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?

I think the worry is that if birth becomes over-medicalised then we end up with a good number of women undergoing unnecessary intervention (and the side effects/risks of such interventions) during birth.

I can totally understand why some women, particularly low-risk women, are keen to avoid intervention or too much of a medicalised process. I’m pretty sure home birth stats for low-risk mothers are very favourable.
I have to deal with the long-term consequences of an emergency forceps delivery with an episiotomy/tear including incontinence in my 20s and constant pain/achiness in the scar area. In my situation it seems it was needed to save my baby (although if I was more informed I believe I would have opted for an emcs instead) but I’d hate to think of more and more births being like mine that really didn’t need to be. The mental and physical trauma still effects me and my daily life years later. Of course this can also happen with intervention-free childbirth but stats are so much higher with instrumental deliveries.

It’s hard, it’s about striking the balance between acknowledging childbirth can be potentially very dangerous without awareness that most women are capable of natural physiological birth (if that’s what they choose)

What would statistics look like if every single woman had an ELCS for every baby? I’m guessing there would be a lower infant mortality rate but higher maternal one?

Tynext a study actually showed elective cesareans had the lowest maternal death rate. I'm guessing because an elective is the only way to definitely avoid an instrumental or emergency cesarean which is often done in a high risk scenario. An elective sort of reduces most risks as you act before anything has a chance to go wrong.

I just don't understand why birth is seen in in a different context to a tooth extraction or broken leg.

I guess it's because a tooth extraction/broken leg is something that's gone wrong and needs fixed so people think of it as medical, whereas birth is a "natural process" IYSWIM

(2 ELCS for me!)

Listen to the medical professionals, get the baby out asap and safely. Different situations require different approaches, be open to whatever is necessary

I didn't do a birth plan and just as well as nothing went as well as it could. Induced labour a few weeks early.

Forceps and all the drugs they were allowed to give me during labour followed by a spinal/epidural finished off with forceps delivery.

I think there's some merit to drugs slowing down the labour/impeding it but at the end of it my baby was still born healthy and feck dealing with that amount of pain.

Statistically I suppose that's right, to me birth is a medical event that needs managing so someone opting for natural (while I support their choice) seems as odd as asking for a tooth extraction with no anaesthesia. It being natural doesn't sway me because many things are natural, natural doesn't equate to safe. However I know many people feel more comfortable when they believe something is natural.

I'm right with you Seline, I think it's just a perspective thing but no thanks to natural and drug free thanks! But I am genuinely happy for any woman who thinks that's the way for them - I just hate the judgement on those of us who don't.

I loved my birth. Natural birth with epidural and other pain relief. The pushing part was my favourite . She was back to back so I would have had an awful time if I had no pain relief.

It’s all a distant memory now and I’m just glad I have a healthy baby.

You need to go into birth with an open mind. I would really not like to have a c section but if it’s needed then you have to make it as positive as possible. The main thing is to feel in control.

I delivered 2 weeks ago.
Planned natural delivery with epidural if needed. Ended up being emergency c section, major haemorrhage and didn't see my baby for 8 hours as rushed to SCBU.
In the future if I decide to have another child I will have a planned c section.
I always said just get him out in the safest way possible and on the day the most invasive way was still the safest way.
We are now home and he's screaming his little lungs away whilst I find a fresh set of match sticks for my eyes. He's a cutie.

birdonawire1
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 agree actually, when I was pregnant there was no free information about what to expect in a hospital in terms of medical care. There should be some kind of guidance for woman to be informed enough that they can be relatively prepared for every eventuality when it comes to labour. Plus more awareness of the mental toll giving birth has.

I don't want to get all spiritual birth but something like counselling during pregnancy could be worth a shot.
Good for the mind and preparation for a likely unpredictable labour. any prenatal or postnatal depressions could be picked up way more easily as well as any other issues that are undercurrent.

Although I previously mentioned my dds birth was totally winged although relatively planned induction and monitoring I was still stressed and vulnerable during my week long stay at hospital. I don't feel they explained how serious or not serious my condition was or had the potential to be and the environment of ever shift switching midwives Even if they are strangers a familiar caregiver everyday is better than a new stranger everyday. It kept me on some kind of backfoot. (don't suppose they can really help that) I had my bags packed everyday after the birth of my daughter as they weren't clear to me that they hadn't finished monitoring me and not for how long they planned too. I was also a bit deluded/desperate to get out of there

P. S baby blues sucks and there's not enough recognition of it.

@Seline that is very interesting.
I wonder whether in the future the ‘maternal request’ c-section will be more the norm and whether it will be a standard option for any pregnant woman to easily choose.

@Seline I did choose a home birth with no pain relief twice. Both times were amazing and I look back on them with really fond memories! I know that I'm lucky, they were what I wanted them to be with only minor annoyances. Annoyances confined to not giving birth in the pool and giving birth to both babies in the exact same spot in the bathroom.

It isn't so strange that women would want this, I'm just lucky to actually get what I want., baby in a comfortable environment and then tucked up into my own bed afterwards.

@Dreaming- often though it's women themselves who don't want an epidural and write this in their birth plan.

Again, if midwives (and the NCT) told the truth about epidurals, perhaps women wouldn’t be so reluctant to use them. Not every pregnant woman will go and research meta evidence and NICE guidelines, and will be able to make an informed choice on her own.

The investigations of the last few years (Furness midwifery report) show that there are turf wars in some hospitals, with midwives willing to sacrifice the lives of mothers and babies rather than let actual doctors in the delivery room.

With my own pregnancies, I was told by the midwives the whole list of “cons” of epidurals- it will slow down my labour (they don’t), it will increase the risk of forceps delivery (they don’t), it will increase the risk of csection (they don’t, they actually decrease it), it’s impossible to have one until you’re 4cm dilated (not true and the exact opposite of NICE guidelines), you shouldn’t have one once you’re ready to push (again not true). This just shows the level of misinformation that I, and I’m sure most women in the country, received form their supposed HCP.

But my favourite was “ok then, do what you want, your baby has no right until they’re born”. This contained the very toxic and alarming insinuation that an epidural will damage the baby, and that if I cared for my baby I would never request one. It is truly devious and cruel, and I’m sure the emotional appeal that it contains works on many women.

That’s the sort of misinformation and judgment women have to fight in order to get pain relief and monitoring during labour.

I've had pretty much every type of birth possible - natural hospital birth, c-sec, home birth, VBAC, water birth, epidural, twins vaginally. Hell I've even given birth in a hut in Africa. I've done it all. And I can honestly say it makes zero difference in the end. The end result is the same. They all have their pro's and con's and they all had aspects that were out of my control.

If you go in expecting an orgasmic birth to dolphin sounds with the midwives standing around fanning you with palm leaves while mother nature herself holds your hand you will be disappointed no matter what. I think it's important to remember that it is first and foremost a medical procedure with the goal of everybody leaving the room safe and healthy. Everything else is just an extra but you need to do what you need to do to reach that main goal. And that means drugging yourself to high heaven or even a c-section then that's what you need to do. It's not a failure, it's just the reality of a medical condition. It effects different people in different ways.

Perinatal negligence costs the NHS over £800 million a year. That is half of all compensation paid by the NHS (£1.7 billion).

Perinatal mental health problems cost the UK £8.1 billion a year.

The stillbirth rate in the UK is amongst the worst in Europe (19th rank).

Fewer than 20% of all births in the UK are “normal” (ie free of intervention).

@Seline - I always ask myself one question with regards to the pushy natural mothers and midwives... WHY the sadistic desire to see women suffer? WHY do they actively want to see women in pain? Stinks of internalised misogyny to me, bigtime.

Coffee it does to me, too. It's like an unwritten internalized idea that women should suffer. Just look at the visceral reactions some people get when they want an elective cesarean. They're told they're "wasting resources", too posh to push, shouldn't have had kids if they weren't prepared to give birth vaginally to name a few.

Yet I've never seen anyone tell a man he should have a vasectomy without anaesthetic, that it's a non essential operation that shouldn't be available on the NHS and if he wants control over his reproductive choices that he should just not have sex. Funny that.

As long as they get out the safest way possible for mum and baby then it doesn't matter. You get people going on about "natural birth" but I didn't think gas and air on hospital getting a cut/tear down there doesnt sound very natural to me! Hahaha the best way is the best way for THAT person x

@Comey
“Again, if midwives (and the NCT) told the truth about epidurals, perhaps women wouldn’t be so reluctant to use them. Not every pregnant woman will go and research meta evidence and NICE guidelines, and will be able to make an informed choice on her own.”

There are many women who will approach labour, having made no attempt what so ever to inform themselves about the care options available to them. It is incredibly difficult to truely have an informed conversation with someone regarding appropriate pain management whilst they’re in the throws of labour. Whilst I do not deny that some care that is provided is not optimal, and there are aspects of practice that needs looking at/changing, we should all take a little self responsibility for informing ourselves of options prior to the birth occurring (I know many do, but equally many do not).
What I find very sad, is that many women will spend hours researching the pushchair, car seat, change bag etc they want, but take no time in informing themselves about what can happen during birth and what care options are available, and thus what choices they can make

I must admit I don't understand why some people don't research it themselves. I spent hours doing that in my pregnancies and have been asked by about six different NICU doctors whether I'm a doctor myself because of the questions I ask.

It is up to healthcare providers to inform women though.

It is part of a HCP role to discuss an ensure informed consent, but sometimes that is easier said than done. Explaining the benefits/risks/side effects of care options can actually be lengthy and can be a challenge to undertake appropriately when you have a women/birth partner who is unwilling to engage in a conversation about it, because they feel they need to have it right now.

From a maternal mental health perspective, the best births are the ones where the mother feels empowered and listened to and begins with an appropriate starting point to her/ baby's needs, and feels informed and consenting as the birth develops. That might be a "natural" birth, a ELCS or a medicalised process like induction.

My second birth was never going to be plan A because it was a VBAC and I was struggling with SPD. However, mentally it was a good birth despite the medium term toll of a 3rd degree tear.
I had a lot of baggage from the first birth which largely stemed from exhaustion, poor pain relief (40 hour back to back labour, big baby with large knobbly head) and feeling completely disconnected to the processes spiraling out of control.

More time to explain waters being broken, pethadine (which I originally didn't want and was too off my face to consent to the second time) or chance for epidural (relief from pain for the first time in 36 hours would have been amazing but I think they were too busy to offer and I was in too much pain to ask), transfer to consultant room and transfer to theatre for EMCS, and baby being taken to NICU would have saved a lot of tears and distress over the following years. The second birth was much better because the midwife engaged with me. I had some support at a 1:1 on labour ward where we came to the plan that I could realistically be active by having a mat and kneeling over a birthing ball and my MW facilitated that. I didn't have to relive my flashbacks of feeling powerless beached up on my back being monitored which is what the consultant would have left me with.

Little things like the MW taking 10 seconds to explain that she is concerned about monitoring the HR and she is about to push the button and it's about to get very busy made a huge difference to my ability to process the birth healthily. That can and should be availiable at every birth regardless of the level of intervention required. That's why rapid births can be traumatic, because events can spiral before they are mentally processed.

I think the blame falls squarely with midwives who fail to provide accurate information during antenatal appointments. There is an active lobbying effort to restrict access to the most effective form of pain relief (ie epidurals). Midwives consistently tell women things that are squarely not true, to scare them off even contemplating asking for it. This is deeply ingrained in the midwifery profession mindset and we see it time and again on these boards, as I have in real life.

I too was often asked if I was a doctor because I dared challenge what was being said to me. But the reality is that for women who are less assertive, less articulate, for whom English is not their first language, or who cannot access information (eg because they lack the abilities or resources to read scientific papers), whatever the midwife says is their only information and they don’t have the means to fight it.

It’s no surprise that it’s the poor (less advantaged) women who suffer the most perinatal negligence.