to think there's an expectation that all women want the same experience of birth?

[ScarlettOHaraHamilton]

I'm hoping I can explain this properly.

I was chatting to a friend today, who is very pro home birth, about the news the other day recommending more home births. I said I remembered there being a conversation on MN a few months back about the same topic and there was a general opinion that all women wanted to experience the same sort of birth - as in, an intervention free, probably significantly pain relief free, vaginal birth.

I then said that was quite honestly the last thing I wanted to ever experience. I had 2 days of labour before having an emcs and I hated it; I will fight tooth and nail for an elcs next time. I then said that if I was in a position where I knew that an epidural or spinal wouldn't work and so I had a choice between a vaginal birth with only G&A and pethidine, or an elcs under a general anesthetic, I would chose the later (if there ever was a choice).

My friend was incredibly surprised by this. She thought that everyone wanted to 'experience' birth and that everyone hoped for a vaginal birth. Which got me thinking about other threads I've read on MN and it struck me that's probably the general assumption. And that that expectation might drive maternity planning. Which probably isn't an ideal thing - the ideal thing being to support women to try and have the birth they want, whether they is a home birth, epidural, or elcs.

Does anyone agree?

Yes I've met women who are all for the 'experience' and they are then very surprised that I wasn't having had 3 children and an epidural each time.

I was told numerous times that I wouldn't get an epidural the second and certainly not the third, but as a previous poster said, the midwives quickly agreed and seemed pleased to just get on with it.

I agree.

If given the option, I would have opted for a ELCS but the NICE guidelines came in just after DS was born.

I ended up with a spinal, epidural and the accompanying oxygen mask etc, in theatre with heavy forceps. I would rather that they had not kept going down that route and had opted for a cs rather than forceps. But after a lot of CBT therapy I accept that they were doing what they thought was best for DS at the time. Even if that meant injuring him. And me.

I would willingly walk across hot coals if it meant I didn't have to experience that again. ELCS for me if I can even bring myself to TTC. People keep saying 'oh it will be much better the second time'. Don't care, don't want to know, no desire to even try!

We are all different, therefore it is highly unlikely that we all want the same birth experience. I read the blog of a ,self styled, birth 'expert' and she said that we should all follow our instinct. She seemed to take it for read that her 'instinct' was the correct one. While I agreed about following our instinct, mine was very different from hers! All babies are also different- one size doesn't fit all. For a start I wouldn't want a home birth- very nice for those that do- but not me.

DS was an ELCS as he was beech
For my second I think the midwifes and consultants thought I was a bit strange as I was hoping for either a straight forward home birth or a CS. I had a CS in the end but as it was pretty calm and not an emergency it was fine (my waters broke and labour didn't progress).

I decided not to have an induction as I was too worried about the pain and the risks of intervention. I do question now why I didn't just have an epidural and give it a try. I think a lot was down to nct and prenatal yoga brainwashing that this was a route to be avoided at all. I think the advice you get before birth isn't very balanced. It's probably made worse because the NHS classes are stretched - I was advised not to go if I could afford nct instead.

I'm rambling a bit but I think yanbu but I do think there is a large industry to condition women into thinking it's the only way. I think it's similar to the push to get women to breastfeed. I can understand why both are desirable but it can leave those who can't achieve it feeling like failures.

I don't think it is "intense", star - just different.

That's where the conflict is, I guess, anothernumberone. Public health policy should be for the best way, but are women's opinions more or less important?

I don't know if anyone else on here who has said they would have preferred an elcs would agree with me, but for me during my first pregnancy it was the knowledge that there were these other ways to give birth. 100 years ago you just gave birth, maybe with morphine to help. Nowadays there are safe ways of having pretty much no pain, or not even having a VB. It's like dangling a carrot to someone who doesn't want to embrace the pain

Ikwym
Many mums seem to be all sympathetic when I say I had a ELC
But I don't feel I missed out on anything good.

I do think there is a large industry to condition women into thinking it's the only way. I think it's similar to the push to get women to breastfeed. I can understand why both are desirable but it can leave those who can't achieve it feeling like failures.

Yes, that's better worded than I have been able to put it. It's probably just an unfortunate side-effect of pushing what is medically the best route. Maybe it's just that there isn't a good way of advocating a social/health policy without either worrying people or not supporting everyone. Like with the change to no alcohol during pregnancy - it's quite dogmatic and has put a lot of people's backs up, though it is clearly a very well-intentioned policy.

Hmm, I think hate is an intense emotion, Scarlett. I also think you should've had the choice for an ELCS for your first because your emotional reaction is so intense. You should not have had to go through labour feeling like that. It's so wrong and not woman centred. Birth choice should be woman centred.

I had an ELCS for breech last time and it looks like this pregnancy is going the same way. The midwives were so apologetic, I couldn't give a rat's ass, I'm relieved to avoid the unpredictable bits of a natural birth! I know if it goes well, it's great, but I don't know many people who avoided birth injuries, traumatic interventions and so on. Yes recovering from a c-section is hard, but at least my bits are in one piece and the process of birthing my baby was a calm and lovely one.

Didn't manage to breastfeed either and really beat myself up about that - but now I'm quite happy I bottle fed and plan to do so for the next one, again hugely disappointed midwives.

Also, I don't trust the current NICE release - of course women who complete their labours in a midwife led unit have smooth and easy births. Those who are transferred to a hospital ward mid labour due to complications are taken out of the midwife led statistics

I personally believe that public health policy for both breastfeeding and maternity care should be evidence based. That does not just have to be quantitative considerations women's experiences can feature in this approach too. The problem with focusing on the individual for public health policy is we all have difference by experiences.

On the individual level though I do believe women's choice should be the number 1 thing deciding what happens.

I am probably a bit unusual because I had a section for number 1 and 2 subsequent Vbacs and I ff number 1 and 2 after 2 failed bf attempts and bf number 3 for 2.5 years. I am all about trying again based on the evidence and not personal experience. I never looked at my ff or section as failures on my part. I did my best with the hand I was dealt.

Ha ha I just read my calling my ff as failed bf attempts but I don't really view them as such iyswim.

I preferred a vaginal birth for the sole reason that it's a quicker heal if it goes smoothly. I healed pretty quickly and out shopping a couple days later with minimal problems. Obviously, I couldn't do any strenuous activity right away, but it certainly beats the 3 week healing period that Csecs average out to be.

I remember being quite taken aback at the idea that a vaginal birth with no pain relief was something to aspire to and that women list it as an achievement!

It's very strange. I never really thought about the 'type of birth' I wanted or what I wanted to experience Like choosing a holiday or soap powder.

I thought you just went to hospital, hoped for the best and dealt with whatever shit came your way.

I had an ELCS with DD after a horrendous hyperemesis followed by SPD pregnancy. I was exhausted, and had no belief that birth would be anything other than horrendous given how bad a state I was in and how limited my mobility was. By the time birth was approaching I'd got to an almost phobic state - I could not contemplate a VB.

We haven't had a second yet but are thinking about it, and for me a second ELCS is what I want. It was a smooth, pleasant experience. In fact it was the best bit of my pregnancy! whenever I say to people that I would chose an ELCS next time around (and I would fight tooth and nail for it if necessary, I did the first time round!) I'm treated like I'm missing out and there's something wrong with me.

There's a how level of statistics and outcomes that are probably unmeasurable but have a significant impact on labour outcomes (in my completely non-medical experience, I have to say!)

For example, the increase in interventions following epidurals. I know I and several of my friends had epidurals less because of the pain but because we'd been going for 1-2 days with little progression and were thus exhausted. Which to me raises the question of how much of the subsequent intervention is caused by the epidural itself, or by the fact that the woman who has had the epidural isn't in a good position to labour simply because she is so exhausted. I know I've never pushed, but I can imagine your stamina is different if you've taken 10 hours to get to pushing vs 2 days to get there.

Also, I wonder whether any women who end up with an emcs might have got there because they have a fear of childbirth and so, even if it is subconsciously done, they aren't able to relax into the contractions and so their body is fighting itself? With hindsight, I would probably put myself in that category - at the time I thought I was doing ok but I was probably tensing and fighting the contractions and causing my body to slow down a bit.

As others are saying, there is an unpredictability to VB against more predictability to cs that a minority of women will find more appealing.

Chunderella I do agree there is no optimum way on an individual level but over a population there is. Have we had this discussion before it feels like déjà vu.

I'm treated like I'm missing out

On what? Tearing? Episiotomies?

There is no good part about giving birth, only the baby at the end. The rest just sucks. IMO

In my NCT class, the instructor was always talking about women's 'choices' and that having the birth you want is your right and so on, not to let ourselves be bullied by medical staff etc. the assumption was that our 'choice' would always be for the most natural birth possible with minimal intervention.

When I said to her 'What if my choice is for an ELCS and epidural - do I have the right to that?' knowing of course that ELCS and epidural on demand aren't an option on the NHS. she just looked puzzled and said she had never heard of anyone who would choose that.

Women's birth choices are respected in the NHS as long as they are the cheapest option. If your choice costs more money then it becomes a problem. Fair enough as NHS has to be cost conscious but don't preach lies about women's choices then.

I only cared about my own birth experience but surely there will be a variety of "ideal" births with a general majority or leaning to a certain ideal - but that does not mean that just because you hold a particular "type" of birth experience as your ideal that you feel other's birth experiences or choices were wrong or not to be valued - there are sadly fatalities in every type or birth/ delivery, IMO going in knowing your options, with an open mind, understanding the birth process and what risks/outcomes are associated with each choice - and within that making your birth partner aware of what you want at each stage so you feel supported are important whatever choices - even based upon both your ideal of an experience (whilst understanding. That sometimes your options may become limited in emergency situations in which case you are happy to both come out alive).

So I think it is natural that a majority of women would love a pain free, injury free birth experience - but if course for a good percentage (if not majority) of birth experiences are a variance away from the ideal - it could probably be plotted and would probably follow a regular population type curve. But just because a person does not hold the majority view of what constitutes "an ideal birth" or had an experience far away from their own "ideal" does not mean that those who hold the majority view or typical experience see anything wrong in the choices or devalue the experience of that person - we make our choices for our own reason and in our own circumstance and there will always be typical and non typical - it isn't a case of right or wrong - just different.

Not going to answer for anyone else, but in my mind this is probably a bit like the general hankering to BF - ideally most people would want it (at least first time) but there will be some exceptions. Science has shown BF to have proven benefits to the baby (and mother), and likewise for vaginal birth. Of course, there will always be many cases when the 'nice to have' benefits are outweighed by serious risks to mother and/or baby health that make intervention a necessity.

I was crap at BFing and despite knowing that for the most part, stopping early is not going to harm my children, I still get sad about it. I do hear the same from mums that have had to have Caesarians; not end-of-the-world by any means, just a vague sense of regret.

But like I say, in both cases there will be women that really are not at all bothered and so I would agree that to say 'all' women aspire to these ideals is inaccurate.

Call me a cynic but I reckon the only reason they're saying "home births are great" is to save the NHS money. When I was pregnant I wanted a home birth and was told as it was my first it'd be too risky and had I looked at a Midwife Led Unit instead? (I had a low-risk pregnancy.)

I tried staying at home for as long as I could because I thought all women were meant to 'get on with it' and have the baby 'naturally' - that's generally the attitude I encounter from pro-home birth women and other parents. I guess I also wanted to prove the midwife wrong.

I needed forceps and epidural in the end because my baby was back-to-back. Was I disappointed I didn't homebirth/do it all myself? Yes.
But at the same time I also realised it's not a competition and I have a healthy happy baby who was delivered safely because I agreed to have the epidural to lower both our blood pressures.
I'd love to have a 'natural' homebirth at some point but if it's too risky or it hurts too much damn right i'm asking for an epidural again

MakeMeWarm you are incorrect on the NICE data, they were analysed on an intention to treat basis. Women who started at a midwife led unit and were transferred to hospital were grouped with the women who stayed in the midwife led unit. Women who started in a midwife led unit were less likely to have interventions than women who started in hospital. That is why it is news, the situation you described wouldn't really be news! ;)

Low risk women in general have fewer interventions if they start out in a midwife led unit. On a population/ public health level that is really useful, because if we build more midwife units and more women choose them, we will save money.

However not all individual women value the same things when giving birth. I personally opted against a MLU and chose hospital, even though statistically MLU was the sensible option- I placed a large weight on the unlikely but serious complications that would need immediate obstetric intervention. As they are rare it was not a logical decision really, but it reflected my own fears and priorities. Also my local unit has 1/3 rate of hospital transfer, unacceptable to me as I would hate transfer, but another mum told me that she was delighted with a 2/3 chance of delivering there- same information, completely different reaction.

I worry about the costs too, Lomega. That probably complicates the elcs argument. Though having said that, part of me thinks they are probably right, especially if you've already had one pretty good birth.

Jackie, I had the same experience when I said I had made a decision not to bf. Kind of had a 'this does not compute' reaction But boxed makes a good point that a lot of women end up with just NCT antenatal classes because there are so few available on the NHS, and the NCT has a certain line it follows, which is its right as a charity, but it does mean that a lot of women will end up with antenatal classes that are maybe not exactly what they need.