward) and writing one can help them feel in control and informed in different scenarios.

I totally agree that if women have been led to believe they can predict exactly how their birth will go if they write a plan and to ignore any notion of complications that can arise then that it is going to be a huge disservice to them and potentially worsen trauma. However, I think the answer is to support women to make plans that do consider different eventualities and emergencies that can occur, rather than using them as an example of why all birth plans are pointless and harmful.

IIRC there was one bit in the book where Kay rolls his eyes at the idea of presenting different options to patients and letting them make decisions. He says that he will decide the best option and present this to the patient and that their ‘choice’ is whether or not they take that or nothing. I thought that was very interesting to read, particularly post the Montgomery court case on informed consent in obstetrics.

I thought it was an awful book, sneering, misogynistic and not in the least bit funny.

[quote quince2figs]@ThePawtriarchy, yes to both of your questions. I can understand how a layperson might view some of the book as misogynistic, but don’t view it that way myself. The book, to me, speaks volumes about how the NHS is a brutal institution in which to work, and slowly dehumanises many of its staff, and ill prepares medical students for life as a doctor. At least, the poor training in emotional handling of trauma was the case at the time he, and I were trainees.
The NHS itself gaslights staff, to the point that a really poor standard of care for patients and staff has become acceptable. This, and the lack of control we have to change this, leads to the dark humour in some, as a coping mechanism.
And yes, as far as birth plans go, I have seen more psychological harm from suggesting to women that whatever is written in them can be predicted, or even adhered to, in an obstetric emergency. That just isn’t the case most of the time. And I hate that women are then belittled or ignored for the consequent trauma they and their families experience.
Again, this is only my experience, and I appreciate it may not be the case for others.[/quote]
Thank you, I really appreciate the thorough response. What I think I was uncomfortable with in Kay’s book though is part of what you’re saying, ‘that women then are belittled or ignored for the consequent trauma’. It sounds like it’s not surprising given the training and environment for doctors, but it makes a hard read in a lauded book.

I don’t have experience of Adam Kay’s stage act and the lyrics above sound bloody horrendous, I have to say

@ThePawtriarchy, yes to both of your questions. I can understand how a layperson might view some of the book as misogynistic, but don’t view it that way myself. The book, to me, speaks volumes about how the NHS is a brutal institution in which to work, and slowly dehumanises many of its staff, and ill prepares medical students for life as a doctor. At least, the poor training in emotional handling of trauma was the case at the time he, and I were trainees.
The NHS itself gaslights staff, to the point that a really poor standard of care for patients and staff has become acceptable. This, and the lack of control we have to change this, leads to the dark humour in some, as a coping mechanism.
And yes, as far as birth plans go, I have seen more psychological harm from suggesting to women that whatever is written in them can be predicted, or even adhered to, in an obstetric emergency. That just isn’t the case most of the time. And I hate that women are then belittled or ignored for the consequent trauma they and their families experience.
Again, this is only my experience, and I appreciate it may not be the case for others.

Some of these accounts (particularly from docs/nurses) really remind me of the TV series 'Bodies', particularly the doctor played by Keith Allen; can't remember his name but (like this book) I would advise against anyone reading /watching it if they're pregnant or due to give birth soon and already an anxious person.

Nothing good will come of it I promise you (!)

I’m so glad to have found this thread. I used to be a big fan of the ‘Amateur Transplants’ - their song, ‘Paracetamoxyfrusebendroneomycin’, really amused me as a junior doctor. I went to see them in concert a few times, but on the last occasion, I think it was at the Underbelly back in around 2008 (wow, where has that time gone?!), I left feeling really uncomfortable. From what I remember, that concert ended up being Adam performing solo (Suman was busy/away/ill). He seemed pretty inebriated, and song after song was loaded with degrading attacks on women. It wasn’t dark humour, it was just dark and horrible, and the idea that he was an obs and gynae trainee made me sick. I’ve found some lyrics, but I think the live ones were even worse:

Northern birds
Are lazy, ugly wh*s who
Smell of burgers
So don't have too much to drink
Or you might f** one
And end up getting AIDS

Nothing at all
When we went back to mine I was up for a shag
In the bedroom I realise you're a dumpy old slag
Your pubes reach your navel and they cover your thighs
Didn't know they made arses that size

Couples Counselling B
You never ever clean flat
You've always asked me if your arse looks fat
You ask me that
Does your arse look fat wearing this dress
Yes
That's why I beat you up!

I haven’t read the book as I can’t stand him, but I am always pretty pee’d off to see how successful he’s been without having to answer for any of the things he’s said. He’s been adopted by twitter and the media as a general all-round good guy - he’s supposedly funny, educates children, all while raising money and advocating for the NHS (although I’d bet he’s made an absolute heap of money for himself from his books and tours). Given the things that some other people have been ‘cancelled’ for, I’d be happy to see him become problematic and quietly shuffled off to the side never to be seen or heard from again.

I suppose it’s just a symptom of how normalised and ingrained sexism is in our society that his book is a lauded bestseller.

*Kay's book was eerily familiar..:it's just the general attitude that women are

1. Wrong about everything
2. To blame for everything
3. Don't have the foggiest about their own bodies*

This sums up his attitudes perfectly. Astonished others can read the same text and not detect misogyny.

Also @quince2figs are you saying you agree with all of the quote? This included?

I also think birth plans are a load of patronising, gaslighting wank to divert women's attention from the fact that the NHS is still duping them into having the most painful childbirth option because it’s cheap, and hey, it’s only women...

@quince2figs I’m absolutely coming from a genuine place of interest and trying to understand, but do you think there’s a reason those of us who have perceived the book in this way (feeling he was dismissive of and derogatory towards women at times) have done so, if it’s truly not the case.

I wonder if I’d have felt the way I did if I’d read it when I was younger / pre children with less of my own maternal experiences and awareness of how older / elderly women are treated, for example.

@FrangipaniDeLaSqueegeeMop I can imagine how stressful working in that environment would have been.

I walked past my CS surgeon in a shop a few weeks after delivery and recognised him immediately but he looked right through me. I understand why doctors might not recognise their patients when they’ve had thousands of them, but I will remember the impact of a traumatic experience for the rest of my life.

I worked in my (relatively short) time as a nurse in A&E then the gynae ward. There was a marked difference in the way men were spoken to by HCP's than women. I was labelled 'difficult' when I worked in the gynae ward because I was forever raising issues what I perceived as misogyny on the ward. Kay's book was eerily familiar..:it's just the general attitude that women are

1. Wrong about everything
2. To blame for everything
3. Don't have the foggiest about their own bodies

It wasn't just HCP's - male visitors were pandered to and treated like Gods and simpered over simply for visiting their sick wives, who in turn were treated like children.

I had a complaint made against me once as one bloke, when told his wife (who he had 3 kids with) would have to have emergency surgery and stay at least a couple of nights, the first thing he said was "And what am I supposed to do with the kids?". I said "You could look after them?". He complained that I was unsympathetic to HIM (ha!) and the matron tried to get me to write an apology.I said I'll resign before I apologise, why are we propping up these damaging and sexist attitudes. He probably expected me to take them home with me.

Yes I hated it. I have no problem with dark/gallows humour but he seemed to take a particular glee in belittling women particularly those he viewed as uneducated/lower value (the sex worker previously mentioned and a women who had come in for a 'stupid' reason but I can't remember what). I also hated the comments around a birth plan 'making women think they have any power in the delivery room'. I think that was pretty much as worded.

However it did help to validate my birth experiences. I just knew that the doctors were sneery and arrogant but you start doubting yourself after the event. His admission that he undertook loads of unnecessary sections is frightening. Leaving the profession was the best thing he did for birthing women.

My BiL thoughtfully gave this to me last week ... I'm end of second trimester.

What a thoughtful present at this time.

(Interesting juxtaposition alongside my hypnobirthing book).

As a midwife I found the book unpleasant. On the surface it’s an entertaining read but with a distinctly nasty undercurrent.

I liked it a lot. I didn't have to agree with all his opinions to enjoy it.
I detected no misogyny.
My sense of humour is quite dark tbf.

if my pelvic floor ends up saggy I won't mind someone describing it truthfully as such

Oh yes the birth plan bit was horrible.
Birth plans are generally a way for a woman to become more informed about labour and birth and therefore more likely to be able to give informed consent and make decisions about their own care (perhaps exactly why doctors like Kay are so quick to deride birth plans as a concept)
Whether or not he really did come across women with literal ‘nine-page laminated’ birth plans I don’t know, but I often see midwives saying that often women who make the most detailed plans have a history of trauma and wanting a lengthly birth plan is just all part of wanting to feel in control and have their boundaries respected. I wonder whether Kay was aware statistically the percentage of his patients who will have had a history of trauma involving males, and just how incredibly important it was for him as a doctor in gynae to be as respectful and sensitive as possible.

What also struck me about the birth plan extract was that having preferences and choices actually benefitted the woman in the end, even though her initial desire for a natural birth had to be abandoned they agreed to do the c-section in a certain way with her own needs and preferences taken into account (what would probably now be the ‘woman-centred’ caesarean that are commonplace in a lot of hospitals) which of course he sneers at.

Also part of a birth plan is ‘if this happens, then I would prefer this.’ not some naive utopian wish list. If things were utopian in that sense, we would need birth plans less anyway. Remembering reading that book, not long after I’d had my second child, brings back those feelings of being patronised and demeaned by doctors when I was at my most vulnerable. It made me sad then but angry now.