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?

If it’s justified (for medical, physical or psychological reasons), then of course intervention should be undertaken.

Who gets to decide what’s ‘justified’?

The cost issue is an interesting one, particularly as EMCS is the great unmentioned thing here. I do wonder if the British system pushes towards instrumental deliveries rather than EMCS for reasons including cost.

The cost issue is an interesting one, particularly as EMCS is the great unmentioned thing here. I do wonder if the British system pushes towards instrumental deliveries rather than EMCS for reasons including cost

This wouldn’t surprise me. It’s crazy how reliant the NHS is on forceps delivery. It’s been called a “dying art” in the US and some hospitals won’t allow it for litigation reasons.

The cascade of interventions is dangerous to women and babies.

It’s been called a “dying art” in the US and some hospitals won’t allow it for litigation reasons.

Yes it’s absolutely shocking. And many women aren’t given proper choices.

In most countries their use is incredibly restricted to absolute experts in their use as well.

@ABingThing

Yes, I know horror stories are real ones but so are the positive stories and both are equally important yet I personally found those with positive stories were reluctant to talk about it. I’ve seem a few PP mentioned they were shamed for having positive experiences.

And your experiences sounded very much linked to poor care. I’ve repeatedly said where interventions are necessary / justified they should be performed. I’ve also said women should be listened to and respected and staff properly trained.

But I do think that there does need to be a dialogue with medical professionals in order for the best way forward to be determined, considering all pertinent factors in each case. The least riskiest option should be chosen but that is not necessarily intervention (but neither is it always “natural” either).

Positive stories of birth and breastfeeding are not welcome on Mumsnet. They are considered cruel and insensitive and smug.

Yes, I think you're right that poor care was an issue, but from these threads I'd say it was also quite common.

I definitely agree women should be in partnership with their medical team - respect and communication are vital here - improving care would go a long way to improving trust and helping those partnerships.

The least riskiest option should be chosen but that is not necessarily intervention (but neither is it always “natural” either)

I see what you're saying about risk - my only caveat would be that it isn't so much the case of least risk as it is acceptable risk. I had a range of risks to "choose" from, and decided that I was prepared to take a higher risk to my life if it meant halving the risk to my baby. The important thing is that I chose the risk combination I could accept, it wasn't forced on me based on someone else's idea of acceptable.

I think this probably goes for birth generally, my only real issue being that women aren't usually fully informed by their medical team in advance, so much is glossed over or couched in emotive terms. I believe that if women were educated, informed and properly consenting then birth experiences could be massively improved because the control would be in the hands of the woman giving birth.

@Stephminx in that case then you DO support maternal request c-sections for the vast majority of the women who ask for one

If this thread focussed on some main things. Women requesting an ELCS and asking for pain relief before needing it (any others?) rather than talking down natural birth that could be better.

And agree with pp that cascade of interventions is worth talking about.

@MarshaBradyo

Women requesting an ELCS
It should be straightforward for women to do this

Asking for pain relief before needing it
The only mention I've seen of this is where women know that it takes a long time for pain relief to arrive - so this is a care issue?

Cascade of interventions
Women should be so much better informed by their medical teams and given choices

I'd like to see a discussion about what good maternity care looks like. I'm sure most of us have a list for this!

I'd also add that consent should be discussed, although there is another thread about this at the moment it is an issue relevant here, too

@neonglow

I’ve never said women should be denied one without appropriate reason. People have jumped on me because I don’t agree that absolutely anyone and everyone should get one without appropriate justification, and in my view simply wanting one without all involved fully considering the risks to all options is not enough. I’ve agreed psychological factors are a factor, but not all women fully research or understand all relevant factors in the way medical staff are (or should be) trained to do. I see no issue with a proper discussion with medical staff around these factors. What if a women demanded a section which wasn’t appropriate, wasn’t warned of the risks and then it all went wrong ? Who is to blame there ? Surely doctors would be breaching their duty of care.

I’ve said more investment and training is needed, along with research in the field in general. I was actually involved in a clinical trial with my second birth that looked at interventions in some clinical cases, which was being undertaken as the evidence simply was not there already.

It’s also interesting people assume my experience was entirely positive because I think like this even though I’ve highlighted some (but not all) of the areas I was let down in both my births. Also that I didn’t have any intervention, when I in fact had two inductions...

What if a women demanded a section which wasn’t appropriate, wasn’t warned of the risks and then it all went wrong ? Who is to blame there ?

The medic/HCP involved. As they should be every time a woman isn't fully informed about the risks and benefits of a procedure they're asking her to consent to/forcing her into, regardless of whether it goes wrong or not.

@Stephminx I get what you’re saying. It’s just a lot of people will broadly say ‘I don’t agree with women being able to just request a c-section’ but when they extend on that, it turns out that actually they do support most of the women who benefit from ‘maternal request c-sections’ being available on the NHS.

Proper consent means a woman being fully-informed of risks/benefits, any woman requesting a c-section will have to go over these before it’s granted.

What if a women demanded a section which wasn’t appropriate, wasn’t warned of the risks and then it all went wrong ?

In which situation would you consider Csection inappropriate?

I don't believe all women choosing vaginal births are informed of all the risks.

People have jumped on me because I don’t agree that absolutely anyone and everyone should get one without appropriate justification,....

What do you consider "inappropriate" justification Stephminx?

I honestly think that more midwives is at least part of the answer to these problems.

More midwives would mean midwives would be able to build better relationships with the labouring women they are caring for - which would help the women feel more supported and so should be more relaxed, and would mean that the midwives were better able to pick up on any problems earlier - if you barely see your patient, it is going to be much harder to pick up on changes in their body language, or to build a clear picture of how their labour is progressing.

It isn't the be-all and end-all of course, but it would be a good start. I know that the hardest part of my first labour was the first night I was in the antenatal ward - my waters had gone, and I was having some contractions, but not really getting anywhere, so they sent dh home to get some rest, and I was left on my own pretty much all night. I was lonely and felt completely abandoned, and I am sure that made it harder to cope. When I did see a midwife, she gave me pethidine, which made me fall asleep between contractions, but the contractions were still bloody painful, and each one woke me up - so basically the night felt like one long contraction, all on my own.

If NHS stopped instrumental birth and went straight to C-section in those cases

Is this a realistic possibility though? Often with forceps, the baby is quite far down the birth canal and then a C-section is not straightforward (I’m not a doctor so will stand corrected if I have misunderstood!) I am very anti-forceps after my experience with them, and may ask for a debrief to find out if they could have been avoided in favour of a section. This may affect my next birth choice.

stephmix totally fine to say women electing sections should be entitled to a discussion about the relative risks and benefits beforehand. But if thereafter she still wants one, that should be sufficient justification.

I’ve never said women should be denied one without appropriate reason. People have jumped on me because I don’t agree that absolutely anyone and everyone should get one without appropriate justification, and in my view simply wanting one without all involved fully considering the risks to all options is not enough.

The unanswered question here is who gets to decide what an appropriate justification is? Is it the people under pressure to keep their C-section rates down? A person who strongly believes that all women should have a vaginal birth if at all possible?

Informed consent is a fundamental of medical care. Any HCP who didn't ensure their patients were fully informed of the potential risks before they consent to surgery is not providing adequate care.

I'd go so far as to argue that informed consent should be total, including for vaginal births.

Is this a realistic possibility though? Often with forceps, the baby is quite far down the birth canal and then a C-section is not straightforward (I’m not a doctor so will stand corrected if I have misunderstood!) I am very anti-forceps after my experience with them, and may ask for a debrief to find out if they could have been avoided in favour of a section. This may affect my next birth choice.

They attempted to retrieve dc1 from mid pelvis with forceps and explained to dh (I was away with the fairies) that was safer if it worked than shoving him back up, hoping he wasn't stuck in the middle and then cutting into a uterus which had been contracting for in my case 75 hours, whilst hoping I didn't bleed too much.

In my case, they were very gentle (in relative terms) and I didn't tear and wasn't cut. I did have quite a bit of bruising though. Dc1 didn't budge though and was delivered by emcs which went better than expected. My uterus did tear however which is apparently a common occurance with full dilation c-sections. In my particular case it wasn't severe enough to cause much blood loss or to affect my chances of vbac had I wanted to pursue one but I was lucky or so I was told.

I had mixed feelings about it afterwards but now, I think I would have always wondered if he would have come out sparing me what ended up being a massively traumatic c-section. I hallucinated, had flashbacks to previous traumatic experience and then passed out, to come round wondering why I was in an operating theatre and why they wanted me to hold a doll.

@StrawberryGoo I originally meant that the NHS only undertook VB without interventions or CS as a theoretical exercise for the purposes of considering cost - I don't actually think it's possible or necessarily even desirable to do so

@Dinosauratemydaffodils do you wish you’d chosen an ELCS for that birth?

I weighed up the risks as best I could. Having asked some questions, it became crystal clear that, in the NHS hospital in which I had my antenatal care, because of my age, the chances of my being able to give birth in the birthing centre were slim to none. I didn’t want to be on the labour ward.

My NHS midwife just palpated at my 35 week
Appointment (my 36 week scan was cancelled) and guessed (wrongly) he was presenting head down. I was almost certain he was breach.

But I was lucky enough to be able to go private and to choose an ELCS because my consultant did a scan at our first appointment with him, which revealed the breach presentation. I often wonder what would have happened if I had stayed in NHS system: would I have pitched up in labour to discover breach presentation late on and EMCS? Doesn’t really bear thinking about.

@ABingThing thank you for clarifying! It’s a shame as I would be far more likely to try a vaginal birth (which is my preference personally) if we could avoid forceps, but I’m just so scared of having them again

Dinosaur that sounds so hard

I’m actually thinking now how I was a classic cascade situation with induction for no reason other than maternal age at 40 weeks. I’m more fearful of a CS so it’s making me question what I did. It was ok but it I was one push away.

I’m actually thinking now how I was a classic cascade situation with induction for no reason other than maternal age at 40 weeks.

All that happened to me because they wouldn't intervene until right at the end. Spontaneous labour a few hours after my waters broke of their own accord. Lots walking around (staggering around outside in Feb with amniotic fluid pouring down my legs with each contraction going back - thighs and making my legs lock up under me), being sent home, having my pain minimalised, 75 hours of being in the most pain in my life because due to dc1's position (on my sciatic nerve), my first contraction hurt as much as my last. Of ending up dehydrated, fevered, exhausted because I hadn't slept for days (no pain relief). A total refusal to discuss interventions or the risks of having my waters gone for so long that by the time ds was delivered my bump had completely deflated apart from a tiny dc1 shaped bubble at the bottom. Asking for interventions and being told everything was fine even though my notes paint a very different story. A baby which ended up in NICU with suspected sepsis because I trusted the people meant to be caring for us.

I lost the first six months of my son's life to mental health issues they caused by their frankly horrendous treatment of both of us. I'm only still here because it turns out I'm as crap at committing suicide as I am at giving birth. Their defense...they wanted to avoid a primary c-section if at all possible. The senior midwife sat across a table at my debrief and told me that herself.

That's why this debate pisses me off, not because I don't support other women's right to make choices such as home birth because I do but because the premise of this thread (that some hospitals/trusts put too much weight on vaginal birth and hurt women/babies in the process) has been denied by so many. I suffered so much and am still suffering because of what they put me through almost 5 years later.

I completely understand why some women might choose no pain relief. I don't take pain killers and had dc1 not been stuck or had arrived at any point in the first 65 hours of my labour, he would have been delivered drug free despite the pain I was in. I didn't even take any pain killers post c-section.

It's the culture I was exposed to I have a problem with. All risks applicable to each indvidual should be explained then women should be supported in their choices. Not be lied to, not having to google stuff themselves whilst in agony to help them argue with staff, not being dismissed or ignored and obviously not having to argue the "allowed" terminology of favoured by certain consultants on the other side.

@Piglet89 Probably not, it's moot anyway because I went into labour with him at 38+4. I just wanted honesty and a discussion about options and interventions even though I may have declined the lot. Reading my notes sounded like someone else's labour.

It's ridiculous though. I've had 2 emergency sections now (babies come on the early side) and the midwife discharging me pointed out helpfully that I'd probably go into labour with number 3 ahead of any planned section date and thus would get a 3rd chance at that vaginal birth...