Mothers are being abused during childbirth. We need our own #MeToo

Well it’s obvious why private healthcare practitioners treat patients much better, the same as why in the school I work in (private) the teachers and the support staff were reminded on our inset day training that we must make every child feel valued, speak to them, reassure them, give them praise and an opportunity to discuss their personal learning journey. Why? Because without the patients or the pupils both the hospital and school will fold. What tosh. State schools up and down the country take a similar approach. They just have larger classes, less funding and a mix of challenges in the classroom. All schools and hospitals lose funding and therefore jobs if people opt to go elsewhere and believe it or not a lot of staff who choose to work in the public sector do so because of a sense of moral purpose. I know who I'd rather have caring for me. Of course what parents of independent schools don't realise is that the staff rooms are full of staff who couldn't cut it in mainstream schools.

The treatment I received during my first birth traumatised me so badly, it was 11 years until I even thought about having another child.

Well it’s obvious why private healthcare practitioners treat patients much better, the same as why in the school I work in (private) the teachers and the support staff were reminded on our inset day training that we must make every child feel valued, speak to them, reassure them, give them praise and an opportunity to discuss their personal learning journey. Why? Because without the patients or the pupils both the hospital and school will fold. And bad staff can be easily got rid of.

State hospitals and state education seem to forget patients and parents are paying for their healthcare and education through taxation.

If you had a bad experience with bupa and that made you switch to say aviva, it’s lost revenue for Bupa.

We are not customers and therefore there is no customer service in anything state provided.

I would like to know how healthcare provision works in Europe. Is it state funded or private? Are their the same issues? Are they following a US model or UK model or neither? What about Sweden or Finland they seem streets ahead in many ways what is their healthcare provision like?

That's certainly an interesting idea but wouldn't work practically- there aren't a lot of midwives in Canada and it's an issue finding placements for all the students here, let alone hundreds of students from abroad. Plus issues of cost, liability etc. However I came to Canada for a 2 week placement as part of my course and others went to New Zealand the the USA; this is definitely an option that should be explored more! We also had a Canadian student come to our Trust every year as part of an exchange, which I know they found valuable. As you say, it's about learning from new experiences, not necessarily about somewhere "better" to learn the "right way" of doing things. (Maternity care in the UK gets such a kicking on MN but there are some aspects that are better in the UK).

I do find myself wishing however that leaders and managers in the maternity services had more exposure to different systems and cultures of care, because a top down approach informs the whole system.

*PhoenixBuchanan" - do you think there's anything to be learned by requiring students to do a placement abroad for a year or at least 6 months in a country with a more enlightened system? Language students do this (even though the countries they study in are not considered "better" necessarily. But a lot of students from less well-off countries are sent to better-off countries to learn business and government etc. Wouldn't it work with us being the impoverished country in terms of attitudes and practices and having our students spend time in Canada or elsewhere where things are better?

Micke you have hit the nail on the head. I am a UK-trained midwife and work in Canada now. I prefer many things about the UK system, but Canada is SO much better at individualizing care. By comparison in the UK everyone is on a conveyor belt according to "risk" level. I have been particularly impressed by the OBs here; they actually listen, spend time with women and provide true informed choice, something I rarely saw from medical colleagues in the UK.

The doctors I saw were, I realise in retrospect, scared of childbirth.

They wanted to manage it to the nth degree. They told me they were "passionate" about women having epidurals and I couldn't be in labour as their monitors said no.

I knew I was in transition. I knew they would fuck things up if I let them near me. I lied, said I was going to the loo. Got into a wide squat and pushed. DS born easily. Carried him out of the loo in my arms to find the MW to take him whilst I birthed the other twin.

I was assaulted in a clinical setting when younger. This time, I did it myself and no one touched me. I delivered my own baby in spite of all their fucking wittering about giving birth on my back with "at least 8-10" people watching.

Fuck that noise.

On the other hand, I knew about the cascade of intervention, I'd done my hypno birthing, I was supposed to be a home water birth (as an older, obese, first time mother! Unheard of in the UK, my Canadian midwifes made sure I knew the risks and were fine with the idea) - but each time, my baby didn't descend, my cervix didn't dilate, and I went to EMCS.

The first time, after induction (gel then syntocin drip), the second just with contractions for a week. Each time I was fully mobile until I was too knackered to stay upright. The second time, had the people actually read my first labour notes, was identical. There was no point sweeping or trying to induce - it went just like the first, but slower because there was no syntocin. I presume I have a funny shaped pelvis or something (not that anyone would ever bother to check).

I think this is the thing - the UK definitely treated me as more of a production line item, rather than looking at what was going on, and helping me and the HCPs make individualised decisions, as we did in Canada

@Dinosauratemydaffodils.

@SDTGisAnEvilWolefGenius Oh no, you were talking about your experience which is just as valid as me talking about mine so not upsetting at all. I just used the similarities to highlight the differences. I think the problem is how do you balance a system around both of us. Not intervening was best for you and your dc, it wasn't the best for me and mine but they seem incapable of having a policy which takes into account both of those sets of circumstances.

It also had an impact on future deliveries, my 2nd was strongly advised to be repeat c-section because of the tear which they admitted probably only happened due to the length of my labour/how low ds was.

@BHStowel I can't imagine how dreadful your experience was, and how much anger you must feel towards them. Even if all that was happening was the baby not latching, they were just mean to you.

Yarnswift
I too had anaesthetic wear off during a c section.

I did as well :( I've always been surprised that I wasn't more traumatised - for some reason it never costs me a thought to go under a general anaesthetic despite waking as they swabbed down my stomach, cut me open, and dragged the baby out. I was awake until I heard the surgeon say "It's a little girl". In fairness, the anaesthetist came to see me the following day and apologised. He explained that they try to keep the anaesthetic as light as possible until the baby is out, in case its breathing is depressed, then up the dose when the baby is clear of your body.

@Dinosauratemydaffodils - I am really sorry if what I wrote upset you or made you feel I wasn’t taking experiences like yours seriously. Obviously you and your baby needed intervention much sooner, and I am sorry you had such an awful experience.

@SarahCarer - you are right about one small intervention leading to more - I believe it is called the cascade of intervention.

Posted too soon. DS was born in about 4 hours after massively strong contractions and no pain relief except the Tens. Apparently I didn't make enough fuss.

Next baby they still didn't listen to me. DD was born in a curtained cubicle on a wardful of people, only Tens for pain relief. Um I've done this before you know; the baby's coming, I'm not making it up.

Gosh yes the not listening. I was told that because I was managing with just a Tens machine I couldn't be that advanced in labor and certainly didn't need any kind of pain relief.

I had a full debrief following a complaint. It turned out they had a picture of how they expected my labour to go (literally what the monitoring should have looked like) and mine wasn't tracking the picture. I was pressurised into the monitoring in the first place and it too was slowing down my progress because i couldn't walk around. There's quite a lot of evidence I've read which suggests that monitoring causes you to not be able to move around which slows down labour which increases the need for pain relief which slows down labour which increases the likelihood of an epidural which further slows down labour and makes a cs much more likely as a "solution" to a long labour. It was the doctor who needed the monitoring in the first place and therefore they created the situation they saved.

I'm an example of someone who was pressured into a venteuse delivery completely unnecessarily by a pushy doctor who the midwives could see was making my birth difficult. In fact pressurised is generous; I never actually consented. My labour slowed down every time he came in the room. He wanted to medicalise it from the start. I was on my third delivery and I knew there was nothing wrong with my baby. It honestly felt like they just wanted the room. In the end my dh had to intervene to prevent a cs. The fact that he was able to prevent it proves it wasn't necessary and it wasn't a true emergency. The key in all of this is "listen to the mother!" Whether it's over intervention or under intervention it is failure to listen to the mother that makes it potentially abusive.

My birth was also described as an emergency situation, but I could have easily given informed consent to either have Keilands forceps tried first or whether to go straight to a c-section if I’d properly been informed. It bothers me that somebody else that made that decision for me, about my own body. I have to live with the consequences of something I would never have agreed to.

Lots of areas of medicine will have issues with consent in emergency situations, however I find in childbirth it’s then just extended out into other situations (including emergencies) where consent and decision input could easily be obtained. And even everyday non-urgent procedures like vaginal examinations etc seem to constantly happen without consent

I do wonder whether it would ruin an aspect of job satisfaction for a lot of medical staff if they are suddenly on equal footing to the women in their care and are expected to gain consent and respect them as equals.

SDTGisAnEvilWolefGenius

I am an example of when the hands-off approach of the midwives led to a better experience for me without any negative results for my baby.

and I'm an example of how that approach can put a baby in NICU and a mother under the care of the adult mental health team still almost 4 years later.

With ds1, my waters went, and from that point until the birth was 37.75 hours.

With my dc1, my waters went and from that point until the arrival was 81 hours because they didn't want to intervene. Ended up with failed forceps following a couple of hours pushing and an emergency section which tore my uterus.

So how do you balance it. I endured 75 hours of agony (first contraction hurt as much as the last) for nothing. My child suffered in utero and in NICU and at no point was I asked what I wanted. My husband nearly lost a wife, my son didn't have a mother for the first six months and nearly 4 years later (and another child) we are still dealing with the repercussions of his arrival.

I detest the argument about not wanting to ‘scare women’ with actual facts to prepare them for labour, so very patronising and infantilising.

I really do agree that better education beforehand helps so so much with being able to give informed consent if a decision needs to be made quickly. My 1st birth taught me that. I only read the leaflets and booklets provided to me by the midwives, I lapped up the mantra that ‘birth plans go out the window, don’t bother’ I genuinely thought I had to go along with whatever the medical staff wanted, that I was ‘allowed’ or ‘not allowed’ to do things, it didn’t even occur to me that my consent was legally needed for anything. I ended up with a really traumatic experience as a result of this. My second birth, I researched and knew my rights, my options, the different choices available if certain things happened. It was much easier to communicate (even via my birth partner) what I wanted and to actually know and understand what I was consenting to.

I think from this angle it’s less ‘scary’ to worried pregnant women to say ‘oh this could possibly happen, you’ll be offered forceps you may wish to choose a c-section instead bla bla’ showing them that you don’t have to hand over total control.

As mothers, do you feel like it's more appropriate to talk about possible emergencies in an antenatal class / appointment, or would that have made you more frightened of labour? (Not a rhetorical question; we're overhauling a few aspects of midwifery care at our hospital and perhaps an extra appointment to talk about these things would be something we could add in.)

Absolutely. At my ante-natal class we had an average age of 36, someone with a pre-existing heart condition, someone with already high blood pressure (which turned into pre-e) and a couple of other things. We asked about interventions and were told we couldn't discuss them, that positive thinking would see us through. We ended up with 3 c-sections including my horrific c-section which I didn't give informed consent for (by the time they shoved the consent form into my hands I couldn't read or remember my date of birth) and 3 forceps deliveries one of which in particular resulted in massive blood loss and a lot of stitches to repair the damage as a large back to back baby was yanked out. There were 7 of us.

I’m not a midwife - sorry if I gave that impression, @PregnantSea. . I did 8 weeks of obstetrics as part of my general training, and was trying to see both sides of the issue. Doctors are highly trained, but are more likely to see problematic births and can be predisposed towards more proactive intervention, whilst midwives - who are also highly trained - see the vast majority of uncomplicated births and are more likely to believe that a birth with no intervention or minimal intervention is not only possible but preferable.

The problem with intervention is that one intervention can lead to another and another, and end in a highly medicalised birth which is not right for the woman, when a bit more patience could have led to a less medicalised birth, a better experience for the woman and an equally safe outcome for the baby.

I am an example of when the hands-off approach of the midwives led to a better experience for me without any negative results for my baby.

With ds1, my waters went, and from that point until the birth was 37.75 hours. I was in first stage labour for 36 hours, u Dee the care and monitoring of the midwives - which is longer than many hospitals will let women go following rupture of membranes. I was monitored for any sign of infection, and was allowed to go through labour at my body’s pace. When I did start to push, that went slowly too, and I wasn’t making enough progress, so I was moved, by the senior midwife, from an ordinary labour room to the higher risk room (where more intervention could be carried out if necessary), but stayed under the care of the midwives. Eventually, when ds1 was crowning, the midwife suggested an episiotomy, and I agreed - and that enabled me to deliver him with no more intervention.

If the doctors had been involved, I am sure I would have been given drugs to speed up my labour, which would have made contractions much more painful, so I might well have been offered an epidural, so I’d have been less able to move around and be active in labour, which would have slowed things down more. I might well have ended up needing internal monitoring, so I’d have been unable to get off the bed. I wouldn’t have been allowed to go on pushing for 90+ minutes - at best, I’d have ended up with a forceps or ventouse delivery, maybe even a Caesarian.

The midwives’ patience not only enabled me to give birth with minimal intervention, it also enabled me to have home births for ds2 and ds3 - if I’d ended up having a CS with ds1, I would have had to have a hospital delivery for subsequent babies - probably sections again.

Doctors are highly trained professionals, but so are midwives, and as I said, both professions should respect the skills, experience and knowledge of the other. We are - or should be - past the days of the nursing staff being seen as inferior to the doctors, and just there to be their handmaidens. Doctors can be wrong too, and when the midwives are arguing with the medical staff, they may well be right!

@SDTGisAnEvilWolefGenius Firstly I just want to say thanks for replying to me in such a calm and balanced way - I hadn't read all of the other comments on here before I jumped in and it seems you are being somewhat unfairly attacked from all sides. I probably wouldn't have pushed my point so strongly if I'd read all of that first.

And of course midwives have an important place in the process of delivering a baby, and I do respect that. However I don't agree with your point about arguing with the doctor when they are planning "unnecessary intervention". I'm sorry but for all the reasons I explained previously, how on earth can you claim to know when a doctor is proposing something that is unnecessary? You are basically saying here that you know better than the doctor .You simply don't have the medical knowledge to make that call against a consultant, that's just logic. Saying that you do is kind of proving my point.

@PregnantSea - the flip side of what you are saying - from my experience as a nurse and when in labour myself - is that the doctors don't see the uneventful births - they only get called in when something isn't going smoothly, problems are arising, and their intervention is needed - and this can lead to an impression amongst them that birth never goes smoothly, and always requires intervention. This can make them more keen to intervene when it isn't necessary and, when left to herself and the care of the midwives, the woman could have given birth with no intervention, or fewer or less major interventions.

Both sets of professionals need to respect the skill set and knowledge of the others - midwives know far more than doctors about managing uneventful, straightforward births, and doctors know more about dealing with problems. Both need - for want of a better word - the humility to know their own limitations, and when to defer to the other group. And sometimes midwives NEED to advocate for the woman - which can look like arguing with the doctor - if the doctor is proposing an unnecessary intervention.

And of course you are right that, at the heart of it all, should be the welfare of the woman and the baby - their needs must come first, and no professional should be putting their professional pride above that.