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?

"brandy you don't agree that childbirth is "terribly dangerous"? Tell that to the ONE IN EIGHT women in Africa who die giving birth. "

Yes - birth is very dangerous for malnourished women who have had no antenatal care, may be suffering from severe anaemia, have previous botched abortions, HIV, malaria, infibulation, and are giving birth without any access to medical care.

Luckily for healthy women in the UK who've had good antenatal care, the likelihood of dying in childbirth is very, very low and has been since the 1950's, when c/s rates were less than a 10th of what they are now.

OK now I'm very confused.

Shagmundfreud:

Where did I mention that women should opt for planned cesarians to avoid these complications? Are you aware that a planned cesarian comes with it's one little set of risks?

Is it possible for you to provide some evidence that most women who have operative births have second degree tears and heal easily? It would be derailing the thread completely but I'd be interested to see some evidence to prove that fact.

NoWay, well quite.

They are probably doing it wrong or something.

I find this all a bit strange, possibly because I am considered high risk and so have seen more medics, with varying viewpoint, than a lower risk woman would. I'm also someone who likes to plan and have read books and Mumsnets and been to NCT classes and I feel I've had a good all round view of what can happen, good and bad. I don't think information is deliberately concealed, perhaps not everyone seeks it out to the extent that I did, but I've had a lot of discussions with midwives, consultants and friends and asked loads of questions and I don't think there is a conspiracy to be found...

Right people are arguing with my comment here:

""But it is a natural process, the problem with it is that it has been taken and medicalised (a lot of that is for the good of course) and taken out of the hands of women and made them feel like they cannot do it"

Yes I would agree with that.

BUT at the same time, pregnancy and childbirth always have been terribly dangerous and are still usually the most dangerous thing a woman in the western world will do in her lifetime."

I was not restricting it to UK 2012, I was talking across all time and all the globe. And pointing out that even with all the advances pregnancy and childbirth are still one of the most dangerous things that modern western women will do.

I think the point SardineQuuen is raising is that inherently the process is dangerous. We can make it safer with better diet, better medication (when required), better sanitation and better health care.

I think that we in the UK do talk an appropriate amount about maternal death risks and foetal deaths and brain damage. These things are rare, but when they happen they are unavoidably visible, and people (widowers, parents) make an understandably big fuss about them.

But I don't think we talk nearly enough about maternal birth injuries, because the women who have suffered horrific injuries in childbirth don't talk about it, because it's not the sort of thing you talk about. I totally agree with SQ - how can you possibly give informed consent to (say) forceps delivery rather than EMCS if nobody has ever told you that tears come in degrees, and they goes up to 4? At my ante-natal class we were given a long spiel about what it feels like to have an EMCS, and how important it is to avoid one, but the non-fatal downsides of VB were never mentioned.

I think the recent NICE report is hugely important for having taken these issues seriously rather than sweeping it under the carpet with "your baby's healthy, and you're not dead! Hurrah!"

I personally have no axe to grind on this one, but a horrified lurk on the ragged bits thread has left me shocked at how little we talk about these injuries in this country.

shagmundfreud those women are still dying though

Just as women in the UK 150 years ago were dying due to poor hygiene

And that's before you even look at all the other lifechanging things that can go wrong which are simply ignored. As long as the woman has survived then that will do. Not good enough IMO.

Rollersara I agree - the info is there if you want it. When I went to have a look around the hospital when I was pregnant with my first we were shown the theatre all the equipment and the rooms. It did scare me actually (but i wanted a home birth but she was born too early for that) - but it was interesting. I have worked at the same unit since then and actually ime the majority of women are pretty well informed (sometimes a little too much and are very panicky about what can go wrong when in fat it is all going fine)

I thought Emmas Diary was a national thing and is in the initial bounty bag they give out (they have stopped giving them to me now as too many children so maybe sucking eggs)

x-post dilys and we make the same point

I agree with you that the NICE report on ELCS and costs finally touched on postnatal difficulties with VB

Rollersara, I'm with you. I was low risk, actually, but the first thing I did when I got my bfp was to pop along to the bookshop. But that's my solution to everything and I accept not everyone is like that.

The information is there; the problem seems to be that there are no signposts to it.

Perhaps what needs to happen is that post natally the care needs to be more comprehensive and continence or the lack thereof needs to be properly followed up - the French give women sessions with a physio don't they - perhaps what would imporve outcomes for that type of injury in this country/

The information on anything is there if you look for it. I think the NHS should be providing this information in the same was that they give information on CS (bad), BF (good) and VB (good). And cover the fact that CS can be good, BF can be difficult, and VB can have adverse effects for mother and baby.

eg CS is safer for the baby. Is anyone told that? Course not.

"Most women know that birth can go wrong. They know about instrumental births - that they happen and that they can be a difficult experience and leave women with perineal damage."

I, like sardine had no idea about how damaging instrumental births could be. I had NO IDEA that I could tear my own bumhole, for example. I vaguely knew about episiotomy because a friend of mine had had one, but really had no idea that you could tear. I didn't know anything about ventouse at all (which was pretty terrifying when it got hauled out to use on me).

I had no idea how long the healing process was, and that I would be terrified to have a poo for virtually 6 months in case I ruined myself down there.

Maybe if I'd know, I would have gone in for perineal massage, ro done more pelvic floor exercises, etc, etc, and maybe that would have impacted my birth experience. Maybe not, but just maybe.

Is a CS safer for the baby?

Lots of things are natural - like dying of cancer. Natural and good are not the same thing.

Many people consider prior knowledge and a chance to think about a situation to be something that enables them to be in control not something that takes control away. Those that don't want information can always say they don't want to know - but when you go to an antenatal class, surely getting information about what might happen to you is the point?

I suspect a small part of the reason the full gory details and risks of interventions are discussed but not the risks of natural childbirth is to do with the legal necessity of infomed consent for an intervention. An anaesthetist would have to give you the risks, benefits and alternatives of an epidural and a midwife would have to talk about the risks, benefits and alternatives of an episiotomy for example. A VB without intervention legally requires no discussion. (Though perhaps morally should). I've certainly heard numerous anaesthetists complain that they feel in a very difficult position when called to see a woman who may have stated 'no epidural' on a birth plan now desperately asking for one - the problem being is it possible to get informed consent under such circumstances and what is the woman's 'true' wish: her birth plan or her request when in pain after hours of no sleep?

I don't think that's the whole reason though.

As for 'what is the point of dwelling on bad stuff':

How about the fact that not having full information about the risks, pain and reality of childbirth is likely to be a factor in developing PTSD after the birth and post natal depression. Incidence estimates of full clinical PTSD following childbirth vary from about 1.5% to over 5% - not insignificant in my view and many more have subclinical levels of post traumatic stress. Things like complications and interventions are factors but there are also many women who appear to have straightforward births but develop PTSD and it is thought that a mismatch of expectations and the reality is a factor. Another factor is feeling out of control and as I've said, for many (maybe most?) people knowing what to expect and what the options are helps people to feel in control.

Is there any research saying that perineal massage changes outcomes for tearing? Has this actually been researched? If you are going to tear to your arse I am not sure a bit of massage makes a lot of difference tbh - I think position of the baby and Mother and how instrumental it is is more of a factor. Skin type is also a factor. I will be honest and say I cannot remember with my first if I knew about that but again not sure the outcomes change really. France have a good follow up system for women with the physio and all but they also love the stirrups etc and women laying on their backs - they also have an appalling bf rate

Yes CS is marginally safer for the baby, and marginally more dangerous for the woman. Talking risk of death.

I don't know how CS and VB compare for the woman when all complications are taken into account - and nor does anyone else in the UK unfortunately they can only guess.

I don't know about which is safer when it comes to other complications for the baby, don't remember having read that anywhere either.

brandy I do'nt have any research saying that it changes the outcome. However, FEELING like it might is surely a good thing? It gives the mother (a) a sense of control that she's doing something proactive, and (b) the view that the outcome might be more positive if she is better prepared.

Sorry, pressed post too soon.

I guess that's generally what I'm saying. If you know more and feel better prepared for something, there is a lot to be said for the sense of control that comes with that.

For example, nobody would suggest that we don't tell new parents about the fact that babies cry ALL the time, nurse ALL the time, wake in the night ALL the time, poo and wee ALL the time, just on the off chance that it will scare them and put them off and make it harder. Women are well prepared for post-birth by countless anecdotes and tricks from friends and family, and a plethora of books written on what to do in those first few months, including books actually given by the NHS.

I just wish that we were more open about birth - we shouldn't have to go hunting on the internet (and scaring ourselves half to death with the absolute worst case scenarios on there). It should be readily available to us in classes and through information handed out to us.

Look NoWay I am all for being proactive - I have done a fair bit of 'massage' in my time (well Dh has) - it can do no harm that is for sure. I do think owmen should be encouraged to take control of these things and actually I do think it changes outcomes. I KNOW being positive and staying active and being in my own home have really helped my births have good outcomes. Having very positive input from my Midwife (and luckily I had the same Midwife for the first two and the same Midwife for the next two as the first retired! The Midwife who delivered the last two will be delivering this one too) - Having a chat with my Midwife who is encouraging and positive and excited about my baby's birth have really helped me too. I know it is a pipe dream but this sort of lovely relationship and input should be available to everyone - crazy crazy dream! It should not be about 'impartial' information given out in reams and 'discussed' - and who decides on the impartial nature of that information. Stats are very dodgy.

"shagmundfreud those women are still dying though"

Yes. As I've acknowledged several times on this thread - some women die in childbirth.

Just for comparison, in the USA maternal deaths for 2005 were 548. Most of these deaths will have been from complications arising from c/s and from thrombosis, and be associated with obesity.

According to Dom Nozzi's listing of comparative risks, 14900 people a year in the US die from falls. And 3300 from choking.

I have yet to see any calls for obligatory training among the general population in how to perform the heimlich manouvre.

"CS is safer for the baby. Is anyone told that? Course not"

Marginally. For the first baby. And then for every baby after it increases the risk of serious complications like placenta accreta in pregnancy and during subsequent vaginal birth or surgery.

Oh - and I think EVERYONE sensible acknowledges that C/S is often a life-saving operation.

"Perhaps what needs to happen is that post natally the care needs to be more comprehensive and continence or the lack thereof needs to be properly followed up"

Yes, I agree. And just as important - women need to know what they can do to reduce the likelihood of perineal damage and assisted delivery, which is mainly to plan to give birth away (if possible) from those environments where these types of delivery are common.

" I know it is a pipe dream but this sort of lovely relationship and input should be available to everyone - crazy crazy dream!"

Not so crazy. There are case-loading practices all over the UK.

The impression I've got is some women simply don't want to know, and giving out more information might put them off or scare them. I like to know everything, I've got a good understanding of risks, not everyone is like that. If a woman is made more scared by being told about all the negatives after becoming pg, is it not more likely that she will be more tense during the birth and therefore more likely to have a bad experience and perhaps need more intervention?

Shagmund - I am very fortunate that I am in this situation with my Midwifery care - I am even moving a little out of my Community Midwifes area (into a bigger house because of the many many children) and she is still up for it - she really values being part of our process as we value her role. We were exitedly discussing having a birth pool this time (as never had the room before) and she was so encouraging about it. I know case loading is done but I do wish that more women had access to this sort of genuine care. In Holland there is also very comprehensive post natal care and a high home birth rate which I feel can only be good for Mummies and Babies. I think it is post natally that the care should be focussed and not loading a woman up with stats.