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?

[shagmundfreud]

"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."

No, and the comparisons are useless to women if they aren't aware that planning to give birth in a CLU appears to massively increase their risk of emergency c/s, and forceps delivery, to which almost all the serious health risks associated with planning a vaginal birth are attached.

The risks associated with elective c/s are pretty consistent across the board. The risks associated with planning a vaginal birth very WILDLY, according to standards and models of care in labour. All women are given to help make the comparison of the safety of vb and elcs are general stats - these are useless in individual cases.

[brandysoakedbitch]

Rollersara makes a very good point at the end of the last page - very good indeed

[shagmundfreud]

I wish it too brandy.

I had an independent midwife for my last two births.

Was fantastic!

[exoticfruits]

I don't think that you want to scaremonger. You have no control over it and it is a perfectly natural process where most women are fine. If there are likely to be problems they will be monitored.
I get pregnant very easily and give birth very easily, it is nothing to do with anything I do, just sheer luck.
Getting in your car next time you want to do a journey is far more risky (and you also have no control over events)and yet people do it all the time.

[brandysoakedbitch]

Mine acts like an independant - she is so lovely and is so pleased to be delivering a third child in our family. That is what is required for women: loving care but it is sometimes very hard to find in the NHS. A lot of people here talk about seeing a different Midwife every time they go and then when they turn up at hospital they are being helped by someone who has never met them before. I remember going to a talk by Mary Cronk and thought if I ever needed someone to help me she would be the woman: she really believes in women and their ability to manage themselves and their bodies and help positive outcomes happen. Don't get me wrong I am not a hippy sort who thinks one can wish oneself well but a positive attitude is vital and a bunch of stats without careful interpretation and careful delivery is terrifying for almost anyone

[SardineQueen]

Are the figures for complications on CLU for all births or just the low risk ones?

I never know with those stats.

I am not sure what all this statistic flinging is for - I am trying to make the point that IME and in the experience of many other women, they receive incomplete information at antenatal classes. People only tend to go to antnatal classes for first babies - and at mine we were told (paraphrasing) CS are BAD and to be avoided at all costs. But not that CS are actually safer for babies (marginally and with the first one which is what people are usually having at an antenatal class). Problems like tears, incontinence, loss of sexual function were not mentioned, nor were things like forceps, ventouse. I I do not understand why that is. They certainly don't seem to mind giving all teh gory details about CS, even though loads of the women they are talking to will end up having them. So why not give the same info for VB. I don't get it.

[brandysoakedbitch]

Exotic I agree about the car thing yes but I also do think that a major factor in birth going wrong is a lack of encouragement and support (for many reasons sometimes that Midwives do not have the time to actually stay with women). Being fearful and scared is a big problem particularly for for first timers and my Midwife reckons that most home to hospital transfers for first time mummies is about pain and fear and the management of that. I do also agree with you that it is about luck, pain thresholds, what sort of person you are etc etc and that cannot be accounted for in stats

[SardineQueen]

Interesting that Holland is mentioned - I seem to remember that they have a very high infant mortality rate but IIRC no-one is quite sure why that is. Anyone here have any more info?

[SardineQueen]

I know far more women with long term problems caused by VB than by car accidents TBH.

[cory]

PeaceAndHope Wed 18-Jan-12 14:15:39
Cory:

"I respect what you're trying to say. Some people know they're taking risks by doing certain things but they don't want to hear about it.

I'm concerned about the vast majority of first time mothers who have no idea about the full extent of the possible complications. I believe they deserve to be informed."

But what with the books and ante-natal classes and television series and ante-natal check-ups and horror stories in women's magazines, surely women can't complain that they didn't know about the possibilities of pregnancy complications: I mean, you'd have to have been living in a cave somewhere. If you choose not to listen that is a different matter, but I really don't see how anyone can claim that the information is not out there.

Our ante-natal classes involved a visit to SCBU: I think you'd have had to be pretty dim not to conclude that there might be a risk of having a premature baby.

[SardineQueen]

I didn't know. I don't watch those programs or read those magazines. Not being snotty, I have plenty of low-brow interests , but those are not amongst them.

I don't live in a cave but the first time I heard about degrees of tears and stuff was on MN after I had my first baby.

[SardineQueen]

The real question for me on this thread though is:

Should all pregnant women be fully informed of the benefits and risks of different birth methods, and about common BF problems and how to avoid / spot / combat them

Or

As happens a lot of the time at the moment, Not.

Personally I think that full factual information about all possibilities is the way forward.

[brandysoakedbitch]

But I fail to see how knowing about degrees of tears changes anything - obviously if you have a baby out of your fanjo things, bad things can happen. Look at baby and look at fango, essential mismatch in the sizes? I just think this info need to be delivered carefully and we do not have the comprehensive kind of care and continuity of care that women need for these stats to be delivered with any kind of meaning (and again it makes bugger all difference)

I do think incontinence full stop is a taboo for almost everyone and happens to almost everyone at some stage in their life - same as getting old and dying or going bonkers, we know it happens but no one really deals with it

[brandysoakedbitch]

But the OP proposed that these stats should be printed out and given to women so they could ask questions - how can you possibly give all the information in a meaningful way?

[brandysoakedbitch]

And all the info is available in something called books.... which you can ask questions about to your HCP if you need to. Surely women need to take responsibility to find this stuff out if they want to. I agree lots of people don't really want to know

[EdlessAllenPoe]

"Interesting that Holland is mentioned - I seem to remember that they have a very high infant mortality rate but IIRC no-one is quite sure why that is. Anyone here have any more info?"

there was a study that over-reported the mortality stats because HCPs reported in deaths from outside the study area which caused that perception.
they were previously better than France's, yet slippage has been caused by an influx of immigrants from north Africa (think FGM, malnourishment, DV, very young mothers, who don't speak Dutch as 1st language)

see here it is still better than the UK at 4.7 vs 4.8 infant deaths per 1000 in the UK.

[SardineQueen]

I think it is wrong that women be expected to seek out all this information for themselves when it can be perfectly well delivered by HCPs.

Risk of things like pain relief and CS are talked about in detail, things like ventouse and tears not mentioned at all. IME, obviously.

If something is a taboo in society then even more reason to tell women about it before they have babies so that they understand that it is a common problem after birth and help is available, rather than struggling on too embarrassed to tell anyone as happens so often at the moment.

[SardineQueen]

Thank you edless that is very helpful. I knew that there was a high incidence and no-one knew why so that clears that one up!

[SardineQueen]

Presumably if people can seek out information for themselves there is little point in HCPs giving factual information to anyone about anything really

[SardineQueen]

brandy it's this you are referring to in many of your posts

"2. In my opinion, women should be given written research papers and facts informing them about possible complications from all modes of delivery and intervention and the ways of avoiding them. There should be an opportunity to discuss individual concerns regarding the written matter in antenatal appointments."

Why is this a bad idea? I think it sounds great.

[brandysoakedbitch]

I think it is wrong that women be expected to seek out all this information for themselves when it can be perfectly well delivered by HCPs.

Yes but SQ my argument is that it cannot be delivered with any meaning in the system that currently prevails in this country - there is such a lack of continuity here in midwifery care that if would not help to have all the information dumped without interpretation.

Edless that is right, chatted about this to my Dutch friend who is a teacher and recently had a baby - her care was amazing, started off at home but ended in a CS for non progression and stress of her little one - she had the most amazing care particularly post natally with someone coming to her house several times to check on her and help out with whatever needed doing - also stellar BF support but of course as a non integrated immigrant this would be useless.

[brandysoakedbitch]

Yes but I don't think it is a great idea - in reality it does not work. We are also assuming a high level of literacy and interpretation for those consumers. We already have the pregnancy book and Emmas Diary and full stats without careful interpretation are not helpful

Like I said research papers? by whom and who decides and who pays for the research - it is a process fraught with problems

[SardineQueen]

But they manage to deliver stacks of information about how terribly risky epidurals and CS are

I'm simply saying there should be balance.

[SardineQueen]

but brandy

"And all the info is available in something called books.... which you can ask questions about to your HCP if you need to. Surely women need to take responsibility to find this stuff out if they want to"

"We are also assuming a high level of literacy and interpretation for those consumers."

I think those things are contradictory. Either women can be expected to find out for themselves or they can't. I think the HCPs involved in caring for pregnant women should be giving this information.

[brandysoakedbitch]

That is because it is a surgical procedure and you have to make informed consent because it is an intervention - VB as a natural process fall outside that remit - also there are pretty standard risks to those procedures and the range of issues associated with vb are so wide ranging and some very rare that it is almost an impossible task without scaring the shit out of people