Should we have lied to newly preggy friend about what birth was like? Is it wrong to join the conspiracy?

[Ushy]

Think I have an ethical dilemma

Five of us went for an evening out with newly preggy friend. When it came to discussion of what the birth was like the ONLY one of us who had had an uncomplicated birth went on and on about how wonderful it was and what an overwhelmingly life changing experience and how she should have the baby at home and resist all the interventions etc etc....
The rest of us said nothing or muttered 'it was ok' because we did not want to scare her. We had all had horrific experiences of childbirth and the three of us that have had elective caesareans have all said, between ourselves, it was far better than the 'intervention free' birth.

We chatted about it afterwards. Do we conspire to lie? I now actually feel quite bad because I remember - after my first birth -thinking why didn't someone tell me how awful 'natural' birth could be? I would have insisted on an early epidural and got DH to drag the doctor in to do a caesarean much earlier.

Somehow I feel I have been seduced into a conspiracy and I feel incredibly bad about it. She's a good friend, asked us a straight question and we lied.

Anyone else had this dilemma?

Spudulika You said "Pain relief used in labour has risks and side effects, therefore it cannot be true that there is no rationale or reward for going without. I chose to not have it in two of my three labours and felt amply 'rewarded' for this choice - physically, spiritually and emotionally.
Labour is (usually) fucking agonising but the women who come out happiest tend to be those who choose to labour in environments where epidurals are not available. Go figure! Pain is not the be all and end all when it comes to childbirth."

But Spud PAIN is a massive issue for a lot of us even if not for you. Its what made labour so awful. I have heard people say that having the right support makes all the difference. Really? At that level of pain the only thing in my book that would make any difference would be a general anaesthetic.

I can see where you are coming from based on what mattered to you but different things matter to different people and this is what makes it so difficult to answer when people ask what birth is like.

I've heard this before but I don't believe there is a conspiracy of silence about the pain of childbirth. Surely no sane woman thinks it's going to be a petal-strewn frolic in the meadows? The one thing everyone knows about it is that it hurts like fuck. "In sorrow shalt though bring forth children", etc. During my first pregnancy horror stories abounded in every direction and as the big day approached I was increasingly terrified, especially when it turned out I was going to be induced. Abject terror = not best frame of mind for pushing out a baby. If I'd heard some more stories like your friend's, I might have been a little less frightened...but luckily it wasn't nearly as bad as I'd feared, and it wasn't the second time either.

Well, being frightened raises adrenaline levels which interfere with the hormone levels that help women deal with the pain in labour so I don't think it's helpful to frighten pregnant women. The best thing I think is to advise women to do their own research and decide what matters most to them and what they think might help them during labour. I decided that the benefits of avoiding pain relief other than gas and air were so great that I wanted to try to manage. As it turned out, I did find the pain manageable which is partly luck and (I think) partly due to being very relaxed due to using hypnotherapy in the run up. But I also had two birth plans, one all about the music and clary sage and natural 3rd stage for my home birth and another for if I needed a hospital transfer.

I tried to be prepared both for the fact that for many women childbirth is a natural and relatively simple process, but also for the fact that for some people it isn't that simple and they need medical support. I was lucky and was one of the women for whom it was relatively easy. The one thing I really don't think helps is telling people it is unbearably painful, because a lot of dealing with the pain can be helped with preparation and support. Other interventions often can't be helped, so everyone needs to be prepared for that possibility.

MainlyMaynie I totally agree that it is not good to tell people that labour is unbearably painful but I am uneasy about saying that you can deal with pain better if you are prepared for it.

My friends and myself all had significant childbirth injuries - 3rd/4th degree tears, significant bruising and some subsequent incontinence. I know we are all older mums so I am not saying that is typical but this was not severe pain that we were imagining. I looked in the mirror at my own particular injuries (once!) and it made me throw up - it looked like a blast injury. Would being prepared have helped me deal with this better and made it less painful? I just don't believe it would.

The only thing that would have been helpful was the reassurance that effective analgesia would be available. And the problem is, in the NHS. it isn't.
In maternity in the NHS, it seems to be accepted that women can be left in appalling pain and their requests for pain relief ignored because well..that's childbirth! But isn't there an equality issue here that we shouldn't tolerate? Would men be treated like this? If men had babies, pain relief in childbirth would have had a research priority that would have left the space shuttle budget look like pocket money

I have used both the private sector and the NHS and there are not issues with pain relief in the private sector. You ask for it, you get it. My hunch is to say 'don't use the NHS' but somehow that doesn't feel right either.

"But Spud PAIN is a massive issue for a lot of us even if not for you. Its what made labour so awful."

Yes - I agree that pain is a big issue for people. I was scared too. But I knew the pain wouldn't kill me and felt that there was something to be gained by going through it, for me and for my baby.

"I have heard people say that having the right support makes all the difference".

I felt this to be the case. I had a friend and colleague as my midwife. Can't explain why it helped, it just did.

"I can see where you are coming from based on what mattered to you"

Actually my beliefs don't just arise from my own experiences. There's also research showing that women who opt to birth in environments where pain relief is limited are more likely to have a satisfying birth experience, compared to similar women who birth in CLU's.

"I think that's a bit of a generalisation."

Yes - it was a generalisation. I thought I made that clear by using the word 'tend' in "women who come out happiest tend to be those who choose to labour". I agree that this is not true for some.

"It's great that you managed without & perhaps if I have another baby I'll have a 2-hour labour and will do the same,"

" I think it's better in that situation to gently lower expectations rather than say 'I did it this way and that's best'."

Nobody was saying that anyone 'should' or 'shouldn't' do it any particular thing, least of all me. Or the op, or anyone really. Although these threads inevitably throw up lots of comments along the lines of 'take all the drugs on offer', which tend to be tolerated vastly better than comments along the lines of 'don't take the drugs' would be.

"Well, being frightened raises adrenaline levels which interfere with the hormone levels that help women deal with the pain in labour so I don't think it's helpful to frighten pregnant women."

Good point!

"In maternity in the NHS, it seems to be accepted that women can be left in appalling pain and their requests for pain relief ignored because well..that's childbirth!"

Most women who request pain relief get it, even in the NHS. If there were vastly more anaesthetists and midwives I'm sure fewer women would be left without the pain relief they request, and I'm all for this. I hate the thought of women asking for help and not getting it.

Spud not sure if you were talking to littlewheel or me but I don't think anyone is suggesting there is anything wrong with not having pain relief if you don't want it.

The NHS is NOT good with pain relief. I looked up the Department of Health's own survey which showed only 65% of women 'definitely' got the pain relief they wanted, the remainder either did not or only got it to some extent. That usually means they were asking for an epidural for ages before the anaesthetist arrived by which time it would be less likely to work as late epidurals fail more often. 35% of women is over 200,000 each year (I think there are over 650,000 births in uk). Having a 1 in 3 chance of not getting the pain relief you want for something that can be traumatisingly painful isn't good enough.

So you can't even be reassuring and say well 'It can be quite painful but if it gets too bad ask for an epidural"

I feel the only reassuring and honest thing to say is don't use the NHS if you can afford not to.

Ushy, I think you are unusual as a group of friends to have all had such serious birth injuries. They don't happen to the majority of women. I had read lots of that sort of story and at the start of pregnancy was really worried about the prospect of tearing and incontinence. I did end up with a second degree tear, didn't feel it at the time and couldn't find the stitches with a mirror when I looked. I know that was lucky, but that is actually a more usual experience and I didn't need extra pain relief. My experiences of the NHS were fantastic, but I am not judging on the availability of pain relief. I had a safe and relaxed birth with both me and the baby healthy, I couldn't have asked for more.

I actually don't think anything anyone tells you can prepare you for what the reality of your own birth will be, because they're all so different.

MainlyMaynie "Ushy, I think you are unusual as a group of friends to have all had such serious birth injuries."

I do think you are right about that but I also think we are all older mums (uni/career/more career/ even more career/partner/baby) and that's a factor. Actually preggy friend is late thirties.

I shall probably get someone posting who will tell me they had a perfect water birth of a 15lb baby at the age of 48 now

I'd have told her the truth. Everyone I know seems to have had really uncomplicated births which makes me feel like a bit of a freak. It would be nice to have known beforehand that encountering problems and damage wouldn't be the end of the world.

Good job this isn't AIBU though, otherwise I'd be telling you YABU for using the word 'preggy'

mainlymaynie "I actually don't think anything anyone tells you can prepare you for what the reality of your own birth will be, because they're all so different."

Absolutely. I've never heard two birth stories the same. You just don't know what will happen.

"I looked up the Department of Health's own survey which showed only 65% of women 'definitely' got the pain relief they wanted, the remainder either did not or only got it to some extent."

Ushy - if you're talking about the information from the survey the Healthcare Commission carried out a few years ago, the question put to women was:During your labour and birth, "did you feel you got the pain relief you wanted". It's not clear to me (I can't find any more information about this study) whether women didn't get the pain relief requested or whether they didn't get the pain relief they wanted - two different things. Remember that more women opt for pethidine/opioids in the uk than have epidurals. The research I have seen shows that pethidine and opioids are not effective as pain relief for a fairly large minority of women that use them. And of course epidurals aren't fully effective for 1 in 10 women who opt for them. In other words the question might have flagged up more than the simple availability of epidurals.

"I feel the only reassuring and honest thing to say is don't use the NHS if you can afford not to."

Have to say - I'm with you on this one. Unless you live in an area which does case-loading and has first rate maternity services.

I always encourage friends to consider an independent midwife, as their outcomes (for low risk women) tend to be pretty good. If I know someone REALLY wants to get through birth with their perineum and abdomen intact then I urge them to consider this option.

If they're more concerned about good pain relief than they are about having an emergency c/s or sustaining perineal damage then they'd be better off with a private obstetrician.

I had what I consider to be an extremely positive experience. I think I would probably describe it as a 'beautiful birth'.

It took days, hurt like a bastard and involved classic cascade of intervention and loads of tearing.

I think that I agree with Zoe Williams, who was describing that Terry Pratchett TV programme where they went to Dignitas to film an assisted suicide:

"When people talk about a "peaceful death", they mean it in the same way as "beautiful birth", with the proviso that you already understand how incredibly fucking painful it's going to be, whether you're going hence or coming hither."

I think the most useful description a friend gave me of birth was quite good about describing the nuts and bolts. She said things like 'You'll probably be able to talk all the way through, but you can't talk when you're having a contraction' and 'You'll be like this at the end [mimes someone gasping and shaking]'. She also said 'Push like you're doing a poo' (TOP ADVICE!) and 'Hit the gas and air as hard as you can when they are stitching you up' (ditto). Good, practical, straightforward, unpanicked, honest advice, really.

I wanted to know all the gory details so I was mentally prepared and when the contractions got really bad I was thinking 'Bring it on! I'm ready!!'

I'd also requested pain relief the minute I got through the door. I got my gas and air and pethidine BEFORE I was desperate for it. That made such a big difference to me.

I say forewarned is forearmed.

What can you do when someone thinks they can take the edge off with a nice smelling candle? Stamp on their foot and light some incence while they're hopping around and ask if it's helping :o

michelleseashell - heavy sedation for you and your baby as a strategy for getting through birth doesn't work well if you go on to have an unexpectedly long labour. As I found to my cost with my first.

Oh sorry to hear that spudulika.

Personally I think my labour would've been longer without them. They gave me the strength to stay upright and push a lot harder. Thinking back, I would've found it hard not to wear myself out by getting hysterical if I hadn't had them. As it happened it was all very calm and straight forward. I'd had strong opiates before though so I knew what to expect.

I'd not had them before and had a very bad reaction to them. I'd never recommend pethidine to anyone now. Horrible drug (although I appreciate some people find it helpful). Hate the thought of my pristine perfect new baby dd getting a big dose of what was little more than heroin on her first day of life.

Calling it heroin is a bit dramatic. I take co-codamol for back pain but I wouldn't say I was on heroin because a small percentage of it is metabolised into morphine in my liver.

I do think the OP's group seem to have suffered a lot more trauma than the average. Not sure what age has to do with it though! Does age increase your chances of tearing? In my nct group of 7, we ended up with 2 ECSs, one forceps with nasty trauma, one vontouse and 3 relatively straightforward births including my own. We were all late 30s, early 40s. I would think this spread of experiences more reflects the average than that of your own group. That's not to say your experiences were any less horrific just less the norm I would think.

So of that group, 4 out of the 5 of us who had a VB, rated it positively. Excrutiatingly painful, yes, but positive also. But then, from my pov, I felt as prespared as I could. I knew it was probably going to be the most painful thing I had ever experienced. I knew my dignity would go out the window so prepared DH for the poo and gore. I expected to tear and need stitches. Nothing really prepares you for it but I felt informed. But I also felt informed enough to drag my fat, exhuasted bum out for a 1hour walk every night in the middle of winter. Not to once slouch on the sofa from 7mths gone and to stay at home until they were 2mins apart and not get on the bed when I got there.

What I'm saying is that it's important to impart this information too. Tell woman not to cosy up on the sofa with hubbie and chocolate at 8mths gone. Get up and out for a cold, miserable walk. I had SPD too so in lots of physical pain but I knew slouching around being comfy and cosy at home would make labour longer and more painful. Even if you dont go out. Stop cosying up on the sofa, sit on a hard chair instead or a birthing ball. Tell your friend not to go to hospital when she feelsd a little pain, only when pain is very regular and unbearable. Tell her not to sit around in early labour but to get up and go for a long walk. All this stuff is just as important to know. Probably more so.

But it is heroin really isn't it? By a different name? It's a very strong synthetic opioid. No comparison with co codamol - we are talking about a powerful sedative, not over the counter pain relief!

Not really. In IUPAC terms, heroin is (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol diacetate while pethidine is Ethyl 1-methyl-4-phenylpiperidine-4-carboxylate, and the molecules look quite different. They are both opiates, obviously, but they work on different opioid receptors.

And codeine is an opioid as well, and one which works on the same opioid receptors as heroine/morphine. In many countries it isn't available over the counter, and it's completely illegal in Greece and not even available on prescription there.

I agree with posters who have said that it's hard to avoid stories about how terrible birth is!

I was relieved to read Spiritual Midwifery in all it's lentil weaving glory and see that it isn't always like that....and more importantly what I could do to maximise my chances of having an intervention free birth. I knew if I could follow that advice (the ususal avoid pain relief, keep mobile etc) any intervention I had would have been unavoidable.

There is a lot you can do to help yourself in labour. But sometimes your luck is just out and interventions are necessary (though as Spud says that doesn't have to mean it is a terrible experience)...I think that is the message I would try and get across.

One last thing in ref to a pp...I detest it when people say "there's no medal for suffering" etc. I avoided pain relief cause I wanted to minimise risks...not cause i wanted a fucking medal. It seems it's ok to have derogatory digs at women who want to labour without pain relief but not those that do. Same as Bf/ff...do what is right for your reasons...if you are measuring yourself by someone else's standard you need to question if you are making the right choice for you. If you know it is right for you you don't care what other people do.

No it isn't heroin. Heroin, morphine, opium, codeine, oxycodone, pethidine, methadone et al are all opiates but they each have different chemical compounds producing very different effects.

Pethidine is no more heroin by virtue of being in the opiate tree than a cat is a tiger.

Herd - that's a bit of disingenuous. In terms of how it's experienced by the user, pethidine isn't much different from heroin. It's a very powerful sedative and we'd never sanction its use on a healthy infant in any other circumstance. It's irrelevant whether codeine is an opioid as well because 1) it's not anywhere near as powerful as pethidine and 2) we don't sanction its use in large amounts for healthy children. Particularly not in the first hours of life when they're trying to establish respiration.

Moonface and others who mention Spiritual Midwifery - I so agree with you. It's such a helpful and inspiring book.

But I still come back to something which, for me, is the crux of the issue, which is that most birth environments and NHS protocols are hostile to normal birth.

"There is a lot you can do to help yourself in labour. But sometimes your luck is just out and interventions are necessary"

Yes - but is it the case that 2 out of 3 first time mums have 'lucked out' in labour - given that this is the proportion who will end up having forceps/ventouse/caesarean/episiotomy/induction?

It bothers me that women are so accepting of our high levels of intervention as 'normal' and 'unavoidable'.