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?

[PamBeesly]

Edless I wasn't aware of the immigrant mother statistic in the UK (I don't live there) but I wasn't aware of it anyway. I do think thats terrible that their risk is so much higher, but in the context of Holland the data was used against immigrant women, especially as a means to justify banning the burka.
Is FGM common place in North Africa? I'm sorry I'm not informed enough about it to know.
Perhaps I should have phrased it differently, home birthing in the Netherlands wasn't put forward as a potential reason for the high infant mortality rate. It seemed the political right jumped on the 'its Muslim womens fault' I do think home births are by and large safe however, I just think its interesting it wasn't given much consideration as a factor in the high rate.

[SardineQueen]

Ouch peaceandhope they were some shockingly shitty comments you had.

My best one was that my manager (female) was unwilling to give me time off to attend appts for anti-D jabs (I am rhesus negative) on the basis that she didn't need anything like that and had never heard of it

That and never (OK well quite often not) getting a seat on the bloody tube even when I was the size of a house

I guess that all of our views are shaped by our experiences. My experiences are as reported on this thread, and I guess coloured by my personality and previous experiences, and are true to me. Obviously others will have had very different experiences. I do feel though that things are obviously rather hit and miss, messages are being delivered in different ways and there is a lot of room for improvement.

Personally I think the thing that needs most attention in maternity services is post-natal care especially BF support - that again is just my view though. We are all different - an example being that I am very happy on a shared ward while many others are happy in private rooms. Horses for courses but at the moment the basics are missing and that is not right.

I really do believe though that more open-ness and talking about issues such as tearing and incontinence would be a good thing and if society in general isn't going to suddenly open up and start chatting about piles and forceps then ante-natal classes really ought to.

[PamBeesly]

I agree Sardine I think these physical and mental processes associated with childbirth pregnancy and post natal life should be spoken about more openly, I don't mean in a scaremongering way, I just mean that in the context of a pregnancy/labour this can and does happen sometimes and there are supports to help/exercises...sometimes there is not and that is a risk, but at least telling women allows them to make their own decisions regarding their own bodies.
There doesn't have to be a veil of secrecy around it

[EdlessAllenPoe]

"""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.""


The average transfer time from a FMLU was 39 minutes over the 29 min average of HB transfer. and the average labour in CLU after transfer was 6 hours in both cases.

although i think HB did every bit as well for second and subsequent births...need to dig out the data tables again...

also there was no mention of how many of those adverse outcomes for first-timers had actually occurred in hospital (transfers were included) and the typical post-transfer length of labour in those cases.

i do remember that these results were heavily adjusted away from the 'actual' so they actually doubled the number of real adverse outcomes in the HB group to compare with the CLU group....(ie, the 'typical' first time homebirther was at no greater risk of an adverse outcome for her child than the 'typical' CLU birther, it is when they 'corrected' the outcomes the difference arose...)

how they came up with those adjustments, i need to find out, as i suspect they may have use the (well researched) ones for stillbirth which may not actually apply to the outcomes studied (in plain terms, i can see why an economically disadvantaged woman is at greater risk from stillbirth in labour. Is she really at greater risk of her baby breaking a bone during delivery? - this may have been the assumption operated on)

really the birthplace study is a great piece of work, and very welcome, but it needs peer-reviewing before i put lots of faith in it.

[EdlessAllenPoe]

Is FGM common place in North Africa?

sadly, in Somalia it is is 95% of all girls. varies from country to country.

[PamBeesly]

Do you know about Morocco Edless? What are the stats there?
I have only ever heard positive home birthing experiences from family in the Netherlands, and the post natal care seems to be fantastic too

[EdlessAllenPoe]

also: One thing the birthplace study made really clear is we need more MLUs!

i am very pro-home birth but i simply don't believe the majority of the population are going to be sold on the idea any time soon (completely regardless of actual statistical outcomes).

MLUs offer really good care (comparing outcomes with CLUs) - great advantages for mothers -and in areas where low-risk mothers were booked into the mlu unless they specified otherwise, they were really well used.

the birthplace study also highlighted that many women do not even think about birthplace as a choice, but assume they'll go to the CLU.

[SardineQueen]

Thing is, having a home birth would terrify me. For various reasons, I like the reassurance of medical types close at hand.

In my ideal world I would have babies at a MLU on the grounds of a big hospital. That for me would be the most comfortable situation. In our area, the MLU is a way away from the hospital, and for that reason I didn't even look at it.

Choice is key here. The trick when giving birth, as I understand it, is to be as relaxed as possible. For me, personally, this would mean more unbiased information ante-natally, the opportunity to labour with access to water and in comfortable surroundings, but near somewhere with lots of doctors, and great post-natal care and support including de-briefing if necessary (can help with post-birth trauma type situations).

Thing is that is what I would like. Others would like things quite different. That's all OK.

I still can't see the argument for not giving women who are pregnant info about tears and stuff though

[SardineQueen]

xposts

[SardineQueen]

unbiased may be the wrong word

more balanced information, more complete information, is what I mean

[PamBeesly]

I'd love to birth at home (I'm a 25 minute drive from hospital if any emergencies did crop up) I feel relaxed and at ease in my own house, I feel I could scream and shout and poo all over the place if I needed too and wouldn't care. I also think midwives can be more skilled in helping a woman deliver than a doctor who sees it as a problem to be solved medically immediately (Now I know that sometimes we need medical intervention and its great its available) Unfortnately home birthing isn't an option where I live, it is only available in a small part of South East Ireland and even that scheme might see their funding cut. There is only one MLU in the country too.

[EdlessAllenPoe]

sardine there is no such thing as unbiased information.

not at the point it has been presented and understood anyway.

[EdlessAllenPoe]

i need to refresh more often :)

[bigmouthstrikesagain]

I haven't read all of this thread so excuse me if this has been discussed already. I do not happen to agree with the OP's analysis - but this is purely based on my own experience/ analysis as I suspect the OP's view is but no less valid for being anecdotal I suppose.

Anyway I have always viewed birth as pretty painful and traumatic as that was my Mum's experience in the 70's and early 80's. She had a breech birth, was transfered to a different hospital during labour, forcep's deliver, 2nd degree tears at each of her three births she also had a very distressing and dangerous late miscarrige. There was no conspiracy of silence or downplaying of the difficulties of birth in our house! I knew all of these stories (in detail) by the time I was in my teens. Surely our Mothers and grandmothers are responsible for informing us about the process of childbirth - the knowledge of older generations passed down, innocence and experience...? Or am I missing something - do most Mothers flatly refuse to discuss birth with their children - I most certainly will - dd1 already knows she was born at home and exactly where on the rug! .

I think information is power and have always been willing to find out about things other people prefer to be vague and hopeful - nowt wrong with that as long as you don't put yourself at risk through ignorance.

[CarrieInAnotherTWOBabiTWINS]

shag the message was very much if you have an epidural you will end up having forceps, or if you have pain relief you will lose the sensation to push.

it wasn't simple facts like. say, if you have an epidural you have 25% more chance of having forceps or whatever.
the message was you will.

for what its worth i had no interventions, spontaneous labour at term, no pain relief,mainly due to what i was told, i was calm, the baby wasnt distressed, nothing that actually that went wrong, yet i still got a 4th degree tear.

[working9while5]

I think the OP makes a lot of sense. Both my grandmothers gave birth to babies who died shortly after birth. My grandmother gave birth to three. My aunt gave birth to a baby at seven months who was born still. In the last three years, I know of seven babies who have died at or before birth from within my circle of friends and their friends, I know three women who have had pre-eclampsia, I know four who have had post-partum haemmorhage, a woman who died of dvt three weeks after birth, a mother who lost part of her bowel when having a cs and nine babies who were born at less than 30 weeks.

This is a small sample, anecdotal blah blah but to me pregnancy and birth are dangerous and unpredictable. Yes, I know many more women who have given birth naturally and without these complications, but who have had e.g. fourth degree tears, gestational diabetes, clotting issues etc. No one knows, that's the problem. It doesn't much matter if the incidence is low if you are the one that it happens to, does it? I think people take a lot for granted now, and pregnancy isn't treated with any real degree of seriousness when it has the potential to absolutely lead to serious health concerns for mother and/or baby.

[working9while5]

Incidentally I couldn't make it to antenatal classes when pg so watched a dvd called birthwise. They had a section on what would happen if your baby was born still. I found it very, very sad but I recognised that some of the information might be important.. information about getting as many pictures as possible and holding your baby, spending as much time with your baby as possible examining and getting to know him/her, looking for all the little quirks that made him/her unique as any new parent does. I think it is possible to hear information presented sensitively and perhaps, just perhaps, that might make people feel less like a freak if it happens to them. 19 babies every day are stillborn in the UK, it is not that uncommon. LunaticFringe, I am so very sorry for your loss.

The other thing I remember about that dvd was so important to me - it described how 1/5 women feel an instant rush of love, 3/5 just feel glad labour is over and want a cup of tea and 1/5 really feel repulsion at the first sight of their child. I was one of the 3/5 but I found it hugely comforting not to buy into the myth it had to be instant/automatic and I'm sure that knowing that 20% may actually feel negative feelings might be very helpful to women who go on to have PND.

I don't think whitewashing the reality is helpful for anyone and I'm not sure why our society finds anything painful to be so unpalatable. Come on Great Britain, you got through two world Wars... get a grip, it is possible to share info without being squeamish. It is no harm to the people who will never need it, but could be tremendously important to those who do!

[CailinDana]

I think you have hit the nail on the head working - there are plenty of good reasons to give out clear information, but there are no good reasons for not giving it out. If clear information could lessen the suffering of those who do suffer even a tiny bit, isn't it worth it?

[AlpinePony]

I'm based in The Netherlands. Home births under midwife led care are very much encouraged, but ultimately it is the mother's choice whether she births at home or in hospital - the first time anyway. As far as a "high" (lower than UK/US/Australia etc.) mortality rate goes there seem to be two major factors with this i) recent immigrants as per PamBeesley* and ii) many, many women choose not to be screened for anomolies which are perhaps ultimately incompatible with life. Until 2003 (I think!) NF testing was not standard, even now it is only "free" to women over 36 years of age.

*I know an immigrant woman here from the Philippines who is pregnant, first of all she has "no idea how it happened", she has no idea what to expect. I've given her a book, sent her along to my midwife unit and insisted that she gets registered at a doctor - she refused to see a male doctor so I directed her to a practice that has 2 female doctors. She speaks no Dutch and doesn't have proper health insurance cover. I've sort of bullied the parents of her Dutch boyfriend in to getting this organised for her. The same story is repeated throughout all countries with a high immigrant population.

Our post-natal care is indeed wonderful - I will have a doula come to my house for 5 days after birth (elcs) to clean, cook, help, etc. so that my husband and I can bond with the baby. Last time I had an unexpected bleed post-partum and covered the bathroom in blood, she showered me and popped me in to bed. When I woke up the bathroom was spotless - I will always remember that as wonderful help.

Wrt a topic brought up on this thread, until mn I had no idea about 3rd/4th degree tears and long-term incontinence. I often cry when I read such threads. I knew that a woman could tear, but I thought perhaps a cm or two. I just didn't know how bad it could be. I'm 38 years old and well versed with real life - but I didn't know. It's one of the reasons I've opted for an elcs this time, I don't believe I'm a good candidate for vbac without such complications.

[PamBeesly]

AlpinePony thats very sad that the woman from the Philippines that she didn't know how it happened. How frightening for her, I'm glad that you could speak to the parents on her behalf.
I also did not know about degrees of tearing or a lot of other aspects of childbirth until I discovered Mumsnet. I'm glad I do know however, I've my first ante natal class on Tuesday so it will be interesting to see if its discussed at all. Good luck with your C-section.

[tiggersreturn]

I remember my first family planning appointment in which all the side effects of various pills were listed. I must have looked slightly aghast because tge nice nurse said "but that's nothing compared to the risks of pg"

[Pastabee]

My NCT teacher did discuss PPH, MROP, 3rd/4th degree tear, interventions, episiotomy, babies born with severe disability and still birth. It was great for DH and I to be prepared as it meant we knew what might happen and what the medical staff would do as a result.

It was all presented in a non scaremongering way and we had a chance to discuss all these issues.

She read 'Welcome to Holland' by Emily Kingsley to start discussion on still birth and disability. I will never forget how much it upset me but talking to a friend who had a still born son it made me realise how important it is to confront the fact that what you want to happen and how you imagine things to be might not be how they turn out to be in terms of birth and the health of your baby.

I'm shocked when I read about NCT groups where none of this is discussed - I thought it was standard but I now realise my teacher was just incredibly experienced and had taught women who have gone on to experience all these things.

[CarrieInAnotherTWOBabiTWINS]

wow never heard of welcome to holand, before so just gooled it and got this

wow very powerful just had me in tears.
extremely moving

[CheerfulYank]

I love Welcome to Holland! I've only read it, though, never seen it performed.

[Pastabee]

Welcome to Holland is very powerful isn't it? So sad of course but contains an important message for all expectant parents not just in terms of your own child but in terms of understanding how those not as fortunate as you feel.

I don't think it is wrong to face up to the fact that things don't always go in accordance with your plans and dreams. It can only help to know that you are not alone and that others feel the same.