To ask for opinions on ‘medicalised’vs ‘natural’ birth?

[birdonawire1]

Read so many stories of mismanaged births, CTG not read correctly, babies not monitored and damaged and then read romanticised stories all about the perfect ‘natural’ birth.

It seems very polarised so what do people think really?

@comeymemo sorry I meant in the instances where there is legal action it usually involves doctors failing to warn women of the less probable risks because they don’t want the women to choose interventions but I definitely agree with you about what you say re midwives. They were so pushy with me both times to have a homebirth that I wonder how many women do it simply because they don’t feel confident saying otherwise.

tynext absolutely agree. Also we could do with removing the "failure" element. Dc1 was a "failed vaginal birth, failed forceps, failure to descend" and whilst rationally I know they were talking mechanics, all I heard was "failure, failure, failure" and it didn't help my mental health at all.

My df died of cancer whilst I was six months pregnant with dc2 and there was a marked difference between his consultant interactions and mine. He was offered choices and suggestions as to what would be the best choice in their opinion but the language was vastly different. It was open, centred around him. Whereas I got a lot of "we will do x y and z to you" and surprised looks when I said "no" or asked why. He was treated like an adult, I was treated like a small disobedient child with my personal favourite, lots of talking to my husband instead of me. I had an consultant anesthetist review because I wanted a general anesthetic if I was having another c-section. The consultant and dh spent a good 25 minutes discussing how stupid/selfish and irresponsible women pursuing vbacs were whilst I looked out of the window. I don't think you'd find that in any other field of medicine.

@Comeymemo

Midwives have a vested interest to keep doctors out of the delivery room do tell, what is this vested interest? Do you think midwives want women to have bad outcomes? These are real people, human beings, people with emotions too.

they are also severely under resourced absolutely 100% true. But through no fault of their own.

so they are drilled to encourage —force— women not to have analgesia that would require continuous monitoring.
Do you realise that continues monitoring is often easier to provide care for than intermittent auscultation?

*They achieve that goal by spreading misinformation, for instance on the great dangers ,,gg

and unavailability, of epidurals, and sadly often waiting too long to intervene.*
You realise that many hospitals have one anaesthetist for obs and gynae, and if they’re busy with another patient then you either have to wait (which yes, sometimes can thus end up being too late) or locate an anaesthetist from the main part of the hospital, which is easier said than done. Neither is the fault of the midwives. A fault of the system no doubt, but not of the midwife.

@Babycatcher, I’m not saying that midwives want bad outcomes for their patients. But the pro-‘normal birth ‘, pro-HB, anti-intervention agenda does not achieve the best outcomes for women and children. You just have to look at the costs and stillbirth rates I posted above to see that the current system could perform much, much better and is falling behind a lot of EU countries.

One of my concerns is that midwives do not seem to have up to date information/training to allow women to give informed consent on various aspects of their birth plan. And it is definitely the case that many midwives, including at the senior levels, think that women should just suffer in childbirth and accept it. They promote the idea that this is good for the mother, good for the baby, helps BFing, and is some sort of badge of honour to be proud of.

Of course I understand that anaesthetists are not always available. But midwives play a crucial role in respecting women’s wishes. For instance, with my first delivery the midwife’s starting position is that she woukd not call the anae unless I was 4cm dilated. She examined me, and said I was at 3 (she said; how could I check that?). I was then left to labour on my own, without any more checks or any pain relief. After 5 hours, she examined me and said I was fully dilated. Too late for an epi, she said, it’s time to push! I tried to argue that I wanted the epidural before pushing, but she was having none of it. She bypassed my request because of her own beliefs. That is not right.

There is no reason why no attempt could be made to meet my wishes, other than the obstructionist mindset of the midwife. She made sure I was robbed of the window to get an epidural.

Obviously I don’t know he full ins and outs of your situation, and thus cannot comment entirely fairly, but It likely wasn’t her so much that was the problem, but the general practice within the trust.
The ‘magic 4cm’ is a massive issue within the provision of labour care, it’s not midwife dependant but the way that the provision of care (Usually trust guidelines/or routine practice) is set up. I know of many hospitals where the expectation is to be in ‘established’ (4cm) labour before an epidural is sited. That’s not down to the decision of a midwife as an individual.

Midwives are meant to be stewards of the NHS budget for maternal care. It is up to them to ensure trusts operate in accordance with evidence based science and in accordance with NICE guidelines.

The NICE guidelines specifically state that epidurals should be available in the latent stage if the patient requests it.

The midwife saying I was at 3 is just her word that I can’t challenge.

By not examining me again until I was FD, when it was obvious I was in active labour and she knew I wanted an epidural, she did not meet her duty of care.

Such is definitely the theory, but doesn’t always pan out so simply.

For example, I know in one trust the guideline states GBS is an exclusion criteria for the use of the birth pool. Even though the research indicates the opposite, this was brought to senior attention 4 years ago, and has been revisited in that time also in an attempt to change it. The guideline remains the same.
Obviously this is not good practice, and I don’t say it to defend midwifery care in general, but that on an individual basis, it is not always down to the fault of the midwife.

And I don’t say that to defend all the actions of the midwife that cared for you, I’m not blind to the act that bad care does happen, just that not all decision/actions are based on personal decision/opinions but that many are restricted/dictated by the protocols/guidelines that professionals practice within.

I've had to argue with anaesthetists to give women epidurals despite them being fully dilated, often I'm trying my best to get that woman the pain relief they want but the anaesthetists drag their heels. Also, you don't need to have continuous monitoring in my trust with an epidural, only the first 30 mins and actually a woman with an epidural and a ctg is a lot easier to look after than someone moving around or in the pool. I have zero interest in keeping a Dr out of my room just purely for a normal birth. My registration means alot to me and I don't know anyone who would risk their registration, do harm to mum and baby purely for a normal birth, just makes no sense! However I would speak up against obstetric staff if I felt they were intervening purely to get something done and not with woman's best interests.

I went into labour naturally, and managed a lot of stage 1 fine with a tens, hot shower on my back, and walking.

But once I went into a delivery room, it got a lot more medicalized and my voice was lost. I was on the conveyor belt. There was a timeline. Here, use the gas and air. Monitoring mandatory. On my back mandatory. Injection for delivery of placenta mandatory. Reassurance to the FTM going through the conveyor belt - completely optional (therefore didn't happen) so stress levels increased and relaxation levels decreased (I had been doing fine on focusing on relaxing everything to allow cervix to relax and stretch - but once I was jolted out of my own pace, there was no catching up or listening to me at all).

DD arrived safely. Cons arrived shortly after and stitched me back up with no pain relief.

Decision there and then was, having given in to DH on hospital birth under cons for #1, if there was EVER a #2, it was going to be home birth by preference, or at the very least, the community midwives team with no cons involvement unless necessary.

Apologies if it’s already been shared but I think this is a fascinating and insightful article on this subject:

www.theguardian.com/commentisfree/2015/mar/05/natural-childbirth-report-midwife-musketeers-morcambe-bay

My registration means alot to me and I don't know anyone who would risk their registration, do harm to mum and baby purely for a normal birth, just makes no sense!

I totally agree that it makes no sense. But just because you wouldn’t do it, doesn’t mean it hasn’t happened. That’s pretty much exactly what happened at Furness Hospital, leading to the deaths of 11 babies and a mother.

I don’t understand why, because as you say it’s irrational. But reading the reports it sounds like a combination of a cultish group mentality amongst that particular team of midwives, perhaps a feeling that handing over to a doctor would be a ‘failure’ and an acceptance that it’s a situation the midwife doesn’t have the expertise to deal with, and of course a decent amount of internalised misogyny.

I fully accept that you and most midwives wouldn’t do it. But it DOES happen. It happened at Furness on a large scale for many years. Worse still, we only know about the babies and mother that died as a result of that behaviour - we don’t know how many more were injured or otherwise harmed unnecessarily.

Keep mum and baby safe...that’s all matters to me. I was so close to death after childbirth (enormous hemmorhage) that I kind of wince when someone complains about their ‘imperfect’ birth. If you and baby are well, then it’s a great outcome!

I had people try to convince me to give birth naturally and reconsider my request for a cesarean. I was 26 weeks and a twin was in distress although no one knew.

Unfortunately it turned into an emergency and a cesarean became my only option but I'm just illustrating that sometimes even in bizarre scenarios like that some push for a natural birth.

I was induced with a back to back baby and denied any kind of pain relief apart from two co-codemol which did nothing (they wouldn’t even give me gas and air) The midwife didn’t believe I wasn’t in labour (and didn’t bother to carry out any checks at all to confirm if I was or wasn’t) and she thought I was ‘doing really well with my breathing’ so I didn’t need anything. This was despite me telling the midwife I was in so much pain I felt like I was dying.

I would have never had agreed to be induced if I had known that I would have been denied pain relief

In no other area of medicine would this happen

It seems like a lottery, when I was in labour (first one) my midwifes were so lovely, they kept offering me pain relief, but I kept denying it (only because I didn’t want anyone near me/talking to me) I kept saying ‘in a minute’ but I really wanted to say ‘fuck off and leave me alone’.
The second time I had gas and air and pethadine? (Sp?) one lovely midwife and one dickhead who managed to ruined my WHOLE experience in an hour (when my mw was on her ‘lunchbreak’) by fucking everything up, not checking on me because ‘I don’t need to be checked for another hour’.
My mw was very surprised when she came back from her break, immediately checked me and discovered baby was crowning.