Kirstie Allsopp and the NCT - what do you think?

[KateMumsnet]

Last week, journalist and MN blogger Linda Geddes accidentally ignited a heated debate when she appeared on the Today programme discussing NCT classes with a representative from the organisation. Fellow MN blogger Kirstie Allsopp - who's been critical of the NCT before - was listening in, and fired off this tweet:

"Turn to BBC Radio 4 for talk of a book about all the absurd myths surrounding pregnancy & birth. More NCT b** as usual though. Lots of people have good NCT experiences, but many don't. This is a very politicised, dogmatic and in my experience, scary organisation."

As she's done previously, Kirstie argues that the NCT is so focused on natural birth that they are letting down women who don't want, or aren't able, to have one by failing to prepare them - with the result that mothers who have Caesareans (for e.g) can feel stigmatized. Here's her blog post - fellow MN bloggers In a Different Voice and When The Baby Sleeps have also posted on the subject.

What do you think - do you agree with Kirstie, and if not, why? Tell us if you blog about this - and if you don't have a blog (why not? ) let us know what you think here on the thread.

"but the instructor didn't come accross as keen to talk about this. Intervention was bad- pain relief was discussed but the downsides emphasized- as much time was spent on homeotherapy as the other methods"

Were the parents given information which was inaccurate? Had they asked to cover c-section and interventions when they set the agenda at the beginning? If not, did the parents give this as feed back to the NCT or complain formally?

As for the downsides of pain relief being emphasised - I consider it really important that parents leave my classes knowing a) what percentage of women find the pain relief they get effective b) the possible side effects and sensations they might experience with the pain relief they choose. I base the information I hand out in class on the patient information given out by the Society of Obstetric Anaesthetists, and link people to their website. Many women come along to the class with the view that all pain relief works for pretty much all women, and are sometimes a bit surprised and worried to find out, for example, that a large minority of women get poor relief of pain with pethidine, and that 1 in 8 women will not get effective pain relief with an epidural. Most women are aware that epidurals are associated with higher rates of assisted birth for first time mum (they assume that there is a simple cause and effect relationship here, and I discuss how this is not necessarily the case). But they are not generally aware of other aspects of epidurals - the link with higher rates of c/s for fetal distress (not higher rates of c/s over all, but higher rates of c/s for fetal distress), or of some women running temperatures with an epidural and the implications of this. I'd feel it was an absolute betrayal of my clients not to set out the important facts about pain relief, because in almost every class I'll have someone who will tell me afterwards that even though they got pethidine/epidural, it didn't work out well for them or they had really unpleasant side effects. That does mean that some people will leave my sessions thinking I've been negative about pain relief - even though I make it clear that loads of women have amazing, fulfilling epidural births, and that many women LOVE pethidine and find it very helpful, and that the most important thing is to ask the midwife for what they need and want at the time in response to how they feel in labour, not go in with rigid preconceptions about what they 'ought' to do.

I also come back to this issue of what women think they hear in classes, as opposed to what was said.

I've had several clients say 'I wish I'd known how incredibly painful labour is'. And I think - other than saying 'Some women find labour more painful than they can bear and some may even be traumatised by the experience of it - thank goodness for the existence of epidurals for situations like this', and 'most women are hugely satisfied with their epidurals' (the exact words I use) what more can I add! And yet women who've heard me say this absolutely clearly, who've been encouraged to read threads on this site about women's experiences of epidurals in labour (I link them to the threads on the childbirth board which have hundreds of comments eulogising epidurals as fantastic) will STILL say at the reunion that they found labour more painful than they anticipated and they wish they'd known how great epidurals are!

Other than doing what a midwife at our local hospital does when it's her turn to deliver the antenatal classes, which is to sit and slowly shake her head at the semi-circle of parents and say 'It's going to hurt you know. It's going to really, really hurt' - what more can I do?

I can see from my own experience that there is something very strange happening - that women's subsequent experiences of birth and breastfeeding hugely impact on their memory of how they prepared for the birth and their feelings about the approach of labour. I'm not denying that there is poor teaching within the NCT at times, but I think there is far more to this than meets the eye.

Ha - I am a university lecturer and can confirm that students apparently knowing less after a 4 year degree than before they started is not that unusual.

Teaching is hard!

What's 'homeotherapy'?

Is it a typo for homeopathy or hypnotherapy?

Yep I agree that there is some shooting the messenger going on here - childbirth can be devastatingly upsetting, and people who are accustomed to being in control and being successful (the NCT demographic, basically) can be very angry about things not going to plan, feeling a failure after not being a "model child-birther" as they were model students, model brides, etc.

However, while I am in some ways a total lentil-knitter and do support the principle that IF women can give birth as naturally as possible it will PROBABLY be a good thing for them in terms of recovery etc, I was upset after the birth of my dc1 (at home) when my NCT teacher was apparently very upset that I had had to have my 3rd degree tear stiched under spinal anaesthetic in hospital. I was on cloud 9. I enjoyed the birth, my baby fed and slept well from the start, the tear healed well (having been dealt with properly in hospital), and I thought it was a fab outcome from something I had been terrified of. I didn't want to hear "What a pity you had to go to hospital" (head on side) again and again!

I suppose what I am saying is that it seemed she wasn't quite sure that it was really necessary - almost as if she was wondering whether the midwives had overreacted in packing me off to hospital. And as if that part of it marred what would otherwise have been a "perfect" home birth. Bloody glad they did, of course.

I just wish that anyone - NCT or otherwise - who promotes a hierarchy of births, knowingly or otherwise, would bloody well stop it. We live in a crazy competitive world where everything can be judged, especially anything pertaining to women. In my opinion, every mother is a hero, whether by VB, CS, or adopting. Or anything else I can't think of. And whether or not they admit to it, NCT people do often promote a hierarchy of birth with implicit successes and failures.

"I didn't want to hear "What a pity you had to go to hospital" (head on side) again and again!"

How many times did you discuss it with her? (mind boggles)

"NCT people do often promote a hierarchy of birth with implicit successes and failures."

So are we supposed to say that health professionals caring for mothers in labour shouldn't be trying to get both mum and baby through in as good condition (mentally and physically) as possible? Or all births are equally successful in medical terms? I think all mothers do the very best they can in labour - it's awesome what a mother will do to get her baby safely delivered. Every week I sit and cry through OBEM at how what the women go through.

But some births are not managed in a way which is going to get an optimal result in medical terms - and an optimal result is a mum and baby in the best possible condition mentally and physically, given their individual circumstances in labour. I think many women see how hard midwives and doctors work, and how well meaning they are, and are very loyal to the care they had in hospital. It's hard to accept that well meaning, kind and hard working people might not have looked after you in a way which optimised your chance of having a straight forward birth. And there's a sense of fatalism about it - what will be will be, and thank goodness I've got a healthy baby. I'm not sure if most parents are aware of the regional disparities in outcomes for birth (such as likelihood of getting timely pain relief, rates of infections, rates of emergency surgery etc) between different hospitals and systems of care. I suspect they think that outcomes for birth are pretty much of a muchness across the board. And I'm afraid they're not always. For me looking in from outside the thought that might be going through my head when hearing mothers' stories of difficult births and breastfeeding, is 'you might not have ended up with that horrible tear/infection/emergency surgery/unable to breastfeed, if you'd been looked after better or differently'. And that's difficult to have to deal with week after week after week.

In other words, if they're anything like me, most NCT teachers aren't thinking that a mother could have done anything other than what she did in labour, but that the care she had might have been better and might have resulted in less damage and trauma. And the mother picks up on the NCT teachers feelings perhaps, and feels judged. But it's not her that's being judged!

"What's 'homeotherapy'?

Is it a typo for homeopathy or hypnotherapy?"

Sounds exciting!

we had a great class, met people we really liked, good teacher who prepared us for pretty much all eventualities, including a c-section (I had an EMCS in the end and though I was pretty out of it by that time, DH was grateful for what we'd covered in the class).

The classes are expensive. However, we got ours at a hefty discount because we are low earners. I was stressed before we went to the classes, thinking I'd be totally out of place, the working-class scum of the group etc - wasn't like that at all. I think it's really important to emphasise that they really do help if you can't afford the classes, so if cost is a genuine barrier - ie, you don't actually earn enough to pay for it - then you can get help (and there was absolutely no stigma or anything about it, it was discreet and easy and the class teacher does not know you have paid less).

I did the postnatal early days class and did not like that very much - it was in a slightly different area and I think it goes to show what a lottery it is.

However I've been volunteering for the NCT since then and I bloody hate it. I've just given up my membership. Horrible, insular attitude. I've found it quite upsetting because they were bloody brilliant to us and for us.

Got to head off but wanted to leave the thread with this: all NCT teachers are self-employed, so if the NCT receives complaints about the quality of teaching (and verifies these complaints), there is no difficulty in them deciding not to offer her any more work, if retraining and support is not an option or is not acceptable to the teacher or the NCT. It is not like the NHS where it's actually quite expensive and difficult to get rid of ineffectual staff.

I urge all parents who've had a bad experience of classes - TELL the NCT Head Office what happened!

Also want to add - that the cost of NCT classes (at least in London) hour for hour, is no more expensive than the majority of group courses run privately by midwives.

Unsubsidised small group learning IS expensive in the UK when it's taught by qualified teachers - whatever the subject!

Fabsmum thanks for your honesty and feedback. I've been reading this thread while wondering whether or not to book NCT classes (I'm now 19 weeks with first baby). I was on the fence as the experiences here seem to differ so much. However, I understand your points about people not necessarily wanting to hear or remembering what's covered in class.

I think I'll go for it.

I wouldn't have been able to continue to breastfeed without the NCT.

I was told in my NCT classes that the baby will want to feed after about 30mins, and feeding as soon as possible after the birth is good. When I tried after being induced and it hurt the auxiliary told me to try on the ward, that was 4 hrs after my hungry boy had been born. I tried in the dark in the middle of the night with no help, because I didn't want to disturb the other mothers. Their suggestion was to take him to the nursery. When I asked to be taken to the toilet because my epidural was so strong I had numb legs, I was just shown it, and I was concerned where to walk in the corridor if I collapsed was down the centre best...

In the morning after no sleep I had love bites all over my breast where my precious newborn was missing.

I was very fortunate not to have to go to hospital with DS2 but only because he came so quickly. He fed within half an hr of birth and I kept asking my midwife for help in the days after.

This was 7 years ago, I will never forget, but I admit I only remember some bits from my NCT classes. But those bits helped me immensely.

They did do what the NHS could not because it is very stretched in our area.

Interesting, from a midwife.

Sheena Byrom blog link

"NCT people do often promote a hierarchy of birth with implicit successes and failures."

This is quite a scaring and sort of putting-off statement in my opinion. Reading this thread made me highly depressed and I might accept my DH advice, i.e. going for an adoption straightaway.
Maybe it's because I'm still 'before' that part but reading that such a hierarchy even exists makes me give up the idea of having a baby :(

If in medical terms it is probably correct to see every baby delivery as a success or a failure (for the medical staff involved in it), how is that applicable to the mother or the baby?
I mean, beyond being both in good health...what's more important? What defines a success or a failure in a few words?

I was doing the bf session just recently, and one of the mothers said her friend had stopped breastfeeding, but she (the mother in the class, not the friend) reckoned she had not tried very hard (implication being that she should have persisted). I would always try to put another view, and not to be critical of anyone's experiences....but I cannot get into an argument (no time, not the place either!). I do wonder (and worry) if other members of the class remember it as 'NCT told me.....' or 'the breastfeeding counsellor said.....'

It's hard, sometimes, and we're gonna get stuff badly wrong from time to time. But some of the time, it's not us, is what I'm wondering.

How the woman feels about the experience? What did she prefer? was she informed about the options she had for place of birth, options for support, managing the pain, ability to move around and feel at ease in her environment? Was she informed and cared for appropriately by the health care professionals? did she feel in control of what was going on and the decisions she was making for her care and her baby's care?
What support did she get postnatally? Were her questions answered? what was her recovery like? Were her decisions supported by her partner and wider family?

All of these aspects and more define how women may view the memories of their births. An elective Csection may be absolutely the right empowered choice for one women, as would a homebirth in water be for another.

All women are different, all choices are different, all are valid. How your baby is born is to some extent based on the choices women make but also on what happens during that labour with those caregivers, in those particular circumstances. I.e. best to know all choices so that on the day, women are able to decide what is best for them at the time.

Some elements of my NCT "lessons" were priceless, especially access to the breastfeeding support. But others left me feeling a total failure when I ended up having a c-section and my baby was in NICU for several weeks. The problem is that the national childbirth trust has SO much variation in the experience, attitude and abilities of the teachers that you cannot be sure of the same information. They need to have a proper syllabus to follow.

We specifically asked our teacher to discuss c-sections but instead she discreetly handed 1 member a book which started along the lines of "too many women have c-sections when they don't need them. C-sections have higher complications, risks and most don't take up breast-feeding afterwards". All based on research, sure BUT when you ask HOW does the NCT make women feel like failures - here's your frickin' answer!! C-sections were never discussed again.

My group was hijacked by a 1 dominant, confident woman planning a home birth and, in hindsight, the group leader pandered to her. Clearly because she too believed in the natural birth approach.

When pregnant with my second, a lot of people asked me if I was going to try for a "natural" birth this time. By which they meant vaginal. Lets face it, natural birth means no intervention, so even those women having vaginal deliveries in hospital aren't actually having natural births. Please can we stop using "natural" to mean vaginal. Is doesn't. And we're all grown ups - say it loud and say it proud V.A.G.I.N.A.L :)

Merlinscot - no no no no there is NO HIERARCHY - in my opinion - I think the division between good births and not so good ones is mistaken.

(medically, professionals must accept that they can do well or badly in supporting a woman - that is different)

Merlin don't let all this put you off because your comment that mother and baby being healthy should be the most important thing is spot on, and many of us feel that way. The same goes for feeding as well as birth IMO. As long as a mother and baby are happy and healthy that is that. I avoided classes for that reason after hearing all about them from my friend and just as well as I had to have intervention, ended up with an EMCS and don't get me started on breast feeding. I was happy and DS1 was happy though.

I had a lovely nct teacher, and they helped me breastfeed = brilliant, kind ladies

love the sales, coffee groups, magazine etc

but - i think there is a hierachy of birth experiences - i had 2 csections and felt really uncomfortable telling the people in my group - i was ok with the decision as so many factors led to it, but I still had to take a deep breath to tell teacher and others as it did feel as if all the classes had been for nothing!

Thanks LittleAbruzzenBear for your comment.

I think both mother and baby should be healthy and happy, no matter how the delivery happened or went etc.
I've had a few friends using the c-section and babies were quite happy and healthy afterwards. Instead, a couple of friends who 'insisted' to have a natural birth in the common belief that babies will come out perfect only because they were delivered that way, ended up having problems anyway (PND, babies unhappy and nervous, etc).

From the comments I could read here, it seems as NCT promotes natural birth but teachers don't stop there though and women fear, as newgirl confirms, to admit to the whole group they had a c-section. That is something I can't accept because such a choice can be made for many reasons and not just because you don't want to feel pain :(

Tinkertills, I would have probably slapped your NCT teacher after she had said "too many women have c-sections when they don't need them. C-sections have higher complications, risks and most don't take up breast-feeding afterwards", so maybe it's better I refrain from partecipating to any of these groups once the time will come for me too. I would probably be kicked off after the first meeting, because I already know I can't have a natural birth.

Has any of these 'geniuses' been alive when women used to die because they couldn't have a c-section? Then assuming that women have one only out of fear for the pain is absolutely insulting!

MerlinScot - she also told us that "babies do not get stuck"... and demonstrated the baby going through a mothers pelvis with the aid of a plastic doll (which was about a third of the size of my baby). Anyway, guess what I had my C-section for? That's right, baby got stuck and distressed. The same happened to my mum in the 1970s, however I was 2 pounds lighter and they managed to drag me out with forceps.

I do agree with other posters too, who have said the NHS antenatal classes push an agenda too. But I paid a lot of money for my NCT classes, i expected them to cover everything I'd need to know. I was in a group of 6 - c-section rates are 20-30% (depending on your region, hospital etc) so roughly 2 of us were statistically likely to have a c-section. Rates for any intervention are roughly 60%... you get the picture. Actually, given that most of those posting on here have said they found NCT very middle class, i reckon that the rates of intervention are even higher for those attending NCT since the middle classes tend to have babies later in life (which increases risk of intervention). So NCT in general do let down the vast majority of women. EVEN if the specific teachers are nice, helpful, experienced etc (as mine was) and EVEN if the people you meet there are nice, formed a good support network etc.

The NCT promote themselves as the ONLY national charity working on behalf of parenthood - to let down a large swathe of these parents is shocking.

Keep an open mind, Merlin, and read the stuff at the NCT website for info about NCT and caesarean section. www.nct.org.uk/birth/reasons-caesarean-birth is a good place to start. You already know there are a number of reasons why someone might have a section, and some of these are prob written about on the factsheet.

I don't think newgirl thought her teacher would be critical of her - and there was no suggestion anyone criticised her.

I have never heard of any NCT teacher assuming a woman only ever has a section out of fear....though this is one (very rare) reason for it.

I have never met anyone who thinks that a 'natural' birth means the baby will come out 'perfect' - this seems a very odd idea, and certainly, a 'natural' birth does not mean the mother won't have PND or the baby won't show nervous behaviour. Sounds like your friends had very misleading expectations :(

Hope you explore a few more ideas, and hear from women who have had different experiences before you make up your mind :)

Tinker - the vast majority of women attending NCT classes are not planning a c-section. The rate of unplanned c/s in the UK nationally is 14%, but for low risk first time mums it can be as low as 7.7% (the national emergency c/s rate for first time healthy mums planning a home birth) and as high as 13% for low risk mothers planning to give birth in an obstetric unit. You are right that statistically women attending NCT groups tend to have higher rates of intervention in birth than women in the general population, because they tend to be older (and also usually having a first baby!).

I always make sure people attending my classes are aware that the majority of first time mums nationally will have interventions in their birth, particularly those mums over 30.

Do you think that women should be told about choices they might make which could reduce the likelihood of them needing interventions in birth, or do you think this is pushing a natural birth agenda, and might make women who go on to have an emergency c/s feel like failures?

fab,as an nct teacher you're unobjective and struggle with the narratives of mums
no one is denying your pov or your experience,I accept it as your authentic account
stop ohh and ahhing about other people account or disputing their recall,it's disrespectful
I see you dispute the recall and accounts you don't like,presumably then you dispute the affirmative feedback and letters you also received?or are you only challenging the poor feedback as inadequate recall....

you're doing a fine job of not listening
you're refuting lots
as unpleasant as it is to read,you need to read and accept someone else lived experience
nct is a fine organization with great campaigning history,it needs to change.as these threads attest there's work to be done