New guidance to reduce epidurals and a target rate of 20% for C-Sections

MLU access is pretty limited.

well, though Hb is the choice of generally MC women, that is also true of MLU and none of those housing factors apply. i think this is more a cultural thing than a circumstantial one.

FrillyMilly, I gave birth in a hospital, I assume this was a CLU. Like you, my care was entirely midwife-led. I did not see a clinician until it was evident that my labour was not going very smoothly after 48 hours of contractions and only 6 cm dialation.

While I can totally see how it may be more comfortable for women to give birth or at least go through a large part of labour at home, I am so not surprised that a hospital birth is a default choice for many. I get a strong feeling that home-birth movement is, sorry if I offend anyone, a largely middle and most likely upper-middle class notion.

Let us just for a moment consider the home of an average mother with a less-than-average family income. It is likely to be a small terrace or a flat, with little sound insulation from the neighbours. This mother may also have other children and nowhere to put them at home during the often rather long process of labour. A hospital may be a safe heaven in such situations where a woman can get some privacy.

My husband and I have a good income, but when I gave birth to my DS, we were living in a shoe-box terrace with a living room door that opened straight onto a busy street full of childrens' tourist parties and teenagers from the nearby college smoking fags and playing loud music from their cars. Homebirth? No thanks. I felt much more relaxed in the hospital.

Now that I have a bigger house with more privacy, I am considering a homebirth, but I will probably be advised against it as DS was born through a C-section.

Do the 95% who give birth in CLU have access to a MLU? Our nearest one is closing down. I gave birth twice in a CLU but my care was midwife led. I was given information about the MLU and decided, based on the information that a transfer to neo natal would take 45 minutes and that there where no facilities beyond basic resus, that no matter how small the risk to my baby I was not taking that chance. That is my choice.

what is wrong with advising MLU birth for low risk first timers HB for subsequent when that comes with much lower levels of

forceps birth
EMCS

for mothers

and lower rates of neo-natal admission for infants?

surely HCPs should advise people to do the least risky things according to the evidence? then if people want to do different, they still can? As currently most assume hospital, they would no doubt be questioning this anyway.

at present the typical MLU/ HB woman is older, and gives birth to a larger baby - yet the rates of forceps/EMCS are still significantly lower. the high rate of EMCS is not solely a population feature.

one of the findings of the Birth Place study was that women go to hospital simply because that's what you do. At the moment 95% of women give birth in CLUs - even those that aren't high risk and don't, at outset, want epidurals.

Let's compare our day to day lives to when home birthing was the norm and it become clear why we need more intervention. I worked full time during pregnancy, drove to most places, slumped in the couch eating junk food, had my shopping delivered, used a washing machine and tumble dryer for the laundry, tidying up involves a quick Hoover and polish. I was sent home 6 hours post delivery where i was then expected to resume normal life. We also are having our children much later. Compare this with the life of my great grandmother who had her child in the 40s when they also had a lying in period after the birth to ensure breast feeding was established and women could rest. However before she died she told me the NHS was the best thing to happen in her lifetime. She grew up in a poor area and people would pay a 'midwife' to attend the birth which was usually an older woman in the community. Still births where very common. We have come a long way to have obstetrics recognised as a genuine medical area and for better ante natal and birth care and it seems the NCT want to undo all this by rose tinting the past.

Some natural birth advocates seen to think you walk in to hospital and are tethered to a bed with an epidural. People shout at OBEM 'get off the bed' but we don't know how long a woman has been in labour or how much pain she's in or if she even has the strength left to walk around. If we all have the right to a home birth (and rightly so even though it's not for me) then we all have a right to go to a consultant led hospital unit and give birth with the level of pain relief we deem necessary. We should also have the right to opt for an ELCS.

When DW was pregant with DS1, some 12 years ago, I was totally unprepared for the amount of 'brainwashing' and pressure that she was subjected to when we visited the hospital maternity unit. Whether it be over pain relief or breast feeding versus formula.

The NCT is just one axis of this pressure and I know several people who are midwives and keen on the NCT mind set. I just dont like their attitude. DW had what might be called an old fashioned male gynecologist specialist looking after her because of health issues and he was rather lovely. He put it simply as this.

'The idea is to come through this as easily as posisble with a healthy live baby'.

He was happy to go with whatever DW wanted. The problem was the midwife who on the day did everything she could to prevent DW having an epidural.

I know doctors and midwives have been in conflict over who 'controls' the birth process for well over a century. No one seem sto think the mother should be the person in control. I dont get it.

I agree with Widow -- I think saying childbirth is natural and not dangerous is a bit ideological, in that it ignores the fact that it is only because of modern medicine and hygiene practices that birth has become so much safer.

This is true even for homebirths -- it's not like you're giving birth alone on a dirty floor with loads of ill people around in close quarters (as women used to). You will optimally have a midwife with you, your house will be clean and disinfected, your family is likely to be healthy and non-contagious.

I think it's fine for a woman to choose no interventions if that's what she wants, I just think this blanket hostility to 'medicalisation' is ideological and kind of ahistorical.

Rosabud - would you look at the statistics for maternal (and neonatal mortality) in rural African and other parts of the world where there is no intervention (or ante-natal care quite often) e.g. www.voanews.com/content/african-maternal-mortality-defies-global-trend-91537854/160268.html
1 in 16 African women die during pregnancy and childbirth. Its even highher in placed like Afghanistan with a 1 in 8 lifetime chance of dying during pregnancy and childbirth (they have no contraception so lots of pregnancies too).

This is what can happen in places where there is little or no intervention available. I do not want to overmedicalise or force interventions upon women who do not want them, but actually obstetricians have saved a lot of women's lives in the UK. They get a hard time when they "over-intervene" but that is because they want to avoid these risks. It can be a really hard judgement call for them. I prefer them to err on the side of caution with mine and my babies lives.

The big difference between here and Africa is the medical care available.

Rosabud - "But I don't think it's idealogical to say that a large amount of childbirth IS natural rather than life threatening and dangerous"

You're missing the point - it is natural that childbirth is lifethreatening and dangerous. Denying that is either naive or wilfully deceptive.

Rosabud None of that makes the kind of attitude I'm talking about excusable. Anyway, this thing about balance was surely always the wrong way to look at it. What was needed was for individual women to have the freedom to choose the options or the balance of options that suited them. On that level there's no balance to be found between having an epidural or not, or between formula feeding or not. The truth is feminism was influenced by New Age anti-rationalist stuff from the 1960's on. That led to Nature and instinct being exalted and identified with women, science/reason and technology being associated with men and therefore patriarchy. The goal was never to balance the two - it was to exalt one in opposition to the other. It's still happening- for example in your own beliefs about the links between instincts, behaviour and environments. They're not uncommon. Indeed they seem to sound like common sense to a lot of women. But they're fundamentally based on an ideology of how women should be, not any kind of evidence.

Sioda Excellent point.
rosabud I think you make a very good point here too, which is why I think it's time for us to try to find a way forward that respects ALL choices.

I'm not suggesting that this is easy, but in my experience I have found that there are more people who choose maternal request CS and epidurals - while also supporting the rest of the spectrum of birth choices - and fewer people who choose (for example) homebirth or no medical intervention - while offering the same support for women making a different choice.

I've said this before, but two wrongs don't make a right. If there's too much intervention for some women, the answer is not to take that intervention away from everyone. Choice isn't a real choice if the choice is being made for you or if there is only a very limited menu available.

I know. But I don't think it's idealogical to say that a large amount of childbirth IS natural rather than life threatening and dangerous and so aiming to reduce the amount of medicalisation involved is a sensible act to redress the balance if possible.

Rosabud, that's true. The problem is that when people become ideological, they get so carried away that they often end up working against the very people they are trying to help.

Sioda, I do agree BUT often the history will be due to huge lack of choice - for example childbirth bacame very medicalised, formula became the norm etc in the 50s and 60s to the extent that the natural breasfeeding lobby were facing an uphill struggle so their "choice" was being removed so, of course, they will argue more vociferously to regain that balance.

Sioda, you're spot on!

That's so true Widow. I've had that in conversation with breastfeeding advocates and natural birth advocates so many times. Women who choose formula or caesareans or whatever can't possibly be making a free choice. It must be the result of outside forces - cultural attitudes, lack of support or education, propaganda, indoctrination. Their free will is completely denied. Of course it's impossible to prove that you have made a free choice and that it's not just your internalized sexism acting because you can't prove a negative.

And if you point that out you'll be subjected to Sociology 101 as if you're some kind of idiot. Some original thinker will point out that we all grow up in a patriarchal society, we're formed by those experiences etc., then they'll treat you to the history of formula company propaganda etc. or the patriarchy of the medical profession and attitudes to childbirth or whatever. It's amazing how many people are total cultural determinists when it comes to other people's choices, but never their own. They, naturally, have attained free will.

"es but they are illnesses - childbirth is not an illness, it is actually something that is supposed to happen and for many women will go OK"

Childbirth is not an illness, but a hugely dangerous event in the life of mother and child. There is no evolutionary pressure for the process to go ok most of the time, as long as enough women and children survive it.

And it's not only dangerous in humans (who have the added problem of birthing infants with relatively huge heads compared to other animals). Just look at how many ewes are lost in each lambing season.

It's natural to give birth, it's also pretty natural to experience grave injury or even die in childbirth.

Yes I do see the point of those who have disagreed with me, I do understand what you are saying.

Lacking, I did sort of feel that some on here were arguing for being hooked up straight away, that it is a choice to say no pain at all, c section on demand or whatever. And, of course, that is a valid choice!

Of course I'm not suggesting that people should only choose to "go natural" or not to have medical intervention when things go wrong. The problem comes when childbirth is seen as a potentially horrendous experience where things go wrong. Like the poster who said that tooth decay and kidney stones are also natural processes! Yes but they are illnesses - childbirth is not an illness, it is actually something that is supposed to happen and for many women will go OK. Perhaps by trying to reduce the rates of c sections etc, that balance, which seems to be disproportionately in favour of "it's an illness/ it could all go horribly wrong" at the moment, might get back into perspective.

Sealeodair "But Rosabud, that's tantamount to saying "you have a choice, but only the choice we approve of". How can that be a choice? "

To be fair, that view is consistent with some feminist views regarding choice - with the patronising and frankly insulting underlying theory of women not being capable to escape indoctrination - their solution is to replace one type of endoctrination with another. Pretty offputting. It doesn't matter much whether its birth, sex, or anything else to do with a woman's life. Other people will tell her what she must do, and that their way is the only way.

Aha - it worked that time. Strange. Sorry - carry on debating!

I can never get bold to work
This is a test - please ignore
I wonder if it's a problem with Mozilla.

Rosabud said I do agree with the feminists that have said that choosing which medicalised version of birth a woman would like is not a choice at all, that the whole debate is wrong in the first place

But Rosabud, that's tantamount to saying "you have a choice, but only the choice we approve of". How can that be a choice?

its just not a one size fits all thing.. which is why you need choices

I would not relax more at home, I was VERY conscious of moaning and groaning because I live in a flat and didn't really want my neighbours to be an auditory audience to my birth thanks v much, especially the prim old batchelor who lives upstairs! I could not relax till I got to hospital!

I've spent half my life in hospitals and was much more relaxed there.. I've worked in hospitals since my teens, my father had a spinal injury when I was a kid so many of my happy childhood memories of spending time with him happened in hospital settings.. lots of doctors etc in the family

My NCT teacher TOLD me I would be more relaxed at home she TOLD me that by comparison I would not be able to relax into labour in hospital, and therefore would start the intervention cascade if I choose hospital not home

who the fuck are they to tell me where I feel relaxed?

and with CSs, how you FEEL about your birth effects you for months/years afterwards, it matters! the NCT lot will often tell you that you'll feel shite about your birth if you have a CS which is rubbish

This is really about the NCT telling women how they feel about what!.. as usual!