To have hated ‘This is going to hurt’ by Adam Kay?

[SweetMelodies]

Just that really. So many recommendations to read it from others, it seems to have so much praise and is a number 1 seller.

I like to think I have a good sense of humour and sometimes a pretty dark one at that but I just found the book absolutely dripping in misogyny. Sure it IS well-written and he is obviously a very talented writer and some bits were indeed funny... but a lot of it really turned my stomach, the language, the way he speaks about women, his really narrow-minded attitude towards birth that isn’t evidence-based at all, just based the very limited picture of birth he has. He clearly puts the women in a category of ‘other’ and ‘less than’.

I did feel terrible for him having experienced the dreadful situation at the end and it did highlight how overworked drs can be... but at the same time I think the language and attitudes displayed in it really summarised the paternal and disrespectful attitudes in the maternity system that lead to so many women traumatised by childbirth.

Despite this I appear to be completely alone in this way of thinking, did anyone else not get a great feel from this (or parts of this) book?

I'm with him on the birth plan front. I made a birth plan..no painkillers, hot tub, doula , blah blah blah!
Oh how i laugh 11 years on with a lovely dd delivered by c section. I was brainwashed by the nct.

Also, of course the mother's wishes aren't "equal" to those of the med team - they are more important!

Her wishes may be as important, her opinion will be in no way as knowledgeable as the medics who specialise in that area, though.

In terms of cancer treatment, then obviously a person can choose to prioritise quality of life over quantity. That is something the medics work with the patient to help them decide etc. Both routes - to treat or not - are equally viable and only affect one person.

Birthing babies is very different. If a baby js stuck and its heart rate is plummeting, than a woman who refuses a c section isnt just choosing to look at things a different way. Both routes - to have a section or not, aren't viable. One will lead to the death of the baby and possibly mother. One won't. In that scenario, anyone who is adamant that they stick to a birth plan is, quite simply, an idiot.

Do you know how many of your birthing mums go on to experience severe MH issues or commit suicide? Or even just how many have serious loss of sexual function or bad prolapses afterwards?

The point is, whilst those things are never desired, the woman is actually alive still to experience them.

You are right about birth not being a medical thing. It isn't - right up until the point that it is! Which is when things start going wrong. To keep going on about a birth plan at that point, is lunacy. In smooth births, then obviously a birth plan can be followed. In other situations it can't.

To care more about the possible outcomes re a woman's mental health or a prolapse in the future, comes way down the line after the reality of keeping that woman and her baby alive, now.

Yes, it does come across as black and white to those of us who have worked on the front line of the NHS. We have to constantly make decisions based on the risks in front of us. And they can change in a heartbeat. The greatest priority is keeping people alive. And as healthy as possible. Not being afraid to intervene due to possible MH issues down the line. To be able to do that, you have to be able to see the overall situation st all times. No-one wants a woman to suffer further down the line. Not at all. But to decide not to push a certain intervention which you believe would be best for mother and child's safety, because of a POSSIBLE MH issue later on, would make the person absolutely rubbish at risk assessment and being able to prioritise.

Joanna you know, on second thoughts, my post attacked you and that wasn't fair. I am sorry about that

Yes you did but apology accepted.

I am sorry to hear about what you went through. I too went through a horrendous labour and birth experience.

I know for sure, though, that both my DD and I would have been dead without the medical interventions I had. I didnt want them, not at all. But they were necessary to avoid loss of life.

Things like avoiding VE when there is a history of abuse is fair enough. Until it comes to the point where the safety of the mum and baby is compromised. What is more helpful then? Two people alive, who sadly may need MH support due to PTSD. Or both mum and baby being dead so the PTSD becomes irrelevant. Those are the stark choices that sometimes have to be made.

In a straightforward birth, there is no reason why a birth plan cant be followed. It is when things start going wrong, and the safest thing to do goes against the birth plan, and the woman STILL objects - that is when it is very frustrating.

@Joanna

I think it must be accepted though that sometimes pregnant women will go against medical advice with certain things (eg decline an induction that the consultant wants her to have) The only way to prevent that would be advocate for law changes that pregnant women have different human rights/don’t need to provide consent because they are also a container for another life? Until then it stands that they can decline whatever treatment they like.

Of course most women won’t want to stick to a rigid birth plan when an absolute emergency arises. That’s the point. It’s about being educated on what can actually happen/go wrong so a woman can have a say in her treatment and what might happen to her body. Eg does she want high rotational forceps or a CS?

And it’s not just total emergency situations being spoken about- the attitude that the HCPs opinion is more important than the woman’s touches upon all aspects of pregnancy and labour care. The woman will take the advice but she absolutely must be the key decision maker.

I might have got more out of the book if he had made me want to take up cudgels about how the NHS is being starved of funds.

That's precisely what I took from it.

@JohnnyMcGrathSaysFuckOff I hope you sued the hospital's arse off for that. There is a big difference between a woman refusing a necessary intervention because it "isn't in the birth plan" (which is what some of us here are grumbling about), and then refusing to investigate a woman's concerns which, if she is right, would be dangerous to ignore.

The second should never ever be done by medics and I am sorry it was done to you. The former, well, it is disheartening when people impede their own and their child's care and well-being.

Sue the backside off the hospital!

Everything that @JohnnyMcGrathSaysFuckOff said.

I haven't read the book so can't comment. But will say that my birth plan was very important to me - as part of the 1% of women who had polyhidramnios and was at risk of cord prolapse I actually bothered to educate and inform myself of the risks involved and state my preferences beyond "a healthy baby safely delivered". I got tested for gestational diabetes after 36 weeks when the results are useless - so effectively had a useless medical test performed on me for no reason - contrary to medical law and ethics. The birth plan is not a "nice idea" - it is as a PP said a written expression of informed consent and frankly it's not too much expect to have things such as "minimum amount of internal examinations", "no student midwives" and "doctors and midwives to introduce themselves by name" respected. I didn't want a stranger in a shirt and tie walking into my room and sticking his hand up me without even bothering to say who he was. Don't think that's really that fluffy tbh.

Yes, it does come across as black and white to those of us who have worked on the front line of the NHS. We have to constantly make decisions based on the risks in front of us. And they can change in a heartbeat. The greatest priority is keeping people alive.

As someone who has done endless Delphi's on patient-centered outcomes, they show time and again that people do not find this acceptable. It simply isn't enough to turn around to people who have suffered major trauma or life-limiting side-effects from interventions and say 'well, you didn't die, did you?'.

There are outcomes that people rank as 'worse than death'. Perhaps not so much obstetrics, but they do exist.

Things like avoiding VE when there is a history of abuse is fair enough.

So surely that’s a good enough reason to support why birth plans are a good idea?
The traumatised sexual abuse survivor could easily turn up to hospital without having gone through any of her options, no plan, has just been told to put herself in their hands and go with whatever needs doing. Then of course she is simply told ‘Hop on the bed, I need to do a VE’ for a routine VE.’ and doesn’t know why/how/alternatives or have the confidence to question it.

However if she’s sat down with her midwife in pregnancy, learnt about VEs and when/why they may be needed, when it can be ok to decline them, the pros/cons then put that down on paper so staff are aware and she doesn’t need to explain her past. She goes into hospital less likely to come out traumatised.

I might have got more out of the book if he had made me want to take up cudgels about how the NHS is being starved of funds.

That's precisely what I took from it.

And it's one of the main things he wants to get across! How the first poster can have missed this so completely baffles me.

Asking for educated and informed choices about birth and labour to be respected - is a million miles from refusing any and all life saving medical interventions (although women can do that legally, provided they have capacity. In those circumstances it's wiser to examine why a woman would choose to refuse something which could potentially save her life and that of her child and explore any previous traumatic births rather than mocking and criticising her).

Sorry...that sent before it was meant to because my husband kicked me in the head (he is asleep, it was an innocent act).

But I was going to say that...a birth plan can give insight, even in an emergency, as to what might be an important outcome for the patient (beyond not dying). And I think that's really important.

@SweetMelodies Of course a woman must always be free to ignore medical advice. Otherwise we start down a slippery slope to Gilead.

There is nothing wrong at all with a woman knowing what is going to happen to her, and discussing it thoroughly. It is only when a woman discards what NEEDS to happen, in favour of what she would PREFER to happen, that it becomes frustrating.

People may say they would have asked for a c section rather than a high forceps birth, but if that had been the safest thing for YOU at the time, you would have been offered it. Every single situation is different. Every baby, every mother, every underlying medical condition, how well the baby is doing or are they in distress etc. None of that will be the same between two women. Those HCPs may have preferred a c section, but it totally depends on the exact situation as to whether using the high forceps delivery was the safest route to take in your individual circumstance.

And that is something that, unless a person is trained in that area, and has seen numerous scenarios, they are unlikely to know.

Drs aren't infallible. But they don't make recommendations for interventions for shits and giggles, either.

I am out as this is going round in circles. Noone has said that all birth plans are a bad idea. Just that some women become invested in them to the point of detriment to their own and their child's lives. The book showed that. HCPs on here have given examples of that. At THAT point, women who stick with them despite there being extremely good reasons not to, are doing their unborn child a disservice. HCPs don't always have the time for nicely explained rationales when the shit is hitting the fan. You can guarantee that they are doing their best to save lives though.

But with high rotational forceps vs CS there was definitely a choice between the two because a CS was to be performed if the forceps didn’t work.

My understanding afterwards from a debrief was that both have their own set of different risks and a CS was a viable option instead of the forceps. The medical team decided to do high forceps first but it wasn’t necessary any safer or better for me- just a different set of risks. Maybe their preferences when faced with two equal options was to attempt baby out vaginally first as per guidelines. Anyway, looking at the risks made me realise that it really would differ from woman to woman what someone would prefer- eg some would opt for a section to avoid the incontinence risks of high forceps, some would prefer forceps because they planned on having lots of children in the future- very personal things that really come down to involving women’s input. Obviously in emergency situations it can be hard but women should be encouraged to learn about these situations in pregnancy.

I found the book funny and thought it gave an intestine insight into the pressure on doctors which I had not fully appreciated. How've it also made me very angry in parts as it reflected the medical gaslighting that many women (and men sometimes too) experience when they seek help fro the medical profession.

There was lots of talk about the "worried well" and the example of the woman with the horrific pelvic pain left me fuming.

Too many doctors are arrogant, dismissive and condescending. Too many ignore women's pain and make assumptions that medical problems are psychological. If the doctors think as described in the book, it's not surprising that this is women's experience of healthcare.

"Intestine insight" made me chuckle! This tupo is appropruate!

Typo

I thought it sucked, too. He came across as startlingly immature and with a low EQ for his age (at the time, that is). Got about halfway through. Just my opinion, but meh.

I’ve read it and enjoyed it. I didn’t think it was “dripping in misogyny”.

There’s not a lot of time in emergency obstetrics. Nuanced discussions about why interventions need to occur and may differ can take some minutes and those minutes can make a huge difference to a fetus that is oxygen deprived.

Surely the accusations of misogyny should be directed towards those who underfund maternity services?

So, more clinic staff, more time for women to discuss expectations and potential outcomes antenatally, proper continuity of care with midwives. In some situations the ability to more closely monitor the labour can give early warning signs that things are not progressing well, but again, this needs staff and funding. Not blaming the person at the pointy end who’s called in to get a fetus that’s in deep shit born safely.

“He came across as startlingly immature and with a low EQ for his age”
He wouldn’t disagree. One of the points of the book.

People seem to be criticising this book for not being the diary of 35 year old who went into medicine after several jobs in caring professions and 10 years of therapy working in a well managed well resources health service.

@SweetMelodies But he frequently highly praised Nurses in that book. Several times he stated how much he admired Nurses and that in many situations, they were more capable than him of carrying out tasks.

I highly recommend 'Trust me I'm a (Junior) Doctor' by Max Pemberton. Absolutely fantastic book. I'd be utterly staggered if you found any misogyny in his book. Utterly hilarious and heartwarming

I am so glad you posted this thread OP as I thought the same. I actually got a refund from a amazon as I couldn’t finish the book due to the way he was describing his female patients.

I know a midwife who worked with him and they found what he said demoralising. In person they didn’t like his character and attitude.