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?

as it is known that baby missing out on passing through the birth canal increases the risk of many diseases for baby in the future.

Is there any actual evidence for this though, as opposed to general speculation?

Dreaming yes I have.

But I’m sure you are aware that there is a long history of the midwifery council turning a blind eye on poor practice and mistakes, even when those resulted in death.

When I met with the head of midwifery at my local trust to explain my concerns, her answer was that I ‘should really consider a home birth next time’ as I had done so well despite being refused care while in active labour.

Needless to say, this did not restore my trust in the profession.

My second pregnancy was very complex and I spent a lot of time in hospital. I witnessed many women (that I shared a room with) being bullied into not having pain relief as they were being induced, a complete flouting of medical guidelines.

Concerns about medication inhibiting breastfeeding sound overstated to me.

I had a crash Caesarian under GA with DS1 and established bfing with no problems whatsoever. With DS2 I had a ELCS and ditto.

@Comeymemo that is really sad to hear. I find it so hard when people have such rubbish care...I know amazing midwives and find it incredible anyone would be declined pain relief...no wonder you have no trust in the profession

If you get a live baby and a live mother out of the process, the rest of it doesn't matter at all

In my case I had a live baby and I was alive but I was a physical and mental wreak for a year due to the ‘care’ I received

I'm so sorry about your baby, OP. I didn't see that post until just now.

I didn't have a choice but to have a managed birth as had preeclampsia. It was quite intense and I chose to have an epidural so I could rest. Had to have fentanyl as the epidural wasn't strong enough to block the pain. From the moment I had the pain management my birthing experience was amazing.

DS was monitored as soon as I got into delivery - they attached a clip when the trace kept dropping off - and kept a really close eye on him. I wouldn't change a thing 😊

If we have another I will probably end up with preE again and will expect a similar birthing experience!

Most of us would fare better left alone at home a proportion would have seriously awful outcomes. Finding those and keeping them safe without creating an unnecessary difficult time for the others is hard.

I agree with this a lot.

It’s something that I’ve wondered a lot about. I’ve had two MC, one requiring surgical intervention after I waited two months for my body to do what it was supposed to. I guess at that point the risk got too high for medical staff but I think in all likelihood I would still have been fine if left and maybe it would have taken another month or two. Miscarriages presumably happened to pretty much everyone in an era pre contraception where people had a lot more pregnancies. How to tell though if I’d be fine or be one of the women who would have developed potential fatal sepsis? I don’t think there is any way of them telling, so I had an operation that was PROBABLY unnecessary but may, just may, have saved my life.

My successful birth was pretty medicalised in many ways but gas and air only (still pain relief of course). Next time I hope to have as natural as possible but I will take whatever intervention is deemed medically necessary.

Both my babies would be dead if it wasn't for a "medicalised" birth.

They're alive and well.

The only thing that matters is their safe arrival (and the mother's safety of course).

As long as the baby arrives with mother and child unscathed, then it doesn’t matter to me how others choose to birth.
Personally, I’m very much in the all natural camp. In a healthy, uncomplicated pregnancy, I don’t see birth as a big medical event - just a normal bodily function.
I’ve experienced both a very medicalised hospital birth and a totally natural home birth, and would choose the home birth again a million times over. Unless some sort of major emergency occurs (placental abruption, prolapsed cord etc) happens, I personally would avoid the hospital like the plague. It would have to be a life or death situation to get me in there to give birth.

What is "medicalised" though? Mine went waters broke (natural), no contractions so had a pessary (medicalised), contractions started without a drip and I managed with tens (natural I guess?), pushed out baby quickly due to him being in distress with gas and air for last 3 contractions (medicalised) then no pain relief at all for pushing. It isn't one or the other.

Most of us would fare better left alone at home. Better, really? I would like to see evidence of that.

Regarding what has been said about analgesia upthread: Scientific evidence suggests epidurals actually decrease the risk of c sections.

Epidurals also do not slow down labour, or lead to more intervention, nor do they increase the risk of needing to receive oxytocin to augment labour.

There are no reported long time effects on babies or mothers, or on establishing breastfeeding or bonding. (See source below)

It is very dispiriting to see midwives on this thread who continue to peddle myths about epidurals. It shows that despite the NMC having been forced to abandon its so-called ‘normal birth’ agenda last year, the mindsets have not changed. It is highly likely that women are still being denied epidural analgesia and fed lies or misinformation by their midwives to deter them from requesting an epidural.

Source: From the latest World Health Organization recommendations (Feb 2018):
“Maternal outcomes

Pain relief: It is uncertain whether epidural analgesia compared with no analgesia reduces pain scores, pain intensity or the need for additional analgesia during labour because the certainty of the evidence for all of these outcomes is very low.

Mode of birth: Moderate-certainty evidence suggests that epidural analgesia probably leads to fewer women undergoing caesarean birth compared with no analgesia (5 trials, 578 women, RR 0.46, 95% CI 0.23–0.90). It is uncertain whether epidural has an effect on instrumental births because the certainty of this evidence is very low.

Duration of labour: It is not clear whether epidural analgesia makes any difference to the length of the first or second stages of labour compared with placebo, as the certainty of the evidence is very low.

Augmentation of labour: Low-certainty evidence suggests that epidural analgesia may make little or no difference to whether or not women receive oxytocin for labour augmentation (3 trials, 415 women, RR 0.89, 95% CI 0.63–1.24).

Birth experience: Low-certainty evidence from a single trial suggests that epidural may increase the proportion of women reporting they were satisfied or very satisfied with pain relief in labour (70 women, RR 1.32, 95% CI 1.05–1.65). Compared with no analgesia, it is uncertain whether epidural affects women’s perceived feelings of poor control in childbirth because the certainty of this evidence is very low.

Side-effects: Review evidence on the relative effect of epidural compared with placebo or no intervention on hypotension, vomiting, fever, drowsiness or urinary retention is very uncertain.

Fetal and neonatal outcomes

Perinatal hypoxia-ischaemia: It is uncertain whether epidural analgesia has an effect on the number of babies born with Apgar scores of less than 7 at 5 minutes because the certainty of this evidence is very low.

Long-term outcomes: These were not reported in the included studies. Mother–baby interaction and breastfeeding: These were not reported in any of the included trials.”

*RCM, not NMC

Can we stop the 'as long as everyone is alive it's ok' bollocks?

It shouldn't take women or babies dying to get improvements in care, and given that there were two reports 10 years apart that said half of baby deaths in the UK are preventable, babies dying due to poor care doesn't necessarily lead to any improvements.

There is no other area of medicine where poor care is consistently covered up by 'at least you're alive', but hey, it's only women and babies at risk in childbirth so it doesn't matter.

Thanks to all those who commented on DD. She’s not a small baby any longer but has significant needs, and I have since had a DD2 by ECS which was a lovely outcome after a pg filled with fear after DD1.

When I refer to medicalised I mean constant monitoring, measurement of pelvis, monitoring placental function and so many other things not done here routinely. I mean monitoring through labour, correct interpretation of CTGs, getting obstetricians involved more quickly instead of hoping ‘normal birth’ with happen.

I’m now in a community no one want to be in, but I’ve heard some horrendous stories of lack of care, monitoring and not intervening at a time which would save the baby.

It seems (my own experience) that many midwives have a laid back attitude and expect childbirth to be this ‘natural’ process, and in most cases, however poor the care is, the mother and baby are unharmed. This is because statistically most babies are fine so the attitude seems very non proactive and they just let nature takes its course.

The degree of PTSD and depression following a poor birth experience is massive and many posts confirm it takes a long time to recover. So doesn’t this mean women go into pg and childbirth with an unrealistic idea of what they will encounter?

Yes, it’s a fine line between scaring people and giving a realistic picture but I’m sure it can be done. Rubbish about breathing through contractions (not allowed to call it pain) and a pain free birth just sets mothers up to fail.

If I had been given a list of worryingly symptoms I would have questioned the advice I was given and insisted I be examined, but such a list in my mat notes wasn’t there, presumably because it would have been considered too worrying for a pg woman.

Imo midwife are complacent and have the attitude that nature will take over and interventions are to be avoided, when the opposite view would be safer.... rule out the worst case scenario and then look for simpler explanations.

When I have time I will be joining organisations to campaign for safer births.

The recently retired head of the organisation that manages the payment for birth negligence was asked what could be done to halt the spiralling costs of negligence claims. His reply was to stop making the same mistakes. I think closer monitoring and a change in midwifery practice and attitude would go a long way towards this.

Can we stop the 'as long as everyone is alive it's ok' bollocks?

Sindragosan I say this, usually in response to concern or pity or censure for not having had a "natural" birth.

if I hadn't had a c-section several weeks before my due date, DS would have died in utero. I was severely ill after he was born, and at one point was told they thought I'd had a stroke. It was the highly medicalised nature of the whole process that allowed us both to survive it all.

I got denounced at my NCT class by the midwife, in front of the rest of the class, for having a c-section planned. There's a lot of shaming of women who have very medicalised pregnancies, and we are expected to feel like failures for not having natural births. This is where I am coming from when I say that er no, not a failure, not a shame - DS and I both came out of it alive, and that's what I celebrate.

This doesn't mean I feel everything is fine - my postnatal experience in hospital was frankly horrendous, and in my view needs a total shakedown - but that doesn't take away from the fact that me and DS surviving was indeed the most important thing. Might be bollocks to you, but it is very far from bollocks to me.

but that doesn't take away from the fact that me and DS surviving was indeed the most important thing. Might be bollocks to you, but it is very far from bollocks to me.

I think it's one thing to say it about your own experiences, it's when other people say it about someone else's I find it problematic. The benefit of time lets me say it now about dc1 but someone saying it to me when he was 20 hours led to me attempting suicide.

Dc1 and I survived our ordeal but when he was in NICU, I tried to kill myself mid psychotic break. That break was caused by the events from my waters breaking to them eventually agreeing with me that he was stuck and delivering him by emergency section 81 hours later having tried everything else including forceps to get him out of me and managing to trigger a previous trauma in the process. I was told it was fine, we were both okay but we weren't. He was in an incubator and I was dehydrated, exhausted and broken inside but because physically I seemed fine, no one was worried. I thought my baby was dead and that they were trying to make me see a doll and that throwaway comment was just enough to shove me over the edge.

Imo midwife are complacent and have the attitude that nature will take over and interventions are to be avoided

I think that can certainly be true of some midwives. The one I saw on the MLU at the start of dc1's labour didn't give me all the information because they didn't want to scare me. I found out at the end that ds's head wasn't on the cervix properly and that no one thought I would get fully dilated (I did but he was stuck and didn't descend). I feel I should have been told that instead of this annoying cheerleading rubbish I got for most of it.

Giving birth is unpredictable I have 3 dc all with a few complications along the way but in the end they arrived safely my advice would be to see how things go don't worry about different scenarios do what feels best for you and don't have any set in stone plans in case it doesn't go to plan then you don't get to upset

You can have a very natural birth in hospital. But immediate access to the best medical intervention is vital. It doesn’t matter if you only are 20 min from hospital.you still have to call an ambulance have it arrive get checked out by paramedics get transferred to the ambulance then your 20 min can begin. Out of my Nct group of 7 2 mums and babies survived from immediate and unexpected issues because the baby was out in 5 min from medical emergency with immediate access to peditricians and specialised medical care for mum.2 other babies survived thanks to immediate intervention by paediatricians.

Unfortunately I know one mum who died during child birth but thanks to being in a medical environment the baby was saved.

Childbirth is still dangerous. Have every medical intervention which might prove necessary to hand imo/e

They say knowledge is power. Surely we should be respected enough to be given all the information available rather than what a health care professional thinks we can manage?

I would agree there is no perfect birth, but you can get pretty close. I think the perfect birth is dependent on your expectations and attitude, not whether it is medicalised or natural.

My almost perfect birth was at home with dc1, dc2 almost as good except didn't call midwife in time and DH delivered him. Another friend's perfect birth was a planned c section, she is just as happy as I am with mine.

Medicalised, please. I've had one planned cesarean and one emergency life saving one, and the planned one was fantastic.

Op I too was left with ptsd from my sons birth (as well as secondary infertility). Luckily me son is ok, he has a few issues that I think might have resulted from his entry into the world. But I wish people would stop with the opinion of so long as everyone is alive it’s all that matters. Actually although the health and safety of my child is the most important thing to me, it does not obliterate the severe trauma I went through.

It seems (my own experience) that many midwives have a laid back attitude and expect childbirth to be this ‘natural’ process, and in most cases, however poor the care is, the mother and baby are unharmed. This is because statistically most babies are fine so the attitude seems very non proactive and they just let nature takes its course.

Imo midwife are complacent and have the attitude that nature will take over and interventions are to be avoided

Yes, I agree. They nearly killed me and DD and DD suffered tremendously due to their negligence. We still don't know the long term outcomes.

In an ideal world, enough resource would be dedicated to make the divide between hippy type births and medicalised ones anathema.

Some birthing centres have beanbags, some have all the hi-tech machines - why not have both at all of them? Why not have a relaxed, homelike environment but with all the consultants and anaesthetists etc on hand in case they're needed?

Aiming for natural birth is rational because oxytocin helps the process. Stress makes the process harder. HCP should have enough time and training to value the softer elements of birth as well, like helping women relax and get through without interventions where they wish to.