... about "natural birth" and "your body knows what to do"?

[ParsnipsAreTheDevil]

I keep seeing the whole "don't worry your body knows what to do" thing thrown at pregnant women and it was a massive part of the hypnobirthing course I did before
DS was born (he's 2 now). When it came to it it turned out my body didn't have a bloody clue what to do. In labour for 3 days, wasn't dilating, emergency c section and we both got sepsis. Felt like a massive failure afterwards thanks to the massive emphasis on natural birth and my body categorically NOT knowing what to do?

Aibu that what we should be saying to pregnant women is to keep an open mind about birth? I've met a few women since who had very similar experiences to me. Breathe the fecking baby out my arse.

YANBU! 2 midwife led VBAC births for me, but my body definitely had no clue at all. Almost 29 hours for DD and for DS 21 hours and my waters had to be broken. I screamed through my last labour, much more useful than breathing through it 😂

@minifingerz - it worked for me.

“Agree. I’ll think people who say things like this are ignoring the shockingly high proportion of women who used to die in childbirth before modern medical interventions were possible. It’s a painful and potentially dangerous process“

In 1970 the caesarean rate was 4%.

The maternal death rate was lower than 1 in 1000.

Maternal deaths plummeted in the 1940’s with the invention of antibiotics, way before caesareans became common.

In 1970 the caesarean rate was 4%.

The maternal death rate was lower than 1 in 1000.

Why is lower cesarean rates necessarily the goal, surely the goal is happy healthy mum and baby?

No, do plan.

I think it’s a good idea to choose the sort of care that will give you the best chance of the birth you want.

You want a drug free, natural birth? Maybe best not to choose to give birth in a frenetically busy, highly medicalised setting without enough midwives and where straightforward births aren’t as rare as fuck.

Maybe choose a setting where they have a track record of high rates of normal birth. Choose caseloading, choose a doula, choose a waterbirth, choose a homebirth, choose a birthcentre birth. Your birth may still not be straightforward but it’s a damn sight more likely to be than if you choose a medicalised setting.

YANBU. I also refuse to use he term 'natural birth'. You can have a vaginal birth, a c-section, no dugs or lots of them, whatever, but calling anything 'natural' makes everything else feel like it's a failure when it NOT.

Low c rate shouldnt be the metric used for success. It tells you nothing about maternal outcome.

A ‘successful’ VB could then be classed as a fourth degree tear and serious maternal injury.

Success should be measured as positive low-impact outcomes for mother and baby. Recent Swedish work does this, and looks at thirty year outcomes for things like:

Adhesions
Prolapse issues/surgery
Urinary incontinence
Faecal incontinence
Sphincter damage
Hernias.

(Incidentally the worst outcomes are for mothers who have had a mix of VB and CS.)

To me a successful birth is one that leaves baby and mother in he best physical and mental shape possible. That can be VB, or CS or anything in between, but what matters is the health AND well-being of mother and baby. We can’t have a CS being counted as a strike and a disastrous VB that leaves lasting damage counted as a success.

I think we need:

Better data collection and reporting
Better education for mums to be
A default low-medicalised approach for low risk births BUT with maternal choice, and any woman who wishes to have a CS should have one after understanding risks and benefits.

“Why is lower cesarean rates necessarily the goal, surely the goal is happy healthy mum and baby?“

Err, who has said that a low caesarean rate is the goal?

Who?

Are you trying to construct a straw man argument where you’re going to suggest that those who are making the case that interventions are overused in the U.K. hospital system at the moment, value a low caesarean rate over the health of women and babies?

Course you are 😒

The point I’m making is that women and babies weren’t dying in huge numbers when we had a very low caesarean rate in the UK.

They’re not dying in huge numbers in Finland today despite their c/s rate being half that of ours.

Caesareans are not trivial - if it’s not the mums choice and if a different pattern of maternity care would allow more women to have a healthy birth without an unplanned caesarean then why wouldn’t we want that for women?

I don't like the term vaginal birth. My birth was natural. No intervention medically. Not a big deal to anyone but me. Therefore I call it a natural child birth. Had I have been induced or had a c section I'd have called it as so. No shame!

“A default low-medicalised approach for low risk births“

Well you can kiss that idea goodbye. We have a big problem with midwife recruitment and retention. Birth centres are actually being closed rather than opened, and there may be plans afoot to start offering more inductions to low risk women before 41 weeks.

Induction rate is now over 30%.

Induction rate will likely go up - there’s recent work done showing that in women over 35 you can reduce the stillbirth rate by roughly 1 in every 500 births by not letting women go too far over.

So they will be weighing that against the increased risks of induction itself. Which in itself is problematic- I know for example that the dates I have are physically impossible so I’d be induced a week early. Of course you can refuse, but again we are back to the consent issue.

UK maternity provision is VASTLY underfunded.

To me, the default should be the low medicalised route but with maternal choice - I feel quite strongly that no one should be forced into a birth route that they don’t want and a CS should be available on request. Just as I feel that low risk unit birth should be available on request. Of course there will always be situations where what you want isn't possible due to valid medical reasons, but I’m talking about ‘regular’ cases.

My body, or rather my brain, knew it wanted all the epidural in the world. My mouth got it what it needed.

The point I’m making is that women and babies weren’t dying in huge numbers when we had a very low caesarean rate in the UK.

What were the rates of instrumental and injury though?

@Marriedwithchildren5 if there's s no shame then why call it something it's not?

Having a baby cut out your stomach or pulled out with metal instruments ta isn't natural, so it's not a natural vaginal birth, there's nothing wrong with them but let's not lie to yourself now

“I feel quite strongly that no one should be forced into a birth route that they don’t want and a CS should be available on request“

I agree with you on that.

furandchandeliers

I literally think you miss read my post. I'd call a natural birth, natural. A c section, a c section etc. My point was I dislike the term vaginal birth. Not quite sure what your point is!?

“What were the rates of instrumental and injury though?“

They’ve been consistent at about 10 - 12% for many years now.

The huge increase in c/s rates has had no impact on assisted delivery rates.

The huge increase in c/s rates has had no impact on assisted delivery rates.

That’s interesting, fair enough on that point. I had thought maybe the cesareans avoided the need for instrumental.

“We can’t have a CS being counted as a strike and a disastrous VB that leaves lasting damage counted as a success.”

None of the birth workers I know would assess birth outcomes in that way. People aren’t stupid.

I mean for official stats mini - I don’t think individual HCPs are thinking that, what I mean is when the ‘lowered c section rate’ is touted as the be all and end all or the high c rate is forced down - I have had friends denied c sections by consultants who openly admitted they were under pressure to drop the rates, and who later had serious issues with VB.

The needs of the individual woman should always be higher priority than a political need to reduce a figure.

There’s also the point that the best way to reduce unwanted c sections is to have a more relaxed and less medicalised environment, NOT to deny maternal choice

It’s so frustrating that instead of denying those who want a elcs there isn’t more investment in those aspects of care which reduce birth complications - caseloading, 1 to 1 care, properly staffed birth centres etc.

But you can see from this thread that women are incredibly fatalistic about birth - there doesn’t seem to be much understanding of how the things I mention above can improve hard clinical outcomes. Sometimes people need to believe that the birth they had was the only birth they could have had.

I wonder if the rate of instrumental delivery stayed the same, despite increased number of C sections, because of mothers generally getting older and heavier. So if the C section rate had stayed as low as 4%, we would have seen the instrumental birth rate rocket. Pure speculation, of course.

I agree with Bowl and Mini about choice for all women, regardless of whether they prefer a low-tech birthing centre approach, or a C-section, or anything inbetween. What needs to be done away with is the ridiculous level of politicisation around birth. Birth choices should be made by the mother. Nobody should be denied choice because of somebody else's ideology.

None of the hypnobirthing or positive mindset, or different decisions about where to give birth would have helped me because my waters didn't break and I had to have them broken, and then there was meconium in the waters. So if I'd been at home or at an MLU I'd have had to be transferred to hospital.

I'd started off in the birthing pool and felt like I was doing really well and all my breathing techniques were helping. After they broke my waters I wasn't allowed to get back in the pool and I also had to have the heart rate monitor attached to the baby's head. I then caved and went for the epidural because the baby was back to back with the head in the wrong position, which was causing me to bear down when I was still only 4cm dilated and had I continued in the same vain I'd have injured myself and the baby.

The staff said due to the baby's position I'd have never got him out on my own. So I do sort of feel that the forceps delivery I ended up with was kind of inevitable, although I wasn't to know that at the start.

t’s so frustrating that instead of denying those who want a elcs there isn’t more investment in those aspects of care which reduce birth complications - caseloading, 1 to 1 care, properly staffed birth centres etc.

Yeah. That’s pretty much my take on it.

Women’s health care generally is second rate. If you look at issues like thyroid problems that affect mainly women, the care standards are dire. Endometriosis takes I think 8 years on average to get a diagnosis, never mind treatment. DH spent most of this pregnancy (during whichbive had HG, SPD and gallbladder issues from constant puking) saying ‘men would never put up with this’ ‘

I think pre and postnatal care is the same. It’s only women, so it’s not important.

The whole process should be evidence based, woman centred and respectful to women’s needs and wishes. Whether you want a Home birth or a CS I suppose is part of the same equation and it’s fairly clear that women’s opinions don’t matter.

“Nobody should be denied choice because of somebody else's ideology”

I’m not sure that women are denied access to choices on the basis of an ideology, unless that ideology is ‘doctor knows best’.

Women are ‘guided’ towards particular choices on the basis of clinical evidence.

I was told I couldn’t have a homebirth on the basis that I had GD and that this made a homebirth unacceptably risky. I looked at the evidence and felt the risks of a homebirth were tolerable. My body. My baby. My comfort zones around risk taking behaviours. I ended up employing an independent midwife and having a homebirth without NHS input.

The rationale for denying low risk women a c/s is because at a population level the evidence suggests that VB is safer for this cohort. (I understand the debate about whether it is safer or not, but that’s the current rationale that’s given). But our preferences for birth are guided than vastly more than just a narrow assessment of clinical outcomes, particularly when overall birth is very safe now, regardless of whether you have a VB or ECS.