Is there a casual and callous attitude towards pregnancy and childbirth in society?

[PeaceAndHope]

Hello everyone:)

I'm sorry if I have posted my question in the wrong section but since I am a newbie I hope you'll all overlook it.

I have spent a lot of time recently wondering about the varied attitudes to childbirth and pregnancy and the lack of proper information regarding the process amongst most people.

I do believe that with the advancement of technology and better care we have been able to make the process a lot safer than it was in say the 1700s when the maternal mortality rate was 35%. However, it is my observation that people tend to take the whole thing for granted and assume all will be well because "women have been doing this for millenia".

I have keenly researched this subject and I have noticed that whenever I point out the risks associated with pregnancy and birth the reactions are those of disbelief and annoyance. I once brought up the possibility of fecal incontinence post childbirth and was admonished (by a man) to stop 'scaring people'.

I recently read a comment on a men's website that said "Pregnancy is the safest thing ever. It's not dangerous-to say that it is dangerous is misleading".
I certainly agree that the mortality rates in the developed world are rather low, but death is not the only thing that makes a process risky.

Pregnancy comes with superficial risks like permanent body changes to more serious ones such as permanent incontinence, diabetes, hypertension, uterine prolapse, obstetric fistulas (although these are rare), and even a permanent colostomy. Even in the developed world women still die of haemorrhage and aneurysms while giving birth.

Why is it that bringing this up tends to anger most people? Why do most people deny that these complications exist despite clear cut medical evidence that they do?

Is it traditionalism by virtue of which women are "meant" to bear children and therefore how can the process not be safe? Or is it just a paternalistic refusal to acknowledge that women do put themselves at risk for a series of complications (irrespective of whether they occur) when they have children?

I am not trying to imply that pregnancy and childbirth are horrible, evil things but I do believe that the attitude towards them is a bit casual and ignorant.

Your thoughts please?

You really think it was unnecessary to have the risks of induction explained to me before I had one, and all the options laid out?

Who has said that?

shagmund I am posting about my personal experiences having a first baby in the UK in 2007.

I have never heard of emmas diary
BF people would not answer questions about downsides
Ante-natal classes were not even-handed at all
Message was drugs = bad

Just because other people may have had different experiences does not mean that these things did not happen to me, in the NHS, recently. And judging by other threads, I am not the only person who has had this type of experience.

You just did Brandy.

"So, if this is all so necessary and improves outcomes for women, why do they not do it then? Do you not think that they may have thought this through (and by 'they' I mean HCPs and trusts etc) and thought better of it?"

BTW in our area they run ante-natal classes for women only for those who do not like to discuss personal matters with men around. I think that reason you have given is a non-reason TBH and if women are beign denied information because it will upset the fathers then whoever decided that needs a good kick.

Yes, at the point of you making your decision whether or not to be induced, a full and frank discussion is important.

You damn well will not get one at the current time.

You'll get" why WOULDN'T you want to be induced? Cascade of intervention? why, that is SO RARE."

If you do do your own research (and I will regret forever not having done so for DC1) you will find accurate and unbiased information. I can't imagine being induced, had I had that information.

Less concentration on the due "date" would help - telling women they are probably going to have the bay some time in a 5 week window would be more accurate and useful.

Sardine - my classes in 2003 were drugs = necessary and good. And BF is nice if you feel like doing it. Oh, and the cracker - you musn't have ANY fizzy drinks if you BF, because it will make the BM fizzy.

Possibly some standardised training for delivery of these classes would help.

Crunchy yes exactly. I would not have had an induction either. When I see threads on here I do tend to tell women about my experience and that I would do it differently if I was doing it again.

Information for women re pregnancy and childbirth is vital and should not be edited to suit the hospital budgets, the HCPs personal ideas and preferences, anyone's timetable, or an assumption that women are feeble and stupid and will have a nervous confloption if they are told some pretty important facts about birth risks for all types of birth, and common postnatal problems.

xposts!

I found that the NHS classes were much better than NCT - I think with NCT it's a bit hit and miss what sort of instructor you get. The NHS ones were very good but as I say I felt they were not even handed and did not cover some of the things that people were likely to face during the birth and postnatally.

Certainly there should be consistency in the messages that are given.

NO one is saying that it did not happen to you but clearly as other people have posted on this thread it does not warrant giving information about all the possible outcomes all the time. Your experience does not necessarily translate into a national experience. I have been very well informed about everything all the way along, every thing that has been done to me or my baby has been explained and I have been able to make a decision about that. Having all the information early on does not necessarily make a difference to the outcomes for women. Some women have expressed the opinion here that they do not need to know all about fistulas etc from the beginning but that has been ignored too.

There are also lots of us who have had repeated (in my case) very very positive experiences, I am actually well informed and I have worked in a Labour Ward too (but after my first two babies) and that has helped. I am not talking about giving women nothing and being in a state of ignorance I am suggesting that the implementation of that information needs to be carefully thought through. Whether you like it or not some women would not like to discuss the more embarrassing parts of what could happen in front of their husbands. I am one of them as it happens - I have no wish to discuss piles and tears and incontinence in from of my DH, nothing wrong with my relationship with him, we are very open but I would not feel comfy with that and nor would he. But I never pee, break wind or burp in front of him either so perhaps it is just me. However he has been at all the births of our children, been amazing and supportive and an excellent Father so it is not to our detriment I feel.

I call for sensitive implementation of information tailored to the particular woman (again pipe dream) and not making the assumption that they want to know everything all the time because they don;t you know, whether you like it or not some people don't want to know about it

you musn't have ANY fizzy drinks if you BF, because it will make the BM fizzy.

Classic Crunchy - my poor babies!

Certainly there should be consistency in the messages that are given.

Yes in an ideal world that would be true but of course when information is given out by different people their prejudices and experiences come into play. That is how come so many people have so many different experiences with their HCPs because they are human beings and bring their own shit to the table each time. Depends on who you speak to and who is caring for you so sadly there is not a uninformed way of delivering this sort of stuff.

That is why one Midwife will suggest you go on your knees and another will ask you to get one the bed and that is why the produce generic The Pregnancy Book and Emmas Diary stuff for the masses with the basics outlined.

and of course it should be nothing to do with budgets either but again the real world dictates otherwise.

I do agree with the OP and do agree that there is a tendency to skim over/avoid reference to the risks of natural childbirth. At my NCT class I asked for stats on likelihood of tearing (she didn't have any) and had to ask for advice on how to look after stitches post-birth. There was no mention at all of likelihood of incontinence (a significant % experience this for a temporary time after birth) and what do to improve this. The horror of an open episiotomy and pooing myself as I walked down the road was a huge shock and one which had me on a watch list for PND.

I would have FAR preferred to be told that there is a small/x% risk of these things happening, a risk which increases with instrumental delivery, or whatever. Ignorance is only bliss when you're one of those fortunate enough to have a straightforward birth and recovery. Giving FACTS (including the actual likelihood of experiencing these complications) is assisting women in preparing for what to expect and to help them make decisions about their care (eg: whether to refuse induction, try to avoid epidural or whatever).

Another related point is the disconnect between the NHS advice given antenatally in relation to risk of complications and the facts you're presented with on the consent form which you have to sign moments before the procedure, eg:
"Forceps can leave small marks on your baby's face but these will disappear quite quickly" is the only reference to damage to mother or baby in the forceps section of the NHS childbirth section on their website. The risks I signed up to whilst racked with the labour pain of a malpositioned baby not to mention being frightened and exhausted included "lacerations, paralysis, (baby) and lacerations, incontinence (me)" - I suffered fecal incontinence and DD is facially scarred. I really don't think that was a fair presentation of the facts. It (NHS website/leaflet) also says the Obs will "gently pull" so I was beyond quite shocked at being pinned to the table whilst the obs dragged with all his strength.

Keeping me under the veil of ignorance did nothing to reduce the stress on me or - in my case - the likelihood of having to have any such intervention, all it did was compound the fear and anxiety when the worst happened.

herethereandeverywhere yes that is the sort of edited / incomplete information I'm talking about.

brandysoakedbitch I can't believe that you are saying that women in antenatal classes should not be given information on piles and incontinence and tears and things in case they / their partners are embarrassed by it.

This sort of approach is why women struggle on with all sorts of problems and don't feel they can tell anyone. Appalling.

lunaticfringe who on this thread has suggested that pregnant women be told about dead babies?

I have suggested that they be told of a nearly 1 in 10 chance of a 3rd or 4th degree tear and what that means.

Not quite the same

Interesting thread. 38 weeks and having a private birth outside the UK. I have a doula and have had twice monthly appointments throughout. My approach to the birth is as a medical, biological event with no spiritual undertones. I've researched the possible complications, written a birth plan which includes rising levels of pain relief and believe I have mentally prepared myself for all eventualities. For me an informed and cautious birth plan is a priority, as is a scientific approach to the process with as little 'woo' as possible.

I am lucky to be in a position to have more options than most and firmly believe that birth is potential painful and possibly life threatening and should be managed as such.

The words are interesting.

Some people are talking about stats, facts, probabilities, risks

Others are talking about scare-mongering, shroud-waving, dead babies

How can these responses be about the same thing? There is a total and utter lack of agreement here isn't there. I don't understand how giving full information about common risks to pregnant women can be interpreted in this way but obviously it can, and so I don't see that accord can be reached.

The trollhunting on this thread is extraordinary.

A poster upstream said that ANY thread that started with a post discussing fecal incontinence would be a troll.

No. There are threads here every week started by women with severe tears who have ongoing problems, including pain and incontinence, and who are (usually) humanely directed towards the Ragged Bits Thread elsewhere on MN.

"I found that the NHS classes were much better than NCT - I think with NCT it's a bit hit and miss what sort of instructor you get."

No - this is true with the NHS too.

My NHS midwife's response to me that I'd heard that having an epidural would make a forceps delivery more likely was to say 'You can read too much you know!'

Which made me feel like an utter, utter twonk.

After my forceps delivery (following on from my epidural) I felt like seeking her out and telling her how she'd made me feel.

In a professional capacity I've also observed some DREADFUL NHS classes, as well as some excellent ones. Ditto NCT.

BTW - just been putting a table together for birth outcomes for healthy low risk first time mums. From the recent 'Place of Birth' study. Does not include outcomes for first time mums being induced. These would be worse I suspect - much worse......

Thought it would be a useful contribution to this thread, and info worth sharing.

Forceps Delivery

OU 9.8%
Home 6.3%
FMU 5.3%
AMU 7.8%
Total 9.3%
Unplanned caesarean section
OU 13.0
Home 7.7%
FMU 6.1%
AMU 7.1%
Total 11.9%
Normal Birth
OU 46.4%
Home 69.3%
FMU 71.1%
AMU 62.9%
Total 49.7%
3rd or 4th degree perineal trauma
OU 4.6%
Home 4.4%%
FMU 4.1%
AMU 4.9%
Total 4.6%
Epidural
OU 37.9%
Home 21.1%
FMU 18.1%
AMU 23.6%
Total 35.2%
Admission to a higher level of care
OU 0.8%
Home 0.5%
FMU 0.2%
AMU 1.0%
Total 0.8%

OU: obstetric Unit
FMU: free standing midwifery led unit
Home: home birth
AMU: alongside midwife led unit

Hang on, let's format this a bit

Forceps delivery

OU 9.8%
Home 6.3%
FMU 5.3%
AMU 7.8%
Total 9.3%

Unplanned caesarean section

OU 13.0%
Home 7.7%
FMU 6.1%
AMU 7.1%
Total 11.9%

Normal Birth

OU 46.4%
Home 69.3%
FMU 71.1%
AMU 62.9%
Total 49.7%

3rd or 4th degree perineal trauma

OU 4.6%
Home 4.4%%
FMU 4.1%
AMU 4.9%
Total 4.6%

Epidural

OU 37.9%
Home 21.1%
FMU 18.1%
AMU 23.6%
Total 35.2%

Admission to a higher level of care

OU 0.8%
Home 0.5%
FMU 0.2%
AMU 1.0%
Total 0.8%

OU: obstetric Unit
FMU: free standing midwifery led unit
Home: home birth
AMU: alongside midwife led unit

Those figures are very different on the tearing than the RCOG figures earlier.

I think it would be useful for pregnant women to have those stats as part of their antenatal preparation. Why not?

I think it's worth adding to this info that the same study (the Birthplace Study) found homebirth carried a higher risk to the babies of first time mothers -

www.bbc.co.uk/news/health-15861280 and www.midirs.org/development/midwiferyweb.nsf/z45/B70C83EAA441387C80257953003CD2C2?opendocument

Worth adding too because it's important to contextualise that the risk (including risk of death/serious problems) is still very low at less than 1%.

This actually illustrates how I feel about keeping women informed. A choice is only a choice if it is informed. Someone looking at a holistic picture of birth will want to take into account every aspect of the outcome, from the likelihood of intervention/injury to the mother to the risks to their baby. Different women will place different values on the same set of risks, of course, and it's human nature to try and ignore those risks which we don't want to accept. But that's not an argument for keeping women in the dark.

Ps yes, I agree that those stats on different kinds of delivery/intervention/injury should be part of antenatal info - I can't think of a good reason why not?