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 think the thing with birth plans is that they are a nice idea, but incorrectly make women feel that they have an "equal" voice in their care.

With all the will in the world, a women having a baby will never have the knowledge and experience of the medics involved. As an ex HCP, we sometimes just "know" things are going a bit wrong, or won't be possible, due to experience and instinct. That is something the woman can never have unless she is a medic in that area.

There are times to state one's views, and times to listen to the advice of those who have been through extensive training and have enormous experience.

I think that some women get pissed off that their views aren't seen as having equal validity to the medics. But we don't argue with mechanics about our cars, simply because we once read a Hayes manual.

That frustration about birth plans, I feel did come over quite well in Adam Kay's book. There is a point where it becomes a choice between do you want to "feel" an equal partner in your care, or have a safe and healthy mum and baby. If the latter, then some women need to stop banging on about their birth plan as if it is something they can simply wish the baby out with.

But Doctors are generally more intelligent than the general public. And we all have 'can you believe how stupid this patient was' stories, it's part of the gallows humour that gets your through.

Adam Kay only treated women (Obs and gynae), so all his 'can you believe how stupid this patient was' stories are going to be about women.

People from all walks of life get pregnant, some are bound to be idiotic or mad. It makes for good stories!

Personally I think birth plans are ridiculous. It's a bit like having a checklist of things you'd like in a child - all well and good hoping for it, but the child has their own ideas! Birth is dangerous, since we have 'over medicalised' it death and serious injury has plummeted. People make birth plans because they think it's a magical experience that they can control, when the 'natural' life expectancy fro women before modern medicine was around 35.

IMO the 'anti-doctor, anti-midwife' stuff that gets bandied around on here is just another extension of the anti-expert, Brexity, Trumpy populist bullshit we are all living through.

I didn’t like it, and I usually love this kind of book.

Babdoc put it so well:

I didn’t have a problem with the black humour - we all made jokes (never in front of patients) to relieve tension, but I never had that undercurrent of contempt for patients that he seems to show in the book. I always saw them as fellow human beings who were in pain and distressed, and tried to treat them with compassion.

I found his tone arrogant and sneering. ‘Undertone of contempt’ expresses it perfectly. I didn’t like his attitude. He also had an inflated sense of his own importance and, I think, considered himself very clever and witty. He isn’t.

@JoannaCuppa but having a birth plan doesn’t mean women aren’t happy to listen to the views of medical staff? Every woman is different and all will have different preferences about which routes they will go down in birth. Hospitals are different to and also have different guidelines with what they will advise- one very good reason to become educated on birth.

Also women have to legally consent to procedures. Eg if a woman declines an induction then she can’t be forced to do it, it’s her body and her choice.

Saying that ‘women are not equal’ when it comes to making decisions about their body suggests women should all their human rights and autonomy at the hospital door and basically be open to medical staff doing as they please and taking ownership of their body?

I understand some of the language and terms used were borderline to some people

However I can totally understand him being sceptical of home births etc, people are saying well he only sees the ones that have gone wrong not the 95pc that go fine. He is human! If he has seen some awful consequences of home births that would have been avoided in a hospital, even if he knows this is a small percentage, of course that's going to stick in his mind more than the rational side of his brain that says most of the time it goes well. I think that's completely normal

"Saying that ‘women are not equal’ when it comes to making decisions about their body suggests women should all their human rights and autonomy at the hospital door and basically be open to medical staff doing as they please and taking ownership of their body?"

No, I am saying nothing as extreme as that. I am saying that women don't have equal knowledge or experience in that area of medicine, unless they work in it themselves. Reading a few books and going to NCT classes is in no way comparable.

Sure, have preferences and consent should always be obtained, but that doesn't mean the birthing lady suddenly becomes as experienced as the medics.

A patient has to give consent for heart surgery too. It would be seen as fairly bonkers for the patient to argue with the cardiologist about the best approach for the cardiologist to take.

Yet in childbirth, there is this strange assumption that we have to understand and agree to everything, which isn't there in other areas of medicine. We trust the medical professionals to get us through whatever procedure it is.

Hence it does drive me mad when a birth plan needs to be deviated from, and the woman is up in arms about it. A healthy baby and mum is the desired outcome for all concerned. That may involve induction, forceps or whatever, which the mum isn't keen on. Personally, I am less keen on a dead baby or mother.

Interventions aren't suggested for a laugh - only if they are needed. It baffles me that this one area of medicine is viewed with such suspicion, and as if the medical advice is something 'optional to bear in mind's, when it isn't in any other area of medicine.

AK describes an escalation of situations that led to him taking too many risks & losing empathy. The situation when he deliberately destroyed the woman's tattoo b/c of her racism was a good example. This happened not because she was a woman, but because he was losing his resilience & moral compass.

I don't hate him for that. I admire him for knowing he couldn't stay in the profession because of a giant grueling process that was overwhelming him.

@SweetMelodies but having a birth plan doesn’t mean women aren’t happy to listen to the views of medical staff?

But sometimes it does. I’ve met women who have written things such as “under no circumstances do I want a forceps delivery” or women who decline caesareans. I’ve sat and looked at fetal heart monitors that are appalling and I’ve felt terrified and yet these women decline interventions because their birth plans state they want a waterbirth. I got the impression that these were the birth plans he disapproved of. No one begrudges someone who writes ‘I want delayed cord clamping, my husband to cut the cord and I’d prefer not to have an epidural’.

Personally I enjoyed the book. Perhaps because a lot of the terminology is ingrained in medical culture a lot, so I didn’t have an issue with him saying he was going to consent someone etc

@joannacuppa - exactly.

Anyone who's worked as a doctor knows what a ball ache it is doing interventions and procedures No way would you suggest it if you didn't think it was needed.Who wants to be doing a forceps delivery or epidural when they could be having a cup of tea and checking their emails?!

The whole 'a woman's body knows what it's doing' thing is ridiculous. In some cases it does, in others it doesn't. Sometimes it grows babies too big that can;t get out, holds onto it's placenta and haemorrhages blood, gets infected. Doctors actually know what they are talking about because of years of study and experience, someone who's watched OBEM and been told by her friend to have a home birth is not an equal medical opinion.

That's not to say it's only women who are unreasonable, the same applies to men, but they don't come into contact with services as much as they don't bear children.

but having a birth plan doesn’t mean women aren’t happy to listen to the views of medical staff?

But medical staff aren't going to suggest forceps for a laugh, only if they think you need it.
So what's the point of a birth plan if you are happy to see how it goes and listen to the advice of the professionals? It's just as easy to say 'I'd like a water birth if possible' than having it written and bloody laminated

I'm a nurse and loved it! So did most of my colleagues as we all passed one copy around the ward, reading it and passing it on.
I'm glad Bodies has been mentioned too, I recently watched this on the recommendation of work friends and absolutely loved it, as did my non-medical DH.

Exactly- sometimes it does, to use a ‘laminated/whale music/smelling salts/nothing to do with intervention’ to represent all birth plans isn’t really accurate.

I certainly respected the drs and HCPs massively and was of course aware they were the ones with the knowledge and experience to help me through pregnancy/birth. However it was still important to me to have agency over my own body and not just be totally unquestioning. I remember switching hospital for care during my 2nd pregnancy and noticed there was almost a week difference between when each hospital offered induction for overdue women, that made me question whether or not to take up the offer or wait the additional days like the other hospital. I felt safe and happy in the hands of experts and still felt it was important to remember my body belongs to me, I have options and choices and should exercise rights.

I also had a high rotational forceps delivery with my first (a CS would have been performed if it had failed) and I’ve had a couple HCPs I’ve met in everyday life admit they would have declined and opted for the CS instead... that really made me think about times when there are options and choices and how we should be more educated to know what preferences we have. Certain things have such different sets of risks that it will really depend on the woman which she would prefer.

I loved the book

Find it very funny at times and very sad at times

Didn’t come across as a misogynist to me

I think many people would be horrified to hear how health professionals or mental health professionals chat - there is often a lot of dark humour it helps when dealing with such serious issues

I took from the book that he was just never suited to being a doctor. He lacked empathy, hadn’t wanted to be a doctor and sort of fell into it. I think this is really key. I think to be a good doctor you really should care.

He cared he did a good job, cared his mums and babies lived, that’s about it. He clearly wasn’t interested in the birthing ‘experience’ of a mother and whilst clearly the most important issue is that mother and baby leave hospital alive and well, he didn’t have any awareness of how a birth experience can have a lasting effect and even impact a mothers MH.

That said I don’t think this necessarily stemmed from being a mysoginist, just a warn out, sleep deprived doctor with nothing left to give and whose heart was never truly in it.

Joanna seems too obvious to say, but heart surgery is a medical procedure. Birth isn't.

It sometimes needs medical assistance, but it isn't actually a medical event.

Also, of course the mother's wishes aren't "equal" to those of the med team - they are more important! Because it's her body. I'm surprised you don't see how this operates across other areas of medicine too - I know more than one person who has refused to go on having chemo against advice e.g. because in their opinion they would rather have a shorter life without the rigours of the treatment. Medical advice is advice , not orders.

I'm also baffled by how black and white and narrow your views are. If you really work in medicine, surely you realise a major problem with how NHS obs gyn is organised is that you don't necessarily see the downstream costs of birth? 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?

I don't think the drs who mismanaged my twins' birth have the faintest idea what the sequel was, so how do they know they had a healthy mum and baby?

Good point. Also I’m pretty sure cancer patients do have choices and options when it comes to their treatment and that their consent is important for any treatments or procedures- there are different avenues you can go down with the treatment of other diseases too. So why is it pregnant women are sneered at for wanting to have a say in their treatment and procedures?

And yes if a woman leaves hospital mentally traumatised due to way she was treated and the way her birth was managed then the healthy baby/healthy mum goal was not met.

‘heart rate with 60 beats per minute’ is apparently a v old and tired urban myth/joke

Can someone remind me what this is about, I’ve read it but can’t remember this bit.

I have to laugh at the posters horrified by obs&gynae being called brats & twats because it’s known as cunts & runts in my neck of the woods

Most of the time birth is normal and doesn’t have to be medicalised, true. But for a significant proportion of women this is a life or death scenario. Yes, I want agency over my body but ultimately that does go out of the window to a certain extent when it hits that point and I accept the advice of the professional who does this every day if I want the outcome where we all come through it healthy. If the baby is stuck or faltering then you’ve got to do what you’ve got to do.

Yes. For some - I am one - it becomes life or death.

I believe it became life or death for me because I didn't have a birth plan. I presumed everything would roll along nicely just as it had in my pregnancy. I trusted doctors - my husband was one and was working in the hospital in which I gave birth.

I should have had a c-section. Instead I had a long fucking awful labour, an episiotomy, a fourth degree tear, a high forceps delivery (in which the doc doing it missed the contraction so the forceps had to say in me for another few minutes - fucking big forceps in my body - a primary post partum haemorrage with a secondary bleed the next day and a night when my newborn was in nursery while I tried to live. Also retained products which almost ruined my first 6 weeks of motherhood (thank god for my mum and my MIL)

If I had a birth plan which said NO to forceps delivery all of that might have been different.

I judge anyone who sneers at birth plans.

@pallisers yes as mentioned above I’ve had hcp acquaintances admit they would have said no to the high rotational forceps delivery I endured. It’s a good example of an ‘emergency’ situation where there actually still are choices.

I've never met anybody at work who didn't care about what they were doing. But you can't only care iyswim. It has to come with other stuff or you would be burnt out in days.
Unfortunately being ill, pregnant, old, addicted or unlucky doesn't automatically make you a lovely person.

I’m a doctor and a feminist and didn’t read it that way at all. However if I read something and feel it is misogynist I tend to just stop reading it. I’m surprised so many people made it through to the end of a book about which they had such grave criticisms.

I also wouldn’t really describe it as requiring a dark sense of humour. I suspect that like all comic books it will amuse some and not others.

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

But, without being personal, I just find the "doctor knows best" attitude so blind.

When my twins were being born, they laughed at me when I said I felt I was in labour, because no cx were showing on their machine and I could talk easily.

10 mins later I gave birth to Twin 1. Alone in a toilet. He was not breathing and I was behind a locked door, in labour with Twin 2, bleeding, and without the knowledge to resus him. His cord had also snapped. So he didn't have any oxygen.

I had to carry him out in my arms down a corridor and shout for the staff to come. When they did, they had forgot to restock the delivery room with cord clamps so they were unable to clamp the cord for some minutes more.

We don't know what effect if any that oxygen loss had on DS. He is over 18 mos and cannot walk still. He continues to be under paeds care and will be till school age, they say.

Two points - 1 that scenario was in large part caused by HCP arrogant reliance on their experience not mine. Yes they are the experts in birth generally. But I told them again and again that I personally had fast painfree labours. They did not listen. 2 those drs have no idea about the ongoing costs of that birth, none. They will not know about the ongoing MH issues I now have or the private women's health physio I use due to the mess they made, or probs even about DS ongoing NHS consultant care. How should they know? They probably believe they discharged a healthy mum and baby as we were all alive. They'd be wrong.

I read it and thought he sounded a bit like Adrian Mole delivering babies

Also the statistics of percentage of pregnant women who are sexual abuse survivors is depressingly high. I read of many of them having birth plans tailored to their trauma, whether that is avoiding routine VEs or other requests.

I agree with you OP. It was a book I really wanted to like but didn't. I found him unsympathetic and inappropriate and thought his humour was really distasteful at times. Yes there was plenty of misogyny - the way elderly women, or those with gynae problems were described was horrible.