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...

No, my pp wasn't missed, I was in hospital for 7 weeks before dd2 was born. But they do get missed. My experience there is that it's the registrars and house officers who are obsessed with protocol etc because they are frightened of getting things wrong. The senior consultants are very sensible & prepared to discuss options. But unless you are 'high risk' it's difficult to see someone senior enough to have a sensible conversation with.

But tbh I'm a bit about this good pain/bad pain stuff. Pain is pain & people have different tolerances and choose to manage it in different ways. I don't think you should have to bear something which to you is unbearable, or even unpleasant, just because someone else tells you it's 'good'.

What really riles me that no-one would suggest to anyone other than a labouring woman that pain is 'good'. I think we (as a society) are in danger of fetishising birth.

Mnay of the antenatal interventions such as screening for placenta previa etc were not available when Leboyer was an obstercian and he was still an advocate of birth without interventions. I'd maintain that women in developped countries are fortunate that differnet birthing methods are available and we should stop bleating about how we're forced into sterile environments, CS and instrunmental deliveries. We do have choice it is up to us to exercise it, the medical professiona are there to guide.
This man is frankly deluded and expresess quite dangerous opinions, a crying baby at birth not natural? birth being akin to the greatest sexual experience a woman can have etc? Come on girls if sex was the equivalent in any way to birth, very few of us would be here!

" and we should stop bleating about how we're forced into sterile environments, CS and instrunmental deliveries"

What - even if they're avoidable and sometimes the result of substandard care? And cost the health service an absolute fortune, and in the case of c/s may be implicated in some cases of stillbirth in subsequent pregnancies? And finally draw resources away from women who have the greatest need for medical care during childbirth?

Are you kidding?

What is the value of these things if they make births more painful and more dangerous for women and babies and not safer?

In what other branch of medicine would you accept that it's ok to have high rates of avoidable surgery taking place that put people at risk of infections and more likely to end up in ICU? Jeez - and new mums at that!

"how can there be evidence of a reduction in cs in women who have a doula?"

Actually this reseach comes from a very wide range of sources and is considered reliable enough to form the evidence base for one of the very few recommendations made in the NICE guidelines on caesarean section: "Women should be informed that continuous support during labour from women with
or without training reduces the likelihood of CS".

NICE

If you look at the Cochrane review it gives more detail on the research on continuous support in labour:

"The review of studies included 21 trials, from 15 countries, involving more than 15,000 women in a wide range of settings and circumstances.

"Women who received continuous labour support were more likely to give birth 'spontaneously', i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. Their babies were less likely to have low 5-minute Apgar Scores. No adverse effects were identified. We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial. Support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience."

And I think many of the studies were done in hospitals where women were randomly chosen for this type of birth support - ie, these were not women who had bought their doula's in with them.

"a crying baby at birth not natural?"

It was traditional in the past to hang babies upside down from their feet and strike them to make them cry at birth - to clear their lungs. It also used to be standard practice to separate mothers and babies at birth, to put drops into babies' eyes and to remove all the vernix from them by washing them with soap. Thank god for Leboyer - probably more than any other doctor this century his views have made birth more humane by drawing our attention to the fact that like any other mammal, human babies need gentle handling and to be with their mothers as much as possible at birth.

"What really riles me that no-one would suggest to anyone other than a labouring woman that pain is 'good'".

But pain in labour isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's body - responding to it can help her get her baby born. Have you not heard of the concept of 'pain with a purpose' in labour?

And on a personal note - I found experiencing extreme pain during my three labours was enriching for me. I've never been pushed to that extent before and come out smiling. Going through my labours was an emotional adventure and gave me confidence in myself and deepened my relationship with my husband - not just because we were having our baby, but because it was the first time in our life together that I felt entirely vulnerable and broken down. I needed him in a way I hadn't before and haven't since, and he was fantastic. I was on a MASSIVE hormonal high after giving birth - particularly after my third labour which was very long. You don't get that high without a shed-load of endorphins, and you don't get the endorphins without the pain. Those feelings of ecstasy will stay with me forever - it definitely enhanced the brilliance and meaningfulness of those first few days with my second and third baby. I didn't have it with my first, as I had an epidural. Yes, it was still beautiful to have her in my arms, but I now know I missed out on the intense euphoria that comes iwth a body full of endorphins, that would have made that first day or so even more special.......

NO one is suggesting a natural birth where possible isn't a good thing. What I do disagree with is the notion that the medical profesion deliberatley instrumentalise and medicalise birth uneccessarily. Good for you if you found the pain enriching, many don't! No one forces an epidural on women, it would be assault. And it's absolutely possibly to get the endorphins without pain, oxytocin is generated by the skin to skin contact of your child so to suggest women who don't expereince this pain (and I'm sorry if you didn't Spudulika) don't get this is insulting.
Yes some medical practices in this country have been historically misguided such as seperation from the mother - we have come on leaps and bounds since. No one is saying a westernised birth is the perfect experience and non interventional births are undoubtedly quicker and less traumatic for both mother and baby however Leboyer seems to be sugesting that intervention is given as a matter of course. I don't believe this, I do believe that although his views about careful handling, closeness to the mother after birth are true that his other views about how the expereince of birth "should be for women" and his complete anti-interventionalist stance are misguided.

Gosh I'm spending way to much time on this thread! I need to prepare for my much anticipated completely interventionist birth by ELCS next week! I'm pretty certain that after the traumatic experience of my 1st birth I won't be short on endorphins when I meet my daughter. It's been interesting.
Ciao x

It's too annoying to comment anymore than to say it is every woman's right to birth, within reason, how she likes. It is not her right to have a homebirth when there is any risk to the baby.

Boogie....Have you planned your music? Got flannels in prep for the terrible itchig when your skin comes alive again? and vasleine for your nose? I always found myself sooooooooo itchy.

Re "pain with purpose" - pain's usual purpose is to tell you that something is wrong.

For example. when my kidneys hurt like buggery, it was very purposefully telling me to get myself into hospital asap. So it's good that they hurt, so I could get some intervention (including prophylactic steroids for my baby's lungs, but thankfully the infection didn't start labour). But whilst the pain had done its purpose to warn me of a serious state, it didn't make me enjoy it.

Neither did I ever enjoy contractions, I vividly remember when I had them with my first child shouting that I wanted them to stop,whilst stupidly having been too scared of the 'chain of intervention' to allow painkillers. I could have saved myself a lot of unneccessary pain there (and purposeless pain at that, she was never coming out that way)

CrapolaDeVille
"It's too annoying to comment anymore than to say it is every woman's right to birth, within reason, how she likes. It is not her right to have a homebirth when there is any risk to the baby."

Yes - it is every woman's right to birth, within reason, how she likes.

However, the one absolute in birth is that there is risk - to the mother and to the baby. The risks of being at home are different to the risks of being in hospital, so trying to compare the two directly is extremely hard if not impossible. Being in hospital will mitigate some of the risks of being at home - but it will increase others.

As is probably clear, I'm quite pro home birth - but I'm more pro informed choice. There are circumstances where, IMO, it would be foolhardy for a woman to choose a homebirth - but there are man instances where the NHS would advise against it but, IMO again, going against that advice may be the right thing to do for an individual woman.

Boogiemumma
"We do have choice it is up to us to exercise it, the medical professiona are there to guide."
That's true - but too many medical professionals seem to "guide" by dictating to women how things are going to be. That is not an environment that facilitates women being active participants, even if they don't want to be the leaders, in the decision making process.

I've experienced it first hand. I know that the consultants have no legal authority to dictate my care - but the two I was seeing were quite dictatorial and wouldn't let me get a word in edge wise such that a discussion was impossible, and I got so frustrated I was almost in tears. Which is a shame, as I now feel like it will be hard to involve them in a decision (which I'm sure they would contribute valuable information to) as they do not respect that its my decision to make.

I have had five c sections....I am pretty much pro alive baby and mother.

But pain in labour isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's body - responding to it can help her get her baby born. Have you not heard of the concept of 'pain with a purpose' in labour?

But pain with toothacher isn't intrinsically harmful, and actually can be a useful indicator of what's going on in the mum's mouth - responding to it can help her get the treatment she needs. Have you not heard of the concept of 'pain with a purpose?

Personlly think why the hell should you hence both mine were ELCS which was fantastic each time. Each to their own.

Endorphins and oxytocin are two different things. Like it or not women who have unmedicated vaginal births will have massively higher levels of both post birth than women who have c/s. Doesn't mean you'll love your baby any less, but it does mean you are likely to feel different.

I also agree that medics and midwives are usually keen forwomen to have a straightforward birth if possible. Our very high rates of intervention are not the fault of individuals but have grown from a risk averse culture and a protocol driven and underfunded healthcare system.

I also agree with the sentiment 'each to their own'. Some people will prioritise control and pain relief. I was more concerned getting through the birth with my abdomen and perineum intact. And of course we're all primarily focused on the well-being of our babies so that's one thing which unites us.

You can get a body full of endorphins by running a marathon spudulika but most of us still aren't going to do it. It's great that you enjoyed your labours. I had an unspeakably dreadful time. Your version was more pleasant for you, but it wasn't intrinsically more 'right' than mine & I resent the implication (more Leboyer's than yours) that the manner of dd2's birth has had a negative impact on my relationship with her, in fact I love her all the more for what we went through together.

I think the problem is that when someone has a wonderful experience they feel (rightly) that they want to share it. But just because it was wonderful for you doesn't mean that it wouldn't be horrifically terrifying & unbearable for someone else. People might read & understand & take into account all of the research you quote & still take the completely legitimate decision to have an epidural or an elcs. What we all object to I think is pressure of any kind being put on women to take decisions they are not happy with.

There is no good birth or bad birth. We all feel differently about our births, we may have positive or negative feelings about it, but we should never feel ashamed (I can't bear it when I hear women say "unfortunately I had to have a c-section") every experience is equally legitimate.

Sorry x-posts.

Ina May stats have bias, simply becasue the women who see her are super-keen to have a VB.,the centre has a much higher ratio of midwives:mothers, and the midwives are super-skilled at VBs. (yes, this should be the norm)

I'd like to see her birth injury stats.

Both Ina May and the intervention-free loon are paternalistic. If I went to them, professing my love of CSs, they would be hellbent on persuading me to have a VB, probably being dishonest about the risks. They would do their best to remove my CHOICE.

"Ina May stats have bias, simply becasue the women who see her are super-keen to have a VB.,the centre has a much higher ratio of midwives:mothers, and the midwives are super-skilled at VBs"

You've made me laugh Highlander.

You are absolutely right - the good outcomes at this particular birth centre probably are largely down to highly skilled midwifery and one to one care. No 'bias' there!

But it's also true that the attitude of the women she looks after probably does make a difference as they're very motivated to avoid having epidurals - more so than the majority of mothers going to ordinary birth centres I should think.

"Both Ina May and the intervention-free loon are paternalistic. If I went to them, professing my love of CSs, they would be hellbent on persuading me to have a VB, probably being dishonest about the risks. They would do their best to remove my CHOICE."

Have you read any of her books? I'm wondering where you get the idea from that she promotes bullying of women when it comes to birth choices, because I've read all of her books and I don't get that impression AT ALL. And actually, far from being a 'loon' she's a highly respected midwife who, as a speaker packs out midwifery conferences around the world. Her books are on every student midwife's reading list and she's one of the few midwives to have had an obstetric manouvre named after her.....

Re: birth injury stats - vastly more mothers who deliver at The Farm give birth over an intact perineum than is the norm in the US (or for that matter here). Their rates of 3rd and 4 degree tears compare very favourably too.

"You can get a body full of endorphins by running a marathon spudulika but most of us still aren't going to do it."

Not sure what point you're making here.

"It's great that you enjoyed your labours."

No -'enjoy' is the wrong word. I found my labours very, very, very painful and at times frightening. I experienced a lot of nausea, pain in my bowel and back-ache throughout labour. Two of my labours were over 24 hours long. During my third I got stuck at 8 cm for 12 hours, which was deeply unpleasant. However, I did have very, very good care in my second and third from my friend and colleague, who is an independent midwife. It made a very difficult experience bearable.

" but it wasn't intrinsically more 'right' than mine"

Not sure what you mean by 'right'. I don't think I've made any claims for having a 'more correct' labour than you have I?

"& I resent the implication (more Leboyer's than yours) that the manner of dd2's birth has had a negative impact on my relationship with her, in fact I love her all the more for what we went through together"

Ok. I'm happy to admit that the first 48 hours with my dd, who was born after a difficult forceps/epidural birth WERE affected by the birth we had - it affected the way I felt within myself and impacted on our experience of breastfeeding. I think I had to work harder to fall in love with her than with my other two, where I was swimming in a sort of hormonal soup of love and bliss for the first few days. It makes sense to me that disrupting the normal hormonal physiology of labour might impact on the very delicate endocrine mechanisms that are at play in early mother/baby interactions. Is this implying that women who have epidurals/c/s don't love their babies as much or don't bond with them as well? That's not the way I see it. I just see it as part of a package of incidental things that can affect our experience of life with our new baby, along with postnatal illness, poor postnatal care, problems with feeding. These things don't stop us loving our babies but they might impact subtly on our experience of motherhood in the first few weeks of life. After all - we are mammals, and we (to a certain extent) give birth like mammals. We know that there are many things which happen around the time of birth which can profoundly disrupt the relationship between mother and newborn in the animal world. Why should we of all mammals be the only ones who're entirely immune to these disruptions?

"People might read & understand & take into account all of the research you quote & still take the completely legitimate decision to have an epidural or an elcs"

Yes - that's true. I understood and took into account all the possible drawbacks and risks of opting for a homebirth when I had risk factors that made a homebirth on the NHS almost impossible to arrange. I very much accept women's right to make their own INFORMED choice when it comes to childbirth, given my own experience in this area.

"the two I was seeing were quite dictatorial and wouldn't let me get a word in edge wise such that a discussion was impossible, and I got so frustrated I was almost in tears. Which is a shame, as I now feel like it will be hard to involve them in a decision (which I'm sure they would contribute valuable information to) as they do not respect that its my decision to make."

Same here. In my case, I've gotten so many contradictory answers and false information pushed on me that I don't know who to trust anymore. So I've turned back to trusting myself. Sad because, like you, I'd appreciate the knowledge of an unbiased professional but no longer believe I can get that.

What I have learned is the gap between what they say and what they do is directly related to the difference between perceived and real risk. Every single time I was told "you'll bleed to death if you go into labour" I asked "so if that risk is so high, why don't you just admit me right now then?" only to get a blank look and a sheepish shake of the head. They are used to spouting hyperbole and being believed because of their position of authority.

But pushed to carry through with what they say, the ones I've dealt with will back down -- and the ones that don't are the only ones I would take seriously now. The day that someone looks me right in the eye and calls MY bluff is the day that I defer to that judgement. But I suspect a lot of women would just believe most of what they're told at face value and do what the good doctors want. Conflict with authority figures is difficult for many people and they go out of their way to avoid it. That's how we're raised in our society, that's how the medical system is set up, and surprise surprise that's how things turn out for better or worse.

Glad that the people who have chosen c-sections or pain relief or homebirths or any of the other many options available to us and I repeat, I believe we are fortunate to have so many choices, to suit every women's individual situation are happy with their decisions. It's just too bad that getting informed enough to make those choices has to be so difficult sometimes.

I just think that people should stop being defensive.
I had a grim time twice in hospital, I was too high a risk to have any kind of homebirth, birth centre, or even birthing pool in hospital. I was induced twice, incredibly painful, horrible midwife the second time fell out with her so ended up basically labouring alone until the last moment when the vile cow caught dd and sorted her out. Neither of us spoke to each other again. It was horrible to have so much anatagonism and lack of support during labout.
Imo this woman should never have been employed as a mw. But what can you do?
Luckily the rest of the staff were fantastic.
But hospital is a grim, uncomfortable unpleasant place to labour in my experience. i'm sure there are loads of exceptions but that's how I found it.
I know several women who have had homebirths and they never talk much about the pain.. That is interesting isn't it?

"I believe we are fortunate to have so many choices, to suit every women's individual situation"

Do you really think that most don't want to know the midwife who'll be delivering their baby? And don't care if they don't get one to one care?

I don't think we have a lot of choices. I think most people take what they're given.

My choice would have been to see the same midwife throughout my pregnancy and to have had her deliver my baby. I wanted a homebirth. I wanted intensive support with breastfeeding - not just 2 half hour visits in the first week from someone who may have had little expertise in this area, and then nothing afterwards.

None of this was available to me, so I went out and paid for a private midwife instead.

This is a really interesting debate

I'm due imminently with dc5 and for the first time am experiencing a homebirth, and a mw who has done my ant-natal care, will be there for the birth (unless I have to transfer) and do my postnatal care. This is an Nhs midwife, and just luck of the draw. (She told me that her community mw colleagues moan that she gets to do more homebirths than them, and their supervisor says "that's because she's signed a contract to be there at her own women's births, and her women love the thought of getting a mw they know rather than a stranger, so more choose hb.")

I'm very interested to experience the difference between the hospitalised (bad in some cases highly medicalised) births I've had in the past, and this one at home. I haven't had a problem bonding with any of my babies, but I did have severe pnd after my 1st, whose birth had been very traumatic, and I think I had PTSD, looking back.

I wanted a homebirth with dc4, and was talked into hospital by consultant. Dc4 caught a hospital acquired infection from our overnight stay, and was in the children's hospital for 2 weeks after that. It really brought home tome that there are risks at hospital as well as at home.

Good luck with your homebirth Checkmate. Hope all goes smoothly! It's great knowing who's going to be with you at the birth isn't it? For me this was the main thing in helping me relax and to prepare for labour. Bet your midwife loves her job!

Can I first say that I totally agree with everyone about the difficulties of challenging people in authority. I always advise people to insist on answers to their questions, & to keep going up the chain until they will find someone who talks to them straight. But it's not easy. All choices should be fully informed.

spudulika
My point about the marathon was a bit flippant, it's just that the appeal of a fabulous rush of endorphins isn't enough to make most of us run a marathon, it's probably not enough to encourage many women to have an intervention free labour & go through what you describe in your post.

On the subject of 'right'ness, Leboyer clearly states that the only 'right' way to have a baby is intervention-free. He actually told Jane Garvey that she felt guilt over her c-sections. Of course he meant that she should feel guilt. I'll say it again, misogynist. She did well not to expel him from the studio with a swift boot up the bum. I'm sorry if I wrongly associated you with this opinion.

I think Leboyer & others send the message that if you go through labour 'properly' you are rewarded by a unique experience and a better relationship with your child. It's like a reward for your achievement.

But birth isn't an achievement. Birth is something that happens at the end of a pregnancy, your body will deliver your child whether you want it to or not and whatever the health implications for you or the baby. With good support and information and the chance to make good choices you can manage this process well and make it an occasion to look back on with joy. Believe me, I wish nothing less than this for every pregnant woman. But the truth of the matter is that even with good advice, support and information things might not go to plan and you might end up with a whole lot of interventions that you didn't want in the first place. But this is not because you didn't do it 'right' and your relationship with your baby is not doomed because of it.

I don't quite get this point about endorphins. If mws gave all mothers a shot after the birth which sent them high as a kite would that be a good thing? It's your hormones that send you crashing down at day 3 or 4 too, that's not something that many people rejoice in. Many people, regardless of the manner of the birth struggle to bond with their babies. This is because of another pernicious lie, that you will automatically, instantaneously fall in love with your child. You might, you might think you do because you are high as a kite on endorphins, but in reality it's a relationship like any other, built on time and patience and shared experiences.

Anyway, this is a truly epic post. I really honestly do understand where you are coming fromspudulika and I really wish that every woman had the option of a birth like you advocate and a genuine chance to explore all the options available. But Leboyer and his ilk turn it into a discussion about the right and wrong way to give birth and I utterly totally object to that.

QueenCeleste what I really want to know, is was Babar a good birth partner?

"she's one of the few midwives to have had an obstetric manouvre named after her..... "

She's named it herself after herself after learning it from somebody else. Also, from what I understand it's very hyped, however actually not used as much nor more successful in comparison to McRoberts.

Maybe - doesn't change the fact that she's generally seen as an inspiration and a highly principled person by midwives and bythose of us who have actually read her works.

It makes me that there are people out there who are so keen to demonise her and other natural childbirth pioneers, without having read her work or knowing very much about her.