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?

But if you’ve chosen ELCS than all this doesn’t apply to you, and the advice won’t fit your situation.
I chose an ELCS, the ridiculous natural birth at all costs ideology made my pregnancy much more stressful than it needed to be.

I think even then it’s subjective - epidural increases the likelihood of instrumental delivery - like you I would much rather a c-section than instrumental delivery.

Though have just been looking at the NCT page on instrumental delivery and it’s dreadful. It describes ventouse and forceps as ‘safe and effective’ while a ‘caesarean birth involves major surgery, which carries risks and takes longer.’

Very balanced, evidence based and woman focused. 🙄

Ahh I think it’s such a tricky one.

I’m not sure if it’s always helpful to turn it into a case of midwives vs doctors, medicalised birth vs natural birth.

I think a lot of issues are around the fact women aren’t listened to and a lack of informed consent. Women need open, honest and BALANCED information that doesn’t push one agenda or the other.

I’m very passionate about all women having the right to choose a ELCS for whatever reason she wishes (I agree that if men gave birth they would always have had this choice) but I also find it unfair the amount of women who are pushed into other kinds of intervention, like being told they ‘must’ be induced without any discussion.

When something like this happens, it turns more into a debate about whether women should be driven down a ‘natural approach’ to birth as standard or whether everything should be more medicalised. There is little focus on the fact that actually centering women in maternity care, being open and honest and non-bias with evidence-based info and respecting autonomy/not treating pregnant women like baby vessels would go a long way in improving maternity care.

Oh and totally agree- ‘healthy baby healthy mum’ is NOT a mum who has PTSD from her experience.

If ‘mum’ is mentally traumatised then ‘healthy baby healthy’ hasn’t happened!

I’m going to get flamed here but I’m not sure that women should be able to demand intervention (and by that I mean induction / c section) without a valid medical reason. I’m not sure of any/many other services offered by the nhs where patients can just demand whatever procedures they want without valid medical reasons.

Those with a valid medical reason (based on each women’s circumstances properly considered on a case by case basis at an early stage by experienced professionals) should of course get the treatment / interventions needed in a timely fashion.

The reality is the NHS and it’s resources are stretched to breaking. There isn’t a bottomless pit of cash. The whole system needs investment both in terms of cash, staff and training.

More needs to be done to prepare women properly for birth so they know what to expect - I found this was woefully lacking in my case with both pregnancies from the whole range of professionals I encountered (although I had a secret inside source who did prepare me well).

I was actually given a risk leaflet which detailed risks associated with “natural”, induced and c section births, but the natural one was glossed over a bit in the appointment. However the information was there if I chose to look.

I also think pain relief should be provided when needed - in both of my births I was “too late” for pain relief.

With my second I kept buzzing and asking (learning from my first birth) but despite me being in a clinical trial for giant babies and advising them my first birth was 4 hours start to finish I was only offered paracetamol (eventually after repeated requests) then a bath ! I was only asking for gas and air at this point, but it was refused. I refused the bath as I wasn’t sure I could get out of it - at that point the midwife reluctantly said she’d check to see if I’d “got myself into labour” and I was 8cm dilated and rushed off to delivery in the lift with a team in case I delivered in there. Not good enough at all.

If women are listened to and given support (and pain relief when needed), it might just change the dynamic of the whole process more than unnecessary interventions.

The whole process is scary and I do think a PMA can help (obviously not in all cases) but women seem to delight in frightening each other with birth tales. I’m not sure I heard anyone encouraging me - rather gleefully telling me how awful the pain is. Yes it stings a bit (😫) but it’s going to isn’t it looking at the anatomy.

Ultimately there is so much medical evidence around regarding what is the best way to proceed, but it should always be decided on a case by case basis and whether people like it or not, funding in the nhs is an issue to be considered. People sometimes forget that while we are lucky to have the nhs it can not possibly fund everything for everyone.

However, there are so many ways that the whole system can be improved. And it should be. Without a doubt it needs an overhaul. I’m just not sure chucking money at elective c sections / inductions to be performed without valid medical reasons (which for the avoidance of doubt includes psychological ones) is the answer.

Marking so I can come and read properly later. Fantastic thread

If you are concerned about costs to the NHS Stephminx, and think that this is adequate reason to deny women choices, and potentially cause a proportion to suffer birth injuries they wouldn’t have had if their choices had been respected, you might be interested to note that it has been found that the cheapest way to do birth would be for every baby to be born by ELCS. This is because this would avoid the massive damages paid out by the NHS when they botch a delivery, leading to brain damage requiring lifelong care.

@Tolleshunt.

I’m not saying cost is a reason to deny the best treatment, but it is a factor the nhs has to consider in general and therefore it can’t just dish out every treatment someone wants without justification. Note the key words ... without justification. If there is proper justification, then I have no issue.

But like it or not just because a woman wants a section for example, it doesn’t mean it is necessarily the best choice. There are other factors at play, including her personal medical history.

If you bothered to read my post, you’ll see that I have said that any woman that needs intervention should have it, in a timely fashion. Women should be listened to and respected.

I have also said there are various things that need to be changed in how the nhs treats pregnant women and places where investment is needed and improvements must be made.

Throwing cash at what in some cases will be unnecessary procedures will not fix all the other problems.

And PI cases are an entirely separate issue. Damages are paid in cases of negligence. Any procedure can be performed negligently including sections and inductions. It is not limited to “natural” birth. Training staff properly in every procedure, including “natural” birth, would be key in improving outcomes and thus reducing such claims and therefore costs.

No matter what the procedure is, it shouldn’t ever be performed negligently. Statistically if more interventions are performed there would be an increase the number of claims associated with those procedures. You’ll see my earlier post also highlighted a need for training. Staff should always be properly trained in every procedure they carry out.

The whole process is scary and I do think a PMA can help (obviously not in all cases)

And how, exactly, do you distinguish between the women who just lacked a Positive Mental Attitude and those who were justified in their interventions?

Was a lack of PMA what led to the EMCS after 106 hours of failed induction? Or was that shown when I opted for an ELCS to reduce the risk of stillbirth? Where do you draw the line steph?

I was actually given a risk leaflet which detailed risks associated with “natural”, induced and c section births, but the natural one was glossed over a bit in the appointment. However the information was there if I chose to look

Like many women I found the RCOG research for my specific risks (I should have been told). Perhaps if they'd told me that at the outset, rather than me having to search, I could've saved the NHS the cost of 7 days in hospital and an EMCS by opting for an ELCS and refusing a course of action that had almost no chance of success?

Even the most cursory of glances at this thread shows that it is not as simple as PMA and women are not being fully informed about their individual risks so they can give informed consent. It doesn't matter which method of childbirth you choose, as long as you're given balanced, accurate risks on which to base your decision

@Stephminx I’m sure it’s been talked about on here before but the cost of a woman requesting an ELCS really isn’t much higher at all than if she goes for a vaginal birth. Because attempted vaginal births often end in emergency c-section, instrumental deliveries, third-degree tears, long-term issues like incontinence, higher rate of birth trauma and the mental health care associated with that and so on. The idea that ELCS is a lot more expensive than a woman attempting vagina birth is a (widespread unfortunately) myth.

Whilst i believe women should be able to request an ELCS without explaining her reason, it’s worth mentioning that out of women who ‘demand’ a c-section for ‘non-medical’ reasons the VAST majority were either a) mentally traumatised from previously giving birth. b) had other trauma relating to past rape/sexual assault or c) had carefully researched their options and realised their own circumstances or health conditions meant vaginal birth was riskier for them and they were much happier to go through the risks of an ELCS than a planned vaginal delivery. I think when people actually look at the reasons behind ‘c-sections on demand’ their perspective does change a bit.

@ABingThing

I’m sorry for your experiences.

I was trying to get across that women are often unnecessarily frightened about birth by others. I was told all sorts of horror stories when there was no need for it.

Women should be given a realistic picture of what to expect so they are more relaxed going into it (if possible) which can help them to keep calmer in unforeseen circumstances and feel more in control. And control has been highlighted by numerous others as a key point.

I’m not saying a PMA can fix medical issues which arise.

But a line has to be drawn somewhere - I don’t think I’m saying much different to many others in reality. If it’s justified (for medical, physical or psychological reasons), then of course intervention should be undertaken. Which is what I said in my post.

But that does not mean other failings should not be addressed so that tragic outcomes can be avoided irrespective of how a woman gives birth.

@Neonglow

You’ll see (if you read my post) that I included psychological reasons within my justifications along with consideration of purely physical factors. In all of your options listed, they would fall under justified reasons I mentioned where intervention might be appropriate. Even in scenario c this should back up the professionals opinion / advice.

Perhaps I haven’t worded it right, but my point is the intervention should be carefully considered and appropriate in each case. Not just undertaken without some checks and balances in place to make sure it’s appropriate.

What if a woman has made a choice without considering a key factor - without any discussion with medical professionals it could be entirely the wrong way to proceed and she might change her mind when she is given full facts. There needs to be some dialogue on this.

Seriously unhappy with my last birth because I had intervention forced on me to my detriment. Until hospital staff stop bullying patients into unwanted and unneeded procedures then YABU.

I did ‘bother’ to read your post Stephminx, it’s just I disagree with you, but am not going to attempt a tedious blow-by-blow examination of every point.

The NICE guidelines disagree with you too, as they state that a woman should be offered an ELCS if she chooses. I don’t agree with your point about ‘medically justified’ vs ‘unjustified’ CS, because the risk profile of CS and VB are so similar now (albeit the risks differ), that its not possible to assert with any credibility that ELCS is not ‘justified’ but a VB is.

As neon says, the costs of ELCS are comparable to VB once all the downstream costs of treating birth injuries from VB are factored in.

Given the risks and costs of both ELCS and VB are now very similar, it is therefore not tenable to say that women should be funnelled unwillingly towards VB if they prefer ELCS. That they are still denied such choice in some trusts is more attributable to outdated (misogynistic, often) attitudes, rather than to evidence re risks.

To me it seems that something is missing from this debate. I think that the stats for EMCS s should be separated from ELCSs, but I do wonder just how many of the EMCS cases start with an induction as e.g. ABingThing talks about rather than a spontaneous onset of labour? In which case, should it not be the induction which is questioned and that should be where the choice of induction or go straight to CS should be offered?

Given the risks and costs of both ELCS and VB are now very similar

Is this really true? If NHS stopped instrumental birth and went straight to C-section in those cases, you could stop a lot of those downstream costs. ELCS is always more costly in countries where you have to pay for such things, I think price is a fair judge here.

Also not talked about is that CS has downstream costs of its own. Not just for blood transfusion and complications for subsequent births down the line. As I had a CS I’m researching adhesions for subsequent pregnancies (and my bladder/bowel health) and am a little surprised at the lack of data on this (though I suppose I shouldn’t be). Here’s an interesting conversation on this: www.medscape.org/viewarticle/587422

It's only a matter of time until we start to see more maternal morbidities, many of them adhesion-related. Often they're placental-related, but I think adhesions in this setting are really under-appreciated -- many more maternal morbidities and also many more fetal and neonatal morbidities directly as a result of adhesions. When you look at this as the most common surgical procedure performed in the United States, it is really shocking the dearth of data that we have in terms of how to best perform this

But don't you see @stephminx that horror stories are real stories?

I was trying to get across that women are often unnecessarily frightened about birth by others. I was told all sorts of horror stories when there was no need for it.

There was only no need for it because you got lucky and it didn't happen to you. I so so wish that other women had been more honest with me beforehand and hadn't waited until afterwards to enlighten me.

Women should be given a realistic picture of what to expect so they are more relaxed going into it which can help them to keep calmer in unforeseen circumstances and feel more in control

A realistic picture includes all of it - most importantly it carries the risks and benefits of all possible outcomes and the factors which predispose you to each one. As for control, once things start going south your options for control are very limited - more so if (like me) you haven't been given the full picture to start with.

But I still don't understand your argument about why a line has to be drawn? Any line will be arbitrary and how can you judge psychological impact? I was initially turned down for ELCS and told to try VBAC. For 26 weeks I researched and argued my case. The blocker? The consultant thought I'd regret not trying a VB.

I would sit awake at night crying with fear that I'd have to do that. It was awful. And why? Because my consultant was less interested in the guidelines, the risks and my mental health than she was about me trying a vaginal delivery. A consultant who was convinced I had GD despite four tests saying I didn't, who believed I had placental calcification which was causing the reduced movements that meant I was monitored three times a week at the FHU by pre planned appointment, plus any other times movements dropped again for the last three months of my pregnancy.

That ELCS, when it was finally agreed, saved DC2s life - and that's not me being emotional, that's the considered opinion of the doctor who delivered them and found the cord wrapped around the neck three times.

So I absolutely disagree with a line being drawn 'somewhere' because even more women would end up in my position and that is utterly unacceptable.

@Peregrina I read somewhere that 1:10 inductions fail to progress, so presumably many of these end in CS or a second attempt at induction. I don't know what the figures are for inductions that result in CSs because labour starts but other interventions fail.

If this information was given before induction is started, including Bishop's Score - something I didn't learn about until two years after mine - then women could make informed choices. My score was 0, which apparently meant the induction would almost certainly fail. If I'd known that - and that I could say no and go straight to CS - things would have been so much better for me.

If anything, I think it's totally the opposite. I have had so much shit (including on here) for wanting an unmedicated birth, people act like you're trying to be a martyr or something. "You don't get a medal" is trotted out every time.

I, of course, would do any medical intervention necessary to keep me or my baby safe, and I don't know any mother who has had or plans to have an unmedicated birth who doesn't think the same. No one should be shamed for wanting any kind of intervention whether it's for safety or for comfort. But equally, if you have the inclination to try it without, why should you be shamed for that?

Of course there are the people who take things too far and who shame others for requesting interventions. There are pricks in every walk of life. But by and large, most women I know who gave birth unmedicated don't even mention it anymore because they get such negative reactions.

As soon as I tell people where I'm giving birth (not in the UK and where I am, we have natural birth clinics, not sure if that's a thing in the UK or not), the smirks and 'you'll be begging for an epidural' and 'why would you want that' comments start. It's not like I go on about it, I just tell them if they ask where I'm giving birth. I'm not in the least bit woo, but where I am you have a choice of an epidural or nothing. Since I don't want an epidural, I don't have much of a choice except going natural.

As long as someone is not being a smug, woo-y twat about it, why can't we all just respect each other's choices? I don't make any comment about anyone's birth so not sure why anyone else sees fit to make comments about mine.

It's just the same bullshit as breast vs formula, sahm vs working, organic baby food or whatever other stupid bullshit that is 100% each individual's choice someone has decided to whip up into a debate to keep women sniping at each other.

@MangoFeverDream in 2011 NICE calculated the difference as £84 (I'll try and find the link).

Downstream costs and, more importantly, outcomes for women, could well be improved if the NHS stopped instrumental deliveries. Although if more women were better informed and their consent properly requested that rate might drop anyway.

It would also be very good to see more research into the long term impact of CS, again so women could better weigh up the risks and benefits and make a more informed choice.

The link is really interesting and has reminded me that the second time around the surgeon did comment that there was no sign of adhesions. Particularly interesting is the idea that recovery is so important - I'm not sure how well that mixes with getting up as soon as the anaesthesia wears off and going home after 24 hours. Although clearly there are lots of potential factors involved and they don't know enough about what's going on yet.

the cost of a woman requesting an ELCS really isn’t much higher at all than if she goes for a vaginal birth.

Appears to be at odds with the claims that natural birth is pushed on us to reduce cost. Posts by pp.

There is something in the induction / epidural leading to c section which is why some women will choose the pain relief free path over those. Not because as previously suggested it’s a piece of cake if to you it doesn’t hurt that much. It still does and is something to get through.

@Zone4flaneur "What I have found a bit weird though is people assuming I've judged them where I haven't - I've actually had people say things like 'oh I bet you think I copped out, having a section' - and these are people I don't know very well so no basis for why they would think that"

Exactly this. I haven't even given birth yet and I've already had comments like this. "Oh I'm not a superwoman like you", "Oh I bet you think I'm a right wimp", "Oh you're one of those hippy mummies who does everything perfectly, not like us mere mortals."

I don't know why people choose to put words in my mouth. I would never judge anyone's birth. I guess people feel insecure and choose to put themselves down before someone else does, you see it in all sorts of situations and I'm sure I've done the same too.

Maybe we should all stop comparing ourselves to others and put our efforts into trying to get better education for women on all of their choices.

I suspect this Appears to be at odds with the claims that natural birth is pushed on us to reduce cost. Posts by pp is because an uncomplicated VB without intervention should be the cheapest method. It is when you look at overall costs for VB vs. CS the gap closes.

Nobody can guarantee a straightforward VB, but that doesn't stop maternity staff pushing you to try because, if you do go on to have that VB then you have saved money.

Still it either saves money as pp says or not.

And if complications means it doesn’t then it doesn’t hold.

@stereolovely "Home births strike me as ludicrous "look at me" steps away from martyrdom."

What is with this thread? If you don't want a home birth, don't have one, it's doesn't mean anyone else is an attention seeker. I'm not interested in one either but if someone wants one, good for them.

It just makes it sound like you have some huge insecurity about yourself and you need to put others down to feel better. "Oh if you have a stay at home birth, you're just a big 'look at me' hippy and since I'm not like that, I didn't have one."

Why not just look at whatever options are open to you and then choosing what works instead of labelling and belittling everything? Doesn't it get tiring being so utterly negative?

Even with the 2011 figures a CS is more expensive on average, albeit less than £100 more.

So yes, using this average figure, VB is cheaper but, no, a CS isn't vastly more expensive and therefore crippling the NHS everytime a woman requests one (which is the other argument the figures are being used for).

We can only go by the averages though because that's all we have access to - they'd need to give us the costs breakdown for each birth to say definitively what the costs are and, since all births will have cost outliers. it would be very easy to pick individual cases that support a point.