majority of labours require intervention!?!

[PrincessScrumpy]

I'm really shocked that less than 50% of labours are done with no intervention - ie: ventouse, forceps.

I'm pg with twins and will be having an elcs but at 31 weeks we are going on holiday (in the UK) so I was researching hospitals and couldn't believe the figures that came up - so I started looking at all the hospitals in our area to compare. All of them came up with 40-49% figures for births without intervention, so more than 50% of women need ventouse or forceps.

That seems crazy to me - is the female body made that badly? I had dd through vb with no intervention. tbh she came within 2 hours and shocked the mw who was trying to send me home until dh asked for another opinion and registra came in to discover I was 10cm and not being the wimp that mw had implied. Not an ideal birth though as dd tore her way out due to the speed and I think I was in panic mode etc. But I was still really surprised to be in the minority of people.

Does this surprise you?

no not at all i think we as a society tend to over medicalise everything. Women don't understand the birth process and many professionals seem to be losing the skills of supporting women to labour and birth naturally in favour of medical intervention.

Don't shoot me i firmly believe that medical intervention is necessary in some cases and does save the lives of babies and mothers but also think unecessary controlling of labour leads to far more interventions.

Better staffing levels would lead to better care. Women taking more responsibilty for understanding the process they are going through and knowing what to expect would help.

Would you have torn if your labour had been assessed properly by the midwife and you had been properly supported?

Sorry a bit of a rant (had a bad day) but i think too many women although they have healthy babies at the end of it and that's all that really matters have births that are not great experiences due to poor support and knowledge

so more than 50% of women need ventouse or forceps.

I suspect it's because of the cascade of intervention, and doing things because of protocol and clock watching rather than need - I wish I had some stats to back up the suspicion.

That seems crazy to me - is the female body made that badly? Intervention rates have shot up over the past 40 years or so. It's impossible to believe that in one generation evolution could have slammed into reverse. Some interventions may be as a result of women having babies when they are older and more obesity, but it can't account for it all.

They tried to force a cses on me not because anything was wrong but because I had had 20 hrs of constant cc (baby was op) and they said most would be to tired to push. I delivered fine no stitches but it showed me why they are so high as they were willing to give a cses just because most would be too tired over the country that attitude could cause quite a increase in intervention rates.

Have any studies been made to see if there is a connection between birthweight and intervention?

Our bipedal design isn't great from the point of view of giving birth and the large heads of human babies make birth harder for us than most other species which accounts for the very high maternal and infant mortality rates in humans.

I wonder whether better nutrition resulting in ever bigger babies is resulting in more birth complications in the West.

ok so were looking at hospital births? Is that right?

Not midwife led units / home births?

If looking at strictly hospital births than actually im not at all surprised... as that were all those who chose home / mid-wife left birth are taken if their birth doesnt go to plan, hence already much more likely to need intervention.

Many mums are transferred because they want an epidural... so chance of intervention is much higher than those who dont choose an epidural, and arnt numbed down there!

Im sure if you look at total births (home + midwife unit + hospital) the figure is much less than 50%, but am not surprise that the figure is at its highest in the place where trickier births happen, and more complex births are transferred to.

We are not good at giving birth as a species. But we are good parents - don't tend yo eat our young.

Does induction count as intervention? If not then yes I am quite surprised.

Does induction count as intervention? If not then yes I am quite surprised.

We are perfectly good at giving birth as a species, but some people have complications and some deaths do occur (as they do in other mammals).

You can get intervention rates down to very low levels and maternal mortality, maternal morbidity and neonatal mortality right down with the right sort of care, which is a mixture of the right help during labour AND sensitive and expert medical care if it's needed.

Unfortunately all of that is very expensive in various ways, hence our system not being (nearly) as good as it could be.

I think these figures are a bit misleading tbh. 40-50% of births may be without intervention, but those that do require intervention are not necessarily by ventouse or forceps.

If you consider that the c/s rate in most teaching hospitals is around 30%, and this includes elective c/s for any reason, then it brings the other types of intervention such as instrumental delivery much lower to 20-30%, which would be more realistic.

Still terrible stats but better than was implied.

However, if you break down the stats still further, to look at women who spontaneously labour themselves, or multiparous women, the chance of intervention is much much less.

All statistics need to be treated with a healthy dose of scepticism until they are proven imo.

"Women taking more responsibilty for understanding the process they are going through and knowing what to expect would help."

Oh that's a dangerous statement to make. Can I have a book for next time that will help? Because I read all of them, I know the mechanics of labour inside out and back to front. Nothing, none of it can prepare you for your own individual experience and what might go wrong. I made the 'right' decisions. I stayed at home, had no drugs, was upright, mobile etc. I was blue lighted to hospital had every intervention going and an eventual cs. I do NOT appreciate the implication that I was somehow ill prepared or it was my fault.

Of course you will now tell me that you didn't mean me, you meant generally. Of course. But how do you decide who you apply this accusation and damning to? I know no women who went into this blind. I know lots who had intervention. Some of them chose it you know.

I think I need to get off MN this morning.

Most people I know have had their babies naturally with no more than gas or air. I would say that around 80% of people I know have had their babies with no problems. Makes me feel a bit inadequate as I ended up with two c/s but its one of those things, I'm not really bothered that I ended up with c/s but there is a pressure to have natural births.

A relative of mine was treated horrendously by her hospital she had pre-eclampsia but they refused to induce because inductions are more likely to result in interventions it all got quite scary, she ended up with eclampsia and both her and her baby were in great danger and the baby ended up being delivered by emcs anyway!

but am not surprise that the figure is at its highest in the place where trickier births happen, and more complex births are transferred to.

It's not as simple as that:

Well designed surveys look into the booked place of birth and still show that home birth/MLUs have lower rates of intervention. (Some 'home births' have an outcome of a CS but you can be pretty sure that the operation wasn't carried out on the kitchen table.)

Some hospitals which are regional referral centres for complex cases have lower intervention rates than other nearby hospitals. I was thinking of the John Radcliffe here and another a few miles away - so the 'we get all the high risk cases' falls apart for the other hospital and its high intervention rates.

IMHO we have concentrated on fixing things when they are broken, rather than asking the question 'How do we get this pregnancy to go right?' What would be the optimum diet for a pregnant women, how to make sure you are physically fit when pregnant? These are the sorts of questions which are neglected.

I agree with the self-fulfilling prophecy if you're just looking at raw data from hospital stats. The method for gathering data may not have been well-outlined, it may break down very differently etc. To pick up on the specialist point it's more likely to reflect a bell-shaped curve. The hospitals equipped to handle normal births will apply the precautionary principle and intervene if unsure of how things are progressing - that uncertainty is less likely with very experienced staff used to handling 'high risk' cases. There's likely to be better continuous support and monitoring, not necessarily intrusive monitoring, which improves outcomes.

If it were that for all labours which started in hospital required that level of intervention I'd be suprised but given the likelihood of a transfer in etc I'm not.

Is intervention defined?

When I had DS I had meconium in my waters and they wanted to monitor me but the trace machine was rubbish (they admitted this) and the machine for putting a clip on the baby's head was broken. So immediately they were saying they might need to use a ventouse and they wanted to give me an episiotomy. This wasn't in any way due to anything being wrong with DS, it was because their equipment was faulty and they couldn't be sure he was ok. I strenuously refused these interventions and DS was eventually born completely healthy with no intervention. It pissed me off big time that despite the fact I could feel DS moving like a mad thing during labour and it was pretty clear from the small amount of monitoring that he was fine they still wanted to intervene because their own equipment was faulty. I was so so happy that instead of having to deal with an unnecessary episiotomy post birth I just had a couple of small stitches.

WriterofDreams - what would your reaction have been if it had gone wrong? Were you completely happy to take the risk yourself, or would it have been a case of blaming the professionals?

The natural survival rate of river herring eggs/fry is less than 1 %. Does this indicate that the river herring has departed from the intentions of Nature? Or simply that Nature doesn't give a toss about the survival of the individual?

We are better at having babies than river herrings- if we define success as all babies surviving- but there is no reason to believe that we are designed for 100 % successful births. Other mammals don't get that. If we want to approximate that goal, then there is probably no other way than departing from Mother Nature. How far we should be departing is, of course, a different matter.

But I always find it silly when people say "Nature designed us to do this". No, Nature didn't. Nature "designed" us for enough individuals in every generation to survive long enough to reproduce.

cory, I admire your common sense and rational thinking. I think the emotive appeal of the words 'nature' and 'natural' is often an excuse for mystifying a subject, or building a Utopian scenario. Also, great introduction of river herring into a thread. :)

Do you think those figures include all medicalised births, so all inductions of any kind also probably anyone that was on a drip to increase the contractions and maybe even people who had drugs like diamorphine.

If this was the case then I would appear in this statistic I have a serious blood conditon but with a managed labour all 3 times with the drip , gas and air and later diamorphine all planned and wanted I had 3 natural deliveries .

I didn't have any ventouse or forceps so not instrumental deliveries but definitley medicalised through necessity.
it all depends what their definition of intervention is

We don't have birthing centres where I live - the hospital is a "women's hospital" and is mw led though.

Yes, I'm only looking at hospital birth stats (not deliberately but needed to know if hospital near my holiday did cs) as I HAVE to have a hospital birth due to CS with ID twins.

Cory, your post is possibly the best reasoned statement I have ever read on mn. I apologise in advance for plagiarising you for the rest of my days.

And a whole heap of guilt about failing as a woman and failing my DD have just gone flying out of the window. Thank you.

We have not been designed: we've evolved such that just enough of our offspring survive long enough to reproduce.

I agree with cory and would also point out that the obs and mws have a limited amount of information at their disposal. If every woman in labour starts with a baseline risk of disaster of (say) 1/5,000 then 10% of them start to show signs that things might be going wrong, and their personal risk has increased to 1/100, then that's probably the point when the medics would intervene, even though the risk is still pretty low in absolute terms.
What I'm saying is that lack of information and the very high stakes mean you have to perform an awful lot of interventions on w

Oops, pressed send too soon.
You have to perform an awful lot of interventions on women who would actually have been fine, in order to prevent one disaster. My CS and forceps delivery were probably strictly unneccessary, but I'm fine with that in the interests of risk reduction.

But we could do better, of course we could, and researchers are working on it all the time.