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

BOF I'm so sorry about your experiences. And I've read many, many threads on Mumsnet of other testimonies from women who are traumatised by what happened to them during birth, so I know that you are not alone.

There was a particularly interesting thread about 18 months ago which was discussing women's experiences of pain in labour and it was striking how - for many people - it was the pain, and being refused pain relief, that was the most traumatising aspect of the experience.

So, while I don't want to tell you what you experienced, I wonder if it was actually the disempowerment and not being listened to that was distressing, rather than the actual medical procedures? Obviously, I would think that, because it backs up my own view.......

And I agree with Sioda because I think that all too often, women's experiences are dismissed or scoffed at and we're expected to put up with pain that would be managed under other circumstances.

Jules125 - I lost my baby after a prolapsed cord. I'm very glad that your delivery had a good outcome.

PS I've requested an ELCS due to anxiety. I still don't have that signed off at 28 weeks. The midwives are trying to encourage me to have a VBAC I don't want. The obstetricians are stalling me a bit ("we'll look at the situation later).

So yes, I think these targets do make it more difficult for women like me to get the births that make them feel less worried.

Some of us do need experienced obstetricians BOF.

In my first pregnancy I developed life threatening complications from pre-eclampsia at 26 weeks. My blood pressure was 240/120 (normal 120/80), my kidneys and liver failed, I had no blood clotting function (not great with childbirth!) and I developed heart failure. I would certainly have died without the mostly male obstetricians and senior doctors intent on saving my life. My DD1 could not be saved and was stillborn.

Yes, my case was very severe but not unique. 5% of first time mothers develop pre-eclampsia. I had no medical conditions or obvious risk factors so was under "low risk" midwifery care. The midwives failed to act on my phone calls or complaints of headaches; I do not really trust them to be able to recognise when a pregnancy becomes very high risk and needs urgent attention. Its possible that DD1 would be alive if they had acted when I first asked for help.

My second pregnancy was much better but DD2 was lying transverse at term. Again, midwives kept telling me she was head down and engaged. It was only very senior doctors (with their machines!) that worked out this was not the case and saved me from a traumatic induction at best (or a cord prolapse and dead or damaged baby at worst). My ELCS was not ideal perhaps but safely delivered me my wonderful DD2.

I do not want to sound like i am criticising midwives; I've also been looked after my some wonderful midwives; they just are not skilled to deal with experiences like mine. And problems in pregnancy are not that rare. I worry that there will not be sufficient senior doctors on the ward, should I urgently need them (I am 28 weeks with DD3).

I am sorry you;ve had traumatic expereiences too BOF. But I am very pro medical intervention (it saved my life twice and possibly my DD2) and very aware of the risks of pregnancy. i would like to be cared for by the most skilled and experienced doctors available. I welcome continuous monitoring (don't want to go through another stillbirth like DD1 and I recognise the pregnancy can get complicated very fast).

I hope you can see that my choice is rational and provides and entirely different perspective. Apologies for long post

BOF, I'm sorry you had such a horrible birth experience. I currently live in the US and one of the reasons I would like to leave is that I don't like the idea of having children here. But my view of labour as a feminist is that it's demeaning, cruel and medically unethical to coerce women into having any form of birth management that they are unhappy with, even "natural" labour as the proposal describes it. People who want an epidural or a caesarian are not trying to take away the opportunity to labour without intervention from anyone: they just don't want it for themselves. Instead of saying that all births will inevitably become medicalised if some people are allowed to choose epidurals, why don't we focus on promoting a culture in which all women's childbirth choices are respected?

I haven't given birth, but I hope to some day. If that day comes then all I really want is to have a vaginal birth with the knowledge that a spinal or epidural is available; and not to have anyone patronise me, or try to coerce me by telling me about the risks of complications from epidurals (I know them), or take advantage of me being vulnerable to deny me pain relief. That is what I fear. And I don't even have tokophobia so god knows what it must be like for someone who does.

"I dont think it really is something that has always been a problem. You don't see animals shitting themselves about giving birth.. even though they have a healthy fear of other animals, threats, etc."

I've heard this argument so many times from the natural birth ideologues and it always baffles me. Humans are a different kind of animal in ways that actually matter. We're a social species with language so we can share complex experiences using words - so we can hear the stories of other women who've given birth and be influenced by them. We have a rational brain that allows us to anticipate the future and plan ahead to avoid risks - like the risk of pain or injury. And we have tool-wielding hands that allow us to create tools like caesareans and epidurals to achieve what we want. The combination of those abilities mean that comparisons to how animals give birth or what emotions we imagine they do or don't feel is, well, bizarre. Inherent in it is the notion that we can switch off our rational brain, re-educate our primate/social brain and just operate from our instincts. It's beyond nonsensical. Our brains just don't work that way.

I'm going to leave this thread because my view of labor as a feminist is that we shouldn't give in to what doctors the majority of them have been male are telling us to do when giving birth. I don't see this as restricting women, I see it as restricting doctors.

Telling us we can't have babies on our own, so we NEED them, is just another way the patriarchy has taken away our power.

If I told you my birth story with dc2 it would make you cry, not only did I get pushed down when I tried to walk but I had to slap a nurse away from me when she tried to physically force me to wear the monitor back on my stomach after I had taken it off after being forced to lie down or hours and in excruciating pain from not being able to walk. they were trying to pressure me in to pitossin which because I believed it would cause painful contraction they were insisting I have an epidural. I was threaened with being asked to leave in the middle of my labor.. And it just gets worse.

If I can face it I may start a thread about the night to let you know what you have to look forward to in your new shiny hospitalised births.

You see this as about choice, women's empowerment in their labor. Some pole dancers say the same thing about dancing, they don't see that they never had a free choice in the first place.

When the UK goes down that route and doctors are in charge not midwives and they don't know how women give birth naturally such as...My doctor told me my labor was progressing too slowly and that people shouldn't be in labor for 12 hours! When I argued with her she said... maybe that's how it works in "homebirths".

She genuinely had no idea how a woman labors without intervention. I fucking kid you not. this is what you have to look forward to if doctors get their way.

BOF - that's fine when it's a black and white case. Is the mother or baby's life in danger if they don't have a c-section?

It's the borderline cases. Where a hospital is running at 19.5% and is having its funding threatened if it breaches 20%. A pregnant woman is brought in who is absolutely SHIT SCARED of giving birth because of a previous traumatic experience, but isn't otherwise showing any medical need. And she gets turned down for a c-section because they don't want to breach 20%. So she's forced into a long, painful natural birth that she doesn't want. Cue months of PND.......

It's drawing the line around who NEEDS a c-section. Who gets to decide? Do the women giving birth get to be part of that decision-making process? Or is it all decided for them by the blardy NCT?

That IS what they have done.

You can't pluck a figure out of the air and say this is what the caesaran rate should be.

You think that's what they have done?

BOF How do you know that 1 in 5 modern women don't need caesareans?
We are having bigger babies, a huge majority in our 30s, we lead more sedentary lives etc etc.

You can't pluck a figure out of the air and say this is what the caesaran rate should be.

There are clinical indications for caesarans very often starting with irregularities in the baby's heart rate.

You may be perfectly happy to hang on to avoid an 'unnecessary' caesarean but I would not be.

It should be each individual woman's choice of where she would like to set the risk not some arbitrary target based on no evidence whatsoever.

that was addressed to ushy

Who is saying they shouldn't be offered when they need one .

I'm stating that in a western country with access to decent health care 1 out of 5 women very likely don't need csec and that doctors and hcp should make an effort to inform women of this. This should be done during prenatal care not on the day of delivery.

Targets are just their to remind the doctors to not make their lives easier by pushing for not medically needy women to have csecs...which is now the norm in many countries.

What FairPhyllis said.

I hear what some of you are saying about reducing fear of labour. But I don't think that's the whole answer. Some of us have very rational reasons for being fearful of labour. What I need to know about my forthcoming labour is that I'll have a choice about how I can give birth and help and support at every step of the way. There's not much I can do to address the reasons why I'm already fearful, but - with help - I can manage my anxiety enough to deliver this baby safely.

Again, it's about acknowledging that women have different needs and responding to the individual rather than diagnosing something wrong with the way that a whole population of women give birth.

BOF just have to come back on this:

"I don't think 20% is such a low number that it will restrict women do you?"

Yes, yes, yes, yes.

I know one child who is brain damaged as a result of doctors delaying c/s, I have a friend with incontinence who, had she been to a private doctor would have been told never to attempt a vaginal birth.

Women need to be offered caesareans when they are needed clinically. That is not a black and white point but a grey one so women need to be engaged in the decision. You do not want doctors checking their caesarean statistics before they decide to save someone's life or health.

Sorry really do not agree with targets. They lead to unintended consequences.

BOF Incentive to do what? Refuse pain relief? Read Fairs post. That is how many people feel.

We're just different. Some women want interventions like pain relief. They won't feel empowered if their doctor has an incentive to persuade them they don't need it. Others feel like you. That's fine.

We're not going to agree on this are we?

Shall we give up an agree to differ?

I don't think 20% is such a low number that it will restrict women do you? I think it will encourage doctors to not automatically start telling women they need a csec for this that and the other. I know women who wanted vbac, but were told not to by doctors.. this will stop that sort of thing..hopefully

I'm certainly not blaming women, I'm blaming a society (and doctors) who give the women the feeling straight away that child birth is something she can't do.

I'm not one of these people who thinks anyone has "failed" if they have any kind of birth in particular. I think telling doctors that should make an effort to see that their patients have a feeling of empowerment and don't necessarily need intervention keeps the doctors in check. Honestly ti would be easier for them if we all epidurals and scheduled inductions. It would be, so there needs to be an incentive.

Sorry BOF - re missed your bit of research, yes, read it and it does say fear increases length of labour for 47 minutes after adjustment but there are other studies saying that fear does not have any impact on caesareans.

So again, I think saying that fear causes many problems is not too good an idea.

Added to which, if health carers start saying they are going to restrict epidurals or leave women in long labours to avoid caesareans, you will turn anxiety into terror.

So this guidance that started this thread off is bad news.

If the NCT and other woo merchants want me to "have confidence in my own body", they can fucking well start by campaigning to ensure that I will be able to have access to pain relief and surgical intervention in childbirth if I feel those things are necessary.

I reserve the right to be scared shitless of something that kills hundreds of thousands of women a year and leaves many more severely injured. This is not the result of a "social problem." This is what birth is "naturally" like.

If there is a social problem, it is with the woo being peddled that it's "natural" for women to suffer intolerable pain and that we should just suck it up because we wanted to have a baby after all.

Sorry I can't be more constructive, too angry right now.

BOF It isn't true you have to be inactive or on your back for an epidural. I gave birth vertically with a low infusion epidural and for me it was a better, calmer and more positive experience than a previous natural birth. I appreciate it's not everyone's choice but it was mine and I was happy with it.

We are all different and I entirely agree that women should get better support and not have a medicalised birth forced on them but neither should they feel they have to conform to the natural birth model.

I agree it is good to reduce anxiety but I think you do have to be very careful about saying fear causes longer labours because it implies a failing on the part of women. Women who suffer 'delay' are not to blame for their problem.

Immacs point is spot on. Improve the birth environment and care but ultimately respect women's choices.

Is it really a revolutionary idea to ask for a more balanced show of women's labors? I wasn't scared of child birth I knew it was what just happens. It makes a difference, I was only scared when I gave birth to my second child here in the states because I knew the medacalised version was going to be pushed on me.

Fear of child birth causes longer labors and more pain for women. Giving a woman an epidural means she has to give birth on her back, and if the epidural doesn't work effectively (which happens) she's in pain but can't move to alleviate it, or give birth in a better position squatting/hands and knees/water

[http://thechart.blogs.cnn.com/2012/06/27/fearing-childbirth-may-prolong-labor/]]

Wikipedia

At the onset of the Industrial Revolution in the 19th century, giving birth at home became more difficult due to congested living spaces and dirty living conditions. This drove urban and lower class women to newly available hospitals, while wealthy and middle-class women continued to labor at home.[2] In the early 1900s there was an increasing availability of hospitals, and more women began going into the hospital for labor and delivery. In the United States, the middle classes were especially receptive to the medicalization of childbirth, which seemed to promise a safer and less painful labor.[3] In fact, the ability to labor without pain was part of the early feminist movement[1]. With this change from primarily homebirth to primarily hospital birth came changes in the care women received during labor: although no longer the case, in the 1940s it was common for women to be routinely sedated and for babies to be delivered from their unconscious mothers with forceps (termed by Dr. Robert A. Bradley as "knock-em-out, drag-em-out obstetrics"). Other routine obstetric interventions have similarly come and gone: shaving of the mother's pubic region; mandatory intravenous drips; enemas; hand strapping of the laboring women; and the 12 hour monitoring of newborns in a nursery away from the mother.

I thought birth at hospitals started during the industrial revoloution