to be annoyed that women who give birth naturally without pain relief are always told they "did really well"?

[Fishandjam]

In brief, this is my gripe. I was induced as an emergency at 38 weeks due to sudden, severe pre-eclamptic liver failure. As you might expect, a fully interventionist birth followed - straight to large doses of drip syntocinon (no messing about with pessaries ? time was of the essence), not allowed to get up from the bed (due to monitoring), unbearable contractions, epidural, episiotomy, forceps. My baby, however, was fine, as was I (eventually).

There was nothing whatever I could have done about the way the birth went. I was exhausted from the liver failure (anyone who has had that will know just how depleted of energy you get). I couldn?t have an active labour due to the need for monitoring, and lying flat on your back makes for very painful contractions ? and the medical staff were only too happy for me to have an epidural, as they weren?t at all sure I?d have the strength to actually birth the baby without a C-section. Forceps were always going to be necessary, due to lying on my back and therefore effectively having to push the baby uphill. But I ? we ? coped, and all was well in the end.

So why do women who are lucky enough to have a normal, active labour, without pain relief other than G&A, and no interventions, get told that they ?did really well?, when people like me are not? I heard so much of it on the post-natal ward, from the midwives themselves as well as family/friends of other newly delivered mothers. Given my circumstances, didn?t I do well too? And why not for emergency C-sections also, where the woman has to go through the trauma of unexpected major surgery?

It just seems to reinforce the idea that childbirth is a competitive display of physical prowess, and that those of us who need medical help to give birth safely have somehow failed. When to me, it seems to be the luck of the draw.

My DS was born by ECS under general, and no pain relief prior as they didn't realise I was so far advanced so didn't examine me, then it was too late, meaning I went to fully dialated without pain relief - had I been allowed I'd have taken it.

The only thing that has bothered me is a few comments such as he came out 'the easy way' or that I was 'lucky' I didn't have to go through a vaginal birth. All said by people who have never given birth. It's that type of comparison that I find unhelpful. I do feel very lucky that when they realised what was happening (shall not bore you with details) they acted very quickly and my beautiful boy was ok - it could have been a very different story

I agree with posters who say that labour isn't really something you can "do well" because it's largely out of your control and there are a myriad of factors that can make whatever type of birth you have more or less easy or difficult to cope with.

I have a friend who had a crash section at 32 weeks because she had eclampsia (not pre-eclampsia, eclampsia), one who had a clotting disorder that meant she couldn't have an epidural even though she was terrified of physical pain (genuine phobia), a friend who delivered in 13 minutes and said it was like dying, one who had twins by section whose scar became severely infected to the point she nearly died, etc, another who delivered twin 7.5lbers at 37 weeks naturally with no pain relief, a friend whose baby died and none of the induction drugs they could offer would progress her labour so she had to wait 10 days before she could deliver her poor stillborn baby girl. None of them chose these births, they just happened - I suppose some of them "did well" to survive them but it seems such a redundant phrase.

"I agree with posters who say that labour isn't really something you can "do well" because it's largely out of your control and there are a myriad of factors that can make whatever type of birth you have more or less easy or difficult to cope with."

While you're right that we have no control over the position of our baby and some other aspects of labour connected to our health and our baby's health, there ARE things we can do to improve our ability to cope with the challenges of contractions, and also to promote the likelihood of a straightforward birth.

Otherwise we might as well all have an epidural at the outset and try to sleep through the whole labour

That's why women do active birth classes - because they know that staying upright and working to conserve energy can help them to push their baby out without the need of forceps or ventouse. Hypnobirthing techniques can help a mum avoid an epidural and therefore reduce the likelihood of instruments being used.

"Would you have a tooth out without pain relief? You would have in Medieval times!! Would you now? Not unless you were a sadist. Medicine progresses..taking on pain when you don't have to doesn't make you a hero and it certainly doesn't make you a better mother."

If using pain relief in labour didn't have implications for babies then your analogy would make more sense.

But opioids like pethidine and diamorphine can affect a baby's ability to breastfeed and interfere in the normal interaction of mother and baby during that 'golden hour' immediately after birth. And epidurals are associated with higher rates of instrumental birth, after which babies are more likely to be bruised, and to develop jaundice.

"In fact studies show that long births can be traumatic for babies" . Yes - and epidurals significantly increase the length of both the first and second stage of labour. And result in higher rates of antibiotic use in labour.

I'm not anti epidurals or pethidine by the way, I've used both myself in labour and damn grateful I was too (for the epidural, not for the pethidine which made me sick as a dog). But it's wrong to imply that there are no drawbacks to using them. There can be. Which is why I tried to approach my second and third birth in such a way as to reduce the likelihood that I'd need to use them again.

I don't know anyone who has had a baby and has not been told "well done", regardless of how the baby actually got out. The baby had to get out somehow, and there's no easy option.

I had no pain relief, (G&A is not offered in Germany. Does anyone know why?), but that certainly wasn't my intention. I would have taken everything and anything, but I simply didn't have the time. Both boys were fast and furious births. I think my body did a very good job, but I didn't feel all that in control of it. (But at least last time, I had a very good looking doctor holding my hand telling I was doing brilliantly. ;) )

"While you're right that we have no control over the position of our baby and some other aspects of labour connected to our health and our baby's health, there ARE things we can do to improve our ability to cope with the challenges of contractions, and also to promote the likelihood of a straightforward birth.

Otherwise we might as well all have an epidural at the outset and try to sleep through the whole labour

That's why women do active birth classes - because they know that staying upright and working to conserve energy can help them to push their baby out without the need of forceps or ventouse. Hypnobirthing techniques can help a mum avoid an epidural and therefore reduce the likelihood of instruments being used."

Yes but you are missing the point here a bit... none of these things would change the outcome for the majority of experiences I listed and so it is still largely out of a woman's control. Personally I did all that active birthing stuff and it was great fun and I learned lots that I used profitably but in the end, with the typical first, two weeks overdue, large, back-to-back baby drip-induced 24 hours after waters following 10 days + of latent labour, I went for the epidural at about 5-6cms. I couldn't move around so all my prep work on the activity side was a bit pointless.. not my choice, but the way these things go sometimes.

It's also really difficult to know, when you have all the typical factors indicating post-dates induction after SROM with a malpositioned baby, if any way I "did" birth would make it more/less likely I would have needed an instrumental delivery. My son's head was 97th centile, very large relative to his body and he struggled to rotate. Would that have been different if a hyperstimulating uterus hadn't driven me to the epidural? Who the hell knows? What does it matter anyway? First timers are learning on the job, our bodies react unpredictably.. it is not something you do well/poorly, it just is. It is very difficult to prepare adequately for an experience you have no mental template for when so many factors are unknown. I didn't know I would be overdue or that my waters would break but labour wouldn't progress, I'm sure the OP wasn't counting on liver failure... there is just NO WAY of predicting things, even if you educate yourself about a variety of possibilities.

"Yes but you are missing the point here a bit... none of these things would change the outcome for the majority of experiences I listed and so it is still largely out of a woman's control."

Don't know about the numbers, but the very, very low rate of c/s associated with low risk mums giving birth at home (less than 3% of homebirths for low risk mums end in an emergency c/s I think, compared to 11% for low risk mums giving birth in a CLU) suggests that emergency c/s isn't something which is common for women attempting a normal physiological birth - if they're given optimal conditions for birthing in.

"there is just NO WAY of predicting things"

I don't think anyone is suggesting that there is. But it still makes sense to take a pro-active approach in my book, because for some (many) women it WILL bear results.

Well...

I don't think women should see birth as some kind of competitive activity, or as something to measure themselves against. I don't judge anybody on what kind of birth they've had.

I think every woman who has given birth should be congratulated. It's not a walk in the park, is it? On the other hand, I do find myself giving special backpats to women who have been particularly heroic, whether it be my petite friend who has given birth to three 10 pounders without any pain relief, or my NCT friend who simply kept going through the most horrific labour I have ever heard about (and I won't go into details here). They showed levels of pure guts and courage that warranted mention, I suppose.

Whereas my own labour was kind of bog-standard 24-hours-on-all-fours-in-vain-before-being-rushed-off-for-emergency-section. Both midwives made a real point of saying, "Well done! You did really well!" to me afterwards, and I thought that was very sweet of them but also a bit . Because I just endured, as every other woman does. Which deserves warm appreciation but frankly I didn't show any special reserves of courage. Which some women truly do.

"It's not a walk in the park, is it?"

No! And actually I find myself sniggering when I hear first time mums talking about hoping for an 'easy' birth. Because, let's face it, even an 'easy' birth is usually hideously painful and all consuming at the time.

I find the stories about births in Spiritual Midwifery very interesting for their focus on mind-set in labour. Where fortitude comes into it.

here

Have also spent some time recently thinking about the role of prayer in labour. Have worked at a very ethnically diverse maternity unit in the past. It was very moving watching some of the Muslim parents praying during labour. I remember one couple, every time the mother pushed she would shout out 'Allahu', and the dad would then say ' AKBAR!' (God is Great). Kept it up right up to the birth, at which point the dad rushed out crying with joy into the corridor to hug his father in law, who had come in with them and was waiting. Brings a tear to my eye thinking about that now.

It's a humbling sight to see woman in full labour, in agony, giving it everything she's got.

I am surprised by the pounding the NCT is taking...I did their course and it was all evidence based with pros and cons for EVERYTHING with the probabilities next to the risks...

Also I disagree that telling everyone who did it with no pain relief they did well and then just not commenting on your birth doesnt amount to the same thing as saying your birth wasnt as good. If everyone but you gets a gold star then that is definitely telling you what people thought of your 'performance' as well as everyone elses.

We also played a game at antenatal classes that involved making labour decisions but also rolling a die a lot...it got the point home that while you may make some decisions that influence the outcome there is a great deal you dont get to decide on at all!

I'm not sure whether you have any more children, but birth is such a personal experience and changes from child to child.

Every single pregnancy and birth is completely unique.

Women arrive at pregnancy in different ways - fertility issues, sudden surprises, miscarriages . . .

They then experience pregnancy differently - some have myriad of complications, some don't. Some have extreme sickness, some don't. Then we give birth . . .

You are simply not in a position to know what backstories women carry with them. I am so sorry to hear about your experience but I am more than happy to congratulate any women on the safe arrival of their baby, however it comes and to sympathesize and respect those who feel differently.

"I am surprised by the pounding the NCT is taking"

NCT always gets a pounding on mumsnet in that the poor practice of the minority of practitioners is taken as being representative of the ethos of the organisation as a whole.

I think it's because lots of people have an axe to grind about the push to increase rates of normal birth (which goes waaaay beyond the NCT. It's an underpinning principle in NHS maternity services and the RCM too).

You'd think that as intervention rates rise and rise, even among healthy mothers, and when doctors and midwives are saying 'something needs to change because this is not a good thing for women and babies' there'd be more and more support for strategies to change this, but it seems to be polarising people instead. You either seem to fall into the camp who believes that something can and should be done about it, or you fall into the camp who believes that the way things are is the way things need to be, and that anyone who questions this view is a lentil weaving, yogurt knitting loon.

I would like to comment that being monitored doesn't have to mean lying on your back as I was monitored with fetal monitor and bp cuff for both my babies and stood up for most of the labours....6/10 hours.

I think I got told "well done" because it was flipping hard work doing it my way! No G&A 1st time just G&A 2nd time. That's why it is called labour!

shag ahhh I see.

I think a lot of people get confused about the difference between the 'natural' approach being better/safer in some measurable scientifically verified way and the natural approach being better/safer simply because it is natural.

The NHS arent as big on the second option as people seem to think...in fact they are pretty much entirely on option one....

"I think I got told "well done" because it was flipping hard work doing it my way! No G&A 1st time just G&A 2nd time. That's why it is called labour!"

I think it's hard work for nearly everyone...

The most pertinent comment on this thread is that every experience is different and it's really quite difficult to extrapolate from your own about the experiences of others, even if they seem superficially similar.

I had a very quick, completely unmedicated labour with a small graze. I don't think I did really well - I was just handed a good deck of cards. The women who did really well are those who have 48 hour labours with hideous interventions and massive tears and long recovery times.

So I was told I had to lie down for close to an hour on the blasted monitor...by which time the pain was totally overwhelming...I tried entonox and it made me puke for very little other effect. I had an epidural which worked for an hour and a half before the pain was unbearable again. I had top up after top up each with around and hour of unbearable pain in between. I tried pushing for an hour at one point but that just made the pain worse and return more frequently. I had a spinal block that took around 3 contractions to even begin to show an effect at which point they knocked me out with a GA and I missed the forceps assisted birth of my DD.

All in all I spent around 6 hours in unbearable crying begging screaming pain, it was easily the hardest experience of my life and one that I deserve a MEDAL for getting through without being rude to either my DH or any of the medical staff.

Noone told me well done.

Conversely DD and I have found BFing trivially easy and with only a few bumps and glitches have arrived at 6mo EBF. No end of people congratulating me on that.....I tell them there is nothing to congratulate as it has involved no particular effort or skill or persistence on my part, it has just happened that way.

Why are drug free labours good, necessarily? You wouldn't have dental work without anaesthetic, would you? Men wouldn't have vasectomies without something to numb the pain? There are no medals for "doing well" in childbirth, a healthy baby is the ultimate goal irregardless of how they get here.

Dental work's not a good analogy, because you only have dentistry if there's decay or infection - whereas usually giving birth is something that needs attention and encouragement, but quite a lot of leaving alone if at all possible.

As for drug-free labour, we're bloody lucky to have the choice. Drug-free isn't better, if you want pain relief. It's illogical to say that it is.

Even I can spot that 'attention and encouragement' don't equal 'quite a lot of leaving alone' - forgive me, I haven't had my snifter yet.
I mean attention and encouragement that aren't detrimental to the process (like forcing a woman onto her back to be monitored when she's pretty much fine).