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?

[HollyJollyXmas]

With my first pregnancy, I was quite level headed, really - with hindsight!
I just sort of knew that whatever happened, it was slightly out of my hands and that I could only prepare, be well informed and be vocal about which choices I would make ideally, where choices were available - but I couldnt just snap my fingers and say 'I want a lovely, quick water birth' and have it. I have no memory of ever wanting birth to be 'good' and although I understood the cascade of intervention etc, I could never REALLY understand the whole 'pain meds free' approach to birth. It seemed martyr-ish to me. Yes, yes, women have been giving birth 'naturally' for years etc... they were also dying in childbirth in droves!

I remember being in an active birthing/yoga class at about 7 months pregnant and thinking the teacher and the majority of other participants were bonkers. It was as if they believed that by willing a lovely, straightforward, empowering birth, they could have it. There was also a huge emphasis on getting an 'experience' out of birth, which I found very odd. I was always a bit of a cynical witch, though .

I ended up with an epic labour ending in emergency section, anyway, so ho hum .

Had vague ideas about a VBAC with my second pregnancy, but illness put that idea to bed and I had an elective section. That was interesting, as it certainly was an amazingly lovely experience and I was left thinking 'well, I suppose it IS really nice for birth to be lovely and serene and empowering'.

I have very mixed feelings towards the whole thing, now, I guess. I have to bite my tongue when friends are having their first baby and are 'planning' their intervention-free, natural, amazing birth 'experience'.

[Girlwhowearsglasses]

I also think that, yes we should have the choice, but not just because we've done our research and marched in with it. I am one of those people who researches and reads up on absolutely everything - but it would be nice I do hope not unrealistic to think that should I not be inclined to scare myself with the possibilities of, for instance, shoulder dystocia, that someone who did know would be able to sit down with me and give me a properly balanced talk through the options (note, options) for care.

IME this is what is unusual (witness doctor that bandied about terms like 'breaking the baby's shoulder to get him out' in this instance - TOTALLY unheard of in the UK)

[NickiFury]

I wanted c-sections from the start. When I agreed to a vaginal birth my only concern was would I be allowed an epidural when I wanted one as I knew sometimes it was a lottery to get one. As it turned out ds was stuck and a 48 hour labour followed by emergency CS. With dd I didn't even let the midwife finish her sentence when she started talking about VBAC. I was booked straight in for a CS. As it turned dd same two weeks early so I had to endure five hours of labour (no progression AGAIN!) before they could fit me into theatre.

I'm ok about my births now but I wish I could have just requested c-sections and not have to go through what we did.

[BeyondRepair]

I fully agree with you, to me an ideal birth is one where I feel as safe and as controlled as possible, without the millions of variables that can go wrong in labour. which absolutely no one can predict.

Placenta pravia/pre elampsia/shoulder dislocation/breech/back to back/tearing/forceps/ polyps/ heomotopia/ and so on.

I want a straight forward ELC surrounded by skilled professionals, who can attend to me, the second there might be a problem, I want the baby lifted out in a calm and controlled way, and I am in a position to be able to look at and receive my baby, having slept well the night before....

As oppose to many sleepless nights with contractions, then the journey of labour, with all its un certaintly and extreme pain....soreness and so on.

That is far from my ideal birth.

ELC is seen as the extreme end of the intervention spectrum, I disagree...in terms of physical fall out and damage to the body, I think far worse things can happen to you, in natural labour.

[BeyondRepair]

That was interesting, as it certainly was an amazingly lovely experience and I was left thinking 'well, I suppose it IS really nice for birth to be lovely and serene and empowering'

I did loads of research all over before my ELC and found, bar the odd horror story, most women felt like this ^ including me.

This is what they are afraid of...and why I think c sections are shrouded with un truths and myserty etc.

They are scared too many women will want one.


However, I would draw attention to Radio 4 earlier this year, the largest cost, the biggest cost to maternity services, is, compensation from natural births going wrong. Often when a baby is starved of oxygen, your looking at life time care awards.

[SnoogyWoo]

Well my mum was in labour with me for 36 hours until the nurse noticed they hadn't taken her tights off!

[Nervo]

I had 2 ELCSs due to a spinal condition. I have never felt like I was missing out and no one has ever suggested it.

I had total peace of mind throughout my pregnancies.

I didn't go to a single antenatal class.

[VeryPunny]

We need to acknowledge that luck plays a huge part in your birth experiences. I swallowed th hypnobirthing Kool-aid twice, and had the most excruciating labours which were transformed into enjoyable experiences by an epidural. Of course, according to the hypnobirthing crowd, I should have been in comfort just by breathing right, and then fore the fact that it was agonising was somehow my fault. DD was breech and turned up by EMCS, DS was a forceps VBAC. Even second time round, I thought birth couldn't possibly be as brutal again.

I wish the money they had spent on the all singing all dancing MLU for low risk women at our hospital had been spent on staff instead - with the wonderful midwives who were with me the whole way for DS's birth I could have given birth in a broom cupboard. IMO it's are about face to give all the posh rooms and resources to low risk women who will probably spend less than 24hrs in and have their partners available around the clock. Watching two midwives and two doctors try and manoeuvre themselves around the small obstetric delivery unit room, complete with instrument table and heated cot thing was comical!

[VeryPunny]

MrsDeVere - partners can stay round the clock at our MLU, which only has private rooms.

[Mehitabel6]

It is indeed luck! I had 3 very easy births- nothing I did, just luck.
No birth plan- just went with the flow.
Even so I wouldn't want a home birth, but fully understand those who do.

[BertieBotts]

Honestly I would imagine that most if not all women want birth to be:

• As safe as possible
  
• As little pain as possible
  
• As least traumatic as possible
  

Perhaps with the last two swapped around. But certainly I'd imagine these three wishes are higher priority than any kind of "experience" and I think it's missing the whole point (not to mention patronising) to say that women are prioritising "experience" over the other things.

The thing is that those things can be achieved in different ways. Pain and trauma can be reduced by pain relief or even surgery, so it's extremely important that this is available. However for most straightforward births it is much safer to give birth vaginally, with as few interventions as possible. That's where the "experience" stuff comes in - I honestly don't think that (most) women are entering the birth experience expecting it to be all fluffy and nice. But all of the things that people often scoff at as being "experience" - water birth, calming music, home birth, special clothes/people/fragrances etc etc, - I don't think that women tend to choose these the way they choose a colour scheme for the nursery. They're generally intended as being used as a way to reduce pain, reduce trauma, reduce the need for interventions which can be risky, painful and traumatic. Absolutely, the evidence shows this to be the case.

Sure, there are women who would rather choose an epidural or a c-section, and those are equally valid choices, and might well be an excellent tool to cut out pain and trauma, and of course in a lot of cases this IS the safest option. But with low risk pregnancies, a lot of the safety and trauma avoidance is about keeping women calm, in control, capable. Don't dismiss those kinds of things as "experience", because if you do you're not looking at the full picture.

[maddening]

Of course for your first birth you have an ideal in mind - same as if you book a holiday - you don't book a hotel which is undergoing refreshment, has shit in the swimming pool, a grubby room and inedible breakfasts which give the family a tummy bug and lost luggage/cancelled flights but sometimes that is what you get and it is ok to be pissed off with it

[RedToothBrush]

I agree and I disagree.

I disagree with criticism on this thread about NICE's latest recommendation regarding home births. NICE made this off the back of some pretty decent research and felt it was about backing choice for homebirths, since one of the biggest hurdles for women getting one, is hospitals are saying its too expensive to provide the service when the figures actually say exactly the opposite.

NICE three years ago argued the case for ELCS stating that was cost effective and cost should not be used as a reason to deny a woman one. Despite the bare bones cost being more than a VB. (They argued that the cost was even smaller when factoring long term downstream costs). They stated how important that choice was for women's mental health.

NICE also state in their guidance about VBAC very clearly and categorically that women's preferences should be listened to.

So that's THREE places where the choice of women is not only recognised but recognised as important to the decision making process. Its very clear that not all women want the same thing and they are aware of it.

On the other hand policy makers and individual Trusts are woefully dismissive of this. NICE are ignored regularly. Hospitals are rated in part on their CS rate and funded accordingly, with CS always viewed as bad rather than a neutral thing. CS are only bad when they are unwanted and unnecessary. Not because they are inherently bad things. Yet hospitals will boast about how good their low CS rates are as a badge of honour. Trusts are refusing to do both ELCS AND homebirth because they are too expensive when this is not true AND it discounts what's in the best interests of individual women.

I also think there is a chronic inability of many in healthcare to be able to read and understand statistics. A lot of policy is driven by fallacy, poor understanding and ideological beliefs which are completely at odds with the data available.

So I think there is a curious promotion of women's choices and a deliberate and wilful disregard for the individual needs of women going on at the same time. Sadly the battle between the two is currently being won politicians and managers who hold the puppet strings of those practising on the front line rather than those who have researched and recommended certain practices.

[anothernumberone]

Redtoothbrush that is an extremely well written post. I would love if we had an organisation like NICE here is Ireland instead of an establishment that quotes out of date studies telling us we are the safest place in the world to give birth, puts one of a handful of home birth midwives out of business on literally a whim over night, offers nothing but consultant led care for 99% of women and sneers at women who suggest they might like something else. I think that women should have choices in childbirth that are evidence based and I think NICE are best placed to do this independent research. Many studies incorporate qualitative data addressing women's views and incorporating them into recommendations. I think these recommendations are what are best placed to shape public policy and advise on outcomes for populations. I will admit I am stone jealous of the maternity system in the UK which of course is not near perfect but from where I am sitting it is a damn sight more perfect than the one offered here.