to think the natural birth at all costs ideology is fucking crackers?

[burnagirl]

We have a scandal on our hands. Shrewsbury Maternity Unit.

I couldn't believe what I was reading, but to be honest, I wasn't all that surprised, having had many a run in with the natural birthers/earth mothers in the past.

There is a toxic and insidious ideology permeating the 'birth culture' in the UK. This culture that tells women that our bodies were 'made' to give birth, that our bodies KNOWWWW what to do, that any intervention means failure on our part. That childbirth pain is something to be endured with happiness and joy - I mean, really? Is it some sort of a more 'noble' pain? Something transcendental and sacred and good?

Nah, fuck off with that. You wouldn't have a root canal with no pain relief, so WHY do we fetishise female suffering in childbirth? To me, there's this mile-wide misogynistic miasma around this narrative, probably rooted in religion.

Then there's this totally daft idea of intervention/c-section being a failure. Such bollocks. We don't seem to realise that, from an evolutionary perspective, it isn't even necessary for MOST mothers to survive childbirth. All we need is ENOUGH mothers and babies to survive, so no, our bodies are not sacred temples that somehow magically Know Best.

Can we please do away with the woo around childbirth and just do what needs to be done to ensure that mothers and babies come out of the (let's face it, fucking painful and dangerous) process alive and well, however the hell it happens?

Whilst I was pregnant I was attending a group which very much leant towards the natural/home birth viewpoint, and whilst I would NEVER have a home birth I was finding myself absorbing the natural birth ideology.

Then I went to visit a good friend. She has had an extreme premie, a still birth at fullterm and 2 fullterm live births.

Her view was "so long as you leave hospital with a healthy baby in your arms the rest really doesn't matter".

It was the reality check I needed. I totally rewrote my birth plan (about a quarter of the length) and ended up having a fully monitored labour (prelabour rupture of membranes) with entonox and morphine followed by a normal vaginal delivery. My dd had a 98 percentile head circumference and I was very glad for the drugs (trying to negotiate with the midwife for more!!).

I agree with others it's about giving women the facts and choice.
I'm an ex nurse so looked up the facts for myself and made a choice, knowing that it might have to change and it did a little for the first two.
I do think we try to fit birth into a nice neat box and that can mean over medicalising unnecessarily for example inductions at 42 weeks when there's a body of research that different ethnicities have different gestation times, but I also understand that there has to be a cut off point and is all about balance.

I choose to have a home birth with my last child and I'm very glad I did. I would have given birth in the car at the side of a dark road somewhere but luckily I ignored the people who gave their unwanted opinion and was safe and calm at home. This choice was very much supported by an excellent midwifery team

My point is that by saying C-section/ consultant led care is better we won't invest in midwifery and supporting home births.

The real problem is that all women's services/ care is underfunded and that as usual women don't matter

Throughout my pregnancy, I was dead set on going to the birthing unit in the hospital. Despite that, I felt continually pressured at my hospital appointments to consider a home birth. As it happened, my birth was straightforward, so a home birth would’ve been fine, but why would I turn down the opportunity to have a hospital full of medical experts right next door?

@JassyRadlett I was paraphrasing a bit- I think the actual wording is 'not associated with maternal or perinatal benefits'. Agree 'not dead' is a pretty low bar, but tbh the entire maternity system seems to be geared to 'not dead'.

I've worked in health reform in a number of developing countries (so seen first hand the low bar) and am CRYSTAL CLEAR that access where medically indicated is a bare minimum and maternal request c section should be facilitated also. We just need to be honest there are diminishing returns to outcomes above a certain level, which shouldn't impact your ability to request an section at all and obviously isn't the same as individualised risk. It is important to challenge the more intervention = better outcomes, though.

My point is that by saying C-section/ consultant led care is better we won't invest in midwifery and supporting home births.

We shouldn’t be saying any model is ‘better’ full stop. It is far too nuanced for that; and even that nuanced and balanced evidence doesn’t fully represent maternal birth injuries and pretty much totally ignore maternal mental health.

There’s a reason the WHO says hospital-level targets shouldn’t exist in this field.

Personal choice, healthy mum, healthy baby however you get there is just dandy. No mum should feel guilty in their choices.

All this 'your body knows what it needs to do', is all well and good but technically mine should, 4 kids, half way through labour and no matter what I do it stalls completely every fudging time. I could trampoline at the Olympic games and they wouldn't shift. Give me the choice to have whatever intervention I want and or need without the judgy brigade getting on one..

@JassyRadlett I was paraphrasing a bit- I think the actual wording is 'not associated with maternal or perinatal benefits'. Agree 'not dead' is a pretty low bar, but tbh the entire maternity system seems to be geared to 'not dead'.

You were right the first time if you’re referring to the WHO statement - I haven’t seen anywhere that 10% is linked to anything but mortality rates. The wording is:

Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10%, there is no evidence that mortality rates improve.

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “They also illustrate how important it is to ensure a caesarean section is provided to the women in need - and to not just focus on achieving any specific rate.”

Across a population, the effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown. More research on the impact of caesarean section on women’s psychological and social well-being is still needed.

@Sickoffamilydrama

But for almost all ethnicities, after 41
weeks the risk of stilbirth does increase. There was very recently a study in Sweden (of predominantly white women) that had to be stopped early when it became clear that not inducing women when significantly overdue was giving rise to a statistically significant risk of infant death.

www.google.co.uk/amp/s/amp.theguardian.com/lifeandstyle/2019/nov/20/induction-recommended-for-women-still-pregnant-at-41-weeks

Black women more usually have a shorter gestation, as I understand do women of Indian and Chinese descent. Which ethnicities have a longer gestation?

I don't think you have read the latest science.

I do think we try to fit birth into a nice neat box and that can mean over medicalising unnecessarily for example inductions at 42 weeks

The most recent trial looking at this was halted last month because of an excess of stillbirths in the non-induction group. So actually, no, I don't agree that induction at 42 weeks is "unnecessary over-medicalisation".

What toddler said, basically

I will defend the right for any woman to have the birth that she wants, but I do feel that both sides of the discussion get entrenched in their opinions.

Whenever I get negative responses to having 2 csections I always tell the person criticising about my births. They normally end up pretty sheepish and hopefully will think before they criticise anybody and their choices again.

I had wanted a midwife led, drug free birth using hypnobirthing and had gone to Private antenatal classes and done antenatal yoga. I wanted immediate skin to skin contact and to breastfeed immediately after birth. I had every confidence that my body would respond as it was meant to. Dd and my body had other plans.

Her heart stoped when I had gone through an unmedicated labour and was 9cm dilated. A csection under GA, 6 transfusions, resuscitation and numerous antibiotics saved both of our lives. I later discovered I had ruptured an ovarian artery. I developed post partum PTSD and postnatal anxiety as a result.

10 years later when I was pregnant with Ds I had to fight to get an elective section. The midwives were keen to push vbac despite knowing my medical history. After Ds was born (by a calm and lovely elective csection) I was diagnosed with a rare and dangerous condition that causes 75% maternal mortality and 95% infant mortality.

All of the treatments that I needed were provided free of charge on the NHS and I am forever grateful that I live in a place and in a time where I could access lifesaving medical treatment. Not everybody has this privilege.

Most births are straightforward, but not all are and medical assistance is sometimes needed. Modern medical treatment has changed our perception of childbirth from a dangerous and unpredictable event to a safe and happy event.

Women need to be given the choice on how to manage their birth and their body, and should be supported in that choice, regardless. Supporting women is more important than criticising how women chooses to bring their baby into the world. Motherhood comes with enough guilt and shame attached to choices without other women adding to it.

@Sashkin

Glad to have company!!

I'm currently working on a research project about the rise in elective cesareans, I've had 4 babies, the last being an emergency c section so I'm really interested as to why anyone would choose major surgery over a vaginal birth. If you'd be willing to help me with my research, totally anonymously, please could you let me know

I didn’t give a ff about natural. But I did want to make the decisions. First one (31 days late) we started at home then transferred to hospital (taking our own midwife) so I could have an epidural to let DD1 turn. Midwife called ahead to confirm we would have the anaesthetist we wanted. It all went pretty smoothly and we were home same day. The next 3 were home births, not due to any natural birth at all costs ideology but because I wanted to stay at home.

You’d have to have a single full time midwife working shifts both in the community and in the hospital labour ward, they wouldn’t be in the hospital full time therefore and taking into account shift patterns, leave, sickness etc. the chances of having the same midwife you’ve already ‘built a relationship with’ would be pretty small. How do you think it would work in practice?

This is what is currently being trialled in Scotland to try to provide that continuity of care. Some midwives are very much for it but a lot question how it will work on practice.
In my experience postnatal care is where the shortfalls are. Intrapartum rightly gets a lot of funding and staffing but postnatal wards are often not as prioritised and this is where many women need proper focused support. The wards are often just too busy and short staffed. It's frustrating and difficult for everyone.

so I'm really interested as to why anyone would choose major surgery over a vaginal birth

Personally, because the U.K./NHS loves forceps more than any other country in the world. An instrumental birth create a 5 to 10 fold chance of serious birth injury to Mum over a c-section.

Other countries have largely moved away from instrumental births but the U.K./NHS perpetuate this outdated practice.

@Tessabelle74

My next one will be an elective, but I assume you don't want people who just say "a traumatic first birth and tendency to grow babies bigger than pelvis can birth". I have already had the major surgery once, so I guess I know what is involved. For me, now, it will likely be safer www.nhs.uk/news/pregnancy-and-child/planned-caesareans-safer-women-past-history-caesarean-sections/.

If it helps, my cousin had one because she was advised to do so physically (by her women's health physio) because she is tiny and had a hypertonic pelvic floor and retroverted uterus as it is, so statistically increased risk of prolapse.

I am not sure why it is that surprising that people would choose surgery, TBH. Once you have had lots of friends who have had vaginal births (as I do now), you start to realise that, in young women, leaking pee, whilst not a normal consequence of a vaginal delivery, does seem to be quite closely correlated to a problematic vaginal delivery with insufficient physio and after care. And whilst it is less optimal for the baby to be born by c section, it is safer - less mortality and far less risk of being starved of oxygen in the birth canal. That risk is vanishingly small - tiny - but i can see why some women balance the risks in that direction. I would have chosen a vaginal birth and tried to have one, but in my circumstances a c section was the only birth possible. I wouldn't recommend either option over the other - I know women who have had great vaginal deliveries and have likely recovered far better and quicker than they would have if they had had a c section and others who have had terrible life altering ones.

See this article, which is good from a reputable publication. To be honest, the fact that you have framed your question in this way (which sounds like "why oh why would ANYONE do this crazy thing?!") suggests that you may come from a viewpoint in which you would tend to minimise the risks of a vaginal birth.

www.google.co.uk/amp/s/www.newscientist.com/article/dn27929-stop-glossing-over-the-risks-of-natural-birth-to-cut-caesareans/amp/

@thetoddleratemyhomework
I'm sorry if it came over that way, I don't judge anyone for the choice they make. I genuinely am interested in the reasons why elective cesareans are on the rise. Some, I'm aware are on medical advice due to baby's size, some due to traumatic previous births. I'd like to hear from anyone so I can get a good range of data

My baby is due tomorrow, and I plan on having an epidural like I did with the last two (fingers crossed!). My son's birth in 2017 in particular was stress and (for the most part) pain free and I have positive memories of it. My daughter's birth in 2007 was very different - I laboured for days on end never progressing and only using gas and air for pain relief because I was under the impression I'd be some kind of 'warrior mum' if I did it without any anything stronger. I just ended up completely and utterly exhausted and poorly and eventually accepted an epidural so I could get some sleep (after being awake for three days). I actually did do hypno-birthing in the run up to my son, and whilst some of the breathing and visualisation techniques were helpful, I didn't agree with the notion the medical staff / intervention was the 'enemy', I was also told to print off large posters and stick them up on the wall to warn people entering the room that I was practicing hypno-birthing and to respect my wishes etc . Yes - very entitled (I obviously didn't do it!)

I just want to know why it’s OK to be so rude and dismissive of robes who decide they want to try and give birth with as few interventions as possible. Because this thread has certainly highlighted which group is the most outspoken and judgemental...

First one (31 days late)

Is that a typo or did you really go 4 weeks over?

Sorry, I assume the last 24 pages have been full of tribal warfare re approaches to childcare. But I do think yabu. Your takeaway, reading about a failing maternity unit that repeatedly failed to learn from mistakes, retroactively altered notes , referred to deceased babies as ‘it’, and just lied and lied.... is to say it’s the fault of the women who wanted intervention free births?

Say whaaaaaat?

Surely it is representative of the fucking scandal that is lack of investment into maternity services? You know one of the reasons they don’t like to offer c-sections? It’s part of the trusts reporting and it’s expensive.

I went to a hen party recently and I think every woman I spoke to with children had a childbirth horror story. I had not realised that my own positive story was so rare (emergency c section after 36 hours of stop start!). The stories were traumatic not because of intervention, but because of poor communication, missed treatments, overcrowded maternity wards, poor care. And that is down to investment. Having a child did radicalise me when I realised how risky it can be and how little it is prioritised. You can bet your stretched to the limit maternity unit that this nonsense would not be happening if men also gave birth.

Unless there is a definitely a medical reason for surgery, I think it might be better to see how labour goes for a while. Stay on feet for as long as possible, walking about. When you go in hospital and are examined the medics will see how you're progressing. It's really not always that bad, I had no idea how many women have forceps delivery now and would have thought that would have been a last resort.

They'll also look at the skin of your perineum to see if it is likely to tear or if a small episiotomy is indicated; If everything runs smoothly, you'll push the baby out, all over.

Reading this thread I can't help feeling hospital staff in labour wards were better forty years ago. I went in at 4.30 am and my baby arrived just after 6.30, I had a little cut which was stitched. I was well looked after and it wasn't a traumatic experience. At that time I knew many people having babies and most were fine, some took a bit longer than others.

My contractions started at home, gradually and then built up, I went to hospital when my waters broke, husband drove me, it only took about 15 minutes to get there. By the time I was undressed, examined and shaved, it was all happening, no drugs. I enjoyed giving birth.

I can assure you that if I had been in dreadful pain I'd have begged for anything that would help, I'm not particularly heroic.

Recent hospital in patient experience after a small accident was horrendous, I hope I never have to go again and intend to do my very best to avoid it.

@Tessabelle74 I had vasa praevia, so didn't really have much choice. But even before that was diagnosed, I wanted a C-section - DS's head was 90th centile and I'm a 5ft woman, he was an oblique breech lie, and prior to the vasa praevia diagnosis I had placenta praevia. Oh, and I had an abruption at 29 weeks. So plenty of reason to think I wasn't going to make it to 40 weeks. All my side of the family have needed C-sections (combination of big heads and small women, plus lots of breech presentations), so I had gone into pregnancy half expecting to need a section.

On top of that, I'd had multiple miscarriages prior to that pregnancy, and so was very conscious of what could go wrong/unwilling to take any risks. The people I know who are strongly against medical intervention don't seem to think neonatal death is something that happens any more - I had lots of ignorant comments at mother and baby groups about vasa praevia and whether that is or is not an absolute contraindication to vaginal delivery (it is - no amount of hypnobirthing will overcome a 95% mortality rate, and no, delayed cord clamping won't prevent the baby exanguinating either).

There was a comment on another thread about buying stuff for babies early, and one woman said if she had a stillbirth it wouldn't matter if she'd bought a load of stuff because she could just re-use her dead child's clothes for subsequent babies - that is a woman who has never experienced fetal loss. I think the "I don't mind risking cerebral palsy or a stillbirth, I don't want any interventions regardless of circumstances" brigade are a less extreme example of that - they don't believe it's a real risk that could ever happen to them.

I wanted a water birth and ended up with an emergency section. I wanted to avoid an epidural but at the point where the head midwife and consultant both said "you really should think about an epidural" I caved. DS was at an awkward angle pressing on my sciatic nerve so with every contraction I was violently sick. Thank god for that epidural because without it I would have had my section under general anaesthetic. And thank god for that section because without it DS wouldn't have lived.

The point is we can all hope for varying births - I know I wanted something quite natural, I had studied hypnobirthing etc, but at the end of the day my birth plan was "whatever is safest for baby and mum" and it turns out that was a category 1 emergency section after a 56 hour labour including epidural. Sometimes though I still do feel like a failure (even though is now a thriving 10mo and without intervention would have indisputably been dead).

So, I think the thing to avoid is any kind of mum shaming. Have your baby however is safest and best for you and them. If you want an all natural birth, good for you and I really hope you get it. If you don't, don't feel badly about yourself. And if you do, don't look badly on the ones who didn't.