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?

That's the point though, CTG's aren't reliable! They haven't reduced birth injuries like they were intended, however they have increased c/section rate. And sometimes they are difficult to read, I've seen consultants disagreeing over their interpretation of the monitoring.

I don’t fall into the less advantaged women category (degree and ICU nurse) and I know highly intelligent women in the same position. I think the issue is you have trust in midwives and obstetricians to do their jobs. Sadly this isn’t always the case.

I think negligence can happen to anyone but less educated women aren't able to advocate for themselves. It happened to me but I'm educated, articulate and well read, which saved my life and my babies lives. Had I just blindly followed what the midwives had said we wouldn't have had the outcome we did.

@Dreaming. If thats the case then why are so many negligence case founded on the misinterpretation of CTGs?

The expert obstetrician can see pathological readings when the case is investigated quite clearly, so they can read them and confirm negligence. Yet those same CTG tracings were seen by doctors and midwives during labour and not acted on. It’s not a case of them being unreliable' it’s a case of simple incompetence.

Swedish women (among the safest births in the world) mostly give birth in very high tech hospitals with close monitoring . I think midwifery and nhs care needs a major overhaul I’m afraid. The ‘every baby counts’ campaign is long overdue.

Dreaming if CTGs aren't reliable perhaps people should listen to the mother more. I told them DD wasn't moving but her heartbeat was found, listened to for a short while and I was told she was fine. Hours later I was being rushed down the corridor for a cat 1 EMCS as DD was decelerating. She was discovered to be in severe distress.

I have had one normal (but prem) birth in hospital, two normal home births and one induced birth in hospital.

Without a doubt, the home births were a far better experience. However, hospital saved DD1's life and made sure that DS was evicted before anything bad could happen.

DS' birth (three weeks ago!) was as close to a beautiful birth as an induction could possibly be. Room was dark and silent, midwife was barely noticeable, DP and I were left alone as much as possible and I was able to be upright and mobile all the way through. Even a medicalised, hospital birth can be a good experience, I feel great about DS' birth!

The idea that a CTG is easy to read, on the basis of a little online reading and a few youtube videos is beyond laughable.
There are features of CTG tracings that are continually assessed, which fall into different types of categories that help assess fetal wellbeing. The issue so often is that the features are often not always clearly one or other catergory. CTGs are incredibly complex, and the guidelines to how the are interpreted regularly changed, as does the recommended care pathways.

Also, those people who scrutinise the monitorings following the birth, are doing so a) with the beauty of hindsight, b) with the benefit of copious time to consider the classification, c) whilst not caring for a woman’s who’s wellbeing and care is also at stake. They are simply looking at the raw data in front of them. They’re not trying to interpret the features of something whilst support a mother in pain, in distress, whilst potentially also having other patients to be thinking of etc.

I am not saying that this makes misinterpretation right, but human factors influence care as it unfolds. Those looking at monitorings following an incident have the benefit of not having these added pressures.

Had a private c-section for twins - went just as planned. Well looked after and comfortable and excellent food for me and DH. Didn't want a vaginal birth.

[shocked] I'm never giving birth...

It is ridiculous to say they (expert obstetrician) are interpreting the CTG readings with hindsight. They are interpreting what is in front of them in the same way the practitioners are doing at the time of the birth. True they don’t have the care of the mother at the time of labour but a competent practitioner should need no longer than 4 minutes to read the strip and rule out clear problems. A mother in labour can spare that for the safety of her baby.

I didn’t say they were ‘easy’ just not difficult to understand the basics from online tuition. Someone exposed to them every day plus expert one to one training shouldn’t have any difficulty. I can interpret most ECGs so to me they are not difficult

I suggest every midwife read these case studies and learn from them rather than get defensive when facts are pointed out to them. Also read up on the presentation of a silent placental abruption and be sure to give the correct advice.

www.fieldfisher.com/personalinjury/case-studies/medical-negligence/birth-injury-claim/cerebral-palsy-negligence?page=2

If it can't be interpreted correctly under pressure by that person then perhaps they are in the wrong job

Much though I am on the side of the medicalisaiton of childbirth, hasn't CTG interpretation training been extensively studied and been shown not to have an impact on neonatal or maternal outcomes?

What I found odd during birth (sorry for getting off topic on the CTG stuff) was that my relatively hippy midwife was coaching me to "push into my bum", I thought that was a no-no amongst the "physiological labour" crowd?

In addition to this, perhaps someone knowledgeable can weigh in on my midwife's claim that I will need a home birth for number 2 as my first labour was so quick - it didn't bloody feel very quick! SROMed at 6pm, contractions started at about 12am, full on pain at 2.30am, full dilation at 3.30am, but birth only at 10.30am due to DS having his hand by his face, with ventouse.

I also find it interesting that the positive birth crowd seem to think that lots of women loved labour, and are continually surprised to find that most don't...maybe there is some physiological difference in pain for this small subset of women who enjoy labour, as every single woman I talked to all said it was the single most painful experience of their life..and they had all done the hypnobirthing route! I couldn't believe how painful it was, I wanted an epidural but was told it was too late when I arrived at hospital as I was fully dilated, but after hours of pushing with no progress I was finally allowed one.

By the fact you are calling it a strip shows how little you know about them.
An ECG is completely different tool for assessing wellbeing and is not interpreted in the same way a CTG is.

@Thisonewilldo

I had two elective cesareans. I've never even felt a contraction and, to me, both of my births were perfect and I could not have asked for anything better

This was me...and did not feel as if I was 'missing out' on anything whatsoever! It was a calm environment, lovely staff, music playing in the background. I count myself very lucky.

My babies were luckily born with no complications, back home within 48 hours both times, milk came in around day 3 each time, breastfeeding etc.

@bird are you a midwife or obstetrician? No, so perhaps understanding the fetal physiology and the complexity of what a CTG is showing you is more than just reading some stuff online? Anyone can do pattern recognition, but CTGS are constantly changing, and rely on far more than looking and interpreting. An ECG is a totally different thing, and I wouldn’t insult a nursing colleague by pretending a bit of a read online tells me everything I need to know.

Continuous monitoring is great, if used for the right reasons and women. Otherwise it literally does no good, it doesn’t stop a bad outcome in its tracks.

And also, you don’t think an expert looking at a case where they aren’t in the clinical environment and have the benefit of knowing the outcome and hindsight is going to be thinking and reacting differently? I’m not saying that excuses shit care because it doesn’t but things get misread in the panic of a moment or a history isn’t given in full or suddenly the emergency buzzer goes. I would have suspected you as a nurse would appreciate there is sadly sometimes an element of human factors when this don’t go to plan. Or have you never made a mistake or forgotten something your entire career?

Oh and also just to add this thread has been titled as This VS That - it’s not. Have the birth you want, I hope you feel safe, stop buying into this bullshit that because 2 things are different they have to be in direct competition.

I had one vaginal birth with no pain relief and 2 elective c-sections. Vaginal birth- labour was ok, but I tore badly and had a terrible recovery with all kinds of pain and side effects. I didn't feel even halfway normal for at least a year. Both elective c-sections were magical experiences with quick recoveries- up and about doing normal stuff within a couple of weeks. Just my experience, but totally different from what I had been told re the relative risks/ recovery times of each.

I’m not saying that excuses shit care because it doesn’t but things get misread in the panic of a moment or a history isn’t given in full or suddenly the emergency buzzer goes.

Easy to say when you're not the poor woman left to die in agony isn't it. I find this a really hollow justification.

@Seline Not a justification at all, and I say that as someone who left the profession because of horrendous bullying. Some people shouldn’t be midwives (or doctors/nurses) and sadly are. What I was trying to say was around CTG misinterpretation really and that human factors do come into play, which sounds like I’m making excuses when I genuinely am not, my friend works in risk management for a big Trust and I am horrified at what I hear.

I didn’t say that midwives being busy or having multiple demands was an excuse for women dying, to quote you. And poor care is poor care and I won’t disagree with you there, and so much work needs to be done. So, just to be clear, I’m not saying busyness or multiple demands or personal issues excuse poor care because they don’t. At all.

I think it's important to be prepared for both ends of the spectrum.

Some ladies want everything to be completely natural, but then have a complication (e.g. cord prolapse) that cannot be anticipated and require an emergency C/S.

Some ladies want to have pain medication as soon as possible, or want an elective C/S, but come in already in labour and are too far gone to have any pain management or to prep for a C/S.

I think it's helpful to have some guidelines of what you would like, but not to be married to those guidelines. I do think that interventions that are not medically necessary and are not likely to provide benefit should be avoided.

I’m very sorry about what happened to your daughter. Both I and my DD nearly died when she was born, but survived due to excellent medical care. We were warned it was possible she would have brain damage, despite the care she received (she’s still very young but doing ok).

I also had a home birth with my other child, where I received appropriate attention and the heart rate was occasionally monitored. I don’t think it’s about everyone needing a high tech, highly monitored birth every time. Appropriate risk assessment and attentive care are what’s needed.

One thing that has surprised me on mumsnet is how overwhelmingly positive most people speak of their ELCS, including when comparing it to a vb experience. It does make me wonder about the narrative that CS should always be last resort and are absolutely something you don’t want to have because they’re so horrific compared to any vaginal birth, I certainly used to believe that to a degree but have opened my eyes up since reading on here.

@Jelly fair enough

@Megan2018 Hospitals don't like doing c-sections so, if it's your first, the baby is head down and everything else ok they will induce you and only if the induction isn't going well will they do a C-section.

Inductions vary so you could be lucky like me and a few other women I know and the baby will be delivered quickly, or it could be a long drawn out process.

Just remind them everytimd you go in that you are over 40 and anything else wrong with you.

It does make me wonder about the narrative that CS should always be last resort and are absolutely something you don’t want to have because they’re so horrific compared to any vaginal birth

I don't know anyone who had an elective cesarean and regretted it. The myth that cesareans are always awful is just that!

@AmyDowdensLeftLeftShoe
My blood pressure is rubbish so if that continues GP thinks that I may be offered it anyway. But I will ask at every opportunity (will be consultant led anyway).
Fortunately there are at least a couple in my trust that are easily persuaded I’m told! My GP had an elective as she knew who to ask. I do hope this works.
I am very good at being heard, not afraid to be a massive PITA if required.