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?

I'm assuming those stats include planned HB that result in hospital transfer at any stage? (routinely people transferred pre-labour are still included in the HB stats. Happy to be corrected!)

I'd be interested to see the stats for the births that actually take place at home.

WRT the language - I found that I was presenting the evidence as I saw it, in a calm, reasoned way, and was confronted by HCP using emotive language and bare faced lies. For example, the SHO who told me my baby WOULD die if I went over 43 weeks, and that I was risking his life by refusing induction. Or the MW who chose to tell me that placentas "fail" at 42 weeks. Anecdotal, yes, but my experience. All I did in response was smile, thank them for the input, and explain that I would be having a HB. Had they used less emotive, more sensible and actual evidence-based language, I would have been far more likely to listen.

There are so many things that can happen in labour and birth, it would take an awful lot of time to explain them fully - especially to women who aren't used to reading science, or who don't speak English. Explaining them in a half assed way (as happens now in many cases) leads to more fear - and fear leads to more pain, a need for pain relief, and often intervention.

There is a need for better education - in part so women can reduce their risks (nothing guarantees a simple labour, but you can increase your chances) of intervention. I don't know how it can possibly done in the current system.

SQ, because it was and is a relevant point. There is the attitude that I noted displayed in many arenas that discuss childbirth, much like many of the assumptions made on this thread. If it is relevant then it is a perfectly viable part of the discussion...the OP was doing the same thing. She made a point, people discuss it. I make a point, people discuss it. Ad infinitum.

However my point should obviously just be dismissed because you say so and it disagrees with your general premise.

SQ although i have agreed with almost all that you have said, i think your callousness towards the poster whose baby died and she almost died is astounding. Miscarriage and still birth are are as part of pregnancy and childbirth as stitches, tears and incontinence. Indeed i would also say that babies dying should be part of the education process because if it sadly happens to you, unless you have been through it before or those close to you have - it is something that most people are totally unprepared for or have a complete lack of understanding about. It's not about scaring people - it's about being realistic- like being open about SIDS. I'd rather be told about it and have some tools in the kit to help reduce the chances of things going wrong.

Anyhow, i have found this thread to be fascinating and even the posters that i wildly disagree with i feel have put forward some really valid points.

Yes,LunaticFringe sorry, you were the poster, i am not surprised you found the response offensive. Such an awful thing to go through.

SQ you need to apologise to Lunatic Fringe - I think you must have misread her post, but you were completely out of order.

Lots to chew over in that data. Mostly as expected, but interesting that FMU has generally better outcomes than home birth. What stood out for me in the context of this thread is the 3/4 degree tear figures, which are terrifying because 1 in 20 / 1 in 25 are big numbers (even bigger as a % of VBs) and the fact that they're near constant across units suggests there's sod all you can do about the risk short of ELCS.

"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)."

This is the most sensible thing I've read so far.

shagmund those stats are very interesting, but it makes me shudder to think what they would be if inductions had been included...

I think the tendency to induce at the levels they do at the moment is ludicrous. And I also agree with the poster who said that having such a focus on a due dute doesn't help either.

A 5 weeks window is surely for more realistic and also reduces the stress and general "fed-up"ness of the mother. Only 3% of women give birth on their due dates.

Hang on -

I'm sure she can correct me if I'm wrong, but I think SardineQueen misread LunaticFringe's post.

The problem is, there have been so many OTT responses on this thread, it makes a climate of misunderstanding more likely. The OP, and SardineQueen (and others like me) have said that they think there needs to be more info about VBs and that the risks are sometimes downplayer/ignored/glossed over.

Some other posters have decided this can only mean we want to indulge in scaremongering - so there have been lots of posts along the lines of 'yes, why not make people look at pictures of gonorrheoea for six hours before having sex!' (I kid you not, it's on this thread...)

So when LunaticFringe posted what read to me as a sad and honest post about the loss of her baby - and then commented that 'people don't want to hear about dead babies' - I'm afraid to say it was possible to read it very quickly and think it was another one of those accusatory and exaggerated responses.

I hope this isn't callous, but it illustrates a point. I feel personally that pregnant women should be given info about illnesses and situations that arise where sadly infant death is a possibility. That doesn't mean I think, before I am accused of it, that I think pregnant women should be forced to look at pictures of dead babies, or any such insane and OTT nonsense.

Surely anyone can see there is a difference.

LF, I hear what you are saying about being part of a whole subculture because of your experience - I think your post was open and honest and I am sorry you have experienced such a loss.

Rates of normal birth

60% hospital obstetric unit
76% hospital midwife unit
83% freestanding midwife unit
90% home

this is from the bbc article - this is good news isn't it? www.bbc.co.uk/news/health-15861280

I do agree that the induction rates are a shocker and I do think there is a good deal of pressure on women to deliver 'on time'. For instance I was told by a Consultant that they do not 'allow' women over 40 to go over 40 weeks and sanctioned sweeps from 37 weeks to ensure I got my homebirth as I made it very clear I was going no where near the hospital for my birth unless it was clinically indicated - I thought it was hilarious when she gave me 'permission' to have a homebirth - I had already had two and it was my third child. I am seeing her again next week for this pregnancy as I need some extra scans because of thyroid issues and she makes me laugh every time (she is just covering her arse of course - she wants a good outcome for me and the baby but she finds it very hard to see it any way but her own) - she loves the statistics and chucks a few into conversation and then I just do what I want anyway - my baby and my responsibility to inform myself

Yes, i am sure SQ misread the post as it is completely out of context with all her previous posts.

I found my midwife was more than happy to try and scare me out of a 2nd ELCS, but was strangely unforthcoming about the risks of a VB.

I Have a huuuuuuge gripe about OBEM, in that, occasional screaming aside, it portrays childbirth as a very casual event, that ends with the baby being presented to the parents. You never see a forceps delivery or stitching. You never have a follow up of parents who are overwhelmed by a PFB. It's all presented in a fluffy, "nothing to worry about" fashion.

For a physiologically normal event, pregnancy is actually a very dangerous time for a woman, and you often feel emotionally vulnerable too. I found the paternalistic attitude from HCPs ghastly.

I had orthapedic surgery a few years after DS2 was born. The attitude of HCPs regarding mode of surgery, and the post-op care, were light years away from obstetric HCPs.

"You never see a forceps delivery" on OBEM?

Yes you do. I have seen 2 forceps births on OBEM

Also emergency c/s.

Also a shoulder dystocia.

Several babies needing resuscitation.

Babies who've had to go straight to special care.

The programme isn't about postnatal life. It's about giving birth.

"but interesting that FMU has generally better outcomes than home birth."

It doesn't surprise me, even though the average transfer distance for the FSU included in the study was 17 miles apparently.

What I would have liked to see were home birth outcomes associated with different models of care. Home birth rates nationally are only 2%, and in some areas there will be midwives delivering babies at home who have very, very little experience of normal physiological birth. In these circumstances I imagine transfer rates are very much higher, and it's the process of transfer that can complicate a delivery. I suspect case-loading and specialist homebirth teams (which they have in some areas) have much lower transfer rates and better outcomes overall.

FSM on the other hand benefit from being staffed by people who are experienced in caring for women in a non-medical environment. Also the fact that there will always be a very senior midwife in situ, and probably easier arrangements for transfer. No doctors of course, or operating theatres, so in that sense they can't offer anything to women that they can't get an home.

"What stood out for me in the context of this thread is the 3/4 degree tear figures, which are terrifying because 1 in 20 / 1 in 25 are big numbers (even bigger as a % of VBs)"

Why 'terrifying' when the majority of these types of injury heal without complication or further problem? You're assuming that every woman who gets this type of injury in birth will have ongoing continence issues. They won't! (thank goodness.....)

By the way - the 1 in 20/25 are a percentage of the births included in the study, not as a percentage of births overall.

"Some other posters have decided this can only mean we want to indulge in scaremongering - so there have been lots of posts along the lines of 'yes, why not make people look at pictures of gonorrheoea for six hours before having sex!' (I kid you not, it's on this thread...)"

I posted that in response to the OP's suggestion that EVERYONE be told the full extent of possible injuries arising from a vaginal birth. Given 'research papers' no less.

"Indeed i would also say that babies dying should be part of the education process"

I strongly agree that this is something that women should know about in pregnancy, given that it happens to 1 in 200 women.

after having a 4th degree tear with dd, i felt so shocked as i never had any idea such serious injuries where possible.

i went to all the antenatal classes as well, no mention of such things, was just all, dont have a epidural as it leads to forceps dont have pain relief dont go to the hospital till the last min, and only talk of bf.

i do feel we should be told the risks of vb and cs we should be treated as the adults we are and allowed to make informed descions.

i also felt any time i tried to talk about what happened to me i was met with a oh well its least the babies ok, or well its over now or something that felt like it ment oh well noone wants to hear i so shut the fuck up

ive had alot of complications due to pg and have felt more ill than ever in my life during pregnancy with hyperemesis high bp boarderline gd carple tunnel nose bleeds
by far te wosre is the hyperemesis
and i totally agree with op.
there is a really weird really unpleasent way women are treated during the pg/birth and postnatal phase.

i dont know why our culture is like this, but i wish it would change

"dont have a epidural as it leads to forceps dont have pain relief dont go to the hospital till the last min, and only talk of bf."

Did the midwife/teacher actually say 'don't* use pain relief'?

Or did she just point out that you're more likely to have a normal birth if you don't have epidural/pethidine? And you have interpreted this as an instruction rather than an opinion?

They only talk about breastfeeding by the way because they know that NO woman is forced to start breastfeeding because her baby won't take a bottle at birth, whereas a large percentage of women who want to breastfeed can't make it work for them and therefore need massively more input than bottlefeeding mums.

Hyperemesis is hideous though.

Have to say - I've never been treated in an 'unpleasant' way while pregnant, or postnatally.

I feel sorry for those people who have. I don't think it's the norm.

Just came back to this and good grief lunatic fringe I am so sorry. fruitybread has guessed exactly what happened in that I didn't read your post properly - I have been in and out today and trying to catch up with huge chunks of this at a time and respond quickly - which is why I have been doing this thing of posting about 4 responses in a row to about 3 hours of posts and then vanishing again.

I was skimming through the (fairly combative) posts and saw the last line and didn't take in the earlier part of the post. Of course I am terribly sorry for your loss and what happened to you and if I had read it properly in the first place I would never have included that line in my post.

I really am sorry.

find this thread fascinating because of the huge differences of opinion some people have on information and how that information is given. There have been some excellent observations, things I would never have thought of. I've spent an hour reading this thread.

I am so sorry Lunatic on your loss. I'm also sorry your are having such a difficult time DoubleDare, I wish you the very best for the rest of your pregnancy,

I'm a first timer and 35 weeks pregnant and live in Ireland so my views aren't reflective of the NHS. The care I've received so far has been all medical, which is fine, I've done all my own research, extensively because I'm the type of person who needs to know as much as possible re incontinence, tears, ventouse, PND. The care offered in the majority of cases in Ireland is 'Combined Care' so your ante natal visits are split 50/50 with the consultant and your own GP. I've spoken to a midwife once at 12 weeks who advised on subjects such as diet, exercise, bleeding etc.
I find it beyond strange that a midwife refused to show forceps to someone at an ante natal class, surely the point of ante natal classes is to arm women with the knowledge of 'what might be' or what instruments might be used if interventions are required. Women do not need to be cocooned from the truth but be given the information or at least pointed in the direction of sources of information that do have statistics. Maybe most importantly women need to be told that every single pregnancy and birth is different and you cannot prepare for any one outcome.

Similarly it is strange that experinences of childbirth aren't more widely discussed, I've been discussing it with all of my female friends who have gone through it and I've also been discussing my pregnancy with anyone who wants to know about it. I don't think there should be secrecy, I'm not sure if this secrecy is malignant or part of a conspiracy though, I thought it might be a generational thing, my mother for example doesn't really discuss her birth experiences or my aunts for that matter (all in their 50's)
As for men and how they 'view' it, I just don't find it helpful,they should not come to their own conclusion that birth is natural and ergo safe and all aspects of birth are normal and women can just accept it considering mens views are so influential in shaping so many decisions regarding female lives.
Also the high number of male consultants always left me baffled, I remember a thread about it a few months back where a poster put the point across that there were so many male gynaes because it was a surgical speciality and men like to be Mr. Fix-It with regards medical interventions. I also read the link WidowWadman posted about Grantly-Dick Read and how he used the natural processes of childbirth as a tool to 'make women accept their fate' (well that was my reading of it) So there really is a mixed bag of ideals and opinions about childbirth and pregnancy, I do feel it is women who have gone through the process of pregnancy and childbirth that should be the experts on it.

As for the question about the high mortality rates amongst neonates in the Netherlands, I did a bit of research into it, I used to live in Holland and my husband is Dutch so I wanted to find out more. One of the suggestions as to why the rate was so high was that Northern African immigrants were contributing to poor standards of health because of their culture, high levels of domestic violence, not getting enough sun exposure, very young mothers, refusing to see a male doctor etc. While all of these things can contribute to infant death, the Muslims were once again used as a political football in the Netherlands where there is a very right wing anti-Islamic government in power at the minute. There is a very high rate of home births in the Netherlands too and this was not scrutinised as thoroughly as a potential reason for infant death.
Sorry if this is a bit rambly.

It is very gracious of you to accept my apology lunaticfringe

Oh now I'm not sure if gracious is the right word.

Kind, I mean. Thank you.

LunaticFringe:

I am so terribly sorry for your loss. I wish you only happy times ahead:)

Double dare:

I can understand your predicament and I sincerely hope that you get through this happy and healthy. Please write me if you ever need to talk and keep us posted.

I think my general question has been misunderstood.

Let me re-phrase it. Have you ladies noticed or experienced a slightly insensitive and casual attitude from some people around you regarding pregnancy and birth? Particularly among men? The kind of attitude that seems to imply "Suck it up and get over it"?

The reason I ask is because when I experienced complications I was made to feel like I was just a one-off case and my bad experience should mean nothing to anyone else. Truthfully, my complications weren't all that unusual at all and yet my friends and their husbands refused to believe that. I got a long lecture on how birth was natural and therefore safe and random bad luck should not influence other people.

One of them actually compared stress incontinence to a broken nail.

The other said that women are supposed to give birth- "they get in there and get it over with. Easy"

When my someone mentioned experiences with gestational diabetes and uterine prolapse, they were told 'So you shouldn't have gotten pregnant then".

Despite statistics which show otherwise, some people insist that complications happen to one in a million women. It's this over simplistic view of birth that I find very annoying.

I found this article interesting. It was emailed to me so I can't seem to locate a link....

"An Australian report by Evelyn Yamine in the Daily Telegraph discusses a new study showing an increased risk of post-natal depression in first-time mothers with "unrealistic views about having uncomplicated births".

This does not surprise me in the least, and I think that women are often not being helped in forming realistic expectations during their antenatal care.

Unfortunately, I haven't been able to locate the study just now, nor indeed email or twitter contact for Ms. Yamine, but in the report above, she writes:

"The survey of 195 expectant mothers revealed they believe there is a 56.2 per cent chance of an uncomplicated birth, which means a baby being born without the use of forceps, suction cups, caesarean section or induced labour.

Pain relief is considered part of an uncomplicated birth.

The figure is more than double that of Victorian data, which shows the chance of having a medically uncomplicated birth is 21 per cent.

A further 30.7 per cent said they believed women would have uncomplicated births without needing sutures. The actual figure is 8 per cent.

"We believe that many women and their carers have overly optimistic views," the report states.
"In this study, we have found that pregnant women, staff and students all overestimate the chance of first time mothers having an uncomplicated labour and delivery.

"The finding is important because unrealistic expectations of the likelihood of intervention may lead to increased feelings of distress in the postpartum period.""

The only dismissive comment I've had in my pregnancy that hit a nerve was from my mother. I had awful SPD flare up at 28 weeks, I could hardly walk down the street. I told her and she said how did other women cope back in their day when there was no fancy name attached to it. She pointed out her grandmother had 25 live births and was back scrubbing floors the next day.

pam beesly political or not, immigrant mothers in this country face up to 2 times the stillbirth rate (if you google 'Nice induction guidelines' and check out the data tables you can see all the results - lots to plough through there) . I actually see this the other way: why are they getting such a bad deal? is it also that they are treated worse as well as the socio-economic considerations?

this is such a well documented phenomena that really you have to accept more immigrant mothers = worse results. the question then is how to address it.

and 'cultural' or otherwise, FGM renders any birth high-risk (i note pregnancy notes now actually have a check-box for it).

home birth in the Netherlands is so well studied, i don't think you can say it hasn't been looked into. Bit irrelevant however if you are giving birth in the UK.