'the only thing that matters is a healthy baby'

[RevoltingPeasant]

I was talking to a friend about ttc and wanting a homebirth recently (whooooole other thread there) but in the midst of trying to dissuade me, she said, 'Birth isn't an experience, it's a process, and really the only thing that matters is a healthy baby'.

Okay - I'd agree with the first bit. I don't expect to go into it and have a Magical Experience Which Will Last A Lifetime. I think it'll hurt and large part of it will be boring and literally shit.

But - it occurred to me that the second bit is something I have heard lots of people say when discussing birth, inc HCPs. And tbh, it really gives me a chill. There are two people involved in birth and the mother counts as well. I do think the mother has the right to think about herself too when negotiating interventions, choices etc. AIBU to think this attitude is really horrid and totally devalues women?

Or is that just because I don't have DC yet?

I think we are so priviledged in this country we have forgotten what child birth meant for hundreds of years. In 1910 one in eight women died as a direct result of childbearing. The infant mortality rate was up to 40% . I would say the most important outcome is an alive mother and baby. Everything else is a bonus and for 90% of our history and still in much of the world being able to virtually guarentee that outcome.would be seen as miraculas

naughtymummy Just because the mortality rate is now significantly improved, or because other parts of the world don't have the care that we have here, that shouldn't mean that we have to put up and shut up and accept what happens to us, when sometimes that care isn't what is best for us and our babies.

naughtymummy
Far from 1 in 8 women dying in childbirth in 1910 the actual figure was 4/100

That statistic is taken from this article, www.ajcn.org/content/72/1/241S.full which in turn has taken them from the Registrar General's figures, so they are accurate.

Nor was the infant mortality rate 40% - in 1900 it was 14% and by 1910 it had fallen to about 11%. Statistics are taken from the ONS cited in this article.
www.parliament.uk/documents/commons/lib/research/rp99/rp99-111.pdf

WidowWadman We were having a long debate this morning about the costs of the health service. If something has to close because the money is running out why should it be the MLUs and homebirth services which get the chop? For low risk women CLUs are neither more nor less safe for the baby but much better for the woman, so why should it automatically be assumed that they should remain open?

I mangled my sentence there. It should have read: For low risk women CLUs are neither more nor less safe for the baby but MLUs/homebirths are shown to be better for the woman, so why should it automatically be assumed that the CLUs should remain open?

So what do you propose for women who are not low risk, if CLUs close? Would that be just tough luck then? Homebirths and MLUs need the CLU as backup when things go wrong. And if things go wrong is unpredictable.

I agree I didn't express myself well there, I did not mean to imply that all that all CLUs should close, although reading it again I can see that it could have been construed as that. Some women will need their facilities from the off and some may need their help if, (not when) things go wrong, so we will always need some CLUs and no one is going to argue otherwise.

With the present system you take pot luck as to the standard of care you get if you are low risk. You might get one to one midwifery, but equally you might well have to share between two other women. You might get a known midwife, but that is extremely rare. You might get to the hospital, be examined but not admitted to the labour ward because you are not at the magic 4cm so you get sent home again, because you are deemed not to be in labour, even though you know you are and are desperate for support. You might get turned away from the hospital because they are full, and have to drive up the motorway to the next one (how many facilities does the hard-shoulder have?) These are all things which are happening now.

We need to have a debate about how to provide a good standard of care for all; some reforms like offering more MLUs/homebirths would offer a significant number of women a better standard of care, would not necessarily cost more, and would free the CLUs to offer a better standard for those who do need them.

LaVolcan - I also think its important to point out that the massive falls in maternal mortality in the last century occurred long before c/s became a common operation. Antibiotics and universal antenatal care were responsible for the biggest falls. Not obstetric input.

I agree. Antenatal care is hugely important. The 1/8 figure I quoted was a woman's lifetime risk. Not j in child birth but also eclampsia and post pupural fever. As shagmunfreud says, the event of anti-biotics was massively I think homebirths are great and most midwy good at transferring women in the ruin into trouble.

Wow, this thread has definitely departed from its original subject!!

naughtymummy You know that maternal and infant mortality and morbidity rates increased during the C19th as a result of more doctors being involved in births? Medicalisation does not equal progress!!

Also, can I just say: my OP actually contains the phrase (well almost) 'I'd agree with the bit that birth is not an experience.'

Not. A. Bloody. Experience. I am not talking about having whale music and putting my 'wants' above my baby's needs.

But, I still object to women being pushed into choices/ situations/ positions by HCPs without proper understanding and thought. And do I think that happens? Yes. Just read ooh about 30% of the threads on this board! Try the one where the woman is 'terrified to give birth for a 2nd time' or sth similar.

I understand that I will be choosing to get pregnant and I accept there will be a risk of permanent injury to my body. But I don't want that increased unless it's definitely necessary to my baby's safety. I don't want to be induced because my first labour is slow, as many women's first labours are. I don't want VEs without proper consent, or someone 'just breaking my waters whilst they're up there', or a random registrar wandering in during birth and putting his fingers into me.

All of this stuff is stuff that has been reported in the last week by women on this board. It happens. And the idea that 'but of course it's best for your baby, you nasty selfish woman' is what is used to justify it.

"Induction at 40 +10/12/14 for being 'overdue'? The facts that the dates can vary so much between hospitals doesn't suggest that the policy is evidence based."

add to this a woman from my sisters NCT coming to hospital in labour at +14...They said she had to be induced and when she declined (because, FFS, she was having contractions already) they then told her she was endangering her baby...

she went home too, her labour stalled with the stress. she stayed there as long as she could before it re-established.

dumb ass stupidity doesn't require a conspiracy.

RP mortality rates peaked aroind 1900 , this was generaly because childbirth was then being recorded , whereas previously most births were not recorded. The biggest drop was around 1940 co-inciding with the introduction of anti-biotics and the pre-cursor of the NHS.

Edlesshow would you design a RCT to gather evidence for the right point to induce ? Tell women "we are doing a trial comparing the stillbirth rate of waiting till 40+14 to induce or doing it at 40+10 would you like to take part ? That would never get past the ethics commitee. The only thing that camn be done is compare outcomes of units that have these policies in place already. Unfortunately different units will do other things differently and therefore there will be confounding factors. Some things you just can't get good evidence for.

Sorry trying to catch up here 40% refers to the poorest women eg; the urban poor not suggesting it was universally that high

Don't the NICE guidelines say that a woman who goes overdue should be offered expectant management as an alternative to induction? I wonder just how many women have this option presented to them as a fully informed choice i.e. induction - pros, cons, expectant management - pros, cons? Or how many get told 'we will book you for induction at.....'?

Personally, I would love to know how many women induced for the sole reason of reaching a date on the calendar end up with an EMCS. I am not sure if statistics are gathered for that. I often wonder if they would have had a perfectly straightforward delivery if watchful waiting had been practiced.

One thing I believe is known, is that despite the rocketing CS rate of the last 20 years, the rates of still birth have not come down. Now some of those will be due to congenital abnormalities, so the baby would die anyway, but what of the rest?

LaVolcan Yes NICE guidelines do say that, and they say that choice should be respected. However, LOTS of women (certainly judging from threads on these boards) are not offered an alternative to induction, nor are they presented with the risks of induction - generally they seem to be told that 'if you don't induce at X days over then your baby might (or WILL) die' and that's the end of the conversation.

Problem is, guidelines are guidelines so I suppose trusts don't feel they HAVE to present all of the evidence - it's probably easier and cheaper to induce and manage the antenatal caseload, and get them on the countdown to transfer from MW led care to the HV after 10 days than have more women choose to continue pregnancy and still have to offer antenatal care to them.

"I always think on these kind of posts that anyone arguing that anything apart from a healthy baby is even remotely important has obviously never had a sick baby"

on the one hand, I couldn't agree more with this. 8 years of experience have taught me that there is no such thing as a well mother with a sick child. If dd is not well, then I cannot be well either

otoh, doesn't it cut both ways? if it had been me who had ended up damaged at some point, wouldn't that have damaged dd too? don't we come as a package to some extent? I struggled to look after dd as it was; I can't imagine I would have coped at all if I had also been struggling from PNDS after a mismanaged birth.

shouldn't we do everything to protect the baby for the sake of the mother and the mother for the sake of the baby?

the evidence already extant only supports induction at +14 (ie the point at which, when last surveyed, the risk of induction is exceeded by that of stillbirth.) This is what the NICE guidelines say.

as it is ok for trusts to have +14 policies , i fail to see how it would be inethical to study that as a universal - in fact i fail to see the ethical justification for +10 (anyone know?)

strangely women challenging induction at +10 i know have had the shit scared out of them with the 'your baby will die' spiel anyway. I have only ever had induction presented in a 'right, let's book your induction' kind of way.No discussion. no choice. no information.

doesn't it cut both ways? if it had been me who had ended up damaged at some point, wouldn't that have damaged dd too?.......shouldn't we do everything to protect the baby for the sake of the mother and the mother for the sake of the baby?

cory that is absolutely right. both need to be cared for. perhaps the op would have been less offended, if her friend had said: "the only thing that matters is a healthy mum and baby". but in order to be healthy it also may be acceptance of a less than "ideal" birth. my daughters birth was in no way ideal, and i certainly did not choose the way it happened, but despite both of us being in a life-threatening situation, we both came through it and are healthy.

I think having a healthy baby is an extremely high priority for every mother. Along with retaining her own health, mental AND physical. The problem I have with the statement the OP quoted, is the implication that any woman who wants to explore home birth and other low-intervention birth choices ISN'T prioritising their baby and is somehow being selfish and/or reckless. This is utter CRAP.

I think birth IS an experience. If it wasn't, then women wouldn't have such heightened emotional responses to it. If it wasn't an experience then we'd all be happy to continue being drugged with Twilight Sleep (setting aside the detrimental effects this had on babies). If birth wasn't an experience then it wouldn't have the power to deeply effect a woman's mental health for both good and bad. Not to come over all hippy or anything, but come on!

To be perfectly honest, whilst it isn't necessarily healthy to over-emphasise the impact of childbirth, (ie: it's probably a good idea to be open-minded about how things may play out on the day, especially when it comes to sometimes vitally necessary interventions) it certainly isn't healthy to go into denial about the impact that birth can have on the mother.

Like it or not, and whether we choose to acknowledge them or not, ALL mothers have feelings about the impending birth of their child. Having a "My feelings don't matter, my baby is the only priority" attitude isn't a very healthy start to motherhood which is FRAUGHT with feelings and inner conflict. Far better acknowledge those feelings and be aware, than shut them in a box and give all the emotional responsibility to a newborn infant!

phew that was cathartic

Badgerina,
funny thing is that I want to have an ELCS, VB is out of the question for me, and this is flapped in my face in the same way. Absurd or what?

That is absolutely absurd. It totally goes both ways unfortunately. Want to make low-intervention choices? Damned. Want to make medical intervention choices? Damned. It seems like any woman who wants to make an informed, empowered and carefully (and sometimes painfully) considered decision about her baby and her body is... damned. Fuck em, I say