Frederick Leboyer on Woman's hour today on childbirth without intervention

[queenceleste]

listen again here.

Amazing considering he's a man, he was one of the first promoters of waterbirth.

Jane Garvey obviously totally disagrees with him but it's all in her tone...

Spudulica, I have read your posts before and appreciate your passion as it shows to me that you care but if I'm honest I find your tone slightly patronising.
Fair enough, as long as you realise that the bargain you strike in opting for a hospital birth is: easier access to pain relief + greater likelihood of needing it.
Yes, I like to know it's there as an option, and when I had my first baby somebody had taken that away, I would have been rather angered.

My friend had a midwife in her homebirth that left her to go to the bathroom to refresh her makeup! I imagine she was a one off but why should I depend on such a random person? I have no more plans to give birth to anymore children after the one I'm expecting, so I want to avoid taking chances as much as possible.

As to your earlier question on whether I'm implying that women who give birth at home put theor babies at risk, I find it slightly inflammatory. The importnant thing is to judge on an individual level and listen to what the professionals are saying as well. If your ob or midwife advise you to give birth in hospital and you ignore them... then yes, maybe you are putting your baby at risk. Otherwise, if they say it's fine, home might be the best place.

I'm talking about MY experience and MY wishes, hopefully we will continue to have choice over the subject rather than put ourselves under danger or stress just to prove somebody else's idea of the perfect birth.

Yes, I like to know it's there as an option, and when I had my first baby IF somebody had taken that away, I would have been rather angered.

"Yes, I like to know it's there as an option, and when I had my first baby somebody had taken that away, I would have been rather angered."

Taken what away? The option of an epidural if you really need one? Gas and air? Both are available for a mum who books a homebirth, should she need them, though the first will require transfer. And of course booking a hospital birth is no guarantee of access to an epidural as a proportion of women who request an epidural won't get one because of inadequate anaesthetist cover on some labour wards.

"but why should I depend on such a random person?"

For the same reason you'd be depending on a random person in hospital! I know people who've had unassisted birth in hospital because the midwife has been off down the corridor caring for another mum. Actually it happens regularly in UK hospitals. Seriously - look at the facts. Women who have their babies in hospital are MUCH less likely to get one to one care from a midwife, and are much less likely to get continuous care from a single midwife. 80% of women who give birth in hospital don't know their midwife - have never seen her before. That's a massively higher percentage than among mums giving birth at home.

"My friend had a midwife in her homebirth that left her to go to the bathroom to refresh her makeup!"

Women who've had their babies at home usually find that it alters the whole dynamic of the relationship between them and their midwife, compared to the way things are in hospital. Most of what midwives do at home is simply watchful waiting. And many women don't want someone to sit there goggling at them.

I really can't understand why anyone would object to their midwife nipping off to freshen herself up at a homebirth, unless they were in the process of actually pushing their baby out or having complications which required her to keep close watch? My midwife slept across the end of my bed at times during my labour at home, which went on for two full days. She was tired. But I knew she was there for me if I needed her, and not with her hands up another woman in the room next door!

"I want to avoid taking chances as much as possible. "

With respect - it's slightly inflammatory to imply that opting for a homebirth is putting your baby at risk, and that's EXACTLY what you're doing here!

And of course things are different if you have medical complications in your pregnancy that put you at increased risk of needing a medical help.

I think the thing that I find difficult about these threads is that while it's fair to acknowledge that these things have to be decided on individual feeling and circumstance, there's also a lot of assumptions being made about what actually goes on in hospital or at home which aren't born out by the facts.

I guess my own experience of two high risk pregnancies (currently due in October) makes me feel quite grateful to the way the NHS has cared for me. For me, homebirth has never really been an option.

To be honest, I feel a lot less scared of the unknown with this second pregnancy, so feel very excited about what my plan is: a hospital waterbirth with gas and air. I feel confident in that choice and all the medical staff I have met so far have been very nice and attentive. If it goes wrong and the baby doesn't want to come out, I won't face a scary ride to the hospital. That's all.

Lucky for you that you have access to such a good hospital, and are low risk - and are therefore eligable for a waterbirth in a MLU.

My local hospital doesn't always provide good care and maybe that's one of the reasons I felt safer at home - despite being supposedly 'high risk' (I hate the 'high risk' label, the way it's applied generically - as though someone with a borderline high BMI is somehow in the same category as a morbidly obese diabetic with pre-eclampsia........ but that's the way the NHS works mostly - clumping women into categories and restricting their choices on grounds of protocol )

In the hospital I'm going to give birth in, i've been assured that I can have a water birth in the main hospital, ie not the MLU.

I guess it's down to our own experiences, I had (in a different hospital) a great labour but the ward afterwards was pretty ghastly... I think that's where you are let down, in the aftercare.
(I am under consultant care as I have hypothyroidism, no placenta worries in this pregnancy yay!)

I do hope you get the birth you want Spudulica, and that it's a positive experience as it makes such a difference to how one copes with all the surprises ahead. I really am not anti homebirth, I just know it's not for me.

Besides, in the country I'm from, it's unthinkable to have an opinion about tour birth, cesaereans are encouraged as they allow obs to manage their timetables nicely, breastfeeding is undermined and women in l abour are often treated like children.

So I appreciate the much more "natural" spirit here, and feel my voice is heard much more.

Apologies for misspelling your name Spudulika...

Back to the OP and the actual interview on R4. Frederick Leboyer says amongst other things that there is no place for fathers at the birth, mother and baby only. Midwife should be 'in the kitchen making the coffee'. The mother should be alone with no pain relief (pain relief prevents the mother from bonding with the baby). Childbirth is a womens greatest sexual experience and we shouldn't avoid risk but be brought close to death in child birth.

Just what I need to hear when I'm finally getting over the fact that I had two induced births and wasn't able to have my planned homebirth. All my fault for being too risk averse. And actually both the births were fine, second one without epidural so bloody painful, but it's never good enough.

I had 3 hospital births for varying reasons. First one was over-managed because I was totally passive and felt that somehow someone should make it ok. Which of course they couldn't/wouldn't totally. I ended with Lethe one and then episiotomy and difficulties establishing bring.

2nd and 3rd time I got on with it. I didn't need the mw tbh because there were no complications. But I can see how easy it would be to allow the medical people to take over and make a labour into an operation with or without the use if a scalpel and anaesthesia.

"I do hope you get the birth you want Spudulica"

Just a lurker metal - not pregnant! I did get the birth I wanted but I had to pay an independent midwife. Don't begrudge it though - it was worth every penny. I do begrudge the months of anxiety I experienced before I booked with her though........

"but it's never good enough."

If it was good enough for you, it's good enough!

I understand where Leboyer is coming from. He's looking at the role of instinct and the hormonal cascade of labour. He's singing from the same songsheet as Michel Odent really. I appreciate these radical voices - I think they enrich the debate surrounding childbirth.

I would love to see some good research done into men's presence at births - whether it impacts on outcomes. Don't see it would be possible to do it though.

Metalelephant, meant to say, I think the discussion of these issues here on mumsnet is GREAT - such a range of voices and experiences.

I find it hard to be objective about this because dd2 and I absolutely would have died left with no medical intervention. I had grade 4 placenta previa & therefore there was no other way out for her than cs & I then lost 7.5l of blood. We both ended up in intensive care. I find it difficult to consider myself and my daughter just unfortunate statistical outlayers. I didn't hear the whole interview but surely Leboyer doesn't think that women like me should be left to get on with it?

Also I think (inevitably) that all that stuff about not bonding is sh*t. I barely saw dd2 for 2 days & if he wants to come round and explain to me how my relationship with my daughter has suffered then I'd be pleased to hear him out kick his ass

(don't worry, I wouldn't really kick a 92-yr old's ass )

Couldn't agree more Spudulika, I have learned so much here, the discussions are priceless! Apologies for thinking you were pregnant by the way :)

"In a similar vein, quicker access to SCBU when you book a hospital birth goes hand in hand with the higher likelyhood that your baby will need special care (babies born at home are less likely to have low APGAR scores and to need to go to SCBU)."

Surely that is not because of the hospital birth, but because these babies have already been risked out from being born at home."

WidowWadman, when NICE reviewed that Chamberlain study they concluded that the hospital group in it was indeed higher risk than the home birth group. Sorry can't remember where i read that.

"I didn't hear the whole interview but surely Leboyer doesn't think that women like me should be left to get on with it?"

You'd hope not wouldn't you?

"when NICE reviewed that Chamberlain study they concluded that the hospital group in it was indeed higher risk than the home birth group"

They acknowledge this on the Homebirth UK site:

"There are probably other, unmeasurable subtle differences too. The home birth group had less incidence of high blood pressure between recruitment for the study, at 37 weeks, and the birth - which could be because midwife antenatal care was less stressful than hospital antenatal care, but could also be because women who developed high blood pressure before 37 weeks (and transferred their booking to the hospital) would not be included in the home birth group, but would possibly be included in the hospital group (although they would presumably still have to be considered low-risk, to be an appropriate matched pair)."

However, the most common birth injury noted in the study was bruising, which you would assume would be mostly down to the higher rates of assisted delivery in the hospital arm of the trial (which may well have something to do with epidural use). Babies born following assisted deliveries may well be more likely to be admitted to SCBU

Leboyer claims that "At a certain point of labour woman is experiencing death and because she?s been able to face death she becomes free from the fear of death."

Does that go for all facing-death experiences, or is it just labouring women who are supposed to get stronger from it? I wonder what Leboyer would have to say to my grandmother who was so traumatised by her homebirth in remote village with village midwife that she could never contemplate the idea of another pregnancy. I am sure she had every opportunity to face the thought of death without any worrying pain relief or medical back-up getting in the way. Shame it didn't make her feel any stronger. But hey, what right had she to decide on her own feelings like that without consulting the Men Who Know?

Leboyer annoys me in the same way that I feel annoyed by same male consultant preaching the benefits of a medicalised birth: it's a male expert telling me what I should be wanting and feeling as a woman in a situation he has never been in and never can be in, telling me whether I should want my partner present or not, telling me what I should be concentrating on- because of course poor fluffy-headed little women can't be trusted to develop their own opinion on anything.

Yes, speaking as someone who faced death whilst giving birth, it ain't all it's cracked up to be.

My point is that some women are always going to need medical intervention. People like Leboyer delegitimise that sort of birth experience & in doing so devalue women's real experiences and also manage to imply that their relationships with their children are damaged. I think it's pretty misogynist tbh.

I am absolutely pro home birth, I really wanted one for myself & many of my friends have had them. However I think sometimes we are in danger of forgetting that there is genuine & real pain & danger associated with birth, and IMO women have the right to manage those risks in whatever way they choose.

Agree with TheFowlandThePussyCat
It could be easy to forget where healthcare is so readily available that we in the developped worls are fortunate to have these interventions and they are imo not used without due cause - they are costly and of no benefit to mother or baby if used uneccessarily.
As an example, mothers in developping countries in Africa have a 1:16 chance of dying in childbirth compared to 1:4000 in any developed country. A large proportion of these deaths are related to complications in childbirth such as haemorrhage, infection and obstructed labour. Tell these African women that they aren't "relaxed" enough. Add to this an infant mortality rate of up to 1:10 in these countries and "natural" birth appears to be a quite a risky business.

I agree with Fowlandthepussycat, it sounds all rather misogynist to me.

Out of interest, is there actually any sound supporting evidence to the validity of Leboyer's theories?

I am all for providing better access to homebirths/relaxed birth/labouring-women-in-control births.

But a 70yo bloke telling me that I have to eschew pain relief so I can have a great sexual experience and be close to death- how is that putting the woman in control of her birth?

First, I'd like to know how often he goes out and courts pain and near-death experiences just for the sake of it.

Secondly, if he thinks this is the greatest sexual experience of a woman's life, I'd wonder what he's like in bed.

We had a bloke like this in atante-natal class, talking loudly about how women didn't need pain relief because it was a natural process. His wife looked pale but didn't get a word in edgewise. Didn't look very empowering to me.

It strikes me that the reason I was so anxious to have dh present when I gave birth was that he is not in any way like Leboyer.

Natural birth certainly is a risky business for impoverished and malnourished women who have had no antenatal screening for conditions like placenta praevia; may have severe anaemia related to malarial infection; have had their external genitalia removed and their vagina sewn up with a dirty thread or thorns; may be 13 and only barely embarked on puberty, or be 35 and expecting their tenth child. Poverty, pre existing illness and lack of basic midwifery care is what's mostly behind the shameful figures for maternal deaths in these countries, not the intrinsic risks of normal childbirth, which are very low among populations of healthy women in receipt of basic midwifery care in pregnancy and around the time of birth.

The only supporting evidence is a very clear reduction in c/s rates for mums who have doulas at the birth. Assume most women who have a doula also ha e their dh's present too though.

Spudulika, how can there be evidence of a reduction in cs in women who have a doula? It's impossible to know whether these women would have had a cs or not, surely? And same as my point re Ina May, there has to be an element of self selection for the women choosing to deliver with doulas - if a woman has had a high risk, highly medicated pregnancy, she's unlikely to step away from the same medic's advice and chose a doula. I suspect that women choosing doulas are much more likely to be confident in their bodies anyway, and having a high risk pregnancy sadly erodes that confidence.
(not being deliberately picky BTW, am finding this thread v interesting!)

Cory, I love your posts. And I agree with TheFowl. Reducing women to a bunch of hormones, and then dictating to them what their experience of birth should be on that basis is very disempowering, and misogynist. His tone is very dictatorial, and, like all strong advocates of ANY kind of birth (someone else has drawn a comparison with consultants pushing very medicalised births), his message is ultimately about restricting choice in birth.

[disclaimer - this doesn't mean I am anti-homebirth, and I think learning about the physical and physiological processes of pregnancy and birth is very useful. But I think that behind Leboyer's comments are a whole host of assumptions about a woman's role and status. If you buy into those, then fine, you'll probably find what he says palatable. I don't.]

TheFowl was your placenta previa missed or misdiagnosed? Because from all I've read, grade 4 (covering the cervix) is one of the very definite conditions requiring a c-section and in fact was the cause of mortality of the woman in childbirth for many years. Mine is grade 1/2 but if it had been grade 3/4 I would not have hesitated to go for an ELCS even though what I really want is a homebirth. I could not have justified the risk of bleeding.

In my mind, something like grade 4 PP is exactly WHY we need medical intervention! And why I'm thankful it's available to us though obviously we all hope we'd never need it.

Back to the OP, having just read Juju Sundin's book where she hammers home the idea that labour pain isn't "bad" pain like from a toothache or kidney infection, I can understand the theory of where Leboyer is coming from. It does seem at times that our society acts as if childbirth is by definition something to be controlled and monitored like it's something WRONG and unnatural (and metalelephant's post above about how her country treats women in childbirth sheds some light on that).

The biggest problem I see with the current attitude of the medical community as experienced by me with the NHS is that it's very hard to know whether you're being told something is a real risk, or an intervention is really necessary FOR YOU, or whether whatever they are saying is based on policy or protocol and you're lumped into a statistical group, as spudulika said.

Good thread btw.