Having watched the programme, I'm extremely frustrated.
Whilst I found it interesting, I also found it extremely annoying too. The problem was that it set all the women up to appear selfish in their own ways for doing something that didn't fit in with mainstream thinking and at times deliberately sought to make them look bonkers. It was the framing of this which I found bad. And all the examples pandered to existing stereotypes rather than scratching below the surface and questioning much about why they had abandoned the mainstream thinking.
The programme only really touched on the psychologically of birth briefly and when it did, it appeared to be either a passing comment or another way of making the woman look bad.
Firstly, the freebirther
One thing I want to say about her, is this - its brilliant that she engaged with the NHS and the midwife informed her in a sensitive and non-judgmental way about her choice and the fact she was able to change her mind at anytime.
One of the biggest risks about freebirthers is their complete lack of engagement with ante-natal services. This means any potential problems are much more likely to go unnoticed and this is one of the areas where the biggest risk lie. In this case, there wasn't much about what the freebirther would have done had something been picked up during the course of this - the focus was purely on the birth itself. We are left to assume that she had a low risk, uneventful pregnancy in both cases.
She was also clearly, whilst very singleminded in her approach, not stupid. She knew what her rights were, what the legalities were, had obviously investigated alternatives (she talked about independent midwives and pointed out that they had given her incorrect information). She also knew a fair amount about the psychologically of birth.
Whilst I disagree with her approach and her attitude of 'millions of women have given birth', I think its also wrong to compare her situation to those women in Africa who give birth unassisted too. Firstly, she has received ante-natal care, secondly her understanding of hygiene/disease is likely to be better by virtue of her education and lastly she does has an attitude of no fear to birth and because she has a choice you are not comparing like for like (You don't eliminate the element of fear from birth from women giving birth in other cultures). And yes there is always an ambulance... So whilst her risks are much higher than the average woman in the UK, they are reduced compared to other scenarios.
Little time was given to why she dismissed the idea of a home birth too. She clearly talked to independent midwives. Why? Was it the NHS protocols that bother her, and then upon approaching independent midwives and being given information about her rights that was incorrect, she dismissed them as a possibility? Was it because she didn't find someone she felt she could trust and accommodate her wishes even with a homebirth? The reason I pose the question, is because a friend attempted a home birth, but one of the attending midwives wasn't on the same page and as soon as she started to make progress the midwife would clockwatch and it would all slow down again. She'd not felt pressured with another midwife; it was just this one particular one.
Then the ELCS lady
Of course they HAD to pick, a woman who was exceptionally well off, and well frankly was a bit of a twit and had a husband who was frankly a bit of an arse going private. They didn't pick a woman, who decided to go down the same route on the NHS or was practically bankrupting herself to go down the private road. The photo shoot at the end really did pander to the 'too posh to push' thing as did all the business of flying to Miami ten days after the baby was born making the husband look like a wanker with no concept of major surgery or how his wife might actually feel. (And neglecting to ask any question of whether airlines might object quite apart from the passport issue). Same old shit peddling the same old myths.
I'm grateful that at least the consultant in question did state that most women requesting an ELCS did so with a massive amount of baggage and anxiety which did include IVF adding to ordinary childbirth fears.
It annoyed me because NICE do say that maternal request ELCS do have a place and that reasons behind them should be explored at length. Just because the woman paid for hers, and bypassed this doesn't mean there aren't issues there. And it does sound like she possibly did fit that bill with anxiety above normal.
Not only that, far from being 'irresponsible' in the same way as freebirthing or going against medical advice to induce labour or have a high risk homebirth, NICE says that whilst carrying some risk ELCS for 'non-medical' reasons are safe and may prevent psychological damage in certain cases. But by putting them into the same framework as the other birth showed, it did rather suggest differently.
Indeed when I had my ELCS which was termed as medical request as they have no category for mental health reasons, one of the reasons it was granted was because they wanted to engage with women as in the past refusing ELCS has lead to some women freebirthing. Basically accommodating and listening to women, no matter 'how out there' their choices were, was essential and was more important than following the system and normal practices.
Personally, I do feel it made the women 'the bad guys' rather than looking at what services and pressures women face in childbirth and how the NHS work with women and how they might be failing those women, who for whatever reason, fall outside normal expectations and thinking and are not catered for. Again there was little discussion of why a high risk woman might go against medical advice in the case of one of the other two women. (I could mention the definition of 'risk' and 'safe' in relation to birth at hospital. and home here. The place of birth study which focused on low risk women is an interesting example as it showed risk to women increased in obstetric settings)
So for me the programme missed the most important issue of all, and failed to really address the link between the mind and body in childbirth and how there might be cases where rational and the irrational might be disconnected because of the emotional nature of childbirth.
I dunno. I'm yet to see anything on TV that really addresses this angle without vilifying women in one way or another, whether consciously or unconsciously and breaking through the myth of 'irresponsibility' and differing concepts of risk and risk avoidance. I'd really like to see something address the politics and ideology of birth a bit more and see how it stands up to the science and whether there can be multiple approaches that fit different groups of women rather than a programme that just ends up focussing on the mechanics and not really challenging our preconceptions.