Induction

I get the sense, OP, that you're talking mainly about induction and assisted vaginal births.

It may be worth remembering that some of us elected for a c-section and actually had a bit of a fight on our hands to opt for the most medicalised birth one can have!

I only mention it because it was absolutely the right option for me and I would do the same again in a heartbeat. Just another point of view.

Induction needs to be looked at properly. Totally reviewed. Women are being induced too early and that is an awful experience.

The new draft Nice guidelines have done this amd they’re proposing to bring the standard induction date forward…I think to 40+7, it’s 40+10 at the minute.

I should add (as it wasn’t clear in my post) that I also had an induction that was botched by the midwife administering it! But ultimately the birth was more complex than that in that the induction was badly done and caused the hypertonic labour, but the cord compression was not necessarily related.

I agree totally that induction needs far better use and management.

I think induction is a massive issue.

I may be biased!

But that's what I think.

@Talkwhilstyouwalk read some of Milli Hills books or even better Sara Wickham’s book on induction. The research on birthing outcomes is rarely clear cut. Wickhams book is very good at explaining this and talking through the studies which have informed policy/guidance in the U.K.

Op I am so glad you started this thread. Read any of the birth club threads, people are being induced left right and centre quite often because they’ve been told by their doctors that their baby’s safety would be compromised if they don’t agree and this is often before anyone gets close to being overdue.

My understanding is that if baby’s safety is at risk or baby is ill they perform a c-section very quickly. They don’t wait days for an induction process that potentially puts a baby through the more intense contractions of an augmented labour.

Women are also not being properly informed by medical staff that once they get on the induction train they can’t get off. So many people seem to be told that they’ll start with the pessary and that’ll be enough, so they assume they won’t need the drip but that so often isn’t the case. Or they want to go home and then get told they can’t or they want more paint relief and that is withheld, or they are told they can’t progress to having their waters broken because their isn’t enough staff.

There needs to be more discussion about the experiences of women in these scenarios, about what they can expect and about what the risks of induction actually are for mother and baby.

'I had a positive birth because I spent my pregnancy researching and reading so that I could make informed decisions throughout about mine and my child's health'

This is the sort of attitude that bothers me. A lot.

The poster is on a different page but if you're still reading I'd love to know what your thinking is around making that comment.

Many women have shit births for a variety of reasons
Many women cannot read up for various reasons, or even think to do so
You must be aware that things change, go wrong with births. Sometimes mothers die. Babies die. Both.

Your view is this sort of thing is essentially the fault of the mother. That's what you said.

Why do you have that view?

You must be aware that women who have had all sorts of terrible outcomes are on MN. A poster earlier on told of the situation with her son.

You realise you're saying it's their fault?

I would like to understand why you have that view and also why you choose to express it when you know women who have had tragic outcomes will read it.

I had a positive birth because I spent my pregnancy researching and reading so that I could make informed decisions throughout about mine and my child's health

I think you’re being quite simplistic about this, OP. I did all of those things, did a lot of research, hypnobirthing, NCT, Gaskin, the whole bundle (and I grew up with a mum who taught seminars on this stuff and was a natural birth advocate and NCT leader, so I was well versed in it all).

In my own DD’s birth, the midwives failed horrendously both at the non-medicalised bit, and then the medicalised stuff. I had an extremely traumatic emergency instrumental birth after a precipitate labour, cord compression and the cord wrapped round the baby’s neck several times so tightly that there was no way I could have delivered normally.

The medical obstetric team (all women) were far better than either the “natural” or the “medical” obstetric midwives, several of whom bordered on negligence or incompetence. I would have been much better off had the birth been more - and more safely - medicalised, rather than the opposite. I would also have been a lot better off if I had seen a doctor earlier, who would have been alerted to what was going on (hypertonic labour which should have been slowed down).

Yes we should be sceptical about overmedicalised birth; but equally, some of the fantasies and practices around “natural” childbirth are also dangerously misleading, and midwives are not qualified to the standards that doctors are (and there is plenty of bad practice and ignorance among midwives). Some of the things I heard both midwives and the hypnobirthing practitioners and doulas advocating were dubious in the extreme and certainly not evidence-based. Some of it, sadly, was old wives’ tales and a bit of woo dressed up to sound good.

Safe, good maternity care should combine both the best and most up to date medicine and excellent woman-centred care. It shouldn’t be one or the other.

One of the things that would make a huge difference to the progress of many births, for example, would be a scan in early labour to check for malpositioning, potential cord accidents and so on. When I asked the emergency consultant why this didn’t happen, the answer was only the expense of having a sonographer on site 24-hours. (This is considered too expensive, but tellingly a multimillion-pound midwife-led water birthing unit which almost never got used was considered just fine….because it fitted with the idea of non-medicalised birth. Only, as soon as you needed anything more than gas and air or had any medical need at all you got transferred right out of there again).

If I ever had another baby I would be asking for an elective CS, my experience with the (female) midwives was that bad. My experience with the (female) doctors was great. I didn’t see a male HCP anywhere in the maternity hospital the whole time I was there, and I gather that’s not uncommon for obstetrics. So it’s not any more just a “female knowledge vs male medical establishment” issue.

I had one induction because my labour was 'too slow' and they needed the room. Horrendous cascade of interventions birth. SIL worked labour ward and said they use inductions to manage patient numbers. I developed a risky condition with my second and was told I would be induced. I asked to see their policy for this condition and when they finally gave it to me it said women should be told the risk of child and maternal death was higher with inductions than from the condition. No induction, perfect labour and we were fine. With my third I was told I would be induced at 40 weeks exactly as I was over 40. It was the element of being told and the fact they were telling me I had to do something that increased my risk that was so shocking.

Obviously some interventions are necessary but many are not.

Medical experts base their decisions on research, why would they do anything else? I don't for a minute believe that their aim would ever be to oppress women! This is a really wired thread!

Can't agree with all of that smokedduck.

I think it's not so cut and dried.

Induction needs to be looked at properly. Totally reviewed. Women are being induced too early and that is an awful experience.

OTOH. My experience of midwifery on the NHS is it is very much Pro natural birth and almost against letting the docs near you. To the point that women get the idea they've failed if they need even pain relief.

' On the one hand complaints that interventions aren't medically warranted and lead to too many sections and poor outcomes. On the other complaints that it should be up to mums to choose sections and interventions no matter whether they are medically indicated.'

It's not about too many sections

It's about instrumental deliveries that can and do cause massive injures to women, and can and do harm babies.

CS is a different ball game.

No I didn't, because I used my savings and hired a private midwife so I had more control over what happened. But I was very pressured for my baby being "late"

Well, that's because the risk of still birth goes up after a certain point. Doctors and midwifes want to act in your best interest but you don't have to take their advice, it's just that most people do......

There is a book called how to give birth like a feminist?! Surely a book called how to give birth safely would be more useful? Whatever next......

'What I found hard was the complete unwillingness of anyone, other than the consultant, to talk about c sections. The midwife refused point-blank in the ante natal sessions. I felt like nothing was particularly upfront. So, what exactly are the risks of a ventouse? Or what are the pros and cons of pethidine? So much time was spent on 'breathing' and how DH could support me, but I was left to research myself. I'm lucky in that I have the capacity to do that - but does everyone?'

Yes. This exact thing.

I asked about CS and pain relief in my NCT class and my NHS one. (PFB ).

They looked unhappy and refused to talk about it.

They DID talk about the cascade of intervention a lot. The message was. As soon as you get any pain relief essentially you're on the road to ruin. So don't.

???

Women in that room were going to end up there, how does that make them feel?

I also raised on my NCT breast feeding session. Do you have any advice if it's painful, you get mastitis, or you just struggle. She said. That's so unlikely there's no point. I said, all of my close friends have had various issues. She said. Well that's extremely unusual.

And that was that.

Why not be honest? Give some useful info?

It's all about shielding women from the bad stuff isn't it. Why? Women are being treated like children imo.

I think it's a little off to suggest that those arguing against medicalisation are suggesting that those with a need for interventions shouldn't have them.

But there is a lot of evidence that too many interventions cause a lot of damage and maternity care is full of unnecessary interventions.

I think to some extent it's about a certain culture of birth that easily grows in a hospital environment. It tends to treat birth as disease and doctors often want to DO SOMETHING when birth is often about waiting. And about convenience in a medicalised setting - timing, moving around, monitoring. Safetyism has also had an impact.

I always find it interesting to se the difference between human medical practitioners and vets and farmers - the latter seem to be much more clear-eyed about the fact that they are dealing with a biological system. So an environment where the mother feels safe and calm, or moving around, etc, are really important factors, and interventions are known to have real potential downsides. Many of these elements are largely discounted in hospitals where the body seems to be viewed as a machine.

As for why this isn't reformed - I think a few reasons. One is that big systems like modern medical systems hate to change and have a huge amount of inertia, and they hate to lose control. They are risk adverse. The aggressive approach of a lot of modern medicine isn't very compatible with maternity care. Good maternity care takes a lot of time and is expensive as a result.

And there are pretty mixd messages from women, too. On the one hand complaints that interventions aren't medically warranted and lead to too many sections and poor outcomes. On the other complaints that it should be up to mums to choose sections and interventions no matter whether they are medically indicated.

BlueBrush thank you

The lying down position was rubbish and I was too uncomfortable to walk around. I thought a sitting position straddling a chair in the opposite way to which you sit would have been more helpful. Or being to put your weight on something, while leaning forwards.

Sadly, the maternity section didn't seem to be geared up for many options for women giving birth.

Iam yes of course it's staffing.

Birthing is in this weird middle ground between medical and not.

Giving birth is huge though. It's a massive thing for the woman to do. She may need help. She may not.

But there's no crystal ball.

What other stuff that is hospital-y though

Are the patients (can't think of a better word!) expected to read up on it themselves so they can know what to do and
Tell the people looking after them how to look after them properly
When else is informed consent so often out the window?
Are there any other abdominal procedures with the same level of severity as a section where you are expected to go home the next day. And be responsible for a newborn?!
Why is pain relief often so hard to get?
And why do they let hard sell people into the ward to flog stuff to women who are tired/exhausted/elated/in pain?
In my case. On morphine!! Hard sell to someone on morphine? I mean come on.
The partners are there 24/7 to provide care... That's why. How is that ok?!

Anyway. I just want things better for women and less pushing of this or that and guilt.

I have 2 friends who feel they failed! Because VB didn't go as planned. I mean FGS.

You sound a bit naïve, op. You've had one experience that you were fortunate enough to be able to afford to hire an independent midwife for, and you've read a few books.

The decision to recommend a medicalised birth is absolutely not taken lightly. Every guideline is evidence based and absolutely has a reason for recommendation. Most midwives will attempt to keep women on as normal a path as possible.

I understand your desire to promote normal birth but I actually think the way you're coming across is a little dangerous and derogatory.

I had two so-called 'elective' sections (a term I particularly hate because neither was actually optional). I knew my births would be radicalised, and I am incredibly grateful that I had two safe deliveries.

What I found hard was the complete unwillingness of anyone, other than the consultant, to talk about c sections. The midwife refused point-blank in the ante natal sessions. I felt like nothing was particularly upfront. So, what exactly are the risks of a ventouse? Or what are the pros and cons of pethidine? So much time was spent on 'breathing' and how DH could support me, but I was left to research myself. I'm lucky in that I have the capacity to do that - but does everyone?

For me, the bigger issues with maternity care are related to the postnatal experience. Pain relief offered was poor and infrequent. My DH is medical and could advocate for me, but the most vulnerable don't have this. This is not the case for other surgeries - why can they manage pain relief?

Plus there is a shocking lack of understanding about BAME amongst many midwives. It is just not acceptable that black women are at such a huge risk of maternal death.

I still need to get that off my chest sometimes.

@NiceGerbil I see you a lot on FWR and you're always full of wisdom, but just for this I'd like to pour a for you and the other women on this thread and just wallow in a moment of shared crapness.

And yes I did loads of research too. They just weren't very honest with me.

I agree induction really needs to be looked at.

One size does not fit all. Term is on average different in different parts of the world. I'm sure I read that women of Asian background are left too long, and those who are full on North European of the very pale variety are done too soon.

I mean that's shit.

If I knew then what I know now I would have insisted on waiting... Or would I? The your baby could die if you don't is a pretty massive push...